Requiring Bedside Experience for NP

futureeastcoastNP · Mar 4, 2014

I think that's a horrible idea. It isn't experience that makes a good NP, it's intelligence. Anyone, including unintelligent nurses, can get experience. I've met endless nurses who have decades of experience but would be totally lost as a provider. Trust me, it is not the non experienced RNs who are causing the problems (example: Walden requires two years of experience).

There are many intelligent, driven people who would make excellent providers, but have no desire to do bedside nursing. To force that would mean losing all of these bright future NPs to the PA or MD profession, where working 12 hour shifts cleaning feces and passing pills for a few years is not a requirement. MDs are not forced to have any experience and yet they do quite well, why? Because medical schools ensure only intelligent individuals are admitted, unlike many NP programs, such as Walden, that will admit people who cannot even read and spell in proper English.

Rather than blindly enforce more experience, which will do nothing to help the current problem, they should institute measures to ensure intelligent. The GRE should become mandatory at all schools, with a score above the 60th percentile required for admission. Prereqs such as organic chemistry or physics should be added to ensure logic. For profit programs should be shut down, and the boards should institute policies requiring a certain number of professors per student as well as forcing all schools to find and vet preceptors for students. All preceptors should be required to have 7+ years of experience.

Some of huge brightest NPs I've ever met were direct entry students with no bedside experience. It's hard for someone to have to have the capacity to both blindly follow orders (RN) and be the leader making the decisions (NP). Some people are more suited to one role than the other. I think the biggest factor in NP quality is school choice, and since some of the best programs are direct entry (UPenn, Duke, Columbia) it proves that experience is not the deciding factor.

Bottom line: more bedside experience does make someone a better provider. They are completely different roles. Bedside nursing focuses on following orders and physically taking care of a patient, while being an NP is about making decision and logically thinking about an issue to come up with differential diagnoses. Spending more time passing out pills will not make someone a more logical thinker. If that were the case, then Walden would have amazing outcomes since they require 2 years experience, and we all know that is not the case.

elkpark · Mar 4, 2014

Requiring bedside RN experience also would basically eliminate the possibility of direct entry programs, which, for better or worse, are v. popular.

On the other hand, the idea that RN practice isn't helpful for nurse practitioners because it consists primarily of "following orders," "cleaning feces" and "passing pills" seems pretty uninformed, to say the least. I went to grad school as an experienced RN and the other students in my track (psych CNS) were all direct entry (non-nurse) students. Although it's obviously a limited sample, the direct entry students struggled a great deal more than I did with every aspect of the program. My nursing experience appeared to be a clear advantage in the program that the other students openly envied. It's called "advanced practice nursing" for a reason. I would be perfectly happy to have the nurse practitioner education and role split off entirely from the larger nursing community, as many people on this site (and other places) have suggested over the years. If that's the case, though, I think the word "nurse" should be taken out of the title.

Laurie52 · Mar 4, 2014

I think that's a horrible idea. It isn't experience that makes a good NP it's intelligence. Anyone, including unintelligent nurses, can get experience. I've met endless nurses who have decades of experience but would be totally lost as a provider. Trust me, it is not the non experienced RNs who are causing the problems (example: Walden requires two years of experience). There are many intelligent, driven people who would make excellent providers, but have no desire to do bedside nursing. To force that would mean losing all of these bright future NPs to the PA or MD profession, where working 12 hour shifts cleaning feces and passing pills for a few years is not a requirement. MDs are not forced to have any experience and yet they do quite well, why? Because medical schools ensure only intelligent individuals are admitted, unlike many NP programs, such as Walden, that will admit people who cannot even read and spell in proper English. Rather than blindly enforce more experience, which will do nothing to help the current problem, they should institute measures to ensure intelligent. The GRE should become mandatory at all schools, with a score above the 60th percentile required for admission. Prereqs such as organic chemistry or physics should be added to ensure logic. For profit programs should be shut down, and the boards should institute policies requiring a certain number of professors per student as well as forcing all schools to find and vet preceptors for students. All preceptors should be required to have 7+ years of experience. Some of huge brightest NPs I've ever met were direct entry students with no bedside experience. It's hard for someone to have to have the capacity to both blindly follow orders (RN) and be the leader making the decisions (NP). Some people are more suited to one role than the other. I think the biggest factor in NP quality is school choice, and since some of the best programs are direct entry (UPenn, Duke, Columbia) it proves that experience is not the deciding factor. Bottom line: more bedside experience does make someone a better provider. They are completely different roles. Bedside nursing focuses on following orders and physically taking care of a patient, while being an NP is about making decision and logically thinking about an issue to come up with differential diagnoses. Spending more time passing out pills will not make someone a more logical thinker. If that were the case, then Walden would have amazing outcomes since they require 2 years experience, and we all know that is not the case.[/quote']
1. Nurses do much more than blindly follow orders and "push pills". Perhaps that is all you do as a nurse but please do not speak for all nurses.
2. Physicians do residencies lasting up to 9 years, depending on the speciality. The number of clinical hour between NP and MD is extensive.
3. If experience is not important, why do you want preceptors to have 7 years of experience.
Bottom line, most NPs work with physicians and follow what they would like done with thempatient

zmansc, ASN, RN · Mar 4, 2014

Future, Please tell us, are you even an RN yet? How much experience do you have, please go into detail? You seem to think your an expert on all things nursing and especially nurse practitioner education, however as far as I can tell you don't know much about what an RN does, nor do you really have any background in education to substantiate your claims that you know what is right and wrong with nurse practitioner education.

Where did you come up with the 7yr rule? Why 7? Why not 6, or 8? What is special about 7yrs? Please explain the logic behind your new rule that appears totally arbitrary (as have most of your other suggestions in past posts).

futureeastcoastNP · Mar 4, 2014

1. Nurses do much more than blindly follow orders and "push pills". Perhaps that is all you do as a nurse but please do not speak for all nurses.
2. Physicians do residencies lasting up to 9 years, depending on the speciality. The number of clinical hour between NP and MD is extensive.
3. If experience is not important, why do you want preceptors to have 7 years of experience.
Bottom line, most NPs work with physicians and follow what they would like done with thempatient

7 years NP experience, not RN experience. Different beast entirely.

I understand what you're saying, and I didn't mean to offend any RNs as I know the role goes far beyond just pushing pills. To me, though, the problem with poorly trained NPs is not due to lack of RN experience but simply lack of intelligence/admissions standards. If there was going to be some concerted effort to increase NP competence, I would advocate ensuring that NP programs only admit qualified, intelligent individuals (even if they are inexperienced) over blindly enforcing experience without any change in lack of other standards at some programs.

Perhaps the best idea would be a combination of more admissions standards as well as X number of hours as a practicing RN. Even better, perhaps NP programs should invent their own entry exams (similar to the MCAT for physicians) that tests basic english, math, nursing, and science knowledge.

In reality though, all of our fighting over these things is pointless. Schools make too much money off of NP programs, and the nursing accreditation board clearly couldn't care less about quality preparation as they race to accredit as many diploma mills as possible. The admissions standards, in regard to either experience OR other metrics, will never change.

Esme12, ASN, BSN, RN · Mar 4, 2014

7 years NP experience, not RN experience. Different beast entirely.
I understand what you're saying, and I didn't mean to offend any RNs as I know the role goes far beyond just pushing pills. To me, though, the problem with poorly trained NPs is not due to lack of RN experience but simply lack of intelligence/admissions standards. If there was going to be some concerted effort to increase NP competence, I would advocate ensuring that NP programs only admit qualified, intelligent individuals (even if they are inexperienced) over blindly enforcing experience without any change in lack of other standards at some programs.
Perhaps the best idea would be a combination of more admissions standards as well as X number of hours as a practicing RN. Even better, perhaps NP programs should invent their own entry exams (similar to the MCAT for physicians) that tests basic english, math, nursing, and science knowledge.
In reality though, all of our fighting over these things is pointless. Schools make too much money off of NP programs, and the nursing accreditation board clearly couldn't care less about quality preparation as they race to accredit as many diploma mills as possible. The admissions standards, in regard to either experience OR other metrics, will never change.

You have Seven (7) years NP experience when your name is FUTUREeastcoastNP? AND you state on your profile that you are a RN BSN?

You have posted in past posts about waiting for admission to a NP program...for 2014

Feb 20 by futureeastcoastNP
Hm, does anyone know if the wait list is ranked? Do they rank in order of GPA, GRE or what?
What was everyone's overall GPA, wait listers and those accepted??

Feb 20 by futureeastcoastNP
I haven't heard yet, which is odd. Why are they staggering decisions?
My GPA was a little lower than yours SilvaRN, so I'm a bit worried at this point. I took the GRE though because other schools I applied to needed it so I figured it wouldn't hurt to submit it.

futureeastcoastNP · Mar 4, 2014

You have Seven (7) years NP experience when your name is FUTUREeastcoastNP? AND you state on your profile that you are a RN BSN?
You have posted in past posts about waiting for admission to a NP program...for 2014

Um I think you need to re read my posts. I said NP preceptor should have 7 years of NP experience or more. Not talking about myself.

scarykarrey · Mar 4, 2014

I am also interested in how your professional background has put you in such close contact with so many NPs to give you such strong convictions about comparative quality of providers among those with and without floor nursing backgrounds.

allnurses Guide · Mar 4, 2014

There are quite a few NP programs without requiring bedside RN experience for admission. I think this should be mandatory especially for online programs that admit 100,000 students every semester. I really wish advanced nursing programs were more standardized in a national basis. I wonder if this was ever a topic when formulating the Consensus Model...[/quote']
My question would be: where's the evidence?
There is dearth of research on the topic, but the studies that have been done have not demonstrated that RN experience is correlated with NP competency.
I agree with the exponential growth of new and potentially sub-standard NP programs there is some concern about educating future NPs, but I am not convinced that RN experience is the way to ensure better preparation.

allnurses Guide · Mar 4, 2014

As far as removing "nurse" from the title, I think that is a bit of a harsh reaction. NPs, regardless of RN experience, are educated in the nursing model, and this makes them nurses as far as I am concerned. NPs function in a very different role, as do other APNs, but this is based on their education and preparation and not just their prior experience.

myelin · Mar 4, 2014

I think if we want to improve NP education and the standing of our field we need to approach it in two ways:

1. Yes, we should have schools with higher standards to ensure intelligence or, frankly, a willingness to work hard to meet admission standards. We need to get rid of programs that are for-profit and willing to accept anyone who has a bank account/loans. NP school shouldn't be wide open to just any RN who wants it. All programs should have actual standards (ideally equal across the board) that NP-hopefuls must work hard to meet... like a minimum GPA, a strong GRE, good interview skills, an eloquently written admission essay, etc.

2. I won't say that experience doesn't matter, but I will say that NP programs need to stop relying on RN experience and beef up the clinical hours required to become an NP. We could argue all day about whether or not RN experience is necessary (I'm going with 'no', since DE NPs do just fine), but the real question is the following: What's more helpful - hours obtained through RN experience or NP clinical training? I'm sure we all agree that more NP clinical training hours are obviously going to be far more helpful than the NP student's previous RN experience. A lot of RNs don't even have any work experience in their chosen NP field. The fact that people are becoming NPs w/only ~500 hours or so of training (especially in a specialty as expansive as FNP or AGNP) is crazy! I think NP residencies are the way to go. We simply do not have the hours of clinical training to be practicing on our own when we graduate and relying on prior RN experience just doesn't cut it.

Also, by requiring RN experience you will eliminate DE NP programs. DE programs are highly, highly competitive and housed at the 'top' schools (Hopkins, Penn, etc.) Due to their competitive nature they attract intelligent, hard workers from other fields into nursing. Do you want to drive those people away from nursing and have them become MDs or PAs instead? If DE PMHNP programs didn't exist, I would have gone the MD route.

Bit of a tangent here: You know what I think is interesting? The lack of for profit CRNA/CNM schools. It seems like both those APRN specialties are holding things to higher standards. I don't know if anyone else can comment on this but it strikes me as quite interesting. I could be wrong, but I have yet to see a for-profit CRNA school with low admission standards. They also force CRNAs to have ICU experience... if NP programs forced RN applicants to have RN experience within their specialty (ie: only peds nurses can apply to PNP programs), then you might have an argument that RN experience is a must. I still argue that actual NP training hours are far more relevant and must be beefed up.