Seeking Advice: Direct Entry Blues

[mk989]

I am a graduate of direct entry accelerated BSN/MSN program for non nurses.

I came into the role of APN, specifically NP as a very green graduate. I did very well in my program, but am finding clinical practice as an APN to be quite challenging. Academic knowledge and clinical expertise are very different. I've been in my present position about a year and have been directed to seek a position elsewhere but permitted to continue working while I search. It was also mentioned I try to seek a specialty area instead of primary care so I can focus my knowledge development.

I'm looking at specialties but wondering about my best options on where to go from here. I am not against applying to bedside RN positions. I've worked so hard but have wondered about leaving nursing altogether for something else.

Any guidance appreciated

[secondtimer14]

Like a PP, I'm a career-changer, working on prereqs now, hoping to become a midwife. I'm still a year out from applying to nursing school, and I'm currently debating between getting an ABSN, working as an L&D nurse for a few years, then getting the MSN, versus the direct entry MSN. If I was young and had time to kill, I'd definitely do the first route. But as someone less young and eager to get my desired career rolling (which is midwifery and not nursing), the direct entry route is tempting. This thread is really insightful for those of us still deciding our path, so thank you.

I obviously have no direct insight, but to throw another MD-like analogy out there -- in my first career, I was a lawyer. Despite being highly trained and paid a full salary upon graduating, no one in the field expects a junior attorney at a big firm to be taking depositions, making oral arguments, or writing dispositive briefs. Your employer trains you, mentors you, and gradually releases control and ramps up the work you perform (over the course of years, not months). All this while making a handsome salary. So I agree (at least hypothetically) that a training period after completing the MSN is invaluable, and not unreasonable to ask of an employer. If they train you well, you will make them good money down the line.

And to OP - I have no advice, but I'm sorry you're going through this.

[nursesunny, ASN, BSN, MSN, LPN, RN]

The VA has a great internship program. This will get you the experience by having a mentor in the APN role....

[Rnis, BSN, DNP, APRN, NP]

But what is learned and experienced as a bed side nurse is very often not applicable at all in a clinic or office setting.

You graduated from a direct entry.....so how can you actually speak to what is applicable? All life experience is applicable.... and I would say my experience as a bedside nurse is invaluable. I also like my parlor tricks of being able to cath and start ivs.... saves soo much time rather than having to wait for a nurse who has these skills. (which is harder than you think)

[BostonFNP, APRN]

You graduated from a direct entry.....so how can you actually speak to what is applicable? All life experience is applicable.... and I would say my experience as a bedside nurse is invaluable. I also like my parlor tricks of being able to cath and start ivs.... saves soo much time rather than having to wait for a nurse who has these skills. (which is harder than you think)

There is extant research on this.

I agree that most people value the experience they have; I think it is pretty rare that having prior RN experience is anything but helpful to practice especially if it is relevant experience.

As far as being able to place IVs and caths I really don't think this is applicable to most provider roles.

[BCgradnurse, MSN, RN, NP]

You graduated from a direct entry.....so how can you actually speak to what is applicable? All life experience is applicable.... and I would say my experience as a bedside nurse is invaluable. I also like my parlor tricks of being able to cath and start ivs.... saves soo much time rather than having to wait for a nurse who has these skills. (which is harder than you think)

I can speak to what is applicable because I know what I do every day. I don't cath patients, place NG tubes, or start IVs, and I daresay most NPs in an outpatient setting don't do it either. I don't use parlor tricks in my practice. What is relevant and beneficial are my years of experience in problem solving, deductive reasoning, and clinical decision making I used in my previous career, coupled with my education and my NP experience.

That's wonderful if you feel your bed side experience helps you. I never said RN experience was not valuable; I said it is not particularly relevant to outpatient clinics.

[Susie2310]

I don't use parlor tricks in my practice. What is relevant and beneficial are my years of experience in problem solving, deductive reasoning, and clinical decision making I used in my previous career, coupled with my education and my NP experience.

That's wonderful if you feel your bed side experience helps you. I never said RN experience was not valuable; I said it is not particularly relevant to outpatient clinics.

I'm not sure why you told the above poster that you "don't use parlor tricks in your practice." I don't think anyone suggested that you were doing this.

According to your bio you specialize in "allergy and asthma, urgent care." Are you really saying that you don't think that acute care nursing experience that includes taking care of patients with acute asthma attacks; COPD; respiratory distress/respiratory failure and severe allergic and anaphylactic reactions, is particularly relevant to an NP practicing in outpatient urgent care clinics? You don't think acute care nursing experience of these conditions that includes triage, assessment, prioritization, and emergency treatment, would help a NP practicing in an urgent care when they are faced with an unstable patient? That the patient would not benefit? Perhaps you are confusing acute care nursing with being a medical assistant.

If you understood more about acute care nursing and had experience yourself as an acute care RN, I think you would appreciate how much acute care RN experience can inform and benefit a NP's practice and ultimately benefit patients.

[BostonFNP, APRN]

If you understood more about acute care nursing and had experience yourself as an acute care RN, I think you would appreciate how much acute care RN experience can inform and benefit a NP's practice and ultimately benefit patients.

Isn't this a bit hypocritic? If we flipped these words around: if you understood more about advanced practice nursing and had experience yourself as an advanced practice nurse, I think you would appreciate...

All of our experiences are different and it is the sum of those experiences that make us who we are. People inherently value the experience they have and base their practice on that experience tempered with their education.

While BC may not have direct bedside nursing experience she is an experienced provider. I would suspect most providers would agree that fairly quickly your accumulated hours of provider experience eclipse your prior RN experience. I would most certainly trust her with her years of provider experience to take care of me in an emergency over a novice NP with extensive nursing experience.

BC also has been active with NP students. I am sure she can relate her observations from training student NPs with varying levels of RN experience. Having done that for quite a while myself, I can honestly say that I see far greater variability in student competency with the quality of their graduate program than with their RN experience.

[Rnis, BSN, DNP, APRN, NP]

Clearly the parlor comment was tongue in cheek. I certainly don't have to do any of those skills it just can take up to 30 minutes to an hour to facilitate those tasks.... which yes we do IV's and straight caths on occasion in primary care.

I think there is just a lot of defensiveness seething from your posts. It sounds like you have a lot of great experience in your profession and I am certainly not judging you as a provider. I just commented that it's not really possible for you to make a blanket statement that previous RN experience is not relevant.

[BCgradnurse, MSN, RN, NP]

Clearly the parlor comment was tongue in cheek. I certainly don't have to do any of those skills it just can take up to 30 minutes to an hour to facilitate those tasks.... which yes we do IV's and straight caths on occasion in primary care.

I think there is just a lot of defensiveness seething from your posts. It sounds like you have a lot of great experience in your profession and I am certainly not judging you as a provider. I just commented that it's not really possible for you to make a blanket statement that previous RN experience is not relevant.

Yes it was tongue in cheek and I'm glad you recognized it as such. FWIW, I do know how to cath and start IVs, but it's not a good use of my time when there are 20 patients waiting to be seen and we have other staff who can do those tasks. So, it really doesn't matter if I can do them or not.

And yes, I am defensive. I've been on this site for over 10 years and get really tired of the constant bashing of DE NPs. I replied to the OP to give support, encouragement, and share my experience. Inevitably, someone or several someones have to start with the put downs. It's especially infuriating when those who are not even NPs make blanket statements that the programs are subpar and shouldn't exist. Sure, there are some bad programs and less than competent DE NPs. You can say the same for traditional NP programs and NPs with 20 years of bedside experience. I've been precepting for a while, and have found that it doesn't matter how much or little bedside experience a NP student has. It's very specific to the individual. Perhaps I should say that bedside experience is not relevant to the success of a NP, because that is what I have observed. Some of the skill learned as a bedside nurse can be relevant, depending on your practice. I can certainly see that to be true with a NP who is a hospitalist or intensivist.

Not all of us need to take the same path to wind up at our ultimate destination.

[LibertarianNurse]

I have always wondered at the lack of experience that people have coming out of a direct-entry program for either BSN or MSN. I would like to think that these graduates have the education and clinical experiences to guide them so that they come out of school knowing what they are getting into, but it just seems like that is not the case. More and more I hear about people such as yourself who have no nursing experience prior to the program and they often flounder, have a hard time in general, or end up quitting. The point of these direct entry programs is to allow more NPs and APNs to enter the job force in a relatively quicker manner than the traditional, but I am skeptical if they are doing the graduates or the public any favors because of these kinds of issues. Many have felt like you do and end up leaving the nursing profession altogether, which is counter to the way the educators envision it to be. I'm sorry you are having this experience. I think your inclination to return to bedside nursing is a good one. Get a year or two of experience under your belt, and perhaps be looking during that time for a suitable NP/APN position, but you will be that much more marketable for those positions with other experience at the bedside. Pediatric NP could be a great choice, if you already have some knowledge there. Best wishes!

[Jules A, MSN]

The point of these direct entry programs is to allow more NPs and APNs to enter the job force in a relatively quicker manner than the traditional, but I am skeptical if they are doing the graduates or the public any favors because of these kinds of issues.

Or are they a cash cow for universities? Encouraging undergrads to stay enrolled through graduate school and billing second degree students graduate tuition for what are actually BSN courses sounds brilliant and has nothing to do with the underserved public.

Sure sounds like shampoo, rinse and repeat to me. Doubles the bottom line effortlessly.

[BCgradnurse, MSN, RN, NP]

I have always wondered at the lack of experience that people have coming out of a direct-entry program for either BSN or MSN. I would like to think that these graduates have the education and clinical experiences to guide them so that they come out of school knowing what they are getting into, but it just seems like that is not the case. More and more I hear about people such as yourself who have no nursing experience prior to the program and they often flounder, have a hard time in general, or end up quitting. The point of these direct entry programs is to allow more NPs and APNs to enter the job force in a relatively quicker manner than the traditional, but I am skeptical if they are doing the graduates or the public any favors because of these kinds of issues. Many have felt like you do and end up leaving the nursing profession altogether, which is counter to the way the educators envision it to be. I'm sorry you are having this experience. I think your inclination to return to bedside nursing is a good one. Get a year or two of experience under your belt, and perhaps be looking during that time for a suitable NP/APN position, but you will be that much more marketable for those positions with other experience at the bedside. Pediatric NP could be a great choice, if you already have some knowledge there. Best wishes!

So, there were 40 in my graduating glass. We keep in touch. Not one felt they couldn't cut it as a NP and ended up leaving NP positions to work as a RN. After I read your post I emailed a professor I work with at a per diem job, who coordinates a Direct Entry program at a large, reputable university and asked her if she was aware of this happening with her graduates. She said she was not seeing this at all. Granted, I'm looking at a relatively small sample size in a specific geographic location, but I'm wondering where you're getting your info from. Is it purely anecdotal? I'm sure there are some DE grads who go back to RN positions, but how many is "many"? And how does that compare to experienced RNs who cannot make the transition to NP and elected to go back to the bedside? There's a thread here where several new NPs who are seasoned RNs are going back to bedside.

It fascinates me how people who are not NPs and have not been through a DE program are so quick to disparage them.