When to apply for nurse practioner programs

JBMmom, MSN, NP · Jul 12, 2019

No one will really be able to tell you what will work for you. There are plenty of people that found a direct entry program without RN experience to be what they are looking for. Personally, I would not have felt comfortable doing that. Even though the role of nurse and provider are very different, I think that my years of floor nursing have been invaluable to improving my assessment and critical thinking skills that I will certainly need in the practitioner role. I was practicing for a little over five years before I applied to NP school and had I been younger than 45 I probably would have waited longer, but that's just my personality and what I would have preferred. You can be successful, or not, with any amount of experience. As for finishing school before having a family, I can totally understand that. My youngest is 11 years old and I've been in school or working two jobs for 10 of those years. I've missed out on a lot, but my kids have also seen the importance of schooling and that's a bonus to going back when you have kids. Good luck with your decisions.

Oldmahubbard · Jul 13, 2019

It would be helpful to have some RN experience before NP school. What type of NP do you want to be? Experience clarifies this.

In the meantime, you might be able to take some of the core classes that all NP's take as a non-matriculated student.

AnnieNP, MSN, NP · Jul 13, 2019

I'm in the camp of having some RN experience first. I'm sure there are many students who do well without it, I just haven't really seen it myself. I have been precepting for over 10 years and I do see a difference between the students that have experience those that do not. I no longer accept students that have no RN experience.

Hoosier_RN, MSN · Jul 13, 2019

out of the 6 NPs that are at my MDs practice, 4 are experienced-5+ years or more-and the other 2, 1 is a direct entry and the other had about 2 months of bedside and then school. The last 2 have had less than 2 years as NPs, the rest- 2 have 10+ years each, 1 is at 3 years, the last of that group is new at it, but was a nurse for 17 years. I personally won't let them schedule me with the 2 (bedside nursing) inexperienced NPs anymore, as there is a difference in the care. The MD is a personal friend as well, and she states that she has had the same comments from many people. Just my 2 cents worth

direw0lf, BSN · Jul 13, 2019

You're going to get a lot of anecdotal stories in response to this question about how long to wait (if at all) to apply to an NP program.

I decided to wait about half a year after I graduated nursing school to apply for NP school, but I did a lot of research sooner than that.

I will tell you, it is very tempting and easy to get into NP programs that aren't very good. There's many programs out there that have nearly 100% acceptance rates, with very little effort on the part of the applicant, and graduation in 12-15 months. Some of these poor schools require 1-2 years of nursing experience -and that's because they don't plan on teaching you very well and will rely on your experience as a nurse.

When I was deciding what to do, like my junior and senior years of undergrad, I really weigh NP vs PA programs. Across the US, PA programs are pretty competitive to get into. My friend is in one, and I'm glad I didn't chose the PA route because for the money, it wouldn't be the best use of a nurse's time and effort to go through PA school IMO. For example, in one of my friend's PA lab she learned how to perform lumbar punctures, venipunctures and insert foley catheters. The science background for PA is very good though..so they understand disease processes very good.

Anyway why am I mentioning this? Because if you specialize in an area for NP, you'll have a more focused education than a PA gets. For example, Acute care Pediatric NP or Adult-geri Primary NP. And why am I mentioning PA at all? Because Allnurses tends to frown on NPs who are new or don't have years of bedside nursing experience first. Ridiculous, when, PAs go into their programs with no clinical experience whatsoever. NPs have the numbers, and they're the ones who will be influencing policies. PA numbers go down, while NPs go up. PAs in the future will be limited in what areas they can work in. I think they'll gain majority in surgery, and that's about it. NPs will control the other specialties. And the disdain for NPs with little to no nursing experience is going to change also, because little to no exp will become the majority. Education will be forced to improve.

So the NP specialty and program you pick are extremely important, and not so much how long you spend working as a nurse first. The future of NPs and their education are changing. Choose a good school for your NP. Look at their rankings (US News) but also look at attrition rates, clinical placement assistance, reputation, etc. I chose my school because it has strong medical and nursing reputations/backgrounds, and the program is excellent in patho and helps place you in clinicals. Look for one like that, it's worth the extra effort you have to give to get accepted. If you haven't already, build your rapports now with your manager or a professor so you get good reference letters. Work hard and smart.

Oldmahubbard · Jul 13, 2019

I know in my field, Psych NP, I would have been totally unprepared without my 4-5 years in the field as a RN. And a huge amount of self prep.

The thing with PA's is that their clinical experience is much more intense, and God Bless 'Em, they don't have all the bull feces coursework about Nursing Theory and the APA format.

I am sad to say my MSN preparation at a private brick and mortar school was so woefully inadequate as to be just embarrassing.

They were apparently working off the model that a physician is in the next room checking your work.

It hasn't been that way in 40 years, if it ever was.

direw0lf, BSN · Jul 13, 2019

7 minutes ago, Oldmahubbard said:
The thing with PA's is that their clinical experience is much more intense, and God Bless 'Em, they don't have all the bull feces coursework about Nursing Theory and the APA format.

PA school is intense but it's also broad. I could have gone to PA school for 2-3 years, or to NP school specializing in one area for 2-3 years. Which will come out stronger in that one area, if both schools are equally good? PA ends up choosing a specialty anyway at the end. While I'm in school, I'll also be working in my specialty as a nurse.

I know PA students usually can't work after the first year of their program, if even that, and they have more clinical hours, but I still think NPs come out ahead.

FullGlass, BSN, MSN, NP · Jul 13, 2019

It depends what kind of NP you want to be. If you want to be in Acute Care or Oncology, you MUST have RN experience and that makes perfect sense.

If you plan to go into primary care, you don't need RN experience. I went straight through from ABSN to MSN NP. I'm doing just fine and have been given good feedback on my performance. As a new grad, I had 9 job offers in the Western US.

Now, with over one year of experience, and having worked with other NPs and PAs, I don't see that NPs with RN experience are any better. The one NP our clinic fired had 10 years of RN experience, including ER experience. She was fired due to a combination of incompetence and poor patient relationship skills. Here's another example: one of our NPs had 10 years RN experience and has 5 years NP experience. Pt comes in with possible abscess (small flesh-colored lump, a little soft), but it was not fluctuant or ready for drainage. I told them to apply warm compresses and come back in one week or when ready to drain. I was not in clinic when patient returned, and the abscess had gotten considerably bigger and become quite hard. This other NP just cut into it and nothing came out. Patient then came back again and saw me. I took one look and knew something was wrong and asked an MD for a consult. He said this was skin cancer! This also required surgical removal as it was so large and surgical referral. He also told me not to just go cutting into lumps and bumps unless one is sure that it is a abscess as that is just creating a gateway for infection. So, score one for the NP w/o RN experience who has some common sense (me)!

In primary care, RN skills really don't matter. Primary care clinics generally do not run IVs or all the other nursing skills that some people on this forum are so obsessed about. The only thing that RNs might have some advantage with are knowing more of the meds and wound care. Both of those things can be learned.

As for physical exam skills, no, RNs do not have better PE skills. The little research indicates the opposite is true! During my schooling, when we had PE labs, the working RNs did not perform better for the most part. I ended up coaching some of them!

As has been discussed endlessly elsewhere on this forum, the little research done on this topic indicates that there is no advantage to RN experience for a primary care NP. NONE. I would argue that it might be an advantage to have a provider mindset from the get-go.

If you know you really, really want to be a provider in primary care, then just go for it!

The only feedback I have received on a personal level about this issue is that because NP is my second career, I am mature individual and had very senior responsible positions before, so I have an advantage in that regard.

adventure_rn, MSN, NP · Jul 14, 2019

Fantastic advice form others.

I just want to add that working may also help you to clarify what type of NP you want to be, or if you'd like the NP role at all. Working in the inpatient setting will give you a much better understanding of the acute care NP role, which can help you clarify if you'd prefer to work in primary care or acute care.

Seyleigh · Jul 17, 2019

Thank you everyone for your answers and advice!