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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?
If you go looking for a problem, you're going to find one - even if there's no problem to be found.I believe research DOES exist that shows there is no difference in care provided between direct entry NPs and NPs with prior RN experience.
Im not against gaining RN experience before going into NP school; I'm against mandating it. If
Lastly, I think everyone is making a mountain out of a molehill. There are only a few direct entry programs (most of which are at prestigious institutions) and their admission requirements are brutal. They take the best of the best. There are no direct entry mills.
Last comment first, we aren't simply taking about direct entry programs but also and per my OP more-so the programs who accept RNs without any previous RN experience and there are a ton of those type "degree mills".
Why would you think if there is no problem one could be found by looking? I think if we look for problems and there are some they will hopefully be found. I don't think snooping around actually creates problems that aren't there.
Without the least bit of snark if you know of research that supports direct entry programs please add it because I would love to be proven wrong. The bottom line is my profession will be influenced by these students regardless of my feelings on them so if I have no need to worry or be skeptical please add the research. Again just anecdotally I have found them to be deficient in diagnosing and prescribing.
Although we might disagree on much of this I am with you 100% that at the very least we, myself included, need/ed more clinical experience.
Most health care professionals don't know jack sh*t starting out :)
I absolutely think that experience in the field is crucial, especially so you know what you are getting yourself into before you embark on tens of thousands or hundreds of thousands of dollars and years of your life that you can't take back . Everyone wants to be in medicine and it seems like a great idea... but have you wiped an ass or had a few people die on you? Played with needles, medical machinery and been exposed to a variety of bodily fluids? Have excellent social skills to communicate and interact with a wide variety of people- families, co workers, superiors, government agencies, etc and while under pressure? It takes a special kind of people!
I can see both sides of the coin. I just think that reality is often overlooked in both cases.
Is it possible to summarize the findings (I don't have a Lippincott log-in).
Sure thing. The article found a negative correlation between years of RN experience and NP clinical practice skills based on assessment by collaborating physicians. Also longer RN experience was related to lower rankings of NP skills. The article brings forth the issue that the more one is a RN, the more one THINKS like a RN, even when the thinking changes in the advanced practice role.
Keep in mind that this is only one article, though. And there were many limitations to the study. Also, this study could have suffered from major bias based on the individuals who did or didn't respond.
Rich, E.R. (2005). Does RN experience relate to NP clinical skills? The Nurse Practitioner, 30(12), 53-56Read this.
Got it, thanks, although it took me nearly an hour to get into my OVID account, lol. Did you get the article from this message board? Its been posted here more than once.
I really can't find much out there that directly addresses this topic. This although exactly the kind of information we need was rather luke warm imo. That it was based on a very small self-report by NPs and physicians who have a relationship and invested interest in them being competent so I question the objectivity. If someone asked me if I were competent I'd fill in the circles indicating hell yes as would my boss. I would really like to see an outcomes measure but again heading in the right direction I guess. To be fair I'm not usually a huge fan of nursing research.
Something interesting to consider regarding the original article was a commentary:
"In our study, "Improving the Effectiveness of Primary Health Care Delivery through Nurse Practitioner/Family Physician Structured Collaborative Practice"1, qualitative findings stressed the correlation between physician perception of NP competence and the establishment of a relationship with that NP. This finding was also observed in the Ontario Medical Association/Registered Nurses Association of Ontario study2where recognition of expertise was based on personal experience with their NP rather than on a view of all NPs as primary health-care experts. We therefore support the statement that physicians may have been influenced by their personal relationships and also would like to ask if the collaborating physicians in Dr. Rich's study had served as preceptors to the NPs that they were now evaluating?"
Linda Jones, RN(EC), BSN, CFNP
Got it, thanks, although it took me nearly an hour to get into my OVID account, lol. Did you get the article from this message board? Its been posted here more than once.I really can't find much out there that directly addresses this topic. This although exactly the kind of information we need was rather luke warm imo. That it was based on a very small self-report by NPs and physicians who have a relationship and invested interest in them being competent so I question the objectivity. If someone asked me if I were competent I'd fill in the circles indicating hell yes as would my boss. I would really like to see an outcomes measure but again heading in the right direction I guess. To be fair I'm not usually a huge fan of nursing research.
Something interesting to consider regarding the original article was a commentary:
"In our study, "Improving the Effectiveness of Primary Health Care Delivery through Nurse Practitioner/Family Physician Structured Collaborative Practice"1, qualitative findings stressed the correlation between physician perception of NP competence and the establishment of a relationship with that NP. This finding was also observed in the Ontario Medical Association/Registered Nurses Association of Ontario study2where recognition of expertise was based on personal experience with their NP rather than on a view of all NPs as primary health-care experts. We therefore support the statement that physicians may have been influenced by their personal relationships and also would like to ask if the collaborating physicians in Dr. Rich's study had served as preceptors to the NPs that they were now evaluating?"
Linda Jones, RN(EC), BSN, CFNP
No, I got it from an integrative review. There isn't much research on this topic, but that article was the only one that somewhat relates to our discussion. Here is the integrative review if you wish to take a look at it; it's in html format:
Some of the cited works are really interesting. Not sure if the link is working on mobile platforms.
No, I got it from an integrative review. There isn't much research on this topic, but that article was the only one that somewhat relates to our discussion. Here is the integrative review if you wish to take a look at it; it's in html format:Some of the cited works are really interesting. Not sure if the link is working on mobile platforms.
Yeah, thanks I can get the link. Won't be able to read it right now but will check it out later. Thanks.
I know up thread, it was asked what were the backgrounds of those folks applying to direct-entry programs. Well, since I am always the oddball, I'll share mine. 0 health care experience, 7 years higher education administration experience, previous BS in television and a passion to follow the career path I should have taken the first time around, but ignored it. (I did all of my pre-reqs while working in higher ed for free - bonus!) Most of the folks in my class however, had science backgrounds/degrees and a few were currently working as PCAs.
As for experience, oddly enough, when I landed in school nursing, I found it was interesting experience if I ever do return to complete my NP. This year, I've dealt with some complex kids, and I know more about asthma, diabetes, seasonal and other allergies, concussions, than I ever thought I'd know (and am always learning more!) and I'm continuing to improve upon what I call my "walk-in-door-and-observe" skill :). I'm on my own, as my boss is not a nurse.
So I suppose my question is - what about NPs with non-hospital nursing experience? I can't read the articles posted before in depth (no access), but I would be curious.
I know up thread, it was asked what were the backgrounds of those folks applying to direct-entry programs. Well, since I am always the oddball, I'll share mine. 0 health care experience, 7 years higher education administration experience, previous BS in television and a passion to follow the career path I should have taken the first time around, but ignored it. (I did all of my pre-reqs while working in higher ed for free - bonus!) Most of the folks in my class however, had science backgrounds/degrees and a few were currently working as PCAs.As for experience, oddly enough, when I landed in school nursing, I found it was interesting experience if I ever do return to complete my NP. This year, I've dealt with some complex kids, and I know more about asthma, diabetes, seasonal and other allergies, concussions, than I ever thought I'd know (and am always learning more!) and I'm continuing to improve upon what I call my "walk-in-door-and-observe" skill :). I'm on my own, as my boss is not a nurse.
So I suppose my question is - what about NPs with non-hospital nursing experience? I can't read the articles posted before in depth (no a altccess), but I would be curious.
I'm not even all that particular as to what kind of nursing someone has done just that I believe the assessment skills you get from working as a RN are worthwhile. Knowing intrinsically what doses of medication are within the normal and the side effects of common meds is valuable. It certainly sounds as if you are building a great repertoire of assessment skills in your present position.
My question is more about the grandiose manner people mention their "life skills" from other professions as if they justify a lack of nursing experience. Being adept at administrative, managerial tasks, being a responsible, collegial, mature adult really doesn't impress me, knowing that a patient with asthma might not have audible wheezes in severe crisis and what to do with that does.
Angeljho, MSN, NP
392 Posts
Lol I'm just being realistic, Jules. Things won't change just because people think it SHOULD happen based on their own experiences. Arguing that NPs with prior RN experience are better is just a matter of opinion, and a very generalized one I might add. If you go looking for a problem, you're going to find one - even if there's no problem to be found. The only way things will change is if research actually demonstrated that direct entry graduates weren't prepared enough, and patient outcomes suffered because of it. I believe research DOES exist that shows there is no difference in care provided between direct entry NPs and NPs with prior RN experience.
Im not against gaining RN experience before going into NP school; I'm against mandating it. If nurses feel NP schools aren't preparing them enough, then fight for better curriculums and a better care model in NP schools. The average program is already 3 years long, so why not one more year of sciences that are actually needed? In all honesty, I think the biggest fight should be for NP residencies.
Experience is not the same for everyone, and everyone won't get the same "gut" feeling you do out of it. If you want better NPs, something has to be done at the NP educational level.
Lastly, I think everyone is making a mountain out of a molehill. There are only a few direct entry programs (most of which are at prestigious institutions) and their admission requirements are brutal. They take the best of the best. There are no direct entry mills.