Rethinking the MEPN

TheSquire, DNP, APRN, NP · Feb 8, 2009

The MENP program I'm in at DePaul doesn't put us all the way through to NP, but does cover the core coursework that any post-master's certificate in advanced practice nursing would require. If you're worried about ending up with an NP that's not respected, perhaps you should consider a program like that?

llg, PhD, RN · Feb 8, 2009

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.

CharmedJ7 · Feb 8, 2009

Hey Merky,

I'm in a similar position to you - I applied for many direct-entry programs and have been accepted to a few but am now wondering if I'll be marketable when I graduate if I go this route. I'm also a bit concerned if I'm *really* sure of my specialty since I've never been exposed to acute care, L/D, etc. In the end, both because I don't want to be fighting for respect from both ends (doctors/AMA, which is inevitable in any situation, AND nurses) and because I think there is some validity in requiring getting a few years of experience, and because direct-entry doesn't seem well accepted in other parts of the world (for example, in Canada you must have 2-3 years before you can apply for NP and NZ has a similar requirement), I've decided to do the BSN first, work, then go masters. I still really want to do NP, but for me this route makes the most sense. Good luck with whatever you decide!

Note: I realize that not all doctors or all nurses give direct entry students and/or NPs grief, but for sure there are a lot that will and the AMA definitely seems opposed to NP autonomy

allnurses Guide · Feb 11, 2009

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.

mom2cka · Feb 11, 2009

As an RN hoping to start NP school this fall, and a 2007 RN grad, I know that I get less respect on the floor by seasoned nurses due to my lack of experience, and every once and a while, a rather sarcastic question or comment from a doctor who is aware that I'm the 'new' one on the floor. I was prepared for that, but it is still frustrating at times - yet I admit that I don't know it all, and though none of us really do, respect my coworkers who've been on the floor for years (and some for a decade or two).

I hope that as I work through school (I'm giving myself 5 years in a part-time program, as I need to work FT), I will continue to gain clinical skills, and in school and through NP clinicals, will gain the knowledge I need to be a competent NP. I know I don't know everything, have good resources to ask questions to, and confidence that I will have the help I need when I experience something new. That said - it's worrisome that I may not have that as an NP, depending on where I start my career, and am glad that I'll have some nursing experience to fall back on.

I would eventually like to teach, and knew from experience that to do so, I need experience as both before I could get respect from students or other colleagues, as we had an instructor who worked as a nurse for less than a year before getting a master's and becoming a college instructor. She had a hard time.

I guess it's whatever path we all choose. Get the experience when and where you can, take advantage of learning opportunities, use the resources you have, and pay attention in class :)

Best of luck with whatever decision you make.

freyalisa · Feb 12, 2009

GradNurse - i'm curious what the issue is around completing the NP portion part-time and why it is so difficult to find RN jobs in the meantime? I thought for RNs, there were always jobs around? Can you explain? I'm curious, as i have been accepted to ETP and was considering working full time and doing graduate school part-time for the masters portion to offset the costs. Thanks for your perspective!

merky · Feb 12, 2009

Really great responses from all! BCGradNurse, I too am intereted in the phenomenon you mentioned about the part-time MSN students that couldn't find RN jobs?? That's a little scary.

allnurses Guide · Feb 12, 2009

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.