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.

[BCgradnurse, MSN, RN, NP]

The thing is, most good schools require at least a year of RN Experience.

What about Yale, Johns Hopkins, Columbia, Vanderbilt, Simmons, Boston College, etc? They all have direct entry programs that do not require RN experience. I think those are all pretty good schools.

[traumaRUs, MSN, APRN]

I'm not a DE APRN - had 12 years RN exp before I graduated. No one asked me about my clinical experiences. However, I got my first job because the doctors felt that with 10 years in a level one trauma center I could think on my feet.

I had my first APRN job for 11.5 years and just started my second. Unsure at this point if it will be my last but I'm back in the hospital and thats a step in the right direction.

[Oldmahubbard]

I am really surprised that such well known schools do not require any RN experience.

With DE, I can't help but feel we are cheapening and dumbing down NP education, which was already cheap and dumb enough.

Twenty years ago, we had the one year certificate program, which could be added on to as Associate's in Nursing, and voila, you were a provider with three years of college.

Then came the Master's requirement, which was a great step in the right direction. It simply gave us a lot more credence.

[BostonFNP, APRN]

I am really surprised that such well known schools do not require any RN experience.

With DE, I can't help but feel we are cheapening and dumbing down NP education, which was already cheap and dumb enough.

Why exactly do you think these programs are dumbing down nursing? There is a large body of research that has examined second-degree/accelerated and direct entry/non-nursing entry programs and has found they not only attract some of the highest qualified candidates in nursing but also are extremely effective educational programs on a number of metrics. These are a few older articles that show how far back this goes.

Shiber, S. M. (2003). A nursing education model for second-degree students. Nursing Education Perspectives, 24(3), 135-138.

Slavinsky, A., Diers, D., & Dixon, J. (1983). College graduates: the hidden nursing population. Nursing & health care: official publication of the National League for Nursing, 4(7), 373-378.

McDonald, W. K. (1995). Comparison of performance of students in an accelerated baccalaureate nursing program for college graduates and a traditional nursing program. Journal of Nursing Education, 34(3), 123-127.

Cangelosi, P. R., & Whitt, K. J. (2005). Accelerated nursing programs: What do we know?. Nursing Education Perspectives, 26(2), 113-116.

[Oldmahubbard]

I could definitely be wrong. I just know in psych, I needed all my RN (psychiatric- specific) experience.

I should keep in mind that some direct entry people could be very much the cream of the crop from their own field.

Still it is hard to picture someone doing really well in another competitive field, and waking up one day, realizing they have always wanted to be an NP. Then borrow enough money to live, and pay tuition for 3 years of full time college as an adult, and come out only earning 100k in many markets.

On the other hand, a nurse could have a year or two of RN experience here and there, in a bunch of different jobs that were not a great fit, times 5, for 10 years of experience. Not sure how this background would be directly applicable to the NP role.

A person making this type of financial sacrifice as an adult either must want it very badly, or they borrow money casually to go to school.

I just don't want the field to be so glutted that our compensation gets any worse!

[HoneyGram, BSN]

I am looking into eventually going for the PMHNP, but at this point finishing up my last semester of ASN. Can you tell me why you think that having experience is important before pursuing the PMHNP? Thank you!

[FiremedicMike, RN, EMT-P]

I'm curious about this topic, especially considering my plan to attend a direct entry NP program in the near future.

Many folks here state that RN experience is essential to being a good NP, citing their own experience of being a nurse prior to their NP training. Would it be fair to assume that their NP training (presumably not a DE program) was tailored towards someone with RN experience, allowing them to skip or glaze over some topics, whereas a Direct Entry program knows that those topics need to be covered in more detail?

What I mean to say is that it sure seems to this outsider that many folks are professing they wouldn't have made it through their own traditional pathway NP program without their prior RN experience, but don't actually have first hand knowledge of the curriculums being delivered from direct entry programs. I know that the direct entry program that I'm looking at is actually 1 year of an accelerated RN followed by 2 years of NP, with 3 years of clinical time in there. I have to hope that this and other direct entry programs have identified over the years what knowledge gaps exist due to a lack of RN experience and have incorporated learning objectives in there to cover those gaps.

[BCgradnurse, MSN, RN, NP]

I'm curious about this topic, especially considering my plan to attend a direct entry NP program in the near future.

Many folks here state that RN experience is essential to being a good NP, citing their own experience of being a nurse prior to their NP training. Would it be fair to assume that their NP training (presumably not a DE program) was tailored towards someone with RN experience, allowing them to skip or glaze over some topics, whereas a Direct Entry program knows that those topics need to be covered in more detail?

What I mean to say is that it sure seems to this outsider that many folks are professing they wouldn't have made it through their own traditional pathway NP program without their prior RN experience, but don't actually have first hand knowledge of the curriculums being delivered from direct entry programs. I know that the direct entry program that I'm looking at is actually 1 year of an accelerated RN followed by 2 years of NP, with 3 years of clinical time in there. I have to hope that this and other direct entry programs have identified over the years what knowledge gaps exist due to a lack of RN experience and have incorporated learning objectives in there to cover those gaps.

Mike-

The programs are somewhat different. The first year is generally an intensive RN program. Keep in mind that the basic sciences (biology, chemistry, anatomy, physiology etc.) must be completed to starting the RN portion, which makes it possible to focus only on nursing in that year. Most DE students (except those with recent science degrees) spend a couple of years completing the pre-reqs before starting the DE program. So, the process takes time, thought and planning. Students don't don't just wake up one day and say gee, I think I'll apply to NP school and do it. Many have experience in other areas of healthcare, and want to make a change to direct patient care. Others have their own reasons. The rest of the program usually consists of the same courses for both DE and traditional NP students, and you can't start those until you pass NCLEX.

All NPs complete their programs and should be ready to practice as novice NPs, not experts. So much of the learning is done on the job. I think having good clinical assignments and a first job that fosters learning is critical to any NPs success, no matter how much or how little RN experience they have. That's why I'm very wary of programs who leave their students twisting in the wind to find their own preceptors, or do not carefully vet preceptors.

Finally, we've heard from a lot of people who have strong opinions about needing or not needing RN experience. Some are NPs, but many are not. Just take that into consideration when reading all of the posts.

[FullGlass, BSN, MSN, NP]

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[FullGlass, BSN, MSN, 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

23 states and the VA already have full practice authority for NPs. In those states, outcomes are just fine. If you have evidence that patient outcomes have worsened in those states, please produce it.

No one here is putting down RNs. But the existing evidence indicates RN experience does not a better NP make. And all the hand wringing and disapproval in the world will not change that. "The times, they are a changing . . . "

[djmatte, ADN, MSN, RN, NP]

I'm curious about this topic, especially considering my plan to attend a direct entry NP program in the near future.

Many folks here state that RN experience is essential to being a good NP, citing their own experience of being a nurse prior to their NP training. Would it be fair to assume that their NP training (presumably not a DE program) was tailored towards someone with RN experience, allowing them to skip or glaze over some topics, whereas a Direct Entry program knows that those topics need to be covered in more detail?

What I mean to say is that it sure seems to this outsider that many folks are professing they wouldn't have made it through their own traditional pathway NP program without their prior RN experience, but don't actually have first hand knowledge of the curriculums being delivered from direct entry programs. I know that the direct entry program that I'm looking at is actually 1 year of an accelerated RN followed by 2 years of NP, with 3 years of clinical time in there. I have to hope that this and other direct entry programs have identified over the years what knowledge gaps exist due to a lack of RN experience and have incorporated learning objectives in there to cover those gaps.

*Years* of clinical time aren't how RN or NP programs are typically rated. RN programs will be 1-2 days a week of clinical which typically falls into 8-12 hours per day. Since they tend to run concurrently with education, you are unable to speed up the process and add more clinicals. APRN clinicals from my experience are based on a set number of hours depending on the school. Average seems to be between 500 and 800. You can do as many as you need to meet your obligation within what the school defines as required. If you don't need to work at the same time, you could clear your clinical out in a few months. Some schools run them concurrently similar to RN school, but I have only interacted with one student where her clinicals were hard-locked to a term.

As for experience vs. DE (BostonFNP, still trying to find the time to read your articles), I am looking more at the comparison to other fields where people like MDs claim that APRN school doesn't do enough to prep the new APRN through school to assume independent practice. Many PA schools require a certain number of clinical time either working or volunteering before you are accepted in it. This can range from CNA, RN, on over to EMT experience. And that doesn't count toward the years of rotations they do throughout PA school. This is compared to DE APRN students who likely have only RN clinical to claim as their medical "experience" when we all know how much that actually prepares you to work as an RN. Argument can be made about as much as a person with CNA experience going into a PA program.

[djmatte, ADN, MSN, RN, NP]

23 states and the VA already have full practice authority for NPs. In those states, outcomes are just fine. If you have evidence that patient outcomes have worsened in those states, please produce it.

No one here is putting down RNs. But the existing evidence indicates RN experience does not a better NP make. And all the hand wringing and disapproval in the world will not change that. "The times, they are a changing . . . "

I'm still reviewing that "evidence". But so far even those who see that "evidence" have hardly stated anything conclusive about it. Most here have stated to some degree there isn't enough evidence to discern whether there is a difference between outcomes of RN training vs. direct entry.