Requiring Bedside Experience for NP

myelin · Mar 4, 2014

I also don't understand arguments against residencies. All of the new grad NPs I know (and I know many) feel that it would be a huge asset. I don't know of one NP who thinks the clinical hours in school are adequate for practice and in my program we all feel we need residencies and/or jobs that are willing to 'train us up'. The clinical hours simply are not there.

I would do a residency in a hot second if I could, but I have loan repayment obligations that cannot be deferred when I graduate. Here is hoping that my first job is willing to provide me with guidance and support.

SubSippi · Mar 4, 2014

I am not impressed by the average entry level NP.
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.

First, I'm not impressed by an entry level anything. Who is?

Second, you're not attacked for suggesting more education, you're attacked because of your rude, condescending, know-it-all tone.

allnurses Guide · 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 seen the outcomes and I am not impressed by the average entry level NP.
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 have never claimed to be the authority on NP education; I have completed education, I do practice in the role, and I have published on the topic. I do have some perspective to how NP education translates into role socialization of novice NPs.

How exactly am I biased? Please point out my bias and use some examples to show it compared to the extant literature.

What outcomes are you not impressed with, please share the studies.

You are not being attacked and chided for advocating and desiring more education; you are being challenged on bold statements you have made without any experience with the topic and without data to back you claims. If one has no experience and no data how strong is their position?

BostonRN13 · Mar 4, 2014

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.

Wow, thanks for your reccomendations Future. Get over yourself!!

Esme12, ASN, BSN, RN · Mar 4, 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.

Then I stand corrected.

Thank you for clarifying.

For the record I believe nurse practitioners need experience in either nursing prior to entry OR residencies post to ensure competencies.

Wrench Party · Mar 5, 2014

Y`all gotta walk before you can run. Anecdotally, the best NPs I`ve encountered had years of assessment and care experiences under their belts; their communication and professional rapport was honed to pick up on subtle cues. And, for the record, book intelligence as people may have in tests and essays surely isn`t the only kind of intelligence required to be successful as a provider.

automotiveRN67 · Mar 5, 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.

Wow. I bet you're popular.

automotiveRN67 · Mar 5, 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.

Maybe you should read some of your rants, before you accuse people of improper grammar.

Cardiac-RN · Mar 5, 2014

To the OP, while I believe that having RN experience prior to entering into an NP program can be very valuable, I do not think it will ever end up being mandated as being required, because as long as direct entry programs are able to turn out graduates who can pass the entry-level board exams, there is not much evidence to justify that they are unprepared due to lack of previous RN experience.

With that being said, as an experienced RN who went back to school, I am so grateful for my RN experience because I cannot imagine going through this program without it. Years of taking good patient histories and performing assessments, considering medications and changes to request from the physician, being involved in procedures, talking with specialists etc. has only been helpful to me by serving as a very broad knowledge base to build upon.

I do feel like direct entry applicants without experience will have a very sharp learning curve- but that does not necessarily mean they will not get there and I wish them luck because I am sure that it is a hard road.

Cardiac-RN

JeanettePNP, MSN, RN, NP · Mar 5, 2014

I think it's similar to the question of whether you need CNA experience to become an RN, or paramedic experience to work in an ER. Sure, it's helpful, and those who go into school with that experience usually have a leg up in school and in job interviews. But after 5-10 years on the job, can you really tell the difference between who started out as an RN and who started out as a CNA or paramedic?

I think the same is true for NP's. I had several classmates with RN experience who were shining stars, and a few who were unimpressive. And there were a few outstanding students among the DE's as well. RN experience can never hurt and I personally recommend trying to get it before going to NP school. Still, you can have a perfectly respectable career as an NP without working bedside first, and the more experience you get as an NP the less and less relevant your RN background becomes, depending of course on the area you're working in.

I'm certified as a primary care PNP, which means I cannot work in a hospital (more and more are requiring acute care certification) so my lack of acute care experience really has no effect on the work I do now.

stickit34 · Mar 5, 2014

Personally, I think the entire educational system for nursing needs to be revamped. If you look at other healthcare professionals' education, it is strict and has minimum standards that everyone has to meet. In nursing, it is all over the place. You can be a nurse from a diploma program, ADN or with a BSN. There should be an absolute minimum that everyone needs to meet. In regards to advanced practice nursing, it also needs a revamp. Minimum standards should be enforced, and there needs to be a firm regulating body for these programs that are monitoring their outcomes and education, not one that just approves programs. I also think that bedside nursing should be seriously considered an asset to the application if anything. How can you say that a year or more of hands-on assessment and clinical critical-thinking skills can be bad or disposable?

zmansc, ASN, RN · Mar 5, 2014

My program only requires 1 yr prior to entering the program. I think it is an interesting debate, and I think Cardiac-RN hit it on the head, the more experience you have in the tasks that overlap, doing assessments, evaluating treatment plans, etc. the easier it will be for you to apply the book learning to real life situations which is a hard part in education programs.

When I was researching what I wanted to do I looked at PA and CRNA programs as well. PA programs are all over the board now. As more schools have developed more programs, some require 10,000 hours and other little to no hours of experience. CRNA programs use to be very standard, don't even apply unless two years at a level 1 trauma center's ICU. Now, there are people getting in with 6 months, or at ICUs in smaller hospitals.

I think there has been a shift from a need to have x years of experience prior to entering these programs, to programs that are designed to take people with less experience. I think if I was to go into a program with no experience I would want to make sure the program was designed to handle that limitation in my background.