Requiring Bedside Experience for NP

matthewandrew, NP · 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.[/quote']
Very good points made! When I posted this I was thinking how ICU experience is required for CRNA programs. You are right though, it's really the clinical hours in the NP programs that going to make a difference...

futureeastcoastNP · 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.

Couldn't agree more with everything you've said. Also notice that CRNAs and CNMs don't have saturation or dropping salary issues yet as NPs are experience in some areas. I think this is directly linked to the rise of for profits pumping out too many NPs.

Also agree about the top schools not requiring experience, and their direct entry programs graduate some of the top NPs in the country. As I articulated in an earlier post, many bright individuals who have the intelligence necessary to be a provider don't want to work as a bedside nurse. It's ridiculous to push them away in the name of experience. I'd rather have a highly intelligent direct entry NP take care of me than a Walden grad with 20 years of experience who can barely spell.

Finally, yes I think most importantly is that FNP programs need more clinical hours. Quite frankly, it wouldn't be that hard to complete all of the required courses (non clinical) in the first year, and then do nothing but full time clinicals (40 hours per week) along with the clinical classes for the second year. This would amount to about 2,000 hours of clinical during NP school, yet because programs are structured to accommodate the "working nurse" they string it along with only one or two courses per semester and barely any clinicals. Quality NP preparation should come before ensuring students can continue to work.

allnurses Guide · Mar 4, 2014

Concurrent clinical and didactic components is a strength over the end-loading clinical experience of PA programs in my opinion. You may find this when you go through your NP program.

SubSippi · Mar 4, 2014

Couldn't agree more with everything you've said. Also notice that CRNAs and CNMs don't have saturation or dropping salary issues yet as NPs are experience in some areas. I think this is directly linked to the rise of for profits pumping out too many NPs.
Also agree about the top schools not requiring experience, and their direct entry programs graduate some of the top NPs in the country. As I articulated in an earlier post, many bright individuals who have the intelligence necessary to be a provider don't want to work as a bedside nurse. It's ridiculous to push them away in the name of experience. I'd rather have a highly intelligent direct entry NP take care of me than a Walden grad with 20 years of experience who can barely spell.
Finally, yes I think most importantly is that FNP programs need more clinical hours. Quite frankly, it wouldn't be that hard to complete all of the required courses (non clinical) in the first year, and then do nothing but full time clinicals (40 hours per week) along with the clinical classes for the second year. This would amount to about 2,000 hours of clinical during NP school, yet because programs are structured to accommodate the "working nurse" they string it along with only one or two courses per semester and barely any clinicals. Quality NP preparation should come before ensuring students can continue to work.

You ignored a previous post, which asked you how your background has put you in contact with enough NPs to give you such strong ideas about NP education and RN experience. Please, tell us.

You are too biased towards your own circumstances for your opinion to merit credibility. You are clearly very young...when you get a little older you'll realize that things are almost never black and white. RN experience would have taught you that.

futureeastcoastNP · Mar 4, 2014

You ignored a previous post, which asked you how your background has put you in contact with enough NPs to give you such strong ideas about NP education and RN experience. Please, tell us.
You are too biased towards your own circumstances for your opinion to merit credibility. You are clearly very young...when you get a little older you'll realize that things are almost never black and white. RN experience would have taught you that.

Edit: Nevermind, I give up.

futureeastcoastNP · Mar 4, 2014

Concurrent clinical and didactic components is a strength over the end-loading clinical experience of PA programs in my opinion. You may find this when you go through your NP program.

Edit: Not worth it, I give up.

HouTx, BSN, MSN, EdD · Mar 4, 2014

[quote=futureeastcoastNP;

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.

Spoken like someone so has so little experience in a direct nursing role that he/she doesn't even realize what staff nurses do or the scope of their responsibility. It sounds like a misinformed layperson - very biased and disrespectful opinion of direct care nurses.

allnurses Guide · Mar 4, 2014

End of story. As it is now I anticipate having to do a residency after graduation to "catch up" to the PAs and MDs who have 2000-10000 hours compared to the 600 or so in most NP programs.

More clinical hours is a bonus.

A residency program is a bonus.

There is no evidence that 2000-10000 hours is needed to provided competent care. If there was, changes would be made. That comes at an increased cost which makes NPs less cost effective and if they are less cost effective they lose their niche. There needs to be a balance driven by evidence.

Again, you are speaking with conviction but without perspective. You state you anticipate needing a residency but in reality you really don't know what you will need as you are in the infant stages of the process.

futureeastcoastNP · Mar 4, 2014

I've edited my previous responses and apologize to anyone I have offended. I do not mean to offend anyone, NPs or RNs. This website is meant to stimulate discussion, and the OP asked about opinions on requiring bedside RN experience before NP school. I answered with my opinion, which is that I think it is unnecessary and that high entrance requirements would likely lead to better outcomes. I also suggested that NPs likely need more clinical hours. Apparently though, my opinion is completely unacceptable and deserves to be bashed and picked apart unlike anyone elses on this forum. So, whatever, I give up. You guys can continue to support Walden University and having a total of 500 clinical hours. You can continue to support having people who cannot even spell the word "Nurse Practitioner" become NPs online. It doesn't effect me and I'm sick of arguing with everyone on here (aside from the few sane ones) about it.

futureeastcoastNP · Mar 4, 2014

More clinical hours is a bonus.
A residency program is a bonus.
There is no evidence that 2000-10000 hours is needed to provided competent care. If there was, changes would be made. That comes at an increased cost which makes NPs less cost effective and if they are less cost effective they lose their niche. There needs to be a balance driven by evidence.
Again, you are speaking with conviction but without perspective. You state you anticipate needing a residency but in reality you really don't know what you will need as you are in the infant stages of the process.

Boston, I appreciate your perspective and your posts, but you are not the ultimate authority in NP education either. You are, quite frankly, a bit biased. I have researched the hell out of NP programs, outcomes, etc. I have spoken to NPs in person and on this board. I have seen the outcomes and I am not impressed by the average entry level NP. I think the training is simply not enough. I don't want to merely be "good enough", I want to be extremely competent. For me, I believe a residency will be necessary. I realize, however, that my aspirations do not reflect everyone else's aspirations and I will no longer post suggestions on how to prove NP education. I realize that perhaps what is not enough to me may in fact be fine for others. To each his/her own. If anything, I should be commended for desiring more education and training, but instead I am attacked for suggesting such a thing and chided for my limited experience. It's a little backwards, but whatever, I've come to expect that.

Dranger · Mar 4, 2014

Boston, I appreciate your perspective and your posts, but you are not the ultimate authority in NP education either. You are, quite frankly, a bit biased. I have researched the hell out of NP programs, outcomes, etc. I have spoken to NPs in person and on this board. I have seen the outcomes and I am not impressed by the average entry level NP. I think the training is simply not enough. I don't want to merely be "good enough", I want to be extremely competent. For me, I believe a residency will be necessary. I realize, however, that my aspirations do not reflect everyone else's aspirations and I will no longer post suggestions on how to prove NP education. I realize that perhaps what is not enough to me may in fact be fine for others. To each his/her own. If anything, I should be commended for desiring more education and training, but instead I am attacked for suggesting such a thing and chided for my limited experience. It's a little backwards, but whatever, I've come to expect that.

I frequent many other forums and came across a PA's blog regarding residencies. I believe he went to an 18 month EM program at a teaching hospital on the East Coast. Pretty much he was expected to function as a PGY 1-2 resident and did the exact same rounds and clinical presentations as all of the other residents there. He felt that in a little over a year he learned more then what was taught in his PA program and his prior HCE combined. Most of these residencies present grads with a certificate that make them that much more marketable.

I don't see how residencies can do anything but help. Actually I think they should be required and not just a "bonus".

futureeastcoastNP · Mar 4, 2014

I frequent many other forums and came across a PA's blog regarding residencies. I believe he went to an 18 month EM program at a teaching hospital on the East Coast. Pretty much he was expected to function as a PGY 1-2 resident and did the exact same rounds and clinical presentations as all of the other residents there. He felt that in a little over a year he learned more then what was taught in his PA program and his prior HCE combined. Most of these residencies present grads with a certificate that make them that much more marketable.
I don't see how residencies can do anything but help. Actually I think they should be required and not just a "bonus".

Sounds wonderful I look forward to completing a residency myself :)

Im sure the extra structured clinical hours will be a huge asset.