You don't need RN experience to get an NP job

[FullGlass]

I'm a new grad Adult and Geri Primary Care NP. I do not have RN experience. Since I started seriously pounding the pavement in my job search, I have had numerous phone and in person interviews. I've also received multiple job offers.

Has anyone asked me if I had RN experience? Yes. When I answer that I have none, here are the 2 responses I've received:

"Good for you!"

"You must be very smart."

This will probably upset some readers, but it's the truth.

There are some job postings for new grad NPs for outpatient specialty positions that do require RN experience - oncology is one.

Conclusion: if you want to be a Primary Care NP, you are fine going straight from BSN to MSN. There are plenty of employers that will be happy to have you, at least in the Western U.S.

[Jules A, MSN]

What good would counting responses be? The plural of anecdote is not evidence. It should be no surprise that people with RN experience find that experience valuable for the most part, it is a natural instinct. Those that don't have prior RN experience have other life experiences they find valuable. This has been shown in the literature as well.

It would possibly serve to challenge the repeated statements that those complaining about DE aren't even NPs.

Can you cite/quote a post where anyone on this forum has said their entire DE class was skilled and successful? I've never actually seen that said. What I have seen, time and time again, is people make an assumption that most DEs are somehow inferior, which is as flawed as assuming all are skilled and successful and this is exacerbated by the fact that many of those posts are made by those with a personal vendetta against a group of people that they have never even met. Lets not call the kettle black.

This is one:

Make that n=2, Jules. If you count my entire cohort, make that n=41. All hired without RN experience; all successful NPs.

As far as admitting psych patients with terrible medication regimens, isn't this part of the natural course of many mental illnesses.

You might want to re-read because I was only referring to my NP class and my inability to report on my classmates' skill set.

[Jules A, MSN]

Did you have psych RN experience? Specialties are really a different story vs primary care and, though I don't have research to support it, I feel like APRNs do need some sort of formal experience outside of their graduate preparation.

While I agree with you I find this contradictory to your repeated support of DE programs. So you only approve of primary care DE programs? Totally not trying to pick a fight just not sure I'm following this thread as it has taken many twists and turns.

[djmatte, ADN, MSN, RN, NP]

I'll concede the reality that is there is little to no research that shows one way or another whether RN experience impacts NP outcomes. One study showed that out of a sample size of 150, there was no statistically significant relationship between year of BSN completion to successful NP program completion, but they also noted that there was a lack of evidence (Richard-Eaglin, 2017). It also was looking at ability to complete the program and had nothing to really do with competence or impact of prior experience at entry level.

So while some of us are accused of using anecdote and "feelings" in our judgement, the same can be said both ways. But with a direct entry degree, you are no better prepared than a PA (possibly even less prepared). PAs in many schools are required to complete upwards of 2000 hours of patient-based care before matriculation...followed by a similar clinical hour requirement to NPs. So when the concern about "independent practice" comes up where some states believe that NPs can have more independent privileges than a PA, what side of the coin will you stand on? Because RNs who have practiced for years have all of that clinical knowledge to reinforce their assertions. Which was the whole point of advance practice RNs in the first place. Utilize a body of clinical knowledge with advanced education to fill gaps in healthcare.

Richard-Eaglin, A. (2017). Predicting student success in nurse practitioner programs. Journal Of The American Association Of Nurse Practitioners, 29(10), 600-605. doi:10.1002/2327-6924.12502

[BostonFNP, APRN]

While I agree with you I find this contradictory to your repeated support of DE programs. So you only approve of primary care DE programs? Totally not trying to pick a fight just not sure I'm following this thread as it has taken many twists and turns.

I really don't have the experience to make any meaningful judgement about PMHNPs and DE programs. I can imagine that acute psych RN experience would be more directly applicable to advanced practice than primary care. Do you feel that only acute psych experience is necessary to the role? Or any nursing experience. For instance, if I spent ten years a a RN in an allergy practice is that experience necessary to PMHNP school?

PMH is a specialty APRN practice but it is coupled with a specialized education and training. I guess I really haven't thought about DE programs in that setting (and as above, no do I have the expertise to judge). I do have reservations about any novice NP (regardless of experience) moving directly into a specialist/sub-specialist role. Perhaps that is unfounded but I have had some questionable experiences that concern me, but at least I can admit my own bias here.

[BostonFNP, APRN]

It would possibly serve to challenge the repeated statements that those complaining about DE aren't even NPs.

Do you disagree that there is a significant amount of passionate opposition to DE NP practice by nurses that aren't NPs?

[WestCoastSunRN, MSN, CNS]

I think if a novice NP is "outed" as having no prior RN experience that they would face an uphill battle. Maybe I'm wrong.

.

My experience with new providers is they are judged according to their ability to work with others and be competent decision makers for the sake of the patients they serve. As with any provider (or nurse) -- those who do not play well with others are not going to receive warm welcomes in morning rounds. Those personalities open themselves up to scrutinization. A provider's basic readiness to practice is fairly evident in the first few meaningful clinical interactions. I assert that this is how nurses initially judge providers -- not based on the school or type of program they went to.

That said, I do work in acute care and in all honesty I have never worked with a DE NP. Maybe I don't know what I'm missing! :)

[BCgradnurse, MSN, RN, NP]

It would possibly serve to challenge the repeated statements that those complaining about DE aren't even NPs.

This is one:

You might want to re-read because I was only referring to my NP class and my inability to report on my classmates' skill set.

And I am only reporting on my cohort's experiences. We've stayed in touch. True, I can only go by what they're reporting, but all were employed shortly after graduation, and continue to be employed as NPs today, with the exception of 1 who is taking time off to raise her children. There were 2 who didn't make it through the program. They couldn't maintain the required GPA or demonstrate competent skills.

Jules-you really seem to look down upon DE grads. I asked before and I'll ask again. I this just something you "feel", or have you had specific experiences with DE grads that have caused you to form your opinion?

[Jules A, MSN]

I really don't have the experience to make any meaningful judgement about PMHNPs and DE programs. I can imagine that acute psych RN experience would be more directly applicable to advanced practice than primary care. Do you feel that only acute psych experience is necessary to the role? Or any nursing experience. For instance, if I spent ten years a a RN in an allergy practice is that experience necessary to PMHNP school?

PMH is a specialty APRN practice but it is coupled with a specialized education and training. I guess I really haven't thought about DE programs in that setting (and as above, no do I have the expertise to judge). I do have reservations about any novice NP (regardless of experience) moving directly into a specialist/sub-specialist role. Perhaps that is unfounded but I have had some questionable experiences that concern me, but at least I can admit my own bias here.

I also admit that a majority of my complaints are my own bias based on how valuable I feel my RN experience was for my specialty. Perhaps it can be said that I'm not the sharpest knife in the drawer therefore I required the thousands of experiences with the different medications, different presentations and adverse reactions to feel competent to practice independently upon graduation with only 500 hours and 2 pharmacology courses?

The truth is as someone eloquently pointed out regardless this ship has sailed so I'm not overly interested in continuing to waste my breath except when I see what I feel are significantly flawed statements.

[FullGlass, BSN, MSN, NP]

I think the "those mean ol' bedside nurses" assertion is not generally true or helpful. I don't actually work with any nurses who possess the us v. them attitude with regard to nursing and medicine or nursing and APN. The truth is all newbie providers benefit from guidance/help from experienced nurses. I don't think those providers need worry that those helpful nurses think themselves superior (if that's an issue) or having education equal to a provider. Nurses advocate for their patients, they do what they can to keep them safe -- and my experience has been that they LOVE watching new, passionate, smart, competent providers come up - NPs included. Now are they watching those NPs closely? Sure -- as nurses we ALL are -- because they represent our most advanced practitioners and that speaks something about the WHOLE profession. We have countless threads on AN about NP preparation. All sorts of people are interested and have skin in that game.

So in the words of Spanked .... I am one of those "twits" that care.

There are very few RNs that work in primary care clinics. The typical practice has MDs, DOs, NPs, PAs, and Medical Assistants. Some have an LVN. So, no, RNs do not have great influence or even contact with Primary Care NPs.

[Jules A, MSN]

Jules-you really seem to look down upon DE grads. I asked before and I'll ask again. I this just something you "feel", or have you had specific experiences with DE grads that have caused you to form your opinion?

I'm no more skeptical about DE grads as the trend to go straight through without ever practicing as a RN and I'll be the first to admit of course there are good and bad in all groups. My biggest complaint is our education which I believe was founded on the notion that RN experience supported a brief formal education. In answer to your question I'm in the Washington DC metro so there are more schools in this area than I care to count and the number of new graduates is increasing exponentially. Working on an acute unit I am privy to the prescribing and diagnostic skills and while there are good and bad in all disciplines in my anecdotal experience the new PMHNPs without any psychiatric nursing experience are generally not good.

I would be in favor of both avenues if admission requirements were more stringent, coursework was more vigorous and/or residencies were required. Again my bias but although I believe RN experience is valuable it is more about my perceived lack of quality and hours in NP programs. Now here's my flimsy n=2 but neither of my well respected NP programs were impressive, light coursework, many inexperienced faculty with minimal vetting of preceptors.

[WestCoastSunRN, MSN, CNS]

There are very few RNs that work in primary care clinics. The typical practice has MDs, DOs, NPs, PAs, and Medical Assistants. Some have an LVN. So, no, RNs do not have great influence or even contact with Primary Care NPs.

True enough. And primary care is outside my realm, to be sure. I'll maintain that RN experience isn't going to hurt a primary care NP -- but anytime I consider this issue -- I am, admittedly, thinking in terms of the acute care world I live in.

[BostonFNP, APRN]

I'll concede the reality that is there is little to no research that shows one way or another whether RN experience impacts NP outcomes. One study showed that out of a sample size of 150, there was no statistically significant relationship between year of BSN completion to successful NP program completion, but they also noted that there was a lack of evidence (Richard-Eaglin, 2017). It also was looking at ability to complete the program and had nothing to really do with competence or impact of prior experience at entry level.

There are about a dozen small studies and they all consistently shown there is no significant correlation of NP role socialization and prior RN experience. None are large studies but they are all rather consistent over different study designs. The Rich study was perhaps the most developed of the studies, and while limited, the body of the evidence surely doesn't suggest any major difference with prior RN experience.

Because RNs who have practiced for years have all of that clinical knowledge to reinforce their assertions. Which was the whole point of advance practice RNs in the first place. Utilize a body of clinical knowledge with advanced education to fill gaps in healthcare.

This has long been the defacto argument, and perhaps it holds weight, at least within the nursing community. The logical counter then is why then do we need graduate clincial experience at all; shouldn't advanced education coupled with years of clinical knowledge be sufficient? Is it safe practice to fill in gaps in provider experience with non-provider experience?