Becoming an NP with little to no nursing experience??

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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.

Specializes in Critical Care, ER.
I will assume that you accidentally quoted me and this is not a response to me directly. If it is, you have grossly misread my posts or I am misreading yours.

You state "NP's with no bedside experience vs. those without". You're comparing two of the same thing.

My opinion is that bedside care is what makes a nurse a nurse. It's not something you learn overnight, it comes slowly over time, and I am of the opinion that you need to learn bedside care in the process of becoming a nurse.

As far as characterizing RN's as "hanging IV bags and delegating tasks"...I have said no such thing. I only reference these as referenced by the OP. Is hanging IV bags and delegating tasks part of being an nurse? Yes. Is that basically all there is? NO! The OP wants to cut these types of activities out, and I'm asking where someone would draw the line.

Would you like me to post logs of daily activities, or cite the Registered Nurse Scope of Practice? Or perhaps post summaries of all the time I spent shadowing or talking with RN's and NPs before entering nursing school?

Sorry, hun, I wasn't in any way referring to your comments. I was directly speaking to the post that I will now quote verbatim;

"As someone with no intention of working as a bedside RN , I feel that it is plain silly to be learning about bed-making and hanging IV's and learning how to designate to a care partner etc. Not because it is beneath me, but because it is taking time away from learning skills I WILL be needing and using as an NP. The point is, the time could be used to have classes on what I WILL be doing instead of doing this back door way of becoming a mid level provider"

All my comments were directed to this post, not any of yours... ; )

Specializes in Accepted...Master's Entry Program, 2008!.

Oops! Sorry for the confusion. :D

Specializes in ED, Cardiac-step down, tele, med surg.

I agree that hanging IV's an bed making (if it's still really done by an RN, I'm not sure, not on the day shift anyway!) will not contribute to skills necessary to becoming a mid level provider. But assessment skills of an RN and learning about different diseases and their treatments, working with MD, RTs, RDs, etc. can add a lot to the practice as a mid level. At least this is what I think.

I agree that hanging IV's an bed making (if it's still really done by an RN, I'm not sure, not on the day shift anyway!) will not contribute to skills necessary to becoming a mid level provider. But assessment skills of an RN and learning about different diseases and their treatments, working with MD, RTs, RDs, etc. can add a lot to the practice as a mid level. At least this is what I think.

It depends on what type of NP you're talking about. Hospital experience should be MANDATORY for an ACNP, but certainly isn't necessary for one working in primary care. I have precepted several NP students who have years of experience in the hospital and this has NOT helped them in the primary care setting.

Just yesterday, I had an ICU nurse/NP student ask me what type of medication "Zyrtec" was and she didn't even know the difference between Decadron and Depot Medrol. In fact, she knew very little about any of the medications that we prescribe in primary care and she had just completed an Advanced Pharmacology class - what are they teaching these students??? The kicker was when she informed me that she had no intention of practicing in primary care, but was going to work in the hospital upon graduation! I told her that she would need to attend an Acute Care NP program in order to do that, because FNP's aren't certified/trained to do that! She was completely dumbfounded! Where are they getting these students nowadays?

Specializes in Critical Care, Emergency, Education, Informatics.
I told her that she would need to attend an Acute Care NP program in order to do that, because FNP's aren't certified/trained to do that! She was completely dumbfounded! Where are they getting these students nowadays?

First of all there are just some people who don't have a clue, no matter what their background was. I've given plenty of Zyrtec and both decadon and depo to inpatients.

I can't tell were you are from your profile, but were I'm at all the NP's taking care of inpatient are FNP's. Yes there are some states that are changing that, but as of right now they are in the minority. There are some liability carriers that are limiting that for certain hospitals.

You should be careful what your telling your students, or at least how you tell them.

First of all there are just some people who don't have a clue, no matter what their background was. I've given plenty of Zyrtec and both decadon and depo to inpatients.

I can't tell were you are from your profile, but were I'm at all the NP's taking care of inpatient are FNP's. Yes there are some states that are changing that, but as of right now they are in the minority. There are some liability carriers that are limiting that for certain hospitals.

You should be careful what your telling your students, or at least how you tell them.

I live in Texas and that's where I went to school for my FNP certification. We were told time and again that FNP's are certified/licensed to work in primary care only. According to the TX BON, we have to practice in the scope set forth by the certifying entities, which is the AANP and ANCC. Both the AANP and ANCC clearly state that the scope of practice for FNP's is in primary care.

This has been a major issue in Texas and several FNP's have been disciplined by the BON for practicing in a hospital setting. Even worse, in the case of a malpractice claim, those NP's insurance companies can & WILL refuse the claim and this exposes the hospital/SP to all kinds of liability issues. I'm surprised to hear that FNP's are being allowed to practice in the hospital setting in your state, because this is not within their scope of practice. Obviously, a lot of NP's/hospital administrators/doctors aren't aware of the various specialties, which is amazing to me, since there is so much to lose.

I'm curious, does your Board of Nursing specifically state that FNP's can practice in an inpatient setting? As far as me needing to be "careful" about setting a NP student straight on her scope of practice...that's my JOB!

Specializes in Critical Care, Emergency, Education, Informatics.
I live in Texas and that's where I went to school for my FNP certification. We were told time and again that FNP's are certified/licensed to work in primary care only. According to the TX BON, we have to practice in the scope set forth by the certifying entities, which is the AANP and ANCC. Both the AANP and ANCC clearly state that the scope of practice for FNP's is in primary care.

This has been a major issue in Texas and several FNP's have been disciplined by the BON for practicing in a hospital setting. Even worse, in the case of a malpractice claim, those NP's insurance companies can & WILL refuse the claim and this exposes the hospital/SP to all kinds of liability issues. I'm surprised to hear that FNP's are being allowed to practice in the hospital setting in your state, because this is not within their scope of practice. Obviously, a lot of NP's/hospital administrators/doctors aren't aware of the various specialties, which is amazing to me, since there is so much to lose.

I'm curious, does your Board of Nursing specifically state that FNP's can practice in an inpatient setting? As far as me needing to be "careful" about setting a NP student straight on her scope of practice...that's my JOB!

CO, KS, GA all allow, and those are the only states I can vouch for. As to that being your JOB, only if you were specic about that being TX rules. Onther places, other rules. From just soing a spot check, TX is in the minority right now in that it doesn't allow it, but that may change as other states and liability carriers are looking into it also. LIke anything in nursing, you have to be carefull in stating absolutes. In some states I was even allowed to start cenral lines, and intubate as a RN, in other states I would have ended up in jail for doing them.

Personally I tend to agree about limiting FNP's, and ACNP. Having hired both in my role as CNO and Assistant Hosp Administrator and neither had the corner on a complete education. THe only one that was ready to hit the ground running was the FNP who had a post grad ACNP.

CO, KS, GA all allow, and those are the only states I can vouch for. As to that being your JOB, only if you were specic about that being TX rules. Onther places, other rules. From just soing a spot check, TX is in the minority right now in that it doesn't allow it, but that may change as other states and liability carriers are looking into it also. LIke anything in nursing, you have to be carefull in stating absolutes. In some states I was even allowed to start cenral lines, and intubate as a RN, in other states I would have ended up in jail for doing them.

Personally I tend to agree about limiting FNP's, and ACNP. Having hired both in my role as CNO and Assistant Hosp Administrator and neither had the corner on a complete education. THe only one that was ready to hit the ground running was the FNP who had a post grad ACNP.

TX isn't that different than any other state. All of them generally follow the State BONs recommendations. TX is unusual in that they actually enforce the recommendations for scope of practice. I found Georgia's new NP prescriptive authority interesting. Especially this part:

"© adhere to a written nurse protocol agreement that is dated and signed by the APRN, the delegating physician, and any other designated physician(s); the APRN’s area of practice shall be in the same or comparable specialty as that of the delegating physician; the protocol shall specify the medical acts delegated to the APRN as provided by O.C.G.A. 43-34-26.3 and shall provide for immediate consultation with the delegating physician or a designated physician if the delegating physician is not available;

Nobody knows how this will be interpreted. In addition the protocols have to be approved by the BOM so they can also interpret this. At least in the hospital environment there is a lot of talk about what this means. Interesting world.

David Carpenter, PA-C

"© adhere to a written nurse protocol agreement that is dated and signed by the APRN, the delegating physician, and any other designated physician(s); the APRN's area of practice shall be in the same or comparable specialty as that of the delegating physician; the protocol shall specify the medical acts delegated to the APRN as provided by O.C.G.A. 43-34-26.3 and shall provide for immediate consultation with the delegating physician or a designated physician if the delegating physician is not available;David Carpenter, PA-C

So, a pediatrician would hire a PNP, an internist would hire a ANP, a family practice doctor would hire a FNP...is that right?

So, a pediatrician would hire a PNP, an internist would hire a ANP, a family practice doctor would hire a FNP...is that right?

In theory. However, who would an endocrinologist hire. Presumably an ANP since this is an outgrowth of internal medicine. However, the ACNP claims this as their domain also. Also what about EM. Urgent care is part of FP or EM but EM claims the emergency room (as does the ACNP). And of course the age old problem of what to do about medical specialties that cross age groups (EM again among others). The EM group that I moonlight with won't hire NPs for exactly this reason. Until it actually gets put into practice (and in all probability litigated) nobody knows.

David Carpenter, PA-C

In theory. However, who would an endocrinologist hire. Presumably an ANP since this is an outgrowth of internal medicine. However, the ACNP claims this as their domain also. Also what about EM. Urgent care is part of FP or EM but EM claims the emergency room (as does the ACNP). And of course the age old problem of what to do about medical specialties that cross age groups (EM again among others). The EM group that I moonlight with won't hire NPs for exactly this reason. Until it actually gets put into practice (and in all probability litigated) nobody knows.

David Carpenter, PA-C

As long as there's a "fast track" ER, then the FNP's can do it. I noticed there is now a ACNP/FNP and a EM/FNP program at Vanderbilt. There was a EM/FNP program at UT-Houston, but they were thinking about shutting it down. The reason being, some of their graduates couldn't get licensed in other states. Believe it or not, there are states that are even more strict about educational preparation than others! I've heard that some states won't even recognize online programs, so people have to be very careful about attending these online programs and "super specialized" program.

Until there becomes a "generalized" NP program, there will continue to be stratification among NP's.

Presently in Texas, we're fighting for 100% independence. There's a good chance this will happen in rural areas. If so, I'm going to open my own clinic. If it weren't for that, I would have gone the PA route - I was accepted into OU's program, but ended up moving to TX so I did the Vanderbilt program.

Specializes in Critical Care, Emergency, Education, Informatics.

All this uncertanty is one of the reasons why I dropped the NP program I'm in. If I didn't have to go back and take all those 20+ year old sciences over I'd go the PA route. Nursing is and probably always be it's own worst enemy. This is the one area were the "nusing model" fails us as nurses. None of this stuff is rocket science, there is no reason someone can't learn this stuff like PA's or even docs to. Learn as we go. As an RN I can gofrom ER to ICU and then to whatever area I want and learn on the job. Why is it considered out of scope of practice for a FNP to start someone on a levo drip. As a flight nurse I start patients on it all the time.

More and more I'm sorry I choose to follow the RN path, I could have done better going the PA route when I had a chance. Nursing doesn't only eat it's young it contuinues to eat it's not so young.

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