I was having lunch with several NP colleagues and as we were lamenting the lack of actual nursing experience in so many of the students we get asked, and refuse, to precept one of them shared something that of course I had always suspected but to know that it is a blatant direction makes me sick. Apparently his university, which is part of a very well known, enormous teaching hospital is pushing the direct entry programs because the philosophy is to keep the money coming in while the student is there rather than take the chance they will graduate and for whatever reason not return to grad school or go to another grad school. No consideration for the value of actually working as a nurse.
Not that I didn't suspect this with the whole push for DNP which is only at this point is only being driven by the universities not my board of nursing. Good business I guess but I'm worried about the quality of NPs going forward.
Your thoughts and experiences with direct entry practitioners?
Hmmm....and at the moment she was handing me my dry cleaning. No healthcare background whatsoever. But hey, maybe her customer service skills at the dry cleaners will translate into an awesome diagnostic approach! :)
And she definitely meets the universal graduate school criteria of being able to fog up a mirror held under her nose, lol.
When I see some of the posts here that are clearly unpolished, and I'm not talking online abbreviations or lingo, just lacking in what I feel is intelligent written communication skills, nursing experience and overall maturity who are heading right for their NP to open their own practice I have to laugh or I would cry.
The idea that 'you don't need nursing experience to become a NP' is ridiculous to me. A few years ago, I worked with a young lady who had received her MSN in Women's Health with a focus on Neo-Natal health. She worked for a year in a NICU and burned out. She ended up on my med/surg floor with NO idea of how to be a nurse. Educating patients? Nope, no clue. Assessments were a mystery. Starting an IV? out of the question. Critical Thinking to problem solve? Don't make me laugh! Working with her was exhausting, as I felt I had an orientee, but with the bonus of 5 patients (hers) on top of my 5.
They aren't similar in clinical hours nor didactics. PA programs typically have a few thousand hours while NP have 500-700.
Which to be perfectly honest doesn't make any sense to me. I would think it would be the other way around and the clinician with more education would be the independent practitioner. A friend of mine who is a Doc and is supportive of me as a NP has said more than once how he can't believe we are allowed to prescribe with such little education. Its true and again in my experience NPs are usually either incredibly sharp or lousy.
Specializes in Cardiac, Home Health, Primary Care.
Which to be perfectly honest doesn't make any sense to me. I would think it would be the other way around and the clinician with more education would be the independent practitioner. A friend of mine who is a Doc and is supportive of me as a NP has said more than once how he can't believe we are allowed to prescribe with such little education. Its true and again in my experience NPs are usually either incredibly sharp or lousy.
I do wish NP programs have more experience and possibly rotations similar to PA programs. I'd probably be more comfortable with ortho issues if I had gotten time with ortho in clinical versus the family clinics where you only get an occasional ortho issue.
I think ideally the NP's should be give credit for RN experience. I know some don't think it counts but as a RN we get comfortable with assessment skills, common med side effects and contraindications, etc. so rather than a PA student who majored in chemistry and got credit for volunteer work starting at square 1 the proficient RN should be given credit for starting at square 4.
Please note I said PROFICIENT RN. I think a couple of years experience before clinical a should be mandatory and it was at my school. I was able to do research, theory, etc while I got this experience which was nice.
Just my opinion though! Anybody who goes back and reads my opinion knows I wish the NP program had more science (which I use daily at work) and less nursing theory and research (which I rarely use)
Perhaps it depends on the program and whether the goal is an independent practicioner.
PA programs frequently don't require experience anymore. They are similar in length and clinical hours.
What kind of "experience" could a PA program require? What kind of experience did they ever require? They're not nurses so they can't have nursing under their belt?
What kind of "experience" could a PA program require? What kind of experience did they ever require? They're not nurses so they can't have nursing under their belt?
Up until recently they required 2000 hours (some 1000 some 4000) of Healthcare experience. Usually it was Corpsmen, PJs, military medics, Respiratory Therapist, Paramedics...
The Genesis of PAs was medics returning from Vietnam (they were the only ones allowed in the first classes).
Well, I remember the days after Vietnam when a lot of medics were getting released and the early, non-masters' programs got started but that was in the 70's. I've worked with mostly orthopedic PA's and they went straight from undergrad to grad school. No patient experience.
Direct Entry NP here.... At first glance, I can understand how many think you can't be an advanced practice nurse without nursing experience, but in my experience it just isn't that cut and dry. Many factors play into the success (and failure) of students graduating from these programs. My background was 20+ years of laboratory medicine experience before entering my program, so I was not a total health care newbie. My school was a brick and mortar program that accepted less than 10% of those that applied. The students came from a diverse set of backgrounds and experiences, and many of them were so bright that it made my jaw drop. Anything below an 84% was considered an F when it came to grades and clinical evaluations. I have never worked so hard in my life. I did learn patho, pharm, and differential diagnosis. Most of us did more clinical hours than were required in the NP portion, because we wanted to learn and see as much as possible. We were driven and inquisitive. It was not an "easy" way to become an NP, not by any stretch of the imagination. No one failed NCLEX, no one failed their NP boards. Many of us tried to find part time RN jobs once we passed NCLEX, but they were few and far between, so we were not able to get RN experience.
When job hunting I found that most employers didn't give a hoot about not having any RN experience. They were much more concerned about not having any NP experience. My first job was in primary care in a busy urban community health center. It was pretty much all new grad NPs, PAs, and MDs. We all supported each other and learned from each other. Some NPs had boatloads of RN experience, some had none...and you couldn't tell who was who, according to my medical director. In fact, one of the new NPs with years of RN experience couldn't make the transition from following orders to writing them. She could not gather the confidence to think on her own. All of the DE grads there did very well. Maybe it's cause we felt we had to try harder, but we were all successful and our patients did not suffer. We knew how to think critically, how to assess, how to go through the differential diagnosis process, and most importantly, to ask, research, look up, etc, when we didn't know something. My cohort all found jobs quickly and as far as I know, have done well. So, in my experience, not working as an RN has not hindered me. My patient outcomes are good, my colleagues and superiors give me high marks, and my patients trust my care. I have been precepting for several years and have had stellar DE students, lousy "traditional" NP students, and vice versa. I want to teach students who are bright, inquisitive, and who can think critically and draw logical conclusions. You don't have to have RN experience to do that. RN experience is valuable, but so are many other kinds of life experiences. We don't all need to follow the same path to get to the same destination.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Many of us tried to find part time RN jobs once we passed NCLEX, but they were few and far between, so we were not able to get RN experience.
I am not the least surprised about this. Back when these direct entry APN programs were brand new, a lot of the students accepted expensive and coveted training from area hospitals. They did this despite knowing full well that they would be leaving after a year or less. This caused a lot of hard feelings among unit managers and their staff. We had several who accepted positions in our critical care nurse residency program. Its an intense 9 month training program that takes news grads and turns them into competent entry level ICU, ER, L&D, PACU, or PICU RN. Initially our managers where excited to hire these direct entry RNs, not understanding that their program would require them to return in 9 to 12 months for the APN portion of their program.
After that experience our managers refused to hire any direct entry new grads. At the time there was confusion about direct entry RN MSN programs and direct entry APN programs.
Specializes in Cardiac, Home Health, Primary Care.
Direct Entry NP here.... At first glance, I can understand how many think you can't be an advanced practice nurse without nursing experience, but in my experience it just isn't that cut and dry. Many factors play into the success (and failure) of students graduating from these programs. My background was 20+ years of laboratory medicine experience before entering my program, so I was not a total health care newbie. My school was a brick and mortar program that accepted less than 10% of those that applied. The students came from a diverse set of backgrounds and experiences, and many of them were so bright that it made my jaw drop. Anything below an 84% was considered an F when it came to grades and clinical evaluations. I have never worked so hard in my life. I did learn patho, pharm, and differential diagnosis. Most of us did more clinical hours than were required in the NP portion, because we wanted to learn and see as much as possible. We were driven and inquisitive. It was not an "easy" way to become an NP, not by any stretch of the imagination. No one failed NCLEX, no one failed their NP boards. Many of us tried to find part time RN jobs once we passed NCLEX, but they were few and far between, so we were not able to get RN experience.
When job hunting I found that most employers didn't give a hoot about not having any RN experience. They were much more concerned about not having any NP experience. My first job was in primary care in a busy urban community health center. It was pretty much all new grad NPs, PAs, and MDs. We all supported each other and learned from each other. Some NPs had boatloads of RN experience, some had none...and you couldn't tell who was who, according to my medical director. In fact, one of the new NPs with years of RN experience couldn't make the transition from following orders to writing them. She could not gather the confidence to think on her own. All of the DE grads there did very well. Maybe it's cause we felt we had to try harder, but we were all successful and our patients did not suffer. We knew how to think critically, how to assess, how to go through the differential diagnosis process, and most importantly, to ask, research, look up, etc, when we didn't know something. My cohort all found jobs quickly and as far as I know, have done well. So, in my experience, not working as an RN has not hindered me. My patient outcomes are good, my colleagues and superiors give me high marks, and my patients trust my care. I have been precepting for several years and have had stellar DE students, lousy "traditional" NP students, and vice versa. I want to teach students who are bright, inquisitive, and who can think critically and draw logical conclusions. You don't have to have RN experience to do that. RN experience is valuable, but so are many other kinds of life experiences. We don't all need to follow the same path to get to the same destination.
There are absolutely exceptions to every rule. It is just tough for me to imagine going through the program and staring farther behind than I already was as a fairly new RN. Now I am curious how the RN thing worked. What did yall do before you took the NCLEX? A down and dirty RN program?? I am not trying to be overly critical...just genuinely curious! How far into the program did you take the NCLEX?
Jules A, MSN
8,864 Posts
And she definitely meets the universal graduate school criteria of being able to fog up a mirror held under her nose, lol.
When I see some of the posts here that are clearly unpolished, and I'm not talking online abbreviations or lingo, just lacking in what I feel is intelligent written communication skills, nursing experience and overall maturity who are heading right for their NP to open their own practice I have to laugh or I would cry.