Requiring Bedside Experience for NP

lmccrn62, MSN, RN · Mar 8, 2014

Another thought and experience with a patient was a patient in a sub acute facility. There for a new BKA. He has horrible DM amongst other issues. I was asked to see him by the NA because he was swollen. The attending saw him 2 days prior and ordered him to see renal and increased his Lasix. He also had a questionable CXR. The doctor wrote he was better. The patient had generalized edema a 30lb weight gain in 2weeks. Lungs were wheezes and rales. He was SOB he said for at least a week. His O2 sats were in the 80's. So to the ER I sent him. Why because he needed to be there and he was admitted.

I had a second lady at subacute rehabbing after a CABG when I saw her her lungs had bilateral rales. Could have been effusion as often seen after CABG. I ordered labs and X-ray even though she looked good. BNP 800 and CXR showed CHF. The same doctor as above saw her and wrote lungs clear. She was treated and now getting better follow up. At this point we avoided a readmission.

So being able use critical thinking and good assessment skills is key. Not sure extra clinical hours do that or even a residency.

PatMac10,RN, RN · Mar 9, 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.[/quote']
I agree. I think experience can be more beneficial than not in most cases.
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allnurses Guide · Mar 9, 2014

I am a new NP with 30 yrs of clinical background as a nurse. NPs are not doctors and we practice differently.
I am a strong proponent of working as a nurse prior to advancement.
Just having experience at any level makes you good.

You said you were a new NP to practice, how long have you been working in the AP role? I only ask because of your statement that we are "not doctors" and "we practice differently": I remember thinking this when I started NP practice, after a year I came to the realization we are not doctors but we practice like doctors and we think like nurses. Perspective from spending a year or more in the trenches may change your opinion in this.

Being a strong proponent of something you feel strongly about is a great thing; my only question to you would be whether you are a strong proponent because of your experience in NP practice or because you don't have enough NP practice and RN experience is all you know. For me it was the latter and I have seen a bit of the light after practicing.

I disagree that experience at any level makes you good; it has to be the right type of experience in the right type of person. There is an example just recent only this forum of a nurse with 17 years experience and straight As in grad school that can't pass the boards. Is has to be the right experience in the right person.

Knowing what you know about NP practice, who would you rather see: a novice NP with 600 hours of NP experience and 30 years of RN experience or a novice NP with 1200 hours of NP experience and no RN experience? For me double the NP experience would give me more confidence.

lorirn58 · Mar 16, 2014

".....YOU'RE an expert....." Thank you.

ixchel · Mar 16, 2014

For me, I'm about to wrap up my BSN. My end goal is NP, but for now, I can just really tell I have so, so much more to learn before I step into that role. That, plus now that I've been through almost every rotation, now I'm struggling to know what I want to be when I grow up. :) So I'm going to take some very needed time off from school, decompress, hopefully do some time in an acute care position I've got my eye on (crossing everything for that!), and when I'm feeling confident (or bored? Or ready to move on?), I'll go back. I'm ready for my break from academia.