kadphilly

I agree we need to have stricter criteria from our accrediting bodies, however I don't necessarily believe the RN experience translates well to a better prepared NP, especially in primary care. We recently hired a brand new NP, no RN experience, attended one of the top programs in the country, and her clinical skills and knowledge are stellar. In my experience in precepting, RN experience transfers few skills to NP I propose the following to further our profession. 1) Longer more stringent education, with a "residency-like"program. I think we should be considered "advanced education" nurses, not necessarily "advanced practice." 2) Programs should have strict academic requirements to be admitted. Candidates should be academically advanced. 3) Programs should be required to find appropriate clinical placements for NP students. No more finding placements on your own. Overall, there are far too may programs that accept anyone and everyone. We need to have stricter academic requirements, and attract young, bright individuals into our profession.

It might familarize you with some clinical situations, however, there is a compete different skill set that NP's required to have. For example, I am a PNP primary care. I diagnose otitis media all day long. I have yet to see an NP student yet who could diagnose an Otitis based on RN experience. It's a skill that needs to be developed and can take a considerable amount of time. I precept FNP students also, and in my experience SOME of them are terrified of young infants. Some of them might work inpatient with adults, so how would they feel comfortable? Their RN experience in an inpatient adult cardiac unit has not provided many skills to care for a 2 month old with RSV. Or to help diagnose an 18 month old with autism. My last FNP students flat out told her clinical site visitor that she was never going to take care of infants in anyway, so she really didn't see the point of seeing them in clinical. Except, that's your degree??? You chose to be an FNP. Part of the issue is that the pediatric clinical requirement for FNP students is far too short. I never feel like they have enough of a grasp in peds at the end of the rotation. There needs to be more trainging at the NP level instead of focusing on RN experience.

There is a brick and mortar school near me with a great reputation, however a few years ago, they started an almost completely online NP program. I know a faculty member from this school. She has 2 years experience as an NP and is already grading papers. They do not vet clinical sites, and they don't even do clinical site visits. So they are graduating students that they have never seen examine a real live patient. I see that as severely lacking in adequacy.

Yes! I have seen a lot of new NP's who highlight their RN experience to perspective employers rather than their NP education and clinical experience. In my experience in hiring NP's, the strength and prestige of the program and the clinical experience are always more important than RN experience.

Not childish, just a fact. I have plenty of children on my panel, including the children of physicians. I honestly do not want to see anyone who doesn't want to see me. I have said that from the get go.

Don't worry, we don't want to see you either. I already have a 2,000 patient following.

Yes! The culture of nurses eating their young, and the jealousy and pecking order is holding us back. We can do better in supporting our profession.

I would agree with this statement. I have been shocked over the past few years at the quality of some of the FNP students that I have been asked to precept. Some programs seem to accept anyone and everyone, without consideration of their suitability to be an NP. I have refused students from all but two universities because of the incredibly low standards of not only the students but the curriculum itself. Back when I went to NP school about 20 years ago, only those who would consider themselves strong academically would consider even applying. Now, it's just open access. It should still be rigorously competitive to be accepted to NP school.

Yes, self-deprecation is what I meant. Lol. I'll correct the typo. I agree, I don't think that bedside nursing experience has no value, however, I do think that there needs to be more of a focus on actual NP education rather than RN experience. The roles are very different, especially in primary care. And you can assume some level of intelligence based on perhaps where they went to school, but not necessarily by just taking the DE route. I can agree with that. We just hired a DE NP who attended an IVY league school for both undergrad and grad school and graduated with an excellent GPA. She is intelligent. We knew that on paper and it was confirmed by her interview. I have precepted for this school for years and their program is stellar and well deserved of it's top tier ranking. Will it guarantee that she will be a fantastic clinician? No, but it's a good start.

I do not think that inpatient RN experience makes a difference for primary care though. Maybe they should increase the credit hours and clinical hours in NP school. I am a fan of he DNP track, but believe it should be far more clinical based, and that should be the entry level for primary care NPs. Not expecting years of working as an RN, but more training in actual primary care. And I have precepted students from probably 19 different universities, and the quality of the program absolutely makes a difference in the preparedness of the student, without or without RN experience.

Not the OP, but we just specifically hired a brand new NP without experience as an RN because the medical director and physician wanted myself and the other NP/MD staff to train and "mold" them from the get go. And they wanted someone who graduated from a top tier school. They actively sought out someone who was brand new.

I would say it is smart for those who know that they want to be a Primary Care NP to go directly through school if they can. This is what I recommend the to college and high school students that I mentor. And to go to the best school that they can get accepted to and afford. Nurse practitioners should be smart. There is nothing wrong with others saying so. Again, it's a self depreciating of nurses. Our profession is moving forward only to be sabatoged by ourselves. It's an attitude of "who do you think you are going to grad school before you put your time in like the rest of us?" We will never move forward with this mentality.

I think that there is an unfortunate culture in nursing that implies the requirement of "putting your time in." We are really one of the only professions that does so. PT's, PA's, Speech Therapists don't require one to work in the profession prior to continuing on in their professions. Many go straight through to their masters or doctorate level. Sure they might have jobs to pay bills while in school, but not necessarily in their professions. As I have previously stated, I do not believe that for the role of a primary care NP that you need acute care experience. I have precepted for close to 20 years and I have not found that hospital experience necessarily equates to strong primary care skills. If anything, that longer they have been a nurse, I have seen a correlation with having greater difficulty with the autonomy of nurse practitioners. I am far more concerned about the number of programs popping up, especially those that are predominantly online and have a near 100 acceptance rate. Nurse practitioner programs should be very selective, and require high academic and cognitive standards, in additional to strong social and interpersonal skills. And there are far too many programs that require students to find their own preceptors. It makes us look comepletely unorganized and unprofessional. We as a profession should be far more concerned about these issues than direct entry.

We just hired a brand new NP without RN experience. And she was offered the job out of about 6-7 candidates who had experience. She interviewed well and went to a top program undergrad and grad. Ultimately, the MD's at my practice wanted a new grad that they could mold, and someone who went to a strong school. I do t think having RN experience matters in the primary car role.

My contract is up for renewal next year, and I have been told that on-call duties will now be expected for myself and the other 2 NP's in my primary care peds office. The call will be every 6th weekend, with the expectation to see patients on that Saturday for 4 hours, and one weeknight every 2 weeks. Its not a lot, but I have taken call at my first job and I know how disruptive it can be to your life. Can anyone share their experiences on how a salary should be structured with the addition of call?

Go for it. You are young, aren't tied down. Other professions will relocate for graduate schools/ professional degrees, why not nurses? We often sell ourselves and our educational experiences short in this profession.

Are any other NP's expected to contribute to the office bonuses for the staff? I work for a hospital owned primary care pediatric practice, and the last few years I have been asked to contribute. First it was $250, then $300 and now they asked me to give $500 this week towards staff bonuses. And I no longer receive an annual bonus the past few years. The NP's used to, however that went away. We are getting by new contracts next year to get reimbursed based in RVU's. What is eveyone else's experience?

I could not agree with this more. I have precepted NP students for many years, and I have not found that years of experience as an RN to be strongly correlated with the skills and effectiveness of the NP student. It's really about thinking autonomously and critically. If anything, I have anecdotally found that more than 10 years or so experience as an RN to be negatively associated with these abilities, in particular for the primary care role. I too would love to study this as I believe the results would not support many years of inpatient experience prior to entering an NP program. I had one year experience as a visiting Peds RN prior to entering my PNP program 20 years ago. I continued working during my masters as a visiting nurse, which was actually an appropriate experience for primary care. I never worked a day in my life in a hospital or an acute care setting. And you are correct in saying that you develop the skills as an NP in the first year or two of practice. I truly believe that it's the ability of the candidate to think critically and autonomously foremost, and the standard of education at their program secondly. I have found that RN experience may or may not benefit, depending on the speciality. Not every RN is cut out to be an NP. I believe that if anything, NP programs should be more selective about the academic ability of the student rather than the years of RN experience. There are too many NP programs that are accepting inappropriate candidates from an academic standpoint.

I would agree with that analysis. I work in primary care pediatrics, and what I see students struggle the most with is child development. For instance the difference developmentally between a 6 month old and a 9 month old. Experience CAN help with that, but so can being a parent. The NP program that I attended (Ivy League) almost 20 years ago does accept direct entry for primary care specialities, but expects a 2 year or so experience in your specialty for all acute care tracks. Primary care is vastly different from inpatient nursing and in my experience in precepting, years of experience as an RN really don't help with that cross over into primary care. And yours truly was only a year out of school when I started my PNP. I worked throughout my program, so I had three years experience by the time I graduated. I will comment on the FNP students that I have precepted for their Peds rotation. The vast majority of them had absolutley no experience in pediatrics prior to precepting them. There years of experience with adults did not cross over well to kids. For instance, a 12 year old with chest pain most likely does not have a cardiac etiology. Some took to the pediatric difference right away like pros, and some struggled the whole time. Again, it was more those with critical thinking skills, because their experience had no bearing.

In my experience in preceprong students with anywhere from direct entry (no experience) to 40 years experience, and everything in between, I have not found a strong correlation between greater than say 3-5 years experience, and a better prepared student at graduation. I have found far more of a correlation between the students ability to think critically, have the ability to act autonomously, and the strength of the NP program. A student with strong critical thinking skills from a strong NP program who has two years prior RN experience will quickly catch up with someone with someone who lacks those skills, in particular if they are at a weaker program. I have had serious concerns about 3 students in the past 15 years in terms of their ability to practice safely as an NP. All three had at least 10 years experience and we're enrolled in weaker programs. My current NP student has two years experience as an RN, and attended a top BSN school, and is now is in a top MSN school. She is by far the strongest student I have had.

I think the school should matter and does at my health system. Of course there has to be a balance between school and experience, but there is no comparison in the selectivity between Yale and Chamberlain. This speaks to the culture in nursing that does not respect academia. We as a profession are selling ourselves short. Other professions would consider and Ivy League or selective university grad over a non-selective school. To imply that the quality of education doesn't or shouldn't matter in nursing is unfortunate. Of course there are stronger programs than others. Just because you are able to the pass the same boards does not mean that your critical thinking and preparedness are at the same level. I have precepted NP students from about 10 universities over the past 15 or so years. I have had strong students from all of the programs, but the strongest students by far are from the most selective universities. There is a difference in the quality of the programs and the preparedness of the students. And the selective universities seem to attract and accept those that are the most intellectual and have the strongest critical thinking skills.

Yale's NP program is not 100% online. It is on campus. It's DNP program is partially online with monthly 1-2 day on campus intensives and 4 week long intensives over the 3 year curriculum. I don't know of any top 10 NP program thst is 100% online. Some are hybrids, but they have significantly more on campus intensives and required on campus classes than a one 3-day intensive. When looking at hiring NPs, we definitley look at the programs, and will not consider graduates of programs that are almost exclusively online. I believe it is different if you are talking about a DNP program, which is more acceptable to be mostly online, but not for an NP program. I do agree that it depends on the area that you live in though. We recently hired some NP's, and honestly the physicians in particular were first interested in the reputation of the school they attended, and then looked at experience. In the end, we were more likely to hire a new grad from a highly reputable school than someone with experience.

My health system will hire an NP if they have at least two years experience as an RN prior to entering their masters. Most of the NP students I precept are still working as RNs throughout grad school as well. I actually find that the students who have 15 + years experience as an RN have a harder time with the autonomy of the NP role. I find that the students who enter their masters with 3-5 years experience to have the best balance of some experience, and the ability to be comfortable with making autonomous diagnosis and treatment plans. I was only an RN for one year when I entered my NP program about 20 years ago. I worked throughout my masters. I do not feel like was any less prepared For my NP career.

Exactly. And when I tell people that I am deciding between a DNP and a PhD in nursing, I get a similar response "why didn't you just go to medical school? You wasted your time being a nurse." The last two people who said that to me were also nurses. It's a different philosophical and practice model. I WANT to be a nurse. The anti-intellectualism and the lack of importance placed on academic rigor and acievement in the nursing profession is an unfortunate culture. And much of this downplaying of the pursuit of academia comes from my fellow nurses who quite frankly seem to think it's a waste of time since we all get the same job and degree in anyway.

I have no doubt that you will get a job no matter where you go tonnurinh school. And get a job at nationally ranked hospitals. There does seem to be a culture in nursing that is a bit anti-academic, with some resentment towards schools that are considered "prestigious" or more selective for admissions. As if it's a waste of time to go to a top 10 nursing school. I think that is a mistake in the culture of this profession.