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 should other APRN programs have lesser standards? NPs diagnose and prescribe after all...there's potential for a great deal of harm to be done by someone who is not at the expert level.
There are absolutely no reasons I can think of that all APRN programs shouldn't have these standards. Its sad and the cavalier attitude so many have is frightening.
Nursing should have some sort of bedside credential for advanced standing with education, experience and competencies as a required component. It is not "cool" as those of us from back in the day would say to be "just a nurse." Many of the young are looking for status and increased salary. If you had a role/ specialty which kept the nurse at the bedside as a nursing expert (not like most APRN roles which include elements of medical practice), then you might have people wanting to stay at the bedide. Of course, the pay would also need to be adjusted to reward the experience, education, and certification. IF the CNS was at the bedside, instead of in project management or education almost exclusively, then this could be a potential role for bedside expert.
As for APRN without nursing experience, I am not impressed with those I have met. I worked with a CNM who had 10 years nursing experience prior to becoming a CNM. She was wonderful. She really grew into the expanded role.I also worked with a "health sciences" grad who went into a very prestigious direct entry program. She got a BSN and passed NCLEX before continuing into the midwifery portion of her program, though never practice as a nurse. She got "red high heels to celebrate" passing that milestone, but that was her experience "being just a nurse." This person had a huge sense of superiority, a high IQ, and was extremely adept at quoting research. In an emergency or even routine situations, she could be inept and at times "scary."
The problem with some APRN's who have little or no nursing background is that they often mistake the choice to be "just a nurse" as a lack of intelligence or motivation, rather than simply an individual choice. I think some people who go direct entry in these roles, often have little idea of the daily work of doing the role.
Perhaps it's NP schools which are at fault. Maybe the nursing model just doesn't work if furthering education is dependent on prior nursing experience. Other professional clinical programs, such as PA, don't require such experience. Maybe nurses should argue for a better curriculum that prepares advanced practice nurses to function independently if said nurses don't think school alone is sufficient preparation.
However, direct entry programs don't allow just any ol' body in. Biology, Chemistry, Psychology; people who enter direct entry programs come from all different educational backgrounds at the BSN level and build on from there. I'm definitely for direct entry programs because they move people into nursing with other experiences who can offer more than just.. nursing. I'm glad such programs exist and don't think they'll be going anywhere anytime soon.
I do not like it and will NOT entrust my nor my family's health care to an NP without any nursing experience.
I'm curious. How would you know if a NP has prior nursing experience or not?
Are you one of those individuals who asks their nurse if they completed a ADN or BSN program? There was a poster here who said they always asked their nurse that before receiving care lol.
Perhaps it's NP schools which are at fault. Maybe the nursing model just doesn't work if furthering education is dependent on prior nursing experience. Other professional clinical programs, such as PA, don't require such experience. Maybe nurses should argue for a better curriculum that prepares advanced practice nurses to function independently if said nurses don't think school alone is sufficient preparation.
However, direct entry programs don't allow just any ol' body in. Biology, Chemistry, Psychology; people who enter direct entry programs come from all different educational backgrounds at the BSN level and build on from there. I'm definitely for direct entry programs because they move people into nursing with other experiences who can offer more than just.. nursing. I'm glad such programs exist and don't think they'll be going anywhere anytime soon.
I agree the NP schools are deficient and for both those who are experienced and people new to nursing. The amount of clinicals and lack of fellowships or residencies are a problem, imo. And yes, definitely the direct entry and online programs are not going away so we need to figure out what areas if any need adjustment.
I always wonder what the wonderful "other experiences" are that people who go into direct entry nursing can offer over and above those who have been nurses? I was an older nursing student and certainly brought maturity, responsibility and the ability to work with colleagues and the public but frankly those things really did a minimal amount to make me a more competent nurse or NP than anyone else who was at least 25 years old and had grown up a bit.
I'm curious. How would you know if a NP has prior nursing experience or not?
Are you one of those individuals who asks their nurse if they completed a ADN or BSN program? There was a poster here who said they always asked their nurse that before receiving care lol.
Speaking only for myself I rarely go to NPs or PAs because I feel the education is deficient as compared to a physician. I will go to a NP or PA I know for basic things and then I really don't care because I usually have figured out what is going on anyway. I also am very particular about which physicians I see also because I know as many bad docs as I do NPs.
What are your thoughts on nurses who have experience, but not relevant experience? Such as med/surg nurses becoming PMHNPs or LTC nurses becoming ACNPs.
What are your thoughts on nurses who have experience, but not relevant experience? Such as med/surg nurses becoming PMHNPs or LTC nurses becoming ACNPs.
I have mixed feelings especially for the specialties of peds and pscyh. Regarding psych it can be very vague and without experience in the different presentations and adverse med reactions I feel there is room for great error. The good news in psych is that it is likely not error that will kill someone but avoidable none the less in an already compromised and vulnerable population and in some cases patients are harmed. I have seen medication induced serotonin syndrome based on an irresponsible NP prescribed regimen and another patient with history of suicide attempts and ETOH history prescribed benzodiazepines who intentionally overdosed. Those are inexcusable and things like being able to realize and effectively deal with the patient who is working you for benzos for their "severe panic" when in fact that class is contraindicated for that patient is invaluable and I think largely comes with experience. People will scream, cry, shake and that can be very unnerving for someone who hasn't seen that a million times before. I have known 1 or 2 psych NPs who were experienced nurses without psych who were really into it and did fair probably due to their over the top commitment to study.
I think med surg and ED nurses would do well in Acute Care. LTC nurses due to their varied experiences and heavy workloads which have exposed them to many presentations and medications would be better prepared in Acute than someone who has no nursing experience, imo. As much as I love the ED I personally don't have the background to be a competent provider so although as a FNP I could probably talk my way into our fast track area I just wouldn't be competent so I stick with psych.
The bottom line is there are going to be exceptions to any scenario both good and bad. There will be NPs who worked in appropriate nursing fields before continuing on who are terrible and also those who are new and have not been a nurse that flourish however based on my personal experience with many psych NPs and FNPs if it were a blind choice I would take my chance on one with experience over one without experience.
I agree the NP schools are deficient and for both those who are experienced and people new to nursing. The amount of clinicals and lack of fellowships or residencies are a problem, imo. And yes, definitely the direct entry and online programs are not going away so we need to figure out what areas if any need adjustment.
I always wonder what the wonderful "other experiences" are that people who go into direct entry nursing can offer over and above those who have been nurses? I was an older nursing student and certainly brought maturity, responsibility and the ability to work with colleagues and the public but frankly those things really did a minimal amount to make me a more competent nurse or NP than anyone else who was at least 25 years old and had grown up a bit.
I know personally a few direct entry students who were bio/chem/general science majors that failed to get into PA or MD school so NP was the next best option. They had 0 desire to be a bedside RN. To them it was a last resort because they knew it was almost a sure thing. I know direct entry is more competitive but if you apply to enough schools you'll get into one even with mediocre grades.
Jules A, MSN
8,864 Posts
There are absolutely no reasons I can think of that all APRN programs shouldn't have these standards. Its sad and the cavalier attitude so many have is frightening.