Pros and Cons of Direct Entry NP Programs?

TheDudeWithTheBigDog, ADN, RN · Feb 13, 2019

13 hours ago, Spadeforce said:
lol a scribe being more helpful than RN prior to entering a provider role keep dreaming

Why not? If you've been documenting for a doctor for years, you've probably learned a lot about diagnosing and how things are treated. There's absolutely no reason that a scribe's experience cant give an advantage of an RN's.

Spadeforce · Feb 16, 2019

Nurses read through the medical diagnoses too and actually have to make some independent decisions. Scrbes just copy notes

TheDudeWithTheBigDog, ADN, RN · Feb 17, 2019

22 hours ago, Spadeforce said:
Nurses read through the medical diagnoses too and actually have to make some independent decisions. Scrbes just copy notes

OK, but scribes are present for the entire time. They get the opportunity to listen to the doctor explaining the diagnosis. They're listening to the doctor explain the treatment plan. They're listening to the doctor explain the symptoms. Are you seriously going to try to claim that they're not going to be learning a lot in that environment? They're not just copying notes, they're present the entire time.

Again, there's absolutely no reason that being a scribe and present in hundreds of doctor visits every month can't give you an advantage over an RN.

daisychains11, RN · Feb 19, 2019

He didn't say being a scribe is more helpful than being an RN, he said he's seen PA's who ended up being better providers with scribe and EMT experience than some of those with RN experience. (the truth is though its hard to measure who is better at their job).

At the end of the day, PA's and NP's are not RN's, and being an RN does not make or break someone's abilities as a PA or RN. Many people who apply to direct entry NP or DNP programs like myself do have other patient and/or medical experience. I have worked administrative in a medical center, volunteered directly with patients in acute neurology, and am also a certified emergency medical responder.

runnyeggs · Feb 22, 2019

What school is MGH? I have been looking at Touro but it's $44k. There are online ones listed at $8k-12k. More reasonable. Also are any of these 15 month-24 programs? I intend to work and get experience that way versus stay in school for 3 years.

Ohm108, MSN, NP, CNM · Feb 27, 2019

On 2/22/2019 at 5:15 PM, runnyeggs said:
What school is MGH? I have been looking at Touro but it's $44k. There are online ones listed at $8k-12k. More reasonable. Also are any of these 15 month-24 programs? I intend to work and get experience that way versus stay in school for 3 years.

Its the Massachusetts General Hospital Institute of Health Professions. It is affiliated with the Mass Gen Hospital network. My friends from Boston have said that it is a good school with a good reputation. I considered applying to the school but it didn’t have the specialty that I was interested in.

DYS NP · May 18, 2019

I'm in my final year of the Northeastern DE program. I applied to all of the programs mentioned above, and chose NEU because it

had a pedi track (my first choice, Simmons, did not)
awarded a BSN after the undergrad portion (most do not)
guaranteed clinical placements (HUGE)

It does take the longest of the 3 programs I feel confident recommending (Simmons, BC, NEU). The PNP DE track at NEU has a 2-year RN work requirement between BSN and MSN (for FNP, it's 1 year). There's an RN work requirement during the MSN portion also, in additional to clinicals.

Simmons impressed me the most during the application process but didn't have a pedi track. MGHIHP impressed me the least--unprofessional, disorganized was my take-away from the info session through the application process.

I will also stress what UMBdude stressed above: Make sure the program you choose 100% guarantees NP clinical placement. It's fiercely competitive in Boston because of the number of nursing programs and limited supply of willing/qualified preceptors. You'll hear horror stories from students in other programs about getting dropped because they couldn't find preceptors. One friend had to temporarily move to the western part of the state to complete her gradual clinical requirements because she couldn't find anything within driving distance. And it's VERY stressful looking.

My NP clinicals start this fall, and I've got my placements without my having to do the legwork; both are in Boston and in the area of practice I requested.

Dodongo, APRN, NP · May 19, 2019

NP education is not designed for direct entry. The CCNE requires 500 hours. That's laughable for even experienced RNs. Do yourself a favor and optimize your experience. Then find the best school you can and do AS MANY HOURS during school as you can.

DYS NP · May 23, 2019

NP clinical requirements apply to all students, regardless of where or how they got their RN. It's hard to see how more than 5000 hours of RN experience will make us better NPs--a different profession requiring different skills—but I’m open to hearing your argument.

My concern with this view is that it implies all nursing experience is equally valuable, regardless of specialty, complexity, range, or site, and that other experience (a four-year degree is required for DE entry) has little or no value. I learned how to manage a team and to separate EB science from shite as a medical research editor.

Regarding the 500 hours required by the CCNE, med-school rotations per specialty last 3 weeks to 3 months for students with (largely) no clinical experience - then they take their boards. Most of us can pass a certification exam, but the bulk of our learning, as for any career, is in actual practice. I’d argue that a post-certification NP residency would better prepare me for practice than additional years of nursing before graduate school.

buttercup9, ASN, BSN, MSN · Jun 2, 2019

On 5/23/2019 at 7:24 AM, emmawdhous said:
I’d argue that a post-certification NP residency would better prepare me for practice than additional years of nursing before graduate school.

While this may be true, very few post certifications NP residency's exist. Good luck finding one.

For what its worth, I graduate in a few weeks from a well known AGACNP program. I have 11 years of RN experience from bedside to ED and I am terrified. I cannot imagine trying to be an NP without this experience.

As for the medical students, I have had rotations with some (and just finished an ICU rotation today). They were in the unit 5-6 days a week 8-10 hours a day. At minimum this was 160 hours in just the month they were there. They have a ton of hours just as students and then they go on to their residencies. Yes, I didn't need to do rotations in ped's, OB/GYN, mental health or family practice as I don't plan on working in those environments but over all, NP's just don't get as much clinical training. I currently have more than the required amount and really wish that we were required more than 500.

As to the comment

On 5/23/2019 at 7:24 AM, emmawdhous said:
My concern with this view is that it implies all nursing experience is equally valuable, regardless of specialty, complexity, range, or site, and that other experience (a four-year degree is required for DE entry) has little or no value

No one is denying the intelligence or capability of DE students. I have been in classes with some of these students and they are extremely dedicated and intelligent people.

I know many bedside RN's who are second career nurses (myself included) and each brings a different perspective to the table. Of course prior experience has value!

I obviously have a bias as I do have RN experience and I have learned so much from this. I suspect that when you hear NP's who were RN's first say that RN experience matters is because we have been there. I am not sure if this will come across clearly, but until you do something, you don't know what you don't know. Or as Rumsfeld puts it "the unknown unknown".

No one is denigrating the intelligence of DE students. It is the required hours that is a problem. Again, as an RN with 11 years of experience (and over the past 2 years as a student), I've definitely used my ED job to practice assessment skills (above and beyond RN), think of my own differential diagnosis, interpret labs etc... I have 600 "clinical" hours and again, I really wish more hours were required.

GraysAnaTummy · Apr 13, 2022

The knowledge base for NAs, RNs, NPs, and MDs are all similar in some respects but quite different in others, especially with regard to their roles. I'm baffled by the arguments and criticism against DE MSN/NP programs. If you want to be a RN, be a RN with RN duties, responsibilities, education and training. If you want to be a NP, be a NP with NP duties, responsibilities, education and training. Same goes for NAs and MDs. If being a NA was sufficient knowledge and experience towards becoming a RN, they'd simply promote. If being a RN provided sufficient knowledge and experience towards becoming a NP, they'd simply promote. Equally, if being a NP provided sufficient knowledge and experience towards becoming a MD, they'd simply promote. They do not because none are one and the same, despite having some shared foundational knowledge/skill sets across each level.

What they share equally is that they are all necessary levels of care that can be provided to ensure the best possible patient outcomes. Wherever you stand - wherever you fit into the model - you are valuable and appreciated.