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?
Why is it irresponsible? Again, I see a whole lot of people wanting change for something that's not even a problem. If patient safety was an issue, those direct entry programs would be shut down. I'm sorry, but I have to play devil's advocate here. You can't effect change based on what you personally think or feel, because it's nothing more than an opinion (not just you, I'm talking in general). I see a whole lot of cries with no supporting evidence to back up with you and other posters are claiming as problematic for the NP profession.
This is in its infancy and it will take time for the evidence to be more than anecdotal. I disagree that concerns from experienced people working in this field who have seen the effects of poorly prepared prescribers is not worth considering in the meantime.
It is flawed logic to say "thats not even a problem". Would we not speculate and open dicusssion that a newly marketed child's toy involving matches and kerosene isn't harmful until burns actually happen?
Look I'll be the first one to say the research may pan out that it isn't a detriment especially because I would imagine there will be more lousy prescribers than truly dangerous ones however I believe this could be somewhat reduced with a modest work experience requirement or a mandatory fellowship.
Experience is invaluable, but I wouldn't say direct entry NPs are unsafe or bad practitioners because they lack RN experience. Are nurses who were never CNAs, techs, or medical assistants irresponsible for going straight into nursing without those prior experiences?
While I do agree that the NCLEX is just a minimum competency exam, ALL NP students must take a competency based exam to become certified. I respect your opinion, though.
I do wish some direct entry NPs would chime in and discuss their experiences.
I get where you're coming from, but I feel as though nurses with no CNA/tech/MA experience is a completely different ballgame than an NP with no RN experience. CNA/tech experience can be very helpful as a new nurse, but by no means is it mandatory. Assistive personnel and nurses still act on the orders of the provider. If a nurse has a question about why something is ordered, they ask the one that ordered it. NP's are the ones GIVING the orders. The mere thought of an NP writing an order for a medication, for example, with very limited or no working experience worries me a bit. I understand that they would have classes to teach them what is appropriate to prescribe when. But I would think that it is important that an NP has experience as a nurse actually administering an working with that medication and have an understanding of it beyond book knowledge.
I feel an NP glut in the future. NO RN I work with has plans to stay at the bedside for more than 2-3 years. Most have their sites on NP school. It will be interesting to see how the market adapts.
This is why I want to do something different. Too many NPs will make it difficult to find a job, just like when I first graduated. I hope nursing informatics does not become a dead field like nurse practitioner is slowly becoming.
The article above is from the LA Times 3 days ago. It talks about the state granting NPs the ability to see patients with out MD supervision. The AMA has been fighting against it for years, but in CALI the shortage of MDs second to multitudes of new patients coming into the system meant the legislature needed to act.
It will be interesting to see if other states follow suit.
I will be starting in an ABSN program this summer. I've talked to NPs who say that it will be better to get nursing experience before going to NP school. I've been seen by both NPs who went through direct entry programs and those who had nursing experience prior to becoming an NP. From a patient's perspective, the NPs who had prior nursing experience seemed more knowledgeable and confident. Many of my classmates in my prerequisite classes wanted to go to nursing school with the goal of becoming an NP/CRNA, but more often NP. Many of these direct entry programs ask us to choose a specialization, but how would we know what we want to specialize in without doing rotations? Med students decide their specialty after doing some rotations in med school. I'm careful these days going to the NP because there are so many NP schools taking students who may not be well prepared according to this website). I think if I were to be NP school, I would not be able to be competent as a provider without nursing experience. As an NP, I would have prescribing authority like MDs, and they go through residency, med school, fellowship, at least 8 yrs before they are practicing independently.
What's more, I realize so many nursing students want to go to NP school that a glut is possible, lowering the salary. So I might want to stay in bedside nursing after I graduate as long as I am physically able to handle the challenges. I feel like going through an ABSN program will allow me to enter the work market asap, and deciding what will be the best route to go for my MSN while working.
Slightly off-topic, but do direct entry NP programs differ from PA programs in this sense? I understand the education is under different "models" (nursing vs. medical) but I am thinking of a friend who is graduating from PA school soon. His only "medical" experience is a few months of being a CNA. I'm just curious if/how a PA's hands-on experience would differ from someone coming from a direct entry NP program, assuming the PA went straight to PA school after completing undergrad.
I don't advocate going to NP school without RN experience..heck I personally placed myself in a variety of fairly bad, and low paying jobs just to gain a more well rounded background in prep for NP school. If I were king, all NP's would have a minimum of 4 years experience as an RN.
That being said, we (as NP's) are going to be mid-level providers, who are competing with PA's for jobs. I don't agree with this designation either, but that's how it is and that's how it will remain for a while. Lets review the PA's base education requirements. To enter PA school you generally need a baccalaureate degree, similar pre-reqs to NP school, and something like 1000 hours of clinical experience. This experience can vary, and often has very little to do with caring for sick people, however A CNA position in an LTC facility would do nicely as an example. Then PA school is two years long, with a similar amount of clinical hours, however over a broader discipline base as PA's are not constrained to a specialty.
I have several family members and friends who are PA's. They had no clinical experience before PA school, and can work in essentially ANY setting after licensure. I don't agree with this either..but that does not change the fact that NP's and PA's are seen as similar practices. Keep in mind that we as a discipline are competing with PA's for positions when discussing this mess. I think its reasonable to argue that an NP with NO experience, is theoretically better prepared to see a limited patient base (ACNP, FNP AGNP) than a PA is prepared to see an unlimited patient base. Again...I dont agree with this issue, but I do understand that nursing is in competition with PA's as midlevel providers, and we as nurses should keep this in mind when arguing (what we do best ). Also keep in mind that Physicians can come from just about any hole in the wall medical school, from any developing country and practice in the US. IMO, our ideals as nurses are great, but I wonder if they will hold up to market economics.
I started out as a direct-entry student gung-ho on becoming an NP. I never wanted to work on a floor, but in primary care so I thought it was the way to do. Well, go back two years. I had just passed the NCLEX and decided to do the NP portion of my program part time and look for work. My program had a work requirement; meaning you have to have RN experience in order to graduate. I landed a substitute school nursing gig and fell in love with it.
I also realized I was NOT ready to be an NP. I needed work experience; I wanted that time to be an RN and better my assessment skills. I ended up switching out of my program and getting awarded my BSN. Now, many of my friends stuck it out. But the ones getting jobs are the ones that worked as RNs while taking classes.
VERY interesting thread. My organization employs a lot of NPs in many different settings. Job candidates have to have experience as an NP in order to even get a foot in the door for an interview. Our clinical risk management/ loss prevention has had a great deal of influence on the adoption of this strategy. (was that subtle enough?)
If you look around on physician forums, this ('short cut' NP programs) is the target of a lot of disparagement. They share a lot of the same concerns that have been expressed in this thread, including inevitable decline in NP outcomes due to watered-down preparation and fast track programs. IMO, this is particularly worrisome for direct-entry FNPs who (without nursing background) would have very limited understanding of the continuum of care and the trajectory of an illness due to the fact that they have inadequate exposure to acute care settings.
...It will be interesting to see if other states follow suit.
The way you worded that last bit makes me wonder if you knew that CA has not set a precedent, but actually followed 19 other states (20 if one includes DC) that currently permit independent NP practice.
Count me as one of the folks that worry direct-entry or overall low-quality NP programs will sharply undermine said independent practice as later studies come to light.
This isn't about direct entry practitioners, but brings to mind a situation while I was in school. Toward the end of my BSN program, one of my instructors announced in class that my classmate had been admitted to the MSN program at the school. She made a big deal of it, as if the rest of us should be in awe. Instead, after class, some of the classmates snickered about the fact that this was the same student who still lived at home at 26, and had never worked one day in healthcare. We all knew that she went into an MSN program to avoid getting a real job. She made no attempt to hide that. I credit the class for nobody challenging the instructor when she made her less than appropriate pronouncement. I don't even recall her trying to encourage any of the rest of us to continue giving money to the school through moving up the ladder. Nor were the students who had obtained LVN licenses so that they could work, ever given credit by anyone. This topic just brought this student to mind. I wonder if she moved immediately from an MSN to a DNP bypassing the need to work in healthcare? Food for thought.
Specializes in Neuro/NSGY, critical care, med/stroke/tele.
Screen-capped, just had to share -- spotted on the Northeastern University's graduate program website!
I think you can take the pre-clinical courses while you work, and then start the clinical sequence once you have the requisite RN experience? Seems like a good way of doing it to me!
). Also keep in mind that Physicians can come from just about any hole in the wall medical school, from any developing country and practice in the US. IMO, our ideals as nurses are great, but I wonder if they will hold up to market economics.
Jules A, MSN
8,864 Posts
This is in its infancy and it will take time for the evidence to be more than anecdotal. I disagree that concerns from experienced people working in this field who have seen the effects of poorly prepared prescribers is not worth considering in the meantime.
It is flawed logic to say "thats not even a problem". Would we not speculate and open dicusssion that a newly marketed child's toy involving matches and kerosene isn't harmful until burns actually happen?
Look I'll be the first one to say the research may pan out that it isn't a detriment especially because I would imagine there will be more lousy prescribers than truly dangerous ones however I believe this could be somewhat reduced with a modest work experience requirement or a mandatory fellowship.