Rethinking the MEPN

The people I know who have taken Master's level direct entry route -- be they in a NP track or some other focus -- have all taken jobs as staff nurses immediately after graduation to compensate for their lack of clinical experience. Only after they get a little actual practice under their belt -- and develop the experiential knowledge that comes with that -- do they move on to advanced practice or leadership roles.

They have had to deal with a few snags in getting/retaining their certification as an NP when they are not practicing as NP's -- but they have been willing and able to make a few compromises and work through those problems.

Your concern is a very legitimate one. Anyone who claims to have "expertise" or be an "advanced" practitioner of any kind needs both academic knowledge and experiential knowledge. You get the academic knowledge in school. You need to also have a plan to develop the experiential knowledge.

Look at all your options and seek one that helps you develop both book knowledge and experiential knowledge. It might be to go ahead and get that MSN as your first nursing degree. That's OK. But then... make a career plan that gives you that necessary experiential knowledge before you claim to be a true expert.

Choose a first job that won't put you in a position where you are not adequately supported ... that will provide you a thorough orientation and colleagues to consult regularly ... or that doesn't expect more of you than you can provide. It might be a staff nurse role or it might be an NP role that is appropriate for a beginner. Either way, choose carefully with your further learning/experience need in mind.

I'm in my last semester in a direct entry NP program, and I understand your concerns. It doesn't seem possible that this type of program can graduate competent NPs, but it does. There have been studies done that show that DE grads are competent without prior nursing experience. I have found that the NP role is very different from that of an RN, and requires different skills. I believe I will be competent to take an "entry level" NP job after graduation. I won't be ready to do acute care or cardiology, but I feel comfortable in the primary care setting. One thing though, that I feel experienced RNs bring to the NP role that DE students don't have is that whole intuition piece. NPs who have worked as RNs can look at a patient and tell if that patient is a little sick, or really sick. I can figure it out after I do an assessment, but not necessarily at first glance. That will come with time, and I need to compensate for that with really good assessment skills.

All of last year's graduates of my program found jobs as NPs. Interestingly, the people who chose to finish their NP part time after finishing the RN portion have had a very difficult time getting RN jobs-the jobs just aren't out there right now. I've run into some criticism, bias, and downright derision about my educational path from both MDs and nurses, but there are also those who have been extremely supportive. My clinical evaluations will speak to my competence and readiness when I start looking for a job. I won't be ready to manage acute cardiac patients or deal with a multiple trauma, but I'll be fine in a primary care office with supportive colleagues.

I don't know if it is isolated to Boston or not, but ME students who decided to find jobs as RNs had so much trouble this past summer. I only know of one person who eventually found a job in Boston proper, working with the homeless, several who had to go out to the suburbs, and several who still haven't found RN positions. They may have missed the boat and applied too late for new grad programs...I don't know. It was pretty surprising to everyone. I work part time in a suburban community hospital (not as an RN), and we have a hiring freeze for all positions, including nurses. I guess the economy has affected healthcare, too.