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?
physician assistant sounds a whole lot less impressive than nurse practitioner
PA are masters level caregivers who work under the direct supervision of an MD. most wanted to go to med school and couldn't for various reasons
nurse practitioners are (supposed) to be ADVANCED level nurses who have been in the game for a long long time and now its time for them deliver quality next level care.
arnp are a different animal. they see the patient from the nurses eye. you have to be a nurse to truly understand what that means.
no... do not take nurse from arnp. NURSE is their core.
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
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.
I found this to be a well thought out response, especially since it is written by someone who has experience teaching Advanced Practice Nurses, NPs in particular. I cannot help but stand by my original opinion that any prior experience would benefit an Advanced Practice Nurse in his/her education. My CNS program in Critical Care/Trauma had a heavier emphasis on Critical care, and the ICU nurses in my class had an easier time with the concepts than those of us with an ED background. I also feel one can learn the new role of a provider such as writing orders, even ease into it. How many experienced nurses have advised/helped/even saved young MDs with inappropriate/incomplete orders? My daughter is an ACNP on an acute floor and a staff nurse in a major Level trauma center ED. Not all NPs work in acute care, thus an NP in a primary care setting might not need an intensive acute care background. I want my provider, an MD, NP or PA to have the very best training and education. The direct entry NP programs, in my opinion, are short sighted in not requiring RN experience before acceptance. How much an RN should have is unknown to me.
The major university where I received my MS requires their NP students (three year direct entry program) to step out after sitting for the Boards to get some experience before moving on to the NP curriculum. That is anecdotal, of course, and perhaps not a popular opinion. With the wealth of information out there, the challenge to me seems far greater to assimilate all that knowledge, and learning the provider role seems very doable with time. There are no shortcuts, in my opinion.
I am a CNS. Most of the few of us left do not work in a provider role. Though we are one of the APRN roles, we have less in common with those roles in many cases than we do with the RN role. Mostly, we do not bill separately in my state or prescribe meds, except for PMH CNS's. Though I have seen CNS's as providers in some areas, most of us are in a supportive and consultative role to the nursing staff -from the bedside to the administrative nurses. I think that our role should be revisited. We are experienced nurses, not like the Master's entry Clinical Nurse Leader role, who are generalists and often entry level. (Why the heck did they allow this role to have a name so close to CNS????---CONFUSING to the general public and even nurses). We are the nurses' nurse, as we were once known. I think the role is needed more than ever as we have many people entering practice who need a lot of support. Many nurses want to advance, but do so by leaving the bedside. We need nurse experts more than ever to support nursing, not just to support the "medical" provider role. Keep at least some of our nurses in nursing...please!!!
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
I am a CNS. Most of the few of us left do not work in a provider role. Though we are one of the APRN roles, we have less in common with those roles in many cases than we do with the RN role. Mostly, we do not bill separately in my state or prescribe meds, except for PMH CNS's. Though I have seen CNS's as providers in some areas, most of us are in a supportive and consultative role to the nursing staff -from the bedside to the administrative nurses. I think that our role should be revisited. We are experienced nurses, not like the Master's entry Clinical Nurse Leader role, who are generalists and often entry level. (Why the heck did they allow this role to have a name so close to CNS????---CONFUSING to the general public and even nurses). We are the nurses' nurse, as we were once known. I think the role is needed more than ever as we have many people entering practice who need a lot of support. Many nurses want to advance, but do so by leaving the bedside. We need nurse experts more than ever to support nursing, not just to support the "medical" provider role. Keep at least some of our nurses in nursing...please!!!
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.
What associate degree PA program are you talking about? You're framing it like this PA degree is a direct entry from high school. I would be shocked too if you're right!
There are Associates, Bachelors, and Masters level PAs, but their curricula are very similar.
PA programs may be direct entry (no experience) or they may have admission requirements of healthcare experience (these requirements vary from shadowing/volunteering a few hundred hours to being a paid healthcare provider with 2 years experience).
PA was originally created for the very experienced provider (Vietnam medics with years of experience were the prototypical PA student). No longer the case...
I am a CNS. Most of the few of us left do not work in a provider role. Though we are one of the APRN roles, we have less in common with those roles in many cases than we do with the RN role. Mostly, we do not bill separately in my state or prescribe meds, except for PMH CNS's. Though I have seen CNS's as providers in some areas, most of us are in a supportive and consultative role to the nursing staff -from the bedside to the administrative nurses. I think that our role should be revisited. We are experienced nurses, not like the Master's entry Clinical Nurse Leader role, who are generalists and often entry level. (Why the heck did they allow this role to have a name so close to CNS????---CONFUSING to the general public and even nurses). We are the nurses' nurse, as we were once known. I think the role is needed more than ever as we have many people entering practice who need a lot of support. Many nurses want to advance, but do so by leaving the bedside. We need nurse experts more than ever to support nursing, not just to support the "medical" provider role. Keep at least some of our nurses in nursing...please!!!
Great post. The CNS's I know are also not in the provider role, but are more experts in a particular area of nursing and a huge support to the staff in those areas. The nurse's nurse. Yes! I would LOVE LOVE LOVE to advance to this role, but I do not see it as a sure thing employment-wise. And I do not understand why there still are so many CNS's (visit a critical care conference and see...), but it looks like the certifying bodies are dropping the certifications. It's confusing to me.
I'd like to ask those who are OK with a brand new BSN going directly into an online nurse practitioner program how they would feel about a medical doctor doing online classes and skipping the four year residency?
My primary care provider is a nurse practitioner. She had a vast wealth of experience prior to becoming a nurse practitioner, then she worked as a hospitalist nurse practitioner before opening up her own practice. In other words she has street cred up the yin-yang.
A coworker of mine in the emergency room just did an online nurse practitioner schooling, and just passed her boards. She did all this while working full-time, and now she's going to come back to us and work as a mid-level in our emergency room. She has enough experience that I have total faith in her. She's worked in the ICU and she worked many years in the emergency room. I have a lot of respect for her and faith that she'll do great. If she was all full of book learning, with a short residency, I wouldn't feel the same.
Specializes in Flight, ER, Transport, ICU/Critical Care.
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"
Oh wow. I'm glad you survived that.
:angel:
And I'd bet my socks that you didn't even need books to school the NP. I'm sad you had go through that experience. I'm so glad you were you and could intervene on your behalf.
What do seriously injured mere mortals do that encounter unqualified clinical practioners in the acute care setting?
I'm a CNS in a provider role x11 years. I had 12 years nursing experience prior to becoming an APRN. The roles are different. Do I think my RN experience helped as a new provider? Yes, because I had solid assessment skills down as well as good time management skills.
However, was I able to easily discuss end of life issues, goals of care with pts/families? Nope - had to learn that part. Also, I had to learn to be confident in my decisions and KNOW I was doing the right thing. Did I have disagreements with pts/families/other providers? Yep and via years of APRN experience I can usually get issues resolved.
Would I trade my RN experience? Nope I absolutely loved my RN role in the ED.
I am a CNS. Most of the few of us left do not work in a provider role. Though we are one of the APRN roles, we have less in common with those roles in many cases than we do with the RN role. Mostly, we do not bill separately in my state or prescribe meds, except for PMH CNS's. Though I have seen CNS's as providers in some areas, most of us are in a supportive and consultative role to the nursing staff -from the bedside to the administrative nurses. I think that our role should be revisited. We are experienced nurses, not like the Master's entry Clinical Nurse Leader role, who are generalists and often entry level. (Why the heck did they allow this role to have a name so close to CNS????---CONFUSING to the general public and even nurses). We are the nurses' nurse, as we were once known. I think the role is needed more than ever as we have many people entering practice who need a lot of support. Many nurses want to advance, but do so by leaving the bedside. We need nurse experts more than ever to support nursing, not just to support the "medical" provider role. Keep at least some of our nurses in nursing...please!!!
I definitely agree. I used to be a CNS -- one who got "pushed out" of the role as some people tired to change it from its original conception of being a nursing leader and supporter of expert practice ... to a job of mid-level provider. That's when I switched to Nursing Professional Development.
I thought it was sad then ... and think it is sad now. We need more of the "old" type of CNS -- the person who is a leader/resource for the staff nurses and others who need expert advice on nursing care.
Interesting thread. This topic has been debated vigorously on the APRN and NP forums.
All available evidence indicates that NPs without RN experience are as likely, or more likely, to succeed in MSN programs. In addition, some studies indicate NPs without RN experience have superior clinical skills as evaluated by NPs and MDs. Not one single study has demonstrated that NPs without RN experience have worse patient outcomes. In addition, I fail to see how RN experience in an acute care setting helps in the primary care arena. Many primary care and outpatient specialists have told me they have no interest in hiring an NP or PA who only has acute care experience. Finally, ironically, this is similar to the MD vs NP debate. We all get frustrated with MDs arguing against full practice authority for NPs even though over 100 studies have shown NPs provide the same, or better, quality of patient care. So now we have RNs and NPs arguing that RN experience is necessary to be an NP, but without any supporting evidence.
I do believe we should have NP residency programs for new grads and the AANP, ANNC, and state level NP organizations should lead the way in helping us with policy, legislation, and funding to support this. It would be great if there was funding for residencies in underserved areas and NPs choosing this route could get tax breaks or some student loan forgiveness.
Online programs deliver didactic content online. Clinicals with preceptors are still required. There are many reputable online programs such as Frontier Nursing University.
With regard to online courses – if it is just lecture, then who cares? In fact, the advantage of an online lecture is you can listen to it as many times as you need, whenever you want. The only value to an in-person class is if there is substantial class participation and Q&A. Only a few of my MSN classes had that, and I went to a top school. There are online learning platforms that do provide for real-time student participation and allow the instructor to call on individual students. Online education is the future of education.
References
El-Banna MM, Briggs LA, Leslie MS, Athey EK, Pericak A, Falk NL, & Greene J. (2015). Does prior RN clinical experience predict academic success in graduate nurse practitioner programs? Journal of Nursing Education, 54(5):276-80. doi: 10.3928/01484834-20150417-05.
Rich, E. R. (2005). Does RN experience relate to NP clinical skills? The Nurse Practitioner, 30(12), 53-56.
Rich, E. R., Jorden, M. E., & Taylor, C.J. (2001). Assessing successful entry into nurse practitioner practice: A literature review. Journal of the New York State Nurses Association, 32(2).
Just Dave
11 Posts
physician assistant sounds a whole lot less impressive than nurse practitioner
PA are masters level caregivers who work under the direct supervision of an MD. most wanted to go to med school and couldn't for various reasons
nurse practitioners are (supposed) to be ADVANCED level nurses who have been in the game for a long long time and now its time for them deliver quality next level care.
arnp are a different animal. they see the patient from the nurses eye. you have to be a nurse to truly understand what that means.
no... do not take nurse from arnp. NURSE is their core.