Nursing students who want to be NP's

Nurses General Nursing

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Anyone else notice that many of their nursing students are becoming nurses as a stepping stone to being a nurse practitioner but have little interest in being a floor nurse? I'm worried we won't have bedside nurses before long.

I think I love you.

I don't get the idea that someone who has not practiced can then complete an online program that will take anyone with a license and a pulse, and then claim to be an advanced practice nurse. What exactly about this person's nursing practice is advanced??

Not a direct comparison, but I thought of singing. The vast majority of singers who receive training while in high school are nowhere near ready for a role in an opera company. They may have all the potential in the world, but the 18 yr old voice still needs more training and practice and TIME to develop. A brand new nurse, likewise has not developed solid assessment skills, hasn't seen the variety of ways the human body responds to meds, has only seen the pathophysiologies in a relatively small number of clinical pts. Even that spidey sense that tells us "I can't pinpoint exactly, but something is very wrong" -- that is developed with time and experience. A new nurse by definition cannot be an expert, which is what the APRN needs to be.

This is a great analogy. You know what I keep thinking about as a comparison? The trajectory of being a parent, from when you are just newly pregnant to when you have an adult child who is leaving the nest. Think about it: when you're pregnant with your first baby, you read all the books and gather all the information, and are sure you have the latest and greatest information on how to do this parenting thing RIGHT. These other yahoos who whine and complain are either lazy or just doing it wrong, surely. Then your kid comes along and rocks. your. world. So you have a newborn, and you're exhausted and jaded and you realize just how stupid you were as that smug pregnant lady who thought she knew it all. You decide it is your job to tell other mothers exactly what's what so they won't fall into the same trap as you. Your child is 6 months old now, after all, so it's not like you're new at this or anything. You KNOW WHAT YOU'RE DOING. Then your child becomes a toddler and everything you thought you knew gets tossed out the window....lather, rinse, repeat. When that cute little cherub who is your first born finally goes off to kindergarten, and you've got another cute little cherub still clinging to your apron strings at home, it's then that you realize: you know SOME stuff about parenting, maybe even a lot, but you're sure as heck not an expert and you thank GOD for those moms who've been there, done that, got the t-shirt and emergency room bill to go with it. It is when you talk to them, with their calm demeanor and lack of judgment even when your kid does what you think is the most naughty thing ever, that you are so thankful for their experience and wisdom, and hope to be like them one day. It is also then that you realize, the longer you do this parenting thing, the more you realize: you don't know bupkus. The smugness falls away and is replaced by humble gratitude for the parents who've gone before you, and you just smile and internally say "bless her heart" when you meet that new mommy who thinks she knows everything. Because soon enough, she'll learn.
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Specializes in SRNA.

What about those with "some experience" regardless of title?

I've been in the health field since 2015 and I have come to realization that I am interested in the pathophys, disease treatment and prevention, and chronic management of patients. I've worked as a nursing assistant (med-surg) and now as a medical assistant (urgent care). Working in both inpatient and outpatient provided two different perspectives.

I'm really drawn to outpatient and I have no desires to be a floor nurse (unless I'm in the ER). I currently function quite autonomously as a MA (I usually begin the treatment plan for patients after triaging way before I clear them for evaluation by the MD/PA/NP)...

Btw, at this urgent care we do not have nurses. The MAs function as the nurses (without the title of course). What the providers won't do, the MAs do. Anywhere from injections, med admin, neb tx, wound care, staple/suture removal, UA, submitting and interpreting labs, other point of care testing, discharging patients with after care instructions at disposition . Yes, I can see where other skills such as IV placements, catheters, and other bedside nursing skills are deficient, but none of these are done in UC. They are transferred to the ER if they are higher acuity and need complex interventions. The ability to assess and intervene as needed can be learned with time in practice, regardless of being a floor nurse or not.

Floor nurses are one of the hardest working (and underpaid) individuals I've observed and worked with and I give them my highest respect. Everyone belongs somewhere in the health field, and mine is working in either a community health center (I'm an advocate for preventive services) or ER/UC.

That said, as an NP....urgent care or primary care is where I will return to. Is it really necessary for me to be a floor nurse before becoming a FNP? I don't believe so unless I want to be a hospitalist (not interested).

Another side not, I have ZERO interest in online NP programs. I need face to face interaction. Hands on practice, assessment of my skills from faculty, and constructive criticism from someone who has directly observed me. See one do one.

PS. I was recently accepted to an ABSN program with plans on pursuing MSN-FNP right after.

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Specializes in Emergency Department.
Oh no. That sounds scary! I hear what everyone on this board is saying... I see both sides. I'm currently in a DNP program at the #4 school for midwifery in the country. I have a year of L&D under my belt and I dont graduate until 2020. Just based on my curriculum now, i dont see how more time in L&D and not being in school would help me. People are neglecting to realize that there are years of pre requisites before you ever even see a patient. Im taking advanced physiology, statistics and epidemiology, nursing informatics....nothing i do as a floor nurse even reaches that stuff. I plan to work my way through school because I know my experience is ESSENTIAL to midwifery. I can read a strip and intervene. I just dont think waiting would be beneficial as im in a place in my life where I can focus on grad school. When it's all said and done, I'll have 4+ years of L&D experience (and7 months of mom baby) when this program is over. Waiting would make me less likely to do it. Just my 2 cents.

Totally agree with you! Congrats and good luck on your endeavours :)

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My concern is with the nursing students who are disgusted by perineal care and want to become NP's so they don't have to clean a patient. I have come across many students who say they will never work bedside because they're going straight to NP school.

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Specializes in Cardicac Neuro Telemetry.
I know what school she went to, but would rather not name it. They may have changed their standards since she attended, I don't know. We (my L&D coworkers and I) were SHOCKED when we discovered this as well. It was very disheartening to us. It was fortunate that she was a kind soul and a humble person as well who did not think she was "above" learning from the floor nurses. She took what we (and of course the physicians and seasoned midwives) said to heart, listened, and truly made an effort to learn. Her bedside manner was outstanding, that I will say. Her first year was distressing for us as nurses, though.

You guys were a lot nicer than most other nurses and physicians would have been. The fact that you had to spoon feed her what orders to give is appalling. Humble and kind, fine. Neither of those two qualities alone make a safe and competent provider. Kudos to you and your co-workers for helping her.

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You guys were a lot nicer than most other nurses and physicians would have been. The fact that you had to spoon feed her what orders to give is appalling. Humble and kind, fine. Neither of those two qualities alone make a safe and competent provider. Kudos to you and your co-workers for helping her.
I remember when she first came, it was specifically *because* of how she interacted with the staff that people were willing to help her out. I distinctly remember one nurse in particular who had a rep of being a real pit bull describing her as "so, so sweet." Then again one of the reasons I stayed at this particular hospital for so long was explicitly because of the people I worked with and how wonderful they were. The teamwork there was phenomenal. Yes, she probably would have been eaten alive elsewhere.
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Specializes in CCU, SICU, CVICU.
I have to agree with OP. I'm in nursing school now and I do plan on becoming an APN (specifically a CRNA) in the future. Most programs I have looked at only require 1 year of ICU experience to be accepted. That blew my mind. I have friends who were in classes ahead of me who graduated and got jobs in an ICU immediately. I can't imagine getting hired, working, and moving on to start administering ANESTHESIA after only 1 year bedside.

Some of my classmates have talked about doing online RN to MSN programs right after they graduate and I just cant imagine that that makes a well-rounded APN. Bedside nursing isn't really my passion either, like some others have posted, but I have a good attitude and genuinely care for my patients and I'll put my 3-5 years in so that I can be sure that I'll be the best CRNA I can be.

Having goals outside of bedside nursing isn't bad or wrong, but trying to make all that happen too quickly (before you get enough RN experience), possibly at the expense of your future patients' care is wrong. You have to ask yourself. Do I want to become a mediocre APN now? Or do I want to become an exceptional APN a little later? Seems obvious to me...

Just FYI, I interviewed at 2 programs and get rejected from both with 2 years of ICU experience, ranging from Medical, Surgical, and Cardiac ICU. The 1-year is a formality, and it is EXTREMELY difficult to get in with that little experience. Realistically, most of the applicants you are applying alongside have more like 4-5 years, their CCRNs, etc. A CCRN is almost a must now, and to even be eligible, you need roughly 1 year of ICU experience. Good luck! It's extremely challenging!

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Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
Just FYI, I interviewed at 2 programs and get rejected from both with 2 years of ICU experience, ranging from Medical, Surgical, and Cardiac ICU. The 1-year is a formality, and it is EXTREMELY difficult to get in with that little experience. Realistically, most of the applicants you are applying alongside have more like 4-5 years, their CCRNs, etc. A CCRN is almost a must now, and to even be eligible, you need roughly 1 year of ICU experience. Good luck! It's extremely challenging!

This is my understanding also to be accepted to a CRNA program. I applaud that this is the case. There's a good reason for it. And to the OP, hope you'll keep trying.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Just FYI, I interviewed at 2 programs and get rejected from both with 2 years of ICU experience, ranging from Medical, Surgical, and Cardiac ICU. The 1-year is a formality, and it is EXTREMELY difficult to get in with that little experience. Realistically, most of the applicants you are applying alongside have more like 4-5 years, their CCRNs, etc. A CCRN is almost a must now, and to even be eligible, you need roughly 1 year of ICU experience. Good luck! It's extremely challenging!

Yep and that is exactly how it should be. Competitive and demanding. I applaud the schools with these standards. Too bad more NP programs are not like this.

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Specializes in CCU, SICU, CVICU.
Yep and that is exactly how it should be. Competitive and demanding. I applaud the schools with these standards. Too bad more NP programs are not like this.

Don't misunderstand me, because I agree. I think all acute care (ICU or floor) NPs should have experience, as well as CRNAs. People argue that you can learn the acute stuff in school for NPs, but apparently not for a CRNA? If a CRNA needs the experience to critically think and act in an advanced setting, why is an NP any different?

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Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
Don't misunderstand me, because I agree. I think all acute care (ICU or floor) NPs should have experience, as well as CRNAs. People argue that you can learn the acute stuff in school for NPs, but apparently not for a CRNA? If a CRNA needs the experience to critically think and act in an advanced setting, why is an NP any different?

Exactly, IMHO.

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You are no doubt foremost among men; when you walk into a room and give a speech, men grow chest hair :smokin:, women curl their toes :o, birds chirp :singing:and cloudy sky turns blue :cool: revealing a twinkling sun as if it's giving you a wink--scratch that--multiple winks ;) ;) ;)

Now that you've spoken for the 7.7% NP's,...I digress.

CriticalACNP gave a well thought-out explanation of his opinion on the topic. You then posted something entirely rude and patronizing in response. It wasn't called for, it's poor form if you wish to engage in debate, and he didn't deserve it. Not appropriate.

CriticalACNP, thank you for your post and point of view, it is appreciated by many.

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