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.

[core0]

lol David! My hubby was in the Air Force for 23 years and I was in the Navy for 3 years. My experience with mid-level practitioners has been for the most part very positive. However, I do agree that it is more than using a computer program to treat patients. If that were the case, we could just put our hand in the DVD player and get our medical care via hand prints!

Its like we used to say about Army medicine; its a good system if your not sick;). It does well with self limiting conditions (those that respond to benign neglect). It also does well with acute conditions. What it has problems with is the ones that fall in the middle. Serious conditions that mimic self limiting conditions for example. There is just not enough continuity or urgency in the system to properly deal with this.

My current situation is a little different. Today in clinic I saw six patients and admitted three (this has become known as "winning clinic"). I just assume that they are all going to crash and burn and plan accordingly. Also we have great nurses that are good at pointing us at the ones that are crashing and burning now as opposed to those who are going to wait til later in the day.

This is where you really appreciate nursing experience. We have some new nurses that are getting better but I have some nurses that I like to eyeball the patient as they wander by and some that I just wait until they have the patient ready. I am not really sure what makes good nursing experience but to paraphrase Justice Stewart I know it when I see it.

David Carpenter, PA-C

[traumaRUs, MSN, APRN]

And that nursing experience is what I fall back on. I have been an APN for a year and don't always know what is wrong with my patient. I do however, have the assessment skills honed by 13 years as an RN!

Without those basic, I'd be scared of me - lol.

[twirlbaby]

I graduated BSN school in 2001 and started MSN school in Fall 2002. I too, did not have a whole lot of nursing experience, but did have years of medical background. I started out as a surgical tech. I think if you feel emotionally, spiritually, and physically ready to commit, then you will be able to do it.

[Atl_John]

That makes me feel better twirlbaby.....I sent in my application to UAB SON one week ago for their ACNP/RNFA program. Glad to hear that not having so much experience with nursing but past medical experience was most helpful.

[patrick1rn, MSN, RN, NP]

Dude, you got some experience as a paramedic, so your not naive. Just go with the flow.

[Mahage, LPN]

Hey Blurr... Sounds to me like you have more than paid your dues and have loads of pertinent expereince. I just graduated as an associate RN and have almost finished my BSN, but am just going to work as a nurse. I was notified yesterday that I have been accepted into the RN-MSN accelerated program. Am I going....Heck yeah I am going. I will get a couple of years expereince nursing under my belt as I am completeing this program. Consider that Doctors are trained to be excellent providers without years or even any patient care experience behind them and from what I have seen as nursing students we get an awful lot of hands on expereince that a resident doesn't. They know the anatomy and maybe more patho than we do but we are drilled on assessment and intervention. My school has had no problems with their grads getting jobs though most do have more nursing expereince than I will. 2 years isn't a lot of time but it is enough to get you in an entry level NP job. I envey you your paramedic/emt expereince. You should be setting pretty. Find you an RN-MSN program, complete the RN portion, go to work and and apply for the MSN portion or maybe even a direct entry program like the one at Vanderbilt, you should be prime. Good luck, Mahage

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.

[HealthyRN]

Hey Blurr... Sounds to me like you have more than paid your dues and have loads of pertinent expereince. I just graduated as an associate RN and have almost finished my BSN, but am just going to work as a nurse. I was notified yesterday that I have been accepted into the RN-MSN accelerated program. Am I going....Heck yeah I am going. I will get a couple of years expereince nursing under my belt as I am completeing this program. Consider that Doctors are trained to be excellent providers without years or even any patient care experience behind them and from what I have seen as nursing students we get an awful lot of hands on expereince that a resident doesn't. They know the anatomy and maybe more patho than we do but we are drilled on assessment and intervention. My school has had no problems with their grads getting jobs though most do have more nursing expereince than I will. 2 years isn't a lot of time but it is enough to get you in an entry level NP job. I envey you your paramedic/emt expereince. You should be setting pretty. Find you an RN-MSN program, complete the RN portion, go to work and and apply for the MSN portion or maybe even a direct entry program like the one at Vanderbilt, you should be prime. Good luck, Mahage

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.

I think that it's a good choice to work while you are completing your MSN program. However, I will caution you that "you don't know what you don't know". I am specifically referring to your statement on how physicians don't have years of patient care experience (going into their schooling) and yet are trained to be excellent providers. They are excellent providers because of the grueling training that they undergo. Medical school and NP school are not comparable on any level.

I used to be one of the posters on this board that would argue that it is not necessary to have nursing experience before becoming an NP. Since beginning an FNP program and gaining more nursing experience myself, I have changed my tune. I still believe that there are people who can complete direct-entry programs and become wonderful NPs. However, it would have to be a highly motivated and intelligent individual willing to devote a significant amount of time to learn information that is not taught in the program. Even then, I'm not sure that I would want to be a patient of an NP with no nursing experience.

I am still in the first semester of my NP program and I am not certain that I will be completing the program. I am very disappointed in the content of the curriculum and this is one of the top programs in the country. The pathophysiology course, which is truely the foundation for advanced nursing practice, is little more than a review of undergrad patho. Compare that to the intense and in-depth courses that physicians receive in the first two years of medical school. The entire first two years of medical school are essentially pathophysiology. And that doesn't even begin to touch on the differences.

I went into NP school expecting something much different, which is another reason to get some nursing experience before jumping into a program. I thought I understood the role of the NP and why a nurse would want to become an NP, but I'm not sure that I did. If someone is considering starting an NP program with little nursing experience, I would recommend a lot of shadowing. At this point, I am almost certain that I have made the wrong decision (even though I did shadowing and I was a nurse for over a year before starting my program). I think I'm going to transfer into a nursing administration and education program instead, but I have still lost time and a lot of money.

[traumaRUs, MSN, APRN]

HealthyRN - thank you for your comments. Its truly appreciated. One of the concerns that I have personally is that how do you know you want to be an NP before you ever are a nurse? ANd if somehow you just KNOW you want to be an NP, which specialty do you choose. What helped me to decide on an APN role was my nursing expereince. I'll be honest here too - I did an MSN in management and leadership, went (very briefly) into management and then went on to do a post-MSN CNS certificate.

[Corey Narry, MSN, RN, NP]

Healthy RN,

I'm sorry to hear that you are not liking your course in pathophysiology and getting disappointed about the whole program itself. You and I are in Michigan but you apparently are attending a different school than the one I trained in. Not that mine is better, but our 3 credit hour course in Advanced Pathology was held at the medical school of our university taught by medical school faculty - a team of "experts" in their fields was how they were touted as. They were good alright, but 3 credit hours was not enough to teach and absorb all the knowledge those gray-haired guys have accumulated over half of their lifetime. Needless to say, most of the information was taught so fast and went over our heads.

But there was a light at the end of the tunnel. Things did get better after a while. I did enjoy the progression of courses that build up on the earlier concepts. As more clinical courses went by, things did make a lot more sense. I am not trying to sway your decisions to stay or leave your NP program. I am just sensing that you are making a judgment of the program you are in based on one course that you have taken. I admit that many of the things I know about my role now, I have learned on the job and through continuing education more than during NP school. But that's how an NP can become better because one has to constantly seek new and updated knowledge. NP school is just the beginning.

[Mahage, LPN]

Thanks Healthy RN for your insight. I don't mean that as NP's we would know as much as physicians, just that if they can start out treating without patient care under their belt, we should be able to learn to become NP's with minimal patient care under ours. I am sure many NP's are as good as any provider can be but I suspect they got that good far beyond NP school. I just believe that the schools that are offering direct entry programs such as Vanderbilt and accelerated programs like the onne at Southern Adventist which I am about to ender would not be risking their reputation if they were not capable of graduating competent providers. Part of it of course is my personal bias since I am a new RN, not new to health care though I have been in a supportive positionn as I have over 30 years experience in medical social work, mental health and A&D. I definately see the need to work as a nurse as I complete my program. In fact I will probably either go part time or take the least number of hours I can for full time till I get a handle on the nursing angle. I never wanted to be a nurse. I wanted to be an MD, but waited till I got to old to decide I was capable, so I looked around and decided to become a FNP. I tried for the direct entry program at Vandy but was wait listed. I decided in the mean time to become a nurse, forget direct entry! Guess what I fell in love with nursing. I hope I love it as much after spending a couple of years in the unit at our local teacching hospital! I had seriously thought about the CRNA program, but decided I am too old and don't think I can afford to fool around getting through the FNP program, so I was thrilled getting accepted into the RN-MSN program. I am almost through with all the BSN courses required for accelerated program and will get to skip about 9 hours looks like. I had BSN Patho and I love it, I look forward to advanced Patho. I dread the project or thesis. Unfortunately one or the other is required at my school. I wish it was more clinical and less research. I don't understand why they do it that way but they must have there reasons.

Mahage

[PMFB-RN, RN]

I don't see how anyone can say that one needs experience as a nurse to be an NP. Many if not most PA schools have no experience requirement at all. This would seem an obvious double standard to me. At least the nurse going to NP school would have received some patient care experience while in nursing school clinicals. This is far more experience than one needs to go to PA school here in Wisconsin.

[core0]

I don't see how anyone can say that one needs experience as a nurse to be an NP. Many if not most PA schools have no experience requirement at all. This would seem an obvious double standard to me. At least the nurse going to NP school would have received some patient care experience while in nursing school clinicals. This is far more experience than one needs to go to PA school here in Wisconsin.

Its comparing apples to oranges. Despite statements from PA leadership from the beginning roughly 1/3 of PA schools have not required medical experience. This has its roots from early research that Dr. Stead did on training medical students during WWII. While his program used experienced Navy corpsman there were immediately variation. MEDEX used experienced corpsman but shortened the didactic training and eliminated non FP rotations. It is probably the precursor to the FNP program. Other programs used the Duke model which involved extensive didactic training and extensive clinical training but used students without medical experience. Over the years the MEDEX model has largely been discarded and most programs use some variation of the Duke model and either require or do not require medical experience depending on the programs design and experience.

If you look at Dr. Fords work, NP training from the beginning built on nursing roots to advance nursing practice. This has evolved over the years. I have not found any specific data, but DE programs are a relatively recent addition from what I read, probably paralleling the DE BSN programs for non nurses in the early 90's.

So there is no double standard. One program is designed to train PAs according to the standards laid down by the PA profession. There is some data that PAs with no medical experience do not preform differently on the certification exam than those that who have medical experience. There is still debate within the community but it is not backed up with data.

Final notes. As long as we are comparing apples to oranges, most PA schools that require medical experience will not accept experience as a student. They rightly acknowledge that a student is not processing the position but being a student. So an RN applying to PA school with a medical requirement would need experience as an RN. Also to the poster above, MDs do not enter practice without medical experience. To get an MD requires two years of medical experience (MS3 and MS4 years). To be licensed as a physician the MD needs at least an internship which is the equivalent to two years of full time work. Most MDs have at least three years of internship and residency before they practice independently.

David Carpenter, PA-C