NO experience new graduate BSN student applying for MSN-FNP graduate school?

[2bABLE]

I am torn on what I should do with my application to graduate school. I have no bedside experience in the nursing workforce, but I don't believe that it would change my abilities to be a competent, compassionate NP. Please help assure me that bedside nursing experience is NOT a necessity in becoming an amazing NP!!!! Thank you in advance.

[Dodongo, APRN, NP]

What student NPs need are more clinical hours.. .

Very much agree. Student NPs should have a year of full time clinical hours. It's ludicrous to have an FNP get 600-800 hours of clinical in school and then graduate and think they're practicing in their scope working in psych, peds, OB, inpatient. Even the specialty programs that get 800 hours in their specialty are doing themselves and their patients a disservice.

[shibaowner, MSN, RN, NP]

At least I have provided some evidence on whether RN experience is necessary for NP success. Those who disagree with me have NO evidence to support their bias, except for anecdotes. I do feel there should be more studies done on this.

Qualifications do matter. That is why "expert opinion" is a level of evidence. "Student and anyone who wants to opine" is not a level of evidence. As a practicing NP, I have more knowledge of the matter at hand than RNs and students. I do not debate RNs on matters pertaining to RN practice.

Anyone who claims that all nursing schools just want money is equivalent to a conspiracy theorist.

Just because a study is old does not make it invalid.

"Confirmation bias" is the what people say when they don't agree with a study and have no evidence of their own.

Why does ICU RN experience benefit a primary care NP or an NP going into psych, derm, sports medicine, schools, etc? It doesn't.

Who cares what people on this forum think? I don't. Who hires most NPs? MDs. Do MDs care about RN experience? Most do not. Do primary care MDs care whether someone worked in the ICU? Most do not. Why don't primary care MDs care about ICU or ER experience? Because a primary care environment is DIFFERENT - most outpatient facilities do not have a vast army of healthcare professionals and equipment. Primary care requires a different mindset and many primary care MDs have told me they DO NOT want an NP or PA who only has hospital experience. Why? Because these MDs have had bad experiences with such individuals.

That said, if a prospective NP wants to work in the hospital, then they should have some bedside nursing experience. Most schools with acute care NP tracks require this. They don't require it for primary care NPs.

What is this obsession with the ICU? Most NPs work in primary care. How many NPs work in the ICU? So should only RNs who worked in the ICU be allowed to be NPs? I haven't worked in the ICU. If RNs with such experience have great assessment skills, wonderful! How come I wasn't dazzled by their exam skills during our assessment classes? Hmmmm. Could it be because ICU RNs are looking for different things than a primary care NP is?

Has anyone here proved that NPs with RN experience have better assessment and exam skills? No. Are better at prescribing? No. Have better patient outcomes? No. Have better patient satisfaction? No.

Yes, I am proud of the schools I attended. I see no reason to be coy about where I went to school - it has to be on my resume, after all. Yale, UCLA, Johns Hopkins. Damn right I am proud! I worked like a dog to get into and graduate from those schools, and pay for them MYSELF (I had nothing handed to me). Was it worth the money to go to top schools? Yes, it has benefited me greatly in my previous career (business) and in nursing. If you think prospective employers and graduate admissions officers disregard schools attended, you are deluded. In addition, finding an NP preceptor is much easier if you are attending a reputable school - the better the school, the easier it is.

New grad NPs who wish for more clinical training can go for an NP residency program or work for an employer that provides intense training.

What is interesting is I see so many posts on AN from former RNs who are new grad NPs and they complain they can't get a job, or their offers are for less money than they were making as an RN. I don't see posts from new grad NPs who can't get a job because they lack RN experience!

Finally, there is a fascinating thread under General Nursing complaining that too many future NPs are just getting 1 or 2 year of RN experience, creating a lot of disruptive churn and wasting the time of the people who have to orient and train them. Perhaps RN jobs should be reserved for people who actually want to be RNs! There are more than enough RNs who truly want a nursing career and do not want to become NPs.

[shibaowner, MSN, RN, NP]

So there is not one nursing role that actually does do this? Not one? Are you absolutely sure about that?

Do you know an RN who is diagnosing and prescribing? If so, they are performing illegal acts.

[shibaowner, MSN, RN, NP]

I emailed the AANP out of curiosity of their position on the debate, as I was willing to concede there might be a cultural bias on my part, as potential nps will not be considered for schooling without a minimum of 2 years. I got quite a lengthy response, and will share below.

"AANP does not take a position on advancing straight into an NP programs or getting RN experience first.

However, I can offer my own personal experience as a NP. I think before you invest in the time and financial resources, it would be helpful to know if you want to take the additional responsibilities as an NP. The only way to find out is to work as an RN. Some RNs may find that they don't enjoy taking the responsibility of providing nursing care to others. Maybe they even find they don't like working with the public as much as they thought they would. Those responsibilities and commitments to your patients become even greater as a NP provider. The work duties alter with a higher level of responsibility, but the bottom line is you still have to like being an RN or you won't like being an APRN. Additionally, the more experience you have with seeing various therapeutic conditions, treatments and opportunities to educate your patients, the better you will be as a NP. There is no substitution for the experience you will have as an RN. Though you gain scholarly and clinical knowledge and experience as an NP student, applying that information is likely to be more difficult without the foundation of experience as an RN. Experienced RNs rely on their experience as a RN to apply and understand the next level as a NP. Granted, PAs go straight from undergraduate to graduate school, but most physicians and ancillary medical professionals (administrators, for example) find our prior RN experience of great value over the lack of medical experience of new PAs.

Some advantages of getting RN experience first is that you would have working knowledge of the profession, less of a learning curve at the next level, more confidence, and the direction of your growth was made based on your experienced instead of perceptions of our profession. If you become an RN first but later discover you don't want to be a provider, there are still other options you can pursue in the medical field before spending more time in school. Perhaps you might find that you like working in research, for example, or may want to pursue a graduate degree in Public Health or other medical-related fields, (AANP, personal communication, Sept 15/17)"

Interesting, but it is just the responder's personal opinion, as she clearly states. If RN experience should be required, why doesn't AANP or ANCC take an official stand?

[Wuzzie]

Do you know an RN who is diagnosing and prescribing? If so, they are performing illegal acts.

I'm sorry but you are misinformed. CCT/Flight nurses do it every single day.

[shibaowner, MSN, RN, NP]

Let's say NPs with RN experience are better. This would be reflected in malpractice insurance cost. So do such NPs pay less? No, they do not.

[Castiela]

I don't know, I was interested in that too. Barnes (2015) found orientation to be more helpful in transitioning to becoming an np than previous experience, but it doesn't report patient outcomes between the two groups.

(Barnes, H. (2015). Exploring the Factors that Influence Nurse Practitioner Role Transition. The Journal for Nurse Practitioners : JNP, 11(2), 178–183. Redirecting)

I guess it comes down to individuals. I don't doubt that you are a good fnp, and that people can be good fnps without additional Rn experience. I guess I wonder if you are the exception and not the rule per say, and out of those who go straight to be an fnp, what are their pass rates compared to those with experience? Patient outcomes? You sound like a mindful individual who rightfully takes pride in their eduction and work. However, what worries me is those who are only in the practice for the pay check; who do not have the critical thinking and cause patient harm. i worry about the non Yale/ John Hopkins programs that do not the same stringent practices as you experienced. Schools where their first goal is to create money and secondarily, make safe nurses.

I know that there are still Rn and Lpn programs that are the same, and I am not a NP or from the us, so I cannot speak to your regulation and safe checks. However, as an RN/ LPN, we tend to have what I imagine are more supports, people to ask questions to and regulation than say a new NP on their own (again, this is speculation on my part).

I think NPs are the future of healthcare, and they are gaining (sometimes it feels very slowly) the trust and respect of the government and the public. I'd be worried about what a sensationalist news story/ stories could do harm to that trust.

Again, I recognize there are "what ifs" to my fears, and I know that all nurses of all experience levels make mistake. However, they do tend to make less as they gain more experience, and don't see how having hands on experience practicing would ever work against someone/ be a negative thing before going to train to be an np.

[KeepinitrealCCRN]

Most primary care NP graduate programs no longer require bedside nursing experience. Note that is primary care. If you want to be an acute care NP, then most programs require some bedside nursing experience. Check with your schools for their requirements.

This has been a controversial topic. But NP schools have been accepting new grad BSNs w/o bedside experience since the 1990s. The evidence, although limited, indicates NP students w/o RN experience actually do better in grad school and also have better clinical exam skills than students with RN skills.

I went straight thru to get my AGNP and many others do, too. Ignore the negativity here and do what you want.

so i believe you can do just fine as an NP without RN experience but seriously??? NP students without RN experience have better clinical exam skills???? how can you even type those words and believe that to be the truth? additionally, there are so many other things that happen when you are actually taking care of patients on top of just assessing a pt that no book, lab or clinical in school can teach you (meds, education, assessment skills, lab values and what they really mean and look like etc). experience as an RN in any capacity will help you be a stronger NP hands down.

[shibaowner, MSN, RN, NP]

so i believe you can do just fine as an NP without RN experience but seriously??? NP students without RN experience have better clinical exam skills???? how can you even type those words and believe that to be the truth? additionally, there are so many other things that happen when you are actually taking care of patients on top of just assessing a pt that no book, lab or clinical in school can teach you (meds, education, assessment skills, lab values and what they really mean and look like etc). experience as an RN in any capacity will help you be a stronger NP hands down.

You're not an NP, are you? I am basing my statements on evidence. Where is your evidence?

[shibaowner, MSN, RN, NP]

To the defensive RNs here: do you really want a bunch of prospective NPs flooding RN jobs for just 1 or 2 years? Or would you rather hire RNs that truly want to be career RNs? There is an interesting thread in General Nursing about how many RNs are sick and tired of training new nurses who leave after 1 or 2 years to go to NP school.

Everyone wants NPs to be well trained. As another poster has pointed out, they need experience that will make them better NPs. The best way to accomplish this is NP residencies, which are growing in number. That way, the RNs have RN jobs and the NPs get directly applicable experience without disrupting the RN workforce.

[Dodongo, APRN, NP]

As another poster has pointed out, they need experience that will make them better NPs. The best way to accomplish this is NP residencies, which are growing in number. That way, the RNs have RN jobs and the NPs get directly applicable experience without disrupting the RN workforce.

What is the best way for NPs to get more clinical experience and training? It is NP residencies, which are growing in number.

Why are NP residencies more desirable than increasing clinical hour requirements within NP programs themselves? Instead of 600 hours we can require 2000 hours. That way NPs can graduate and hit the ground running, rather than needing extensive "orientation". That is something programs and, theoretically, accrediting bodies can implement easily and swiftly. Increasing the number of NP residencies would be quite costly and take a long time.

[KeepinitrealCCRN]

You're not an NP, are you? I am basing my statements on evidence. Where is your evidence?

my evidence is in common sense. I'm not an NP and have zero desire to be one, if i did i would go back to school and become one (its really not that hard). the fact that i am not an NP means nothing though so I'm not sure why you are asking.