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?
When you consider how difficult it has been for new grad RNs to find jobs, is it that surprising to find NP students without bedside nursing experience?
This will sound terribly ignorant, but based on what I read is going on in bedside care, I don't understand how bedside experience is all that relevant to diagnosing, prescribing and disease mgmt.
I'm not suggesting *no* experience, I'm just don't understand the strong connection between med/surg and managing patients in an out patient setting.
Specializes in orthopedic/trauma, Informatics, diabetes.
I work at the bedside. I have watched three of my colleagues finish and graduate as NP. Neither of them could draw blood, de-access a porta-cath, do a proper naso pharyngeal swab, start an IV. When I go to my urgent care, the PAs there can do all that. I am very scared of the lack of basic skills that the new NPs I know (small pool, granted) have.
Jules, I'm glad you're voicing this concern because you ARE a NP. When I've voiced it, it's been insinuated that I'm really just jealous of those with "more advanced nursing education". I put that last bit in quotes, because while their college education--in nursing--is certainly 'higher' than mine, I find the lack of ability to connect the dots among some of the newest NPs and NP wannabes to be concerning.
It is in PRACTICE that one learns the finer points. Making the connections that come from applying the knowledge base learned in school because one is actually working as a nurse. If one moves in a strictly classroom and controlled-clinicals setting....how is this happening?
I know a MSN-prepared nurse who received that MSN when it was quite uncommon to see one at the bedside. She was hired at the same pay as the BSNs (read: 25 cents more an hour than ADNs, kid you not). And it wasn't long before the nurse manager was griping to me--privately, I'm a good listener, LOL---that she wasn't worth the extra quarter! She had gone through all that schooling but needed to learn the same basics of bedside care that the novice ADNs did.
Following that story...how could one be considered a qualified nurse practitioner with such a little bit to work from?
I have taken classes and had clinical alongside the grad-entry students, and I must say that I was very underwhelmed. The students were a few months away from graduating the RN portion of the MSN program but couldn't take a manual blood pressure to save themselves. The other BSN student and I both agreed that the idea of someone with a non-nursing/healthcare degree walking right out in practice as an NP with zero bedside experience was the dumbest thing ever.
Most of the NP job postings I have come across want a minimum of 3-5 years RELEVANT clinical experience, and for a good reason.
Specializes in Management, Med/Surg, Clinical Trainer.
I think it depends upon how the program is set up. If the BSN direct program was set up to where the admittance criteria is very high for grades and experience. Then once the potential NPs are in training they will have a long internship afterwards.
I think some of the drive to move RNs right into NP programs is two fold.
One back in 2007 when the economy was slowing down many other students, in different majors, were staying in school because job prospects were so low. That included nursing. My company had 3 nursing lay-offs from 2009-2013.
Two, in the original version of the ACA there was a provision to increase the number of NPs to help support the new patients who would be added to the roles. I do not remember what happened in the next version of the bill, but i would guess many schools took advantage of the then upcoming law to recruit new students.
Specializes in Management, Med/Surg, Clinical Trainer.
This will sound terribly ignorant, but based on what I read is going on in bedside care, I don't understand how bedside experience is all that relevant to diagnosing, prescribing and disease mgmt.
I'm not suggesting *no* experience, I'm just don't understand the strong connection between med/surg and managing patients in an out patient setting.
I have to agree. My son sees an NP at his allergist's office. She is fantastic. We have talked about her background and she has never done bedside. She knew going into nursing that she wanted to be an NP.
She graduated from NP school and she worked a few MD practices until she found allergy [her niche]...now she has been there many years.
I'm not too sure I agree here. Most examples are anecdotal and along the lines of "When I was in school, these nurses couldn't *insert nursing skill here.*" Has there been an increase in patients with poor outcomes who were under the care of direct-entry NPs as opposed to NPs with prior nursing experience? It seems a lot of people are arguing that nursing experience is needed just because it feels right rather than proving that the education track of direct-entry NPs is an actual problem.
Does anyone know if any solid, comparative research was done on this?
Specializes in Neuro/NSGY, critical care, med/stroke/tele.
This is such an important thread!
Most of the direct entry programs I looked at (full disclosure, I absolutely plan to go the NP route and did from the start) *WILL NOT GIVE YOU A BSN* when you get to the NCLEX point. This is a way of keeping you committed to the school through the end of the graduate sequence, but it also means you have a much reduced chance of getting work as an RN while you complete the masters level material. So there are cohorts full of freshly-minted NPs with only clinical rotations as their formal experience. I know many of them who have found it hard to get jobs when they are finished.
I chose to go the accelerated post-bac BSN route. Same amount of time for the pre-licensure stuff, BUT you get a BSN and can stop and work before moving on to the advanced practice stuff.
I've looked at entry requirements for MSN programs for those who are already and RN/BSN -- most do require at least a years' experience (especially the specialty ones like peds/acute/psych) BUT I have definitely found those that don't.
I don't know what the answer is, but I do know we need to keep talking, as a discipline, to figure it out. And safe practice should always, ALWAYS be the priority.
I think it depends upon how the program is set up. If the BSN direct program was set up to where the admittance criteria is very high for grades and experience. Then once the potential NPs are in training they will have a long internship afterwards.
I think we are going to need to go to fellowships because I have never heard of the long internships you mentioned or even orientations. I started 2 jobs at the same time as a new grad inpatient I was given one day orientation on the EMR and started seeing patients. At the outpatient job, no joke, I was given a prescription pad and a client.
Specializes in orthopedic/trauma, Informatics, diabetes.
Does anyone know if any solid, comparative research was done on this?
I agree, but this is SO new that I don't know if there has been enough time to do a longitudinal study to look at outcomes. I may be a non-issue. I just feel better when I have an NP/PA to work with that has more experience than I do
This will sound terribly ignorant, but based on what I read is going on in bedside care, I don't understand how bedside experience is all that relevant to diagnosing, prescribing and disease mgmt.
I'm not suggesting *no* experience, I'm just don't understand the strong connection between med/surg and managing patients in an out patient setting.
Not ignorant at all especially with as often as we see it espoused now that all these programs are popping up. I would absolutely assert that the assessment skills we get as seasoned nurses are invaluable. Although not in their scope of practice and not done formally I feel med surg nurses are very experienced at diagnosing and medication management. What about ED nurses? Those chicks and dudes totally tell the docs what is going on! My psych nurses are almost always right on with diagnosing even the more subtle presentations.
One of the first questions I ask when a nurse calls me if they haven't already laid it out for me is "what do you think is going on?" They usually have a good idea of what is wrong and are tuned in to even subtle changes in status so in the rare cases they don't know their description of what is going on will help me trouble shoot and therefore also teach them to troubleshoot and diagnose.
Each area of nursing has different skills but at the very least knowing when the person is actually trying to die on you and when they aren't is a huge plus, imo. I will tell anyone that seeing patients in an outpatient setting for me is harder than inpatient. You have minimal labs, no information about their medication compliance and trust me almost no one is medication compliant and if you send them home with something inappropriate you will won't know until it gets ugly.
Not_A_Hat_Person, RN
2,900 Posts
When you consider how difficult it has been for new grad RNs to find jobs, is it that surprising to find NP students without bedside nursing experience?