More and more, I am seeing posts from people who want to leap straight from taking the NCLEX into an advanced practice role. (Often you see plans of "pre-nursing" students already plotting their CRNA careers, but that's another story.)
Also, an increasing number of schools are designing programs that greatly reduce or eliminate the need/chance for actual nursing experience before acceptance.
It's almost as if the advanced practice role is becoming ever more distant from its origins, i.e. hands on nursing.
On top of that, with questionable programs opening up (which often results in weak practitioners), is it possible that nursing as a whole gets a black eye by association?
Bottom line: is it time for a divorce? Should advanced practice nurses be retitled and called something along the lines of physician's assistants?
I have lots of girls on my unit going back to school for their masters and doctorates. Many of them having been nurses for years and I know they will be great APRNs. I'm excited for them to expand their knowledge and practice. I also work with some great NPs. The ones that are the best are the ones that have had years of experience on our unit and know our patients and have extensive knowledge about what brings our patients to our unit.
My hospital has flat out stated they will not hire NPs with no experience. They said they are having a hard time finding qualified ones as these direct entry programs pop up.
I feel like it devalues the degree and the experience that our great APRNs have. Advanced Practice is just that, practice. How many times a week do we field questions from people in here asking what is the quickest way to NP? And what we see in here in the tiniest drop in the bucket of people with this mentality.
If the school's won't require a minimum amount of experience to be accepted into their programs maybe it should be lobbied that X amount of years is required to become a licensed. I would support that without hesitation.
I'm a newish RN but as a 20 year paramedic I am declaring you a step trauma (step 4 in our system) on those details. You get crushed up by a cow butting you in the chest I have all sorts of bad possibilities in mind. Pulmonary contusion, broken ribs into lung tissue, cardiac contusion, great vessel damage, solid organ damage. I would want to rule all of that out. But then I've also been knocked sideways by livestock and understand their power.
Can you imagine if other professions (pilots maybe) wanted to do this? Can I just skip lessons 1-100 and get right to the part where I'm responsible for peoples' safety?
ETA: And by "this" I mean people wanting to skip the RN role entirely.
Those that believe skipping bedside to a means of gaining NP, Im not even sure Id want them as my RN to begin with. I love my NP. Ill take her over an MD any day, but as a patient I do my research. If your gonna touch me and my family, you better have your experience and knowledge down to a T.
I have lots of girls on my unit going back to school for their masters and doctorates. Many of them having been nurses for years and I know they will be great APRNs. I'm excited for them to expand their knowledge and practice. I also work with some great NPs. The ones that are the best are the ones that have had years of experience on our unit and know our patients and have extensive knowledge about what brings our patients to our unit.
My hospital has flat out stated they will not hire NPs with no experience. They said they are having a hard time finding qualified ones as these direct entry programs pop up.
I feel like it devalues the degree and the experience that our great APRNs have. Advanced Practice is just that, practice. How many times a week do we field questions from people in here asking what is the quickest way to NP? And what we see in here in the tiniest drop in the bucket of people with this mentality.
This post captures the problem perfectly.
Nursing school behavior will only be policed by market forces. If employers refuse to hire inexperienced NP graduates, they will tighten up their admission standards.
Regarding vernacular, why bother dropping the nurse title? NPs are overseen by the BON...
This topic is near and dear to me. I'm an experienced nurse who really loves the profession. I appreciate all of the many opportunities this profession has to offer --- whether they are at the bedside or not. That said, the strongest clinically trained (in the broad sense) nurses are those at the bedside. APN education has traditionally been built upon this fact. You cannot 'advance' what you have not even started. To my knowledge direct entry programs have not somehow reinvented the wheel in a way to satisfy a candidate's lack of real world clinical proficiency. I have heard all the arguments in favor of direct-entry programs. I'm just not convinced and I'm entitled to my opinion (and having been a nurse for over 20 years, I kinda think I've earned the right to it as well). I'm a very happy person. I have no ax to grind -- I see that accusation a LOT on these boards -- if you disagree with direct-entry NP programs you are just hateful and unhappy with your own life so you have to 'attack' others (BIG sigh).
I am in deep mourning for the CNS role -- it is so purely advanced practice nursing. In terms of general APN practice, I am in favor of NOT diluting the contribution of advanced practice that the profession of nursing has made in healthcare. I think the greatest thing would be for patients to see an APN and not be confused but know they are seeing a NURSE -- a real, live, very experienced and knowledgeable nurse who will provide accurate diagnostics, effective treatments and management, while also caring and advocating in ways that historically only nurses do.
My life was at stake by such APN, I had a closed chest injury where a crazed cow butt me in my chest, flipped me and walked on left elbow....compression fx t5...... 48 hr later increased increased pleuritic pain, I had to go back to ER as they forgot to give me tetorifice.....I wanted a chestxray follow up.....as pleural effusion etc can devolve from such closed chest injury the brand new NP, never work as a nurse did not understand the pathophysiology I was concerned with, Plus she forgot to sign scrips she gave me......with my 45 years experience in critical care, cv surg, CCU and ER...... We had some "schooling"
I'm not defending your NP in any way. But we have to train new doctors, too.
Direct entry NP with no previous experience. True online programs that only require a 2 week campus visit. They all meet the NP requirements. I work with one RN graduating from NP school and she has a 22 y/o in her class that had no previous experience who will be out in the world this semester. I got an email the other day- some site must have sold my address, not sayin nothin- online only ADN to NP without having to stop @ BSN and collect $200. I honestly don't know why anyone would go to RN school anymore. There are Associate Degree PA schools in FL (it was located in my "medical campus" was how I know)- when I tell PA's that they tell me I'm full of crap and must be MA or some-other eieio alphabet medical profession. We go to the website and they are shocked they spent so much time and money when 2 years is all you need to be a PA. The problem with PA's is there is no national standard- EMS addressed that problem by National Registry, if you want to be NR you have to do approved course and CEH hours to renew. Its always up to the state you live in to license you but more and more states and employers are deferring to NR. NR also makes it soooo much easier to receive reciprocity if you move.
Hello all, I was hoping someone had some good suggestions for EKG resources??? I will be starting my first NP job in a few months, which is a Cardiology clinic position. My program did not require me to learn how to read EKG. I have a few mo months so I am wanting to prepare. I have ACLS and i have taken an arrhythmia course in the past, so I have basic understanding of some things; however, i want to be more prepared than what i feel now, Thanks!
I currently teach advanced practice nursing courses (classroom and clinic with online components). Some of my students are in a direct entry program and some are experienced career nurses, so I've seen examples of everything you're talking about in this post first-hand from an instructor's perspective. Honestly, helping seasoned RN's make the transition to advanced practice (FNP) has been one of my biggest challenges as an instructor, because many experienced RNs find it difficult to get into the mindset of thinking like a provider†as opposed to doing what they've always done so well for their whole careers, which has been fulfilling physicians' orders. I'm constantly reminding my students that they are the ones giving the orders now. The NP role really does involve a different way of thinking from the RN role.
As I was reading this thread, a few things came up for me as important points to keep in mind: 1) hospital bedside nursing is not the only type of nursing; 2) nurses are trained under a fundamentally different philosophy and paradigm from physicians (physicians are trained to fix problems and nurses are trained to assess how well those fixes are working for the patient); 3) the concept of advanced practice†is more about advancing the nurse's scope of practice through academic preparedness than logging hours of experience; 4) there is no substitute for experience, and where the individual's journey begins for obtaining that experience should not matter; 5) not all experience transfers well into all work environments or job descriptions (which brings me back to point number 1).
As healthcare in general moves farther and farther away from valuing the human touch (less time allotted for medical encounters, algorithm-driven treatment protocols, tele-medicine, robotic and AI assisted assessments and procedures), I believe there will be more and more demand for well-trained nurses because nurses are trained to emphasize the human connection. Ultimately, that's what people want--better health and wellness--and you can't have that without quality human interaction. Having said all that, there is absolutely no excuse for bad nursing education programs, and weak practitioners will either get stronger with experience or find more suitable work for themselves. This is definitely an interesting topic.
Specializes in critical care, ER,ICU, CVSURG, CCU.
The Md on service was excellent....it was just this inexperienced NP that did not understand the pathophysiology potential in a violent close chest injury.....she did not see justification of follow up chest X-ray.... I literally have been elbows to elbows in cv surgery at Texas heart institute in Houston.....she did not have a clue, and attempted to not allow me a follow up chest X-ray, I'm funded with very good ins$,.... After some bitter "schooling" by me she relented.....a patient in distress should not have to fight for normal follow up care.... And her not signing her scripts were more exaole of her lack of knowledge
LovingLife123
1,592 Posts
I have lots of girls on my unit going back to school for their masters and doctorates. Many of them having been nurses for years and I know they will be great APRNs. I'm excited for them to expand their knowledge and practice. I also work with some great NPs. The ones that are the best are the ones that have had years of experience on our unit and know our patients and have extensive knowledge about what brings our patients to our unit.
My hospital has flat out stated they will not hire NPs with no experience. They said they are having a hard time finding qualified ones as these direct entry programs pop up.
I feel like it devalues the degree and the experience that our great APRNs have. Advanced Practice is just that, practice. How many times a week do we field questions from people in here asking what is the quickest way to NP? And what we see in here in the tiniest drop in the bucket of people with this mentality.