Requiring Bedside Experience for NP

[matthewandrew]

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...

[scarykarrey]

I wonder if a good compromise to this issue would be to require a certain number of patient contact hours before being licensed, rather than before enrolling in a program?

For example, let's use an arbitrary number like 3,000 patient contact hours being required prior to licensure, with a maximum of 2,000 PCHs that can be applied from previous RN work experience. In this case, a seasoned nurse would be able to apply the max 2,000, and then would need an additional 1,000+ hours to come from their graduate program. In the case of a direct-entry applicant, they would need to get the full total of 3,000 hours, either from their graduate program, working while in school after earning their RN licensure, or maybe through the development of some sort of transitional residency program. (If 1,000 is a "fair/average" number of clinical hours for a grad program, then 2,000 in a transitional program is a little less than a year of 40hr workweeks)

Obviously, these are arbitrary numbers, but would something like this work as a compromise?

[lub dub]

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.

It's called disagreeing with you, not considering your opinion to be completely unacceptable and deserving to be bashed and picked apart unlike anyone else's on this forum. There's a difference.

[TammyG]

My own view is that some RN experience is helpful to understand the medical system in general, how hospitals work, how orders are written, looking at patient management systems, etc. Plus, the patients that you take care of as an RN (even though you are not doing diagnoses) add to your total knowledge base. I think that I would have had a harder time than I did in NP school had I not had several years of RN experience.

Along the same lines, ANY experience in life (working in business, say, or government) provides good experience and maturity and also helps both in NP school and in real life.

That doesn't mean that direct-entry students do not make as good (or even better) NPs then NPs who had previously been RNs. But I do think every type of experience is helpful.

[kanzi monkey]

I am a DE NP who worked as a bedside RN during the NP portion of school. I have now been practicing as an NP for 4 years. My experience as an NP has helped me become a better NP. My experience as a nurse gave me the opportunity to learn about some aspects of our health system (the setting was acute care, so that was my frame of reference). I also became very comfortable interacting with patients and families and other members of the health care team. When I was a new NP, I had that edge over med students and junior residents, but not with medical knowledge and diagnostics. That has come entirely from experience as an NP, and, while I am happy with my RN experience, I would have exchanged it for more clinical hours or a residency.

Also, and this is just a side bar--I have recently worked with some brand new DE NPs with NO clinical background other than what they got in school. And these NPs have been exceptional--in some cases more thoughtful and open-minded than I am (these are qualities I really strive for). I have seen them approach patient scenarios in ways that I did not consider, and their management choices were very effective. It's really put things into perspective. Ultimately, I've concluded that they are less jaded than I am. I only realized that I was jaded after watching them. It's a good lesson for me.

[hopetsanchez]

Considering that the CRNA program requires at least 1 year of ICU experience, I think that there is a good point to the idea of nursing before becoming an NP.

[BostonFNP, APRN]

Considering that the CRNA program requires at least 1 year of ICU experience I think that there is a good point to the idea of nursing before becoming an NP.[/quote']

Devils advocate: based on what?

[blusueNP, MSN, APRN]

MD's do quite well because they have at the very minimum a 3 year residency. NP's are thrown to the wolves upon graduation with 6 months to a year of clinical exposure - which doesn't come within a 100 miles of what med students get. Give me a major break! I would never in a million years think my medical know-how is equal to that of a physician. Make no mistake - NP's are practicing medicine, and while my 17 years as a bedside/home health/case manager RN experience will enhance my practice - it is the physician's mindset I now embrace. I personally do not believe that someone who graduates, passes the NCLEX and never provides pt care deserves to be called a nurse. Here is an example of how nursing experience comes into the clinical picture: a graduate NP from Georgetown University started her first job at a busy clinic. A pt came in, f/u from an UC visit the day before for CP - she was still having it. The NP came into the MD's office and said the pt was scaring her. The only thing she could think of was getting an ECG. An experienced hospital RN would have the presence of mind to think: MONA and call 911. She/he would also assure the pt that help was on the way. I firmly believe that patient care - and PLEASE do not sum up this care to mean cleaning up the mess - this is only a small part of it- it includes patient education, technical dexterity, knowing how to interact and cooperate with the medical team - this is what makes a nurse a N.U.R.S.E. If you never are exposed to this- what are you bringing to the table? You have no skills. Go the PA route - please.

[greygooseuria]

I do think my RN experience has helped me in being an NP, but I don't think it's been necessary. That being said, if as an RN you are blindly following orders, you are not practicing nursing. A nurse is supposed to be a patient's advocate and protect them from harm that may come from stupid medical orders, so if you aren't critically thinking as a nurse, you are not doing your job right. I think those skills more than anything have helped me.

I do think NP education needs to be more rigorous though. Admission requirements should be tougher, online programs should be done away with, prerequisites should be more intensive. Having a knowledge of chemistry and physics should be required; I had to self-study these and they have helped remarkably with my practice, as has molecular biology. I know some people like online programs because they have a family and work and yadda yadda yadda, but the healthcare system shouldn't be geared towards making it easy to go through a graduate program preparing you to be an independent provider, it should be geared towards developing the most competent providers possible. More clinical hours and residency would also be a good idea.

[blusueNP, MSN, APRN]

Yes, I am absolutely appalled that residencies are not mandatory. There are approximately 24 sites around the country - each with 2- 6 slots for applicants and everyone and their mother is applying for them. A good number are associated with universities and the associated hospital/clinics. They have so many people applying that they have their choice of candidate. Many of the FNP residencies want you to be bilingual.

[BostonFNP, APRN]

MD's do quite well because they have at the very minimum a 3 year residency. NP's are thrown to the wolves upon graduation with 6 months to a year of clinical exposure - which doesn't come within a 100 miles of what med students get.

A pt came in, f/u from an UC visit the day before for CP - she was still having it. The NP came into the MD's office and said the pt was scaring her. The only thing she could think of was getting an ECG. An experienced hospital RN would have the presence of mind to think: MONA and call 911.

I am curious how long you have been working as a NP in practice?

As far as the first statement about "MDs doing quite well" I would point out that NPs do quite well too. Studies time and time again have demonstrated similar outcomes for NPs,

PAs, and MD/DOs. Can you link to a study that shows MDs do better? The clinical hours an NP gets compared to what an MD gets is not something anyone would debate, however, those extra hours come at extra cost to the system, so are they required to produce quality outcomes?

As far as the second statement,was this a personal experience? Chest pain is one of the ten most common complaints that patients present with in primary care and very few of those represent ACS. MONA and EMS are not my first thought for every chest pain complaint; in fact my office doesn't have morphine or nitro or oxygen.

[greygooseuria]

I'd second that. I get around 2 complaints of CP a day and I've only had one in the past year that turned out to be an acute MI. We have an EKG in office and use it to rule it out, but it's almost always chest wall pain or GERD.

[matthewandrew, NP]

Well if they were SOB or diaphoretic as well I would get EMS. But assess first, PQRST, EKG... is it reproducible? One way to distinguish it from GERD is actually to give them a glass of cold water. But don't tell any of your patients that... You'll find them passed out or dead beside their refrigerator. Lol.