Becoming an NP with little to no nursing experience??

[Blurr156]

Hello to all!!! I have worked as a parmamedic for 20 years, have a B.A. in Economics, and I wanted to advance my career in healthcare. I was originally looking to pursue the PA route, but for certain practical reasons (including my union not helping to pay for it) I have been looking at other options, nursing/NP.

I was very excited to learn of a school near me that has a combined BSN/NP program for people with non-nursing bachelor degrees. I was about to start looking deeper into this program when a good friend of mine who is a member of an interview committee at a nearby hospital told me that I shouldn't do the program because I would have trouble getting a job.

The reason stated was because I wouldn't have been seen as having "paid my dues" as a nurse first.

Is this true?

I could understand why someone might feel that way about someone who went through this type of program never having worked in healthcare before. However, I like to think that to a certain degree I've paid my dues (I know it isn't nursing, but from a time in healthcare perspective).

My friend did say that I might be considered an exception to that rule. The program is at a VERY well known school and I was told by my friend even then it wouldn't matter. I was wondering what people here thought regarding this topic.

Thank you for any guidance you can provide.

[Clarence Nightingale]

Wow - that is a prestigious program!

Well, it's rigorous for sure. They are putting us through the paces but I'm loving every minute of it. You've heard of the program before Trauma?

[BrandyNP]

Wow - that is a prestigious program!

I also graduated from their Adult/Geriatric program. It has opened up many doors for me. I was already a nurse when I started the program, so I was allowed to do my clinicals in my city of residence (non-nurses have to stay in Nashville). I completed all of my clinicals at a huge internal medicine clinic in town, where the doctors also train residents from TX A&M and UTMB. I was the only NP they had ever trained and I would never have been given that opportunity if it weren't for the Vanderbilt connection!

[core0]

Thank you neuronightnurse for bringing up a point I wanted to share. We're talking about NP's coming out with no experience, but look at resident physicians and even new grad PA's. All of them come out of their training with a similar lack of experience. I am in the middle of my MSN at a University with a teaching hospital, and I can say that we spend 2 years after our Bachelor's degree with very little social life. We study just as much as med students and we end up spending 1000's of clinical hours in the hospitals/clinics, just like med students. And there are many people in my program who have the grades and motivation to have attended medical school, yet chose NP because they prefer the nursing model over the medical model. snip

The problem is that there is no consistency in NP education. You state that in you program you spend thousands of hours in clinical time, but this is far from the norm. Most programs have around 500 clinical hours which is the minimum. There are those that go above that but there is no consistent format. Your comparator groups residents and PA students have at a minimum three years of progressive training for residents and one year of training for the PA's. Also this is medical training that covers the spectrum of medicine from psychiatry to surgery. This depth of training is largely lacking from NP programs. So to compare the clinical NP training to these groups doesn't fly. There are very good NP's out there, some working outside their original training, but this relies more on the nurse than the training.

David Carpenter, PA-C

[Corey Narry, MSN, RN, NP]

The problem is that there is no consistency in NP education. You state that in you program you spend thousands of hours in clinical time, but this is far from the norm. Most programs have around 500 clinical hours which is the minimum. There are those that go above that but there is no consistent format. Your comparator groups residents and PA students have at a minimum three years of progressive training for residents and one year of training for the PA's. Also this is medical training that covers the spectrum of medicine from psychiatry to surgery. This depth of training is largely lacking from NP programs. So to compare the clinical NP training to these groups doesn't fly. There are very good NP's out there, some working outside their original training, but this relies more on the nurse than the training.

David Carpenter, PA-C

CoreO, here we are again comparing NP and PA programs as if they are the same. You have to remember that NP programs are directed towards a specific specialty whereas PA programs prepare providers to be generalists. I have examined a PA program in my state prior to attending NP school. The entire second year consists of rotation to 7 main branches of medicine and general surgery: Internal Medicine, OB-Gyn, Emergency Medicine, Pediatrics, Psychiatry, General Surgey, and Family Medicine. If you divide 12 months between those specialties, you only get about a month and a week to spend between each of them.

Now, look at an FNP program which in essence is a family practice training program for advanced practice nurses. If they spend 500 hours of clinical time in their specialty, that is even more than the one month and a half that you claim you guys spent in family practice rotations. Same with the ANP program - that's 500 hours of internal medicine in an out-patient setting!

I agree with you that many times NP's practice outside of their intended training. But that happens with PA's too. Your program prepares you to be generalists. But how many times have you seen a PA working in a sub-specialty such as cardiology, neurology, or neurosurgery. Don't tell me that you had adequate clinical rotations in those specialties during PA school! This is where if I was a cardiologist in need of a mid-level provider, I would rather hire an NP with CCU background as an RN to work with me. Because even though there was no adequate exposure to cardiology in this person's NP program, I know darn sure that this nurse knows his/her stuff when it comes to cardiac problems.

[kenzy]

One quick note on Excelsior I have done the research in my state PA., and the are the only at home or on-line program recognized by our State Board of Nursing. Hope this helps

[BrandyNP]

The problem is that there is no consistency in NP education. You state that in you program you spend thousands of hours in clinical time, but this is far from the norm. Most programs have around 500 clinical hours which is the minimum. There are those that go above that but there is no consistent format. Your comparator groups residents and PA students have at a minimum three years of progressive training for residents and one year of training for the PA's. Also this is medical training that covers the spectrum of medicine from psychiatry to surgery. This depth of training is largely lacking from NP programs. So to compare the clinical NP training to these groups doesn't fly. There are very good NP's out there, some working outside their original training, but this relies more on the nurse than the training.

David Carpenter, PA-C

I work with a PA who is a good friend of mine and he disagrees with this. He said that he didn't feel that he received adequate training in his PA program (Master's level). He thinks that the PA programs should specialize just like the NP programs. At Vanderbilt, the Adult NP students spend close to 800 clinical hours in internal medicine. Same for the pediatric NP's, psych NP's, etc. On top of that, a lot of these people already have prior experience in their chosen fields. One day, I commented that I wished that I had spent some time in surgery during training, because I wasn't exposed to suturing in my clinicals, although we had a weekend class. My friend laughed and said that he spent a total of 30 hours in surgery and he didn't feel like he had learned that much at all! We had a long discussion about this very topic. The fact is, if a NP actually practices in their specialty, then they're the ones for the job. Unfortunately, there just aren't that many specialty NP's out there, so FNP's end up working in the various specialties, just like the PA's!

[core0]

CoreO, here we are again comparing NP and PA programs as if they are the same. You have to remember that NP programs are directed towards a specific specialty whereas PA programs prepare providers to be generalists. I have examined a PA program in my state prior to attending NP school. The entire second year consists of rotation to 7 main branches of medicine and general surgery: Internal Medicine, OB-Gyn, Emergency Medicine, Pediatrics, Psychiatry, General Surgey, and Family Medicine. If you divide 12 months between those specialties, you only get about a month and a week to spend between each of them.

Now, look at an FNP program which in essence is a family practice training program for advanced practice nurses. If they spend 500 hours of clinical time in their specialty, that is even more than the one month and a half that you claim you guys spent in family practice rotations. Same with the ANP program - that's 500 hours of internal medicine in an out-patient setting!

I agree with you that many times NP's practice outside of their intended training. But that happens with PA's too. Your program prepares you to be generalists. But how many times have you seen a PA working in a sub-specialty such as cardiology, neurology, or neurosurgery. Don't tell me that you had adequate clinical rotations in those specialties during PA school! This is where if I was a cardiologist in need of a mid-level provider, I would rather hire an NP with CCU background as an RN to work with me. Because even though there was no adequate exposure to cardiology in this person's NP program, I know darn sure that this nurse knows his/her stuff when it comes to cardiac problems.

You speak of NP "specialty". From a medical standpoint these are not specializations. A specialization in medicine is additional training that occurs off a base residency such as GI from internal medicine. Essentially PA's are trained for family practice medicine. The rotations that you looked at for PA's are the required rotations (you actually need two FP so about 320 hours minimum for FP). You can usually do at least 1to 2 other rotations on top of that. Depending on your program these can be 1-2 months long. So you have adequate time to get at least a base training in a specialty. This is on top of the basic medical training that you have. Yes an NP with a CCU background would be good. However, they would have less cardiology training as a mid level than PA (IM training and ER training plus dedicated cardiology classes vs whatever training they get in outpt FP for cardiology). It would very much depend on the PA just as it would an RN.

The medical background of a PA parallels the development of an FP physician. During their internship year physicians go through many of the same type of rotations as a PA does (psych,surg etc.) This helps develop complete medical decision making process and exposes you to more than you would be exposed to if you just did FP.

Both programs produce generalists. The FNP is probably the closest to the PA generalist training. When reading the NP literature you see the development of the DNP and the call for NP residencies. I think this is a realization that for some students the training is insufficent. There is a paralell development in the PA world with the development of PA fellowships. These seem to be farther along than those in the NP world. I will also note the average PA program has lengthened from 21 months to 26 months in the last eight years. While there are some NP programs that are going that way, for the most part the opposite seems to be happening with increasing online and partial campus courses.

Mostly for both professions this seems to involve the low hanging fruit syndrome. All of the early adopters that understand the use of mid-levels have hired them. Early adopters are willing to train mid-levels and work with them to develop their skills. A lot of people that are hiring mid-levels now are hiring them because their business manager or practice manager told them that they can make more money that way. They don't understand the process that goes into making a mid-level relationship work.

In our market I see NP's that are tremendously underutilized. I was told by one of the cardiology NP's that they are not allowed to do plans on the patients so the physicians can charge (mostly a case of the physicians not wanting to give up control and a not knowing how to bill). I also see some of that with PA's (mostly in surgery with the MD having the PA assist on simple cases) once again a case of not knowing how to use a mid-level. If you ascribe to the left-right nursing continuum, in our market, I see the nurses used much more on the left side than the right. I think this is the reason that you see many more NP's not using their training than with PA's. There is no question about using a PA as a nurse while there is confusion about where the nursing role ends with an NP.

David Carpenter, PA-C

[traumaRUs, MSN, APRN]

Hmmm - some very interesting discussion here. Thank you.

[Corey Narry, MSN, RN, NP]

You speak of NP "specialty". From a medical standpoint these are not specializations.

Who cares whether you feel that these are not specializations from a medical standpoint! We NP's do not aim to be MD's or DO's nor claim to have the same training as they do. We are nurses with advanced training in the medical model. These are NURSING specializations as far as I am concerned but that does not make us less competent as a provider than you guys are. I remember back in NP school, a student said that she has an RN friend who pursued PA studies for her Master's. The professor responded by saying "that's going backwards as far as her career". Now I understand what she is saying. She is not denigrating the PA profession, she is merely saying that this RN missed her chance to specialize as a nurse since she did not take the NP route instead.

However, they would have less cardiology training as a mid level than PA (IM training and ER training plus dedicated cardiology classes vs whatever training they get in outpt FP for cardiology)

Out-pt FP cardiology! are you kidding me! That is not specialty training in cardiology. That's just barely touching the tip of the iceberg. There is no way that is going to fly with a cardiologist.

The medical background of a PA parallels the development of an FP physician. During their internship year physicians go through many of the same type of rotations as a PA does (psych,surg etc.) This helps develop complete medical decision making process and exposes you to more than you would be exposed to if you just did FP

Don't even go there! How can you compare your meager months of basic medicine rotations and a few more months of specialty rotation in family practice to that of a full-fledged family practice trained physician. I know how resident rotations work. I have been an RN in a teaching hospital for 14 years. There is no way the two programs compare equally PERIOD!

In our market I see NP's that are tremendously underutilized. I was told by one of the cardiology NP's that they are not allowed to do plans on the patients so the physicians can charge

Well, I got news for you. They do the same for PA's here. I know a bunch of PA's in Neurosurgery who are not allowed to write the A/P part of their medical history because the physicans do this themselves. They are merely scribes as far as I'm concerned!

[mvanz9999, RN]

..... These seem to be farther along than those in the NP world. I will also note the average PA program has lengthened from 21 months to 26 months in the last eight years. While there are some NP programs that are going that way, for the most part the opposite seems to be happening with increasing online and partial campus courses.

I really don't understand where people are getting these low figures of months to become an NP. If we're talking about Direct Entry (which is what I believe NP with no nursing experience entails), the months are too low. I know of two schools whose core requirements are between 15 and 22 months. This is just the core nursing curriculum. Then there are additional years of the post master's NP certificate program, the length depending on which specialist track you take.

[HealthyRN]

You speak of NP "specialty". From a medical standpoint these are not specializations. A specialization in medicine is additional training that occurs off a base residency such as GI from internal medicine. Essentially PA's are trained for family practice medicine. The rotations that you looked at for PA's are the required rotations (you actually need two FP so about 320 hours minimum for FP). You can usually do at least 1to 2 other rotations on top of that. Depending on your program these can be 1-2 months long. So you have adequate time to get at least a base training in a specialty. This is on top of the basic medical training that you have. Yes an NP with a CCU background would be good. However, they would have less cardiology training as a mid level than PA (IM training and ER training plus dedicated cardiology classes vs whatever training they get in outpt FP for cardiology). It would very much depend on the PA just as it would an RN.

The medical background of a PA parallels the development of an FP physician. During their internship year physicians go through many of the same type of rotations as a PA does (psych,surg etc.) This helps develop complete medical decision making process and exposes you to more than you would be exposed to if you just did FP.

Both programs produce generalists. The FNP is probably the closest to the PA generalist training. When reading the NP literature you see the development of the DNP and the call for NP residencies. I think this is a realization that for some students the training is insufficent. There is a paralell development in the PA world with the development of PA fellowships. These seem to be farther along than those in the NP world. I will also note the average PA program has lengthened from 21 months to 26 months in the last eight years. While there are some NP programs that are going that way, for the most part the opposite seems to be happening with increasing online and partial campus courses.

Mostly for both professions this seems to involve the low hanging fruit syndrome. All of the early adopters that understand the use of mid-levels have hired them. Early adopters are willing to train mid-levels and work with them to develop their skills. A lot of people that are hiring mid-levels now are hiring them because their business manager or practice manager told them that they can make more money that way. They don't understand the process that goes into making a mid-level relationship work.

In our market I see NP's that are tremendously underutilized. I was told by one of the cardiology NP's that they are not allowed to do plans on the patients so the physicians can charge (mostly a case of the physicians not wanting to give up control and a not knowing how to bill). I also see some of that with PA's (mostly in surgery with the MD having the PA assist on simple cases) once again a case of not knowing how to use a mid-level. If you ascribe to the left-right nursing continuum, in our market, I see the nurses used much more on the left side than the right. I think this is the reason that you see many more NP's not using their training than with PA's. There is no question about using a PA as a nurse while there is confusion about where the nursing role ends with an NP.

David Carpenter, PA-C

I agree with a great deal of this. There needs to be uniformity to NP education, just as there should be to RN education. I don't think Mr. Carpenter is trying to say that a PA program is the same as being in a family practice residency. It seems that he means that it is similar in that PAs are exposed to a variety of rotations. This does not happen in an FNP program, so when FNPs refer patients to speciality practices, they may not have as clear of an idea about what goes on in that speciality. Is that experience absolutely necessary to function as an FNP? Probably not, but it certainly couldn't hurt to have a better grasp of the bigger picture of a patient's care.

Also, I realize that many people on this board attend online programs. I'm sure that many of the programs are very reputable and I do believe that the right person could do well in an online program and become a great APN. However, we have to realize that the rest of the world does not hold online programs in high regard. Maybe someday it will be the norm, but many people are still wary of these programs. It is my opinion that this may not be the best thing for NP education at this point in time.

[Corey Narry, MSN, RN, NP]

There needs to be uniformity to NP education, just as there should be to RN education....This does not happen in an FNP program, so when FNPs refer patients to speciality practices, they may not have as clear of an idea about what goes on in that speciality

Sorry, but I don't agree with this. Uniformity in NP programs will make advanced practice nursing an exact copy of PA programs. If that is what you're after, then by no means attend a PA program. I have no problem with an RN wanting to go through the PA route. Advanced practice nursing historically is about being specialized. Just look at the oldest APN role - the CRNA as well as the first NP program in the country which happens to be in Pediatrics.

"When an FNP refers a patient to a specialty practice, they may not have a clear idea of what goes on in that specialty"... You actually believe this? Ask any FNP and they will prove you wrong. Better yet, ask any NP for that matter. The reason why you refer to another specialty is because you know that the medical problem can not be addressed by your scope of practice and a specialty is best suited to address the problem.

we have to realize that the rest of the world does not hold online programs in high regard

I do agree with this comment. Not that it matters, my program is completely classroom-based with clinical rotations within the metro area where the university is located. You also have to remember that on-line courses can serve a purpose. For instance, at one point, there is only one Certified Nurse Midwife program in Michigan based at the Univ of Mich in Ann Arbor. Because there was a need to train CNM's in rural areas of Michigan, that school decided to offer on-line programs for interested RN's living in Upper Michigan who have no means of traveling to Southeast Michigan for schooling. I don't know how successful this program was, but this is just an example of how an on-line program can meet the need for providers in an area where there is a lack of expertise in training such providers.