Spacklehead

I guess what I find interesting in all of this discussion is the fact that both medical schools and PA schools want their applicants to have so many patient care hours (varies among the schools) before applying while many NP schools do not. The NP programs also require the least amount of clinical hours. Again, I'm not taking away from NPs without nursing experience but it is an interesting observation to me. Why would they require it if they didn't feel it was necessary? I'd be more than happy seeing NP applicants with any type of patient care experience, not just specifically nursing experience.

Oh, and just to add - your JHU FNP program prefers applicants with nursing experience as listed on their Web site. ETA: https://nursing.jhu.edu/programs/doctoral/MSN-DNP/DNP-family/#requirements

Wow, you really put a lot of words in my mouth. I never implied that NPs without RN experience were the ones specifically sending patients to the ER. That is totally on you if you took it that way. You made it a point in your OP to talk about the RNs with experience who did no better than you academically or clinically, and how your preceptor would not hire an RN with acute care experience due to their inability to adapt to an outpatient practice. You also specifically called out an ER RN who got fired from their NP role due to terrible patient interaction skills and being lazy and sloppy. I would think you could figure out that those issues were not because the nurses had experience, but because they had character flaws. MD's who work in primary care did residencies in hospitals, so I'm pretty certain they do have hospital-based acute care training under their belts - not just primary care only. As a matter of fact, I know they do as I currently work with them at a large teaching hospital. I think they are very qualified to work in primary care. Please stop grasping at straws and being obtuse by saying I insist all NP's (and PA's and primary care docs) should work as ER nurses first. I never stated that anywhere in this thread. Do I think ER experience is great to have and would only help? Yes, absolutely! But again - you are greatly misinterpreting my posts. I'm not taking anything as a personal attack - but just remember - you decided to quote my post first and then tried to educate me about the existing evidence which you keep saying you'll post on here. Keep in mind that I still have not dismissed NPs without nursing experience, I have only defended those that do have nursing experience under their belts. And now let's bring up the schooling…….congrats on graduating from JHU. My cousin attended undergrad and med school there, so very familiar with them. Great school - but I'm pretty sure my education was just as good from the local state college where RN experience was required for admission.

They don't necessarily need 3000, but as much as possible helps. I'm well aware of the PA process, my dd is going through it now. Alas, you missed the point of my post.

...and just like your anecdotal interview experiences on here and in previous threads where you've posted about this, my anecdotal experience is that employers LOVED the fact that I was a former ER nurse. They knew I could think on my feet, prioritize things quickly, handle myself well when the s*** hit the fan, and respond calmly and quickly if a patient presented to the clinic who should have gone to the ER instead. I just think it's absurd to hear that some employers frown upon NP's who have previous nursing experience. Sounds like they wanted a PA instead.

Many of the schools don't agree because they saw the DE NP programs as cash cows. They realize how much money students are willing to pay and used that to their advantage to be able to churn out higher numbers.

I am well aware that ER nurses are not providers, no one is saying they are - but they do work off of protocols based upon a "presumed diagnosis" or presenting complaint. They have to use their in-depth assessment skills and history-taking ability to determine the best rabbit-hole to jump down and get labs and other diagnostic tests started while waiting for the patient to be seen by the provider. Do not discount the physical assessments that RN's can do. Did you not learn how to do a thorough neuro assessment in your BSN program? Have you ever worked with an occupational health nurse? Some don't have providers at their worksite everyday yet they are supposed to assess and treat work-related injuries on their own per protocols. They base their decision-making off the history of the injury and their assessment. They then decide if the patient needs to be sent to another location or can stay on site and provided recommended treatment (per protocol).

With regards to point #1, you essentially did what ER nurses who work in small, remote, community hospitals do on a daily basis, minus making the "official" diagnosis. At least you had other staff to assist. Regarding point #2, so you are saying your previous life and work experiences (non-nursing) brought directly transferable skills to becoming a NP, but those of us with years of previous nursing experience did or do not? Got it.

I don't know who is/was sending the patients to the ER from the PCP office, for I don't find it necessary to keep a tally of who sent who where be it an NP with nursing experience vs one without vs the PA, MD, or DO. It's just an observation of how it's been for several years and it's why ER nursing experience is a great primer for NP programs. I am all for EMT's advancing their knowledge and career. I'm also pretty certain most of them go the PA vs NP route because then they don't need to become a BSN first. However as a PA student, they would need many patient contact hours before applying to school - the average being 1000+ hours (the best candidates do a lot more than the bare minimum required to have a competitive application) on top of the average of about 3000 hours+ clinical hours they get during school. Would I have been as good of an NP if I didn't work as an RN first? I can confidently answer that question with a big "no way.” When I first step foot in the hospital as an RN student at the age of 19 I was terrified to go into my patient's room. So, when you worked in that rural clinic were you completely alone as a new NP (no other nurses, med assistants, docs, other NP's onsite to help) or did you have at least one other staff member there with you?

The difference is I shared how my RN experience was extremely beneficial to my career as an NP without being negative regarding NP's who had no RN experience. I didn't have to share those stories to make my experience sound better. As far as being a NP in primary care and how nursing experience is related, reread what I posted regarding my ER experience. So many cases in the ER and especially urgent care facilities can be handled in a primary care office, so the nurses getting the experience in those environments are most definitely able to have it translate to their primary care NP role. What's really sad is how many cases are turfed out to urgent care or the ER because that should have been handled by a PCP office. I worked alone as an NP in a couple of different settings where my only contact with my collaborating physician was either by phone or twice per month in person. I thank god that I had my ER nursing background to fall back upon when the more urgent, emergent and complex cases came into the clinic.

Yeah - once people need to throw in how great they are or toot their own horn is where they lose credibility to me.

I worked as an RN for about 7 years before going back to school to become a NP - mostly ER experience. I have stated this many times in the past on here - my nursing experience taught me that sixth sense, that gut feeling you get when you just know something is off that needs more investigation. ER nursing taught me the uncommon presentations for common conditions such as MI, sepsis, appendicitis, etc. When you work in the ER you develop very good listening and assessment skills in order to decide which protocol to follow before the MD or APP sees the patient. You learn what needs to be ordered to arrive at a diagnosis. Since the ER tends to be the stop for a lot of non-emergent cases anymore you learn how to treat what could have easily been handled in a PCP office. I also learned to know what I don't know, when to ask questions, and when not to just assume things. The NP role was developed originally for nurses who were considered experts. The NP education was an expansion to build upon their years of clinical experience. To say it is a different way of thinking is just ludicrous, as I still to this day, after 15 years of NP practice rely on skills and experience that I embraced while practicing as a RN. NP practice is based upon the nursing model - there will always be things you learned as an RN on the job that you will use as a NP. We all have our own anecdotal stories about NP students who had lots of nursing experience vs those who had no nursing experience. I tend to take them with a grain of salt.

When I started and it was just lectures I went to school twice per week - each class was one 4 hour lecture. Once clinicals started, it was class once per week but clinicals at least 3 days per week. It also depended on how you wanted to structure your clinical time as long as you did "x" amount of hours in a semester. Some students did longer days, less days per week and some did shorter days, more days per week. I typically tried to do the longer days with less days per week due to needing a sitter.

When I decided to return to school to become a FNP my kids were 6 mos and almost 2 years old. I went PT and completed my degree in 4.5 years. The one thing I have to say that I feel helped me the most was that I went to a school that was in-person only. That was my "me" time and it was a welcome relief to be around like-minded individuals after being with the little ones most of the day. My classmates and professors were very supportive as I was the only one with little kids at the time. My classes started at 4pm and I was out by 8pm. I only worked on the weekends while in school. Once clinicals started, I dropped down to per diem and would pick up 4 hour shifts on Fri/Sat nights two weekends per month just to my ER skills up. Luckily, my husband was also very supportive and really helped a lot with the kids when I needed time alone to study or write papers. We also were able to get sitters from the local college to help with watching the kids from the time I had to leave for school until the time DH got home from work. We also were able to get sitters on my clinical days. My recommendations: Attend school in person if possible; attend a school that helps with clinical placement (I never had to arrange my own - it is one less thing to worry about); if you need to - go to your local library or designate a quiet time/room in your house to be your study time. It was definitely difficult at times, but also very doable. Good luck!

Somewhat of a similar scenario but involves moving from one very well-paid NP job to another, lower-paying NP job. I did it because I needed something different. I needed a change of scenery. I took a $7K per year pay cut but did gain full employer-paid medical insurance and an extra week of vacation time - both which helped to lessen the salary blow. I also get that time off whenever I need it, and within almost 3 years I am now making more at my current job than I did at my previous job. This was by me proving my worth to my employer. Sometimes you have to sacrifice the salary for better work-life balance and other benefits. You typically can find ways to make it work, even if it means cutting back a bit on your current lifestyle. Cutting little things like a few premium TV channels, switching internet providers, and renegotiating personal cell phone contracts can help save money. If you find a job closer to home it can help to save gas and wear and tear on your car. Preparing your own food and bringing it to work and not eating out often really cuts costs. I enjoy my job so much more now and love that I can just say, "I need this day off" and it's done. I'd never get that at my previous position, never mind as a staff RN. If you can eat the salary now for a few years, I bet you would find it well worth it down the road.

This sounds very similar to my state school B&M program. Admission requirements were 3.0 minimum in a BSN program, GRE exam, pre-admission interview, essay, and two years of experience working as an RN. While in the program, a 3.0 had to be maintained with no course grade below a B- (80) in order to continue through the program. Preceptor sites were arranged by a dedicated coordinator (current NP) who worked for the college. No online classes at all, they were all at the college in-person. Very small cohorts. Courses taught by current practicing NP's - I think only one did not have a doctorate degree. Guest lecturers included physicians and a pharmacist. My preceptors were NP's and physicians at state public health clinics (adults and peds), FP, Ped, OB/GYN and IM physician offices, a nursing home, and rounding in a hospital with the IM office-based physician. I loved everything about my MSN program. I felt very prepared when I graduated and had no problem finding a job right out of school. Our clinical coordinator would come out to our preceptor sites usually 1-2 times per semester to talk with our preceptors, observe us, and observe how the preceptor interacted with us. I can also say that I've precepted several students from a very "prestigious" local school and never had a faculty member come do a site visit to observe me nor their students. I like to think my school did it right. This was about 15 years ago. I have always been extremely surprised by the amount of NP students now who prefer the online classes and minimum amount of clinical hours. Trust me - you are doing yourself and the profession a disservice if you want to shortcut the NP education.

Consider working for a pharmaceutical company. They are typically always looking for RNs and NPs to work clinical trials or become drug reps. Some handle post-market issues (adverse reactions, etc).

When I was in school many moons ago we just bought an APA guide which was sold in the college bookstore. Had examples of how to cite everything and anything.

You can definitely voice your concerns but there is a much more tactful and classy way to do it. ……and there it is.

If you've read my posts now and over the years you'd know the answer to that.

Just go back to the last page and you will see it. Just look through several other NP threads and you will see it. Same game, different players year after year. It's petty and it gets old.

As long as the criticism is constructive, I'm all for it. Speaking negatively about a profession in general is just extremely condescending. It has no place here.

What is very sad to me is that I will disappear from this board for months to a year or so at a time and will eventually come back to find there is always some cavalier poster (typically not in the nursing profession) who feels compelled to come on here with the sole intent to put down the NP profession on this board. This is nothing new. It's also very insulting to those of us who became NP's in the way the the profession was initially intended. We have years of nursing experience behind us and became NP's to build upon that solid foundation. Every physician I have ever worked with was thrilled to have me as a part of their team. They respected my knowledge and expertise and that respect was mutual. We would often bounce ideas off each other if cases were more involved. I have never once felt that a physician wasn't appreciative of the role I fill. They realize the important part we play as part of a medical "team.” If you want to continue to drag down the profession, head back over to studentdoctor.net where it seems to be the repetitive theme among the med students and residents. Funny how it's rarely ever the physicians who have been practicing for a while who seem to have the issues with us. You know what they say about those who have to put others down in order to feel better about themselves....

What I find odd is how frequently a current medical resident has time in their day to post in a nursing forum.