Straight to FNP or work full-time first?

Matt799 · Feb 29, 2012

One of the responders to the OP on the other thread complain that schools are letting unlicensed people in to NP programs. I know NOTHING about that...our admission is contingent upon passing the NCLEX, we just don't have to apply - we're auto accepted (except CRNA).

Matt799 · Feb 29, 2012

Anyway, I appreciate the strong opinions, I know they come from a place of concern for patients and making your work experience more tolerable, so I get it. Being 30 years old, there's a desire to accomplish things quicker, but I do agree it would be difficult.Tell me this - everyone seems to be responding from the standpoint of a hospital FNP working on a unit...but what about a private practice under a doc? Or, working in a minute clinic at CVS? One of the community clinical instructors did the RN and NP in 3 years (with no experience), got hired at CVS and said it was a great first job out of school.

LynnLRN · Feb 29, 2012

I don't feel like you will have the "best" assessment skills without the actual experience and it comes with time. Clinicals are great but you still don't have that autonomy that you have as an actual employed RN. As an FNP you have more responsibility and even more liability. I'd be afraid I would miss stuff if I went straight into an FNP program after my BSN especially if you are a practitioner in a outpt setting and you send the person home you don't have the backup of other hospital staff monitoring your patient.

pro-student · Feb 29, 2012

i thought that most reputable np programs would only accept people who knew something about being an actual nurse, like with experience. how do you expect to do advanced practice when you haven't done beginning practice first?

unfortunately, this kind of thinking is quite common especially in the older generation of nurses. i'm a brand new nurse and as well as a grad student at one of the highest ranked nursing programs in the nation. i was accepted without a day of "actual nursing experience." in fact, i got my acceptance before even graduating nursing school much less sitting for boards. it really irks me how many people buy into the notion that experience in nursing makes for a better nurse. there are abysmal nurses with decades of experience and outstanding ones fresh off the line. there is no evidence to support that experience makes for a better clinician. in fact, there is data which suggests that nurses are less likely to provide the standard of care the farther they are from initial licensure. not to say that all experienced nurses are awful, but it assumes way too much that putting in your time on the floor translates into more knowledge, better care provided, better outcomes, or a stronger basis for future education and practice.

i went into nursing knowing i wanted to be an advanced practice nurse. i don't mind being a "beginning practice" nurse, but it's not why i got into the field and it's not what i want to do with my career. my advanced practice specialty is in primary care which has extremely little correlation with what i do as a staff rn. the same holds true for the debate over experience in a specialty for advanced practice (i.e. - do i need psych experience to be a psych apn). most np specialties don't have a strong rn equivalent since the roles are so drastically different. it also doesn't hold true that the advanced in apn implied a progression from basic rn --> experience --> apn education. advanced refers to the higher level scope of practice. yes apn education builds on and requires basic nursing education, but it doesn't necessitate having hoofed it out for x many years. comparable clinical competence has been demonstrated of traditional apns with rn experience vs. direct-entry apns without rn experience (the later group generally having done all of their basic nursing in only about 12 months or so). i just wish we could shake this antiquated mind-set.

myelin · Feb 29, 2012

Yup, there is no evidence that RN experience yields a superior NP. In fact, the only study I've found on the subject found no benefit of RN experience related to NP practice. I agree, not all RN experience is the same. Not everyone has the same career goals. I'm doing a DE program to become a family psych NP. I have no psych nursing experience, this is true. I do, however, have extensive experience in developmental psychopathology research, including assessment, differential diagnosis, and crisis intervention work... all supervised by PhD clinical psychologists. Somehow I think that background will be more helpful for me than a year of med-surg. Other people think I'll be terrible because I won't be a floor nurse before I become a FPMHNP, as if no other experiences could possibly be relevant. Can't please everyone, I suppose. I'm confident in myself and believe that if I work my butt off these next 3 years, I can lay down the foundation for becoming a great NP. :)

allnurses Guide · Feb 29, 2012

I can speak from my personal experience. I made a mid career change and went to nursing school. I went to a Direct Entry NP program at one of the best nursing schools in the country. I have never worked as an RN-in part beccause there were no new grad RN jobs in my area at the time I passed NCLEX. I chose to continue my education full time and had several NP job offers before graduation. My previous boss, an MD with 40 years experience, told me I was the best NP she'd ever hired. She has hired several other Direct Entry grads from my program and has nothing but praise for them. I have precepted both tradiitonal NP students and Direct Entry NP students and have found no difference in their ability to perform as an NP. Direct Entry programs have extremely high standards for admission and do not take people who have not demonstrated the ability to handle critical thinking. I think it's an individual's ability that detemines their success, not the number of years they've been an RN.

nurseprnRN, BSN, RN · Feb 29, 2012

bcgradnurse (go eagles) is correct that older de grads tend to be more at ease as new grads than 20-year-olds due to their longer life experience, but this does not always equate to a leg up in clinical expertise.

everyone has met older nurses who are bad and new ones who are good. however, anecdote is not the singular of data.

the definitive work on the subject of experience, from novice to expert, by patricia benner, may be of help to you in this discussion.

pro-student · Mar 1, 2012

Myelin, I completely agree. I'm not a direct-entry nurse but all the ones I've interacted with bring really incredible experiences to the field. I would contend that they are really strengthening nursing, particularly advanced practice nursing.

BCgradnurse, at my school as well as all the direct-entry programs I know of, the standards of direct-entry admission are extremely rigorous, much more so than for RNs. While healthcare issues becoming increasingly multi-disciplinary and multi-contextual, direct-entry nurses really bring some amazing strengths to the table. They're not bogged down by the traditions of healthcare and tend to be really creative problem solvers.

I have read From Novice to Expert and while I think Benner have some very good ideas, bear in mind this is a theoretical framework which pulls heavily from the Dreyfus's theory of skills acquisition neither of which have been empirically validated as a whole. Also, you might recall that Benner doesn't address the issue of the APN (nor was she wasn't one herself). Her work focused almost exclusively how experience related to skills competence and problem solving. It was also first published in 1984 only 19 years after Ford started a movement with the very first NPs. Any yes, while I don't have a study to quote on the old-horrible nurse vs. new excellent nurse phenomenon, if it's as universal as you suggest, that's not quite anecdotal (most like a very reasonable challenge to the notion that practice in nursing makes perfect).

myelin · Mar 1, 2012

That's interesting, prostudent. I'm glad the DE students you've worked with have been great. :) And yes, DE programs are extremely selective. Anyone can learn more than they ever wanted to about the application experience by reading the Columbia, Yale, UCSF, Penn, Boston College, Hopkins, etc, etc. direct entry applicant threads on this website. All kinds of people with extremely competitive grades, GRE scores, and backgrounds get rejected or waitlisted!

Aniva · Mar 4, 2012

Depends on your long term goals as an NP. I discussed this issue with various health care/nursing professionals and HR directors/staff. For some reason, the nursing experience is perceived as being essential to the NP education and not as much as the other professionals. Do you have to have nursing experience to be a good provider? No. Will it help? It depends. Working a few years as an oncology nurse may not make you look as hot as a nurse who worked 1 year part time in the ER if you're applying for an ER NP position. Granted, there may be a steeper learning curve during your journey through the MSN program, but if you have good instructors and preceptors, you'll be fine. I've seen amazing physician assistants, nurse practitioners, and MDs/residents. They all have different backgrounds and vary in skill levels. Those who came from a strong academic program, became great providers. Don't get sucked into the narrow mentality that nursing experience is an absolute must to be a good NP. The purpose of the MSN programs is to prepare advanced practice nurses: providers, not RNs. An HR director at a community health center told me once she would rather take a new graduate NP with no nursing experience, but with primary care clinical experience over a NP with 10 years of nursing experience in oncology or surgical ICU. The RN experience may not translate over to what you will be doing as an NP. Don't underestimate good experience though (and I mean good, not decent or subpar). Its up to you if you feel ready to be a provider or not. RN experience essential to be a good provider? I don't think so. I wonder if those who believe otherwise would run up to an MD or PA and criticized them for not having nursing experience and therefore judge them as inadequate providers..

Leah325 · May 30, 2012

Unfortunately, this kind of thinking is quite common especially in the older generation of nurses. I'm a brand new nurse and as well as a grad student at one of the highest ranked nursing programs in the nation. I was accepted without a day of "actual nursing experience." In fact, I got my acceptance before even graduating nursing school much less sitting for boards. It really irks me how many people buy into the notion that experience in nursing makes for a better nurse. There are abysmal nurses with decades of experience and outstanding ones fresh off the line. There is no evidence to support that experience makes for a better clinician. In fact, there is data which suggests that nurses are less likely to provide the standard of care the farther they are from initial licensure. Not to say that all experienced nurses are awful, but it assumes way too much that putting in your time on the floor translates into more knowledge, better care provided, better outcomes, or a stronger basis for future education and practice.
I went into nursing knowing I wanted to be an advanced practice nurse. I don't mind being a "beginning practice" nurse, but it's not why I got into the field and it's not what I want to do with my career. My advanced practice specialty is in primary care which has extremely little correlation with what I do as a staff RN. The same holds true for the debate over experience in a specialty for advanced practice (i.e. - do I need psych experience to be a psych APN). Most NP specialties don't have a strong RN equivalent since the roles are so drastically different. It also doesn't hold true that the advanced in APN implied a progression from basic RN --> experience --> APN education. Advanced refers to the higher level scope of practice. Yes APN education builds on and requires basic nursing education, but it doesn't necessitate having hoofed it out for X many years. Comparable clinical competence has been demonstrated of traditional APNs with RN experience vs. direct-entry APNs without RN experience (the later group generally having done all of their basic nursing in only about 12 months or so). I just wish we could shake this antiquated mind-set.

Hi prostudnet! I will graduate with my BSN spring 2013 from the #2 public university in the nation. I am interested in pursuing a similar career path as yourself, I am going to apply to graduate (FNP) schools in hopes to start studying part-time Fall 2013. How many schools did you apply to? What was your journey like during your 4th year in the undergraduate nursing program? Any information would be extremely helpful.

sandnnw, BSN, MSN, EMT-B, APRN · Jun 2, 2012

This article was handed out to us during my first semester during grad school (VU)

Rich ER. Does RN experience relate to NP clinical skills?Nurse Pract. 2005 Dec;30(12):53-6.

After studying, observing and now living alongside the e/-e NPs...I don't see anything to worry about.