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.
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! :)
You must be luckier than me because I know lots of competent physicians that don't play nice with each other let alone the nursing staff!
I am not sure the ultimate competency of providers can or should be judged by their first clinical interactions. Each July there is a new crop of medical interns that if judged by their first clinical interactions would be heavily favored for ultimate failure in medicine!
I'm sorry; I was a bit cranky yesterday. However, in my previous career I was quite successful, so based on my experience, people who plan to fail will indeed fail. While it is important to have a realistic view of one's career choice - job market, trends, salary, etc. - people who have a gloom and doom attitude are generally unsuccessful. Successful people are empowered individuals who believe in their own ability to achieve success despite the odds. Individuals who think: "oh, the job market is terrible, so I won't find a job," "oh, i can't work more than a 5 mile radius from my home," "i can't possible move to get a good job," and so forth will indeed fail.
Let's look at acting - certainly a field where there are more hopefuls than there are good jobs. Yet, that doesn't stop people from pursuing an acting career and every year there are new stars who do extremely well. I will say that pursuing acting seriously generally requires moving to LA or NYC and individuals who refuse to do so are putting themselves at a serious disadvantage.
Projections are just estimates. It is very hard to make an accurate projection beyond 5 years. The farther into the future the projection is, the greater the margin of error. At any rate, if there is a surplus of NPs in the future, then the best will still get jobs.
We have a surplus of lawyers, yet the graduates of the top law schools still get hired for big bucks by the top law firms. There is no shortage of aspiring business hopefuls, but graduates of top MBA firms still get hired for big bucks by corporations.
Having a can do attitude, planning for success, and being willing to make some sacrifices in order to achieve one's goals are necessary for NP success, and success in any other field, for that matter.
Oh, I fully plan to succeed :) I wouldn't be making a mid-life career change (also from a previously successful one) to do this if not! I am excited I have the chance to do it. I am also not planning to go the primary care route, partly because of the saturation in my area. Then again...that wasn't my area of interest anyway.
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.
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?
hmmm. I don't think that's a logical counter. djmatte is just saying advanced practice is about building on a solid nursing foundation -- I don't see her saying there isn't a difference in clinical experience.
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.
Of course they aren't any good! They are novices with or without experience; I would hope we could all admit in our first year or more of practice we were far from experts. This is true of physicians as well, in their intern year and beyond.
So the big question: at what point does it balance out? When does years experience as a provider eclipse years experience as a relevant RN, or does it ever?
I would be in favor of both avenues if admission requirements were more stringent, coursework was more vigorous and/or residencies were required. .
There is obviously a great concern for the lack of standards in the exponential increase in NP programs, I hope we can all agree on that.
hmmm. I don't think that's a logical counter. djmatte is just saying advanced practice is about building on a solid nursing foundation -- I don't see her saying there isn't a difference in clinical experience.
What makes that foundation? Nursing education and pre-licensure experience? All RN experience? Relevant RN experience?
I at one point made an argument that if we are going to have DE programs than those students should be taught from day 1 as APRNs rather than spending 1-2 years learning as an RN then another 1-3+ years re-learning as providers. Would this be better or worse?
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.
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?
I found 1 small study using ebsco host that stated there wasn't enough data and more needed to be done. But by all means, present your "dozen" studies and I would gladly retract my views. I'm betting it generally hasn't been studied.
Regarding the defacto argument...that was the argument for APRNs early on. RNs serving populations in significantly under-served regions were already practically serving roles of providers. Mary Breckenridge was teaching midwives in the Kentucky Mountains well before someone decided it should be a Master's degree. And at the same time improving patient outcomes and getting access to needed care where there were few providers. Adding the advanced degree structure simply gave it more legitimacy and improved it from a safety perspective. Outside that, it only serves to gain recognition with grander accrediting bodies and motivate states to further recognize the role.
But there is a safety aspect when it comes to experience as well. RNs have strong experience in patient safety and advocacy. And as I noted, that experience places the RN experienced NP more on par with a new PA and likely more experienced than most new MDs out of med school than any DE NP fresh out the gate. So when MDs complain about autonomy because NP school prep is insufficient, for DEs I think they have a legitimate gripe. NP school as a whole lacks compared to the requirements of other fields...especially when people use it as a fast-track to provider status. I pointed out the differences between DE NP school experience and PA school and in many states where NPs are getting independent practice, PAs are still stuck on MD tethers. Maybe that is evidence of PA unions failing, or perhaps the general community and voting bodies don't realize their NPs have less actual healthcare experience upon graduation than they were hoping.
I found 1 small study using ebsco host that stated there wasn't enough data and more needed to be done. But by all means, present your "dozen" studies and I would gladly retract my views. I'm betting it generally hasn't been studied.
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Of course they aren't any good! They are novices with or without experience; I would hope we could all admit in our first year or more of practice we were far from experts. This is true of physicians as well, in their intern year and beyond.
So the big question: at what point does it balance out? When does years experience as a provider eclipse years experience as a relevant RN, or does it ever?
Of course none of us were impressive immediately but in my experience there is a marked difference in the quality of diagnosing and prescribing from new PMHNPs who do not have psychiatric experience as compared to the new grads who have worked as a psych RN.
Excellent points about what the future brings and I would imagine the gap does narrow however in psychiatry the outpatient prescribing jondra can be quite the silo. I have seen bad prescribers of all disciplines who are only privy to their own work and who never improve. Like you mentioned earlier the actual results in psych can be unpredictable and also difficult to quantify. My major concerns are outrageous peds diagnosing, unjustified poly pharm, multiple meds with none at therapeutic levels, benzos with opioids and/or stimulants etc. Seriously negligent practices because the majority of psych is actually rather subjective.
I don't disagree with this statement at all but also don't think not being a NP reduces the value of our colleagues' opinions and concerns.
Opinion and expertise are two different things.
I have an opinion about the treatment of decompensated schizophrenia. I am sure you do too. Are our opinions of equal value? Does expertise play a role in the value of opinion?
Of course none of us were impressive immediately but in my experience there is a marked difference in the quality of diagnosing and prescribing from new PMHNPs who do not have psychiatric experience as compared to the new grads who have worked as a psych RN.
So it is specifically psych RN experience? I can understand that in a narrower specialty.
I think this becomes a difficult thing to qualify in the primary care world: how do you qualify which type of RN experience is valuable and which is not?
Excellent points about what the future brings and I would imagine the gap does narrow however in psychiatry the outpatient prescribing jondra can be quite the silo. I have seen bad prescribers of all disciplines who are only privy to their own work and who never improve. Like you mentioned earlier the actual results in psych can be unpredictable and also difficult to quantify. My major concerns are outrageous peds diagnosing, unjustified poly pharm, multiple meds with none at therapeutic levels, benzos with opioids and/or stimulants etc. Seriously negligent practices because the majority of psych is actually rather subjective.
This problem is rampant through all of medicine and from all sorts of different providers. You bring up an excellent point about the fact that many prescribing practices are directly inherited from our mentors or colleagues. Our local community hospital has a single inpt psychatrist: could having extensive psych experience as an RN on that unit also lead to inappropriate prescribing as a provider if the current psych is not up-to-date or otherwise practicing poorly?
BostonFNP, APRN
2 Articles; 5,584 Posts
You must be luckier than me because I know lots of competent physicians that don't play nice with each other let alone the nursing staff!
I am not sure the ultimate competency of providers can or should be judged by their first clinical interactions. Each July there is a new crop of medical interns that if judged by their first clinical interactions would be heavily favored for ultimate failure in medicine!