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.

[FullGlass, BSN, MSN, NP]

Rich, E. R. (2005). Does RN experience relate to NP clinical skills?. The Nurse Practitioner, 30(12), 53-56.

Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178-183.

Pellico, L. H., Terrill, E., White, P., & Rico, J. (2012). Integrative review of graduate entry programs in nursing. Journal of Nursing Education, 51(1), 29-37.

Hart, A. M., & Bowen, A. (2016). New nurse practitioners' perceptions of preparedness for and transition into practice. The Journal for Nurse Practitioners, 12(8), 545-552.

Faraz, A. (2017). Novice nurse practitioner workforce transition and turnover intention in primary care. Journal of the American Association of Nurse Practitioners, 29(1), 26-34.

Steiner, S. H., McLaughlin, D. G., Hyde, R. S., Brown, R. H., & Burman, M. E. (2008). Role transition during RN-to-FNP education. Journal of Nursing Education, 47(10), 441–447

Rich, E. R., Jorden, M. E., & Taylor, C. J. (2001). Assessing successful entry into nurse practitioner practice: a literature review. The Journal of the New York State Nurses' Association, 32(2), 14-18.

Pasarón, R. (2013). Nurse practitioner job satisfaction: looking for successful outcomes. Journal of Clinical Nursing, 22(17-18), 2593-2604.

Brown, M. A., & Olshansky, E. F. (1997). From limbo to legitimacy: A theoretical model of the transition to the primary care nurse practitioner role. Nursing research, 46(1), 46-51.

Cusson, R. M., & Strange, S. N. (2008). Neonatal nurse practitioner role transition: The process of reattaining expert status. Journal of Perinatal and Prenatal Nursing, 22(4), 329–337.

Kelly, N. R., & Mathews, M. (2001). The transition to first position as nurse practitioner. Journal of Nursing Education, 40, 156–162.

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.

As you state, bad prescribing practices occur with MDs and PAs. So are you contending the majority of bad prescribing comes from only DE NPs? Can you please give us a breakdown of where the bad prescribing practices are coming from? Also, I am curious - how do you know the background of all the PMHNPs? In other words, if a patient comes to your facility from elsewhere, you know the school, number of clinical hours, and RN experience of every referring PMHNP?

[FullGlass, BSN, MSN, NP]

Rich, E. R. (2005). Does RN experience relate to NP clinical skills?. The Nurse Practitioner, 30(12), 53-56.

Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178-183.

Pellico, L. H., Terrill, E., White, P., & Rico, J. (2012). Integrative review of graduate entry programs in nursing. Journal of Nursing Education, 51(1), 29-37.

Hart, A. M., & Bowen, A. (2016). New nurse practitioners' perceptions of preparedness for and transition into practice. The Journal for Nurse Practitioners, 12(8), 545-552.

Faraz, A. (2017). Novice nurse practitioner workforce transition and turnover intention in primary care. Journal of the American Association of Nurse Practitioners, 29(1), 26-34.

Steiner, S. H., McLaughlin, D. G., Hyde, R. S., Brown, R. H., & Burman, M. E. (2008). Role transition during RN-to-FNP education. Journal of Nursing Education, 47(10), 441–447

Rich, E. R., Jorden, M. E., & Taylor, C. J. (2001). Assessing successful entry into nurse practitioner practice: a literature review. The Journal of the New York State Nurses' Association, 32(2), 14-18.

Pasarón, R. (2013). Nurse practitioner job satisfaction: looking for successful outcomes. Journal of Clinical Nursing, 22(17-18), 2593-2604.

Brown, M. A., & Olshansky, E. F. (1997). From limbo to legitimacy: A theoretical model of the transition to the primary care nurse practitioner role. Nursing research, 46(1), 46-51.

Cusson, R. M., & Strange, S. N. (2008). Neonatal nurse practitioner role transition: The process of reattaining expert status. Journal of Perinatal and Prenatal Nursing, 22(4), 329–337.

Kelly, N. R., & Mathews, M. (2001). The transition to first position as nurse practitioner. Journal of Nursing Education, 40, 156–162.

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.

I suggest you go directly to some well known nursing school websites. Johns Hopkins does indeed require RN experience for acute care NPs. However, Hopkins does not require RN experience for primary care NPs. That is typical. I agree that relevant RN experience is useful for an acute care NP. However, given very few RNs work in primary care, and RN studies are focused on acute care, with some public health, I fail to see how RN experience is necessary for a primary care NP.

As far as "dumbing down" nursing, I fail to see how DE NPs are doing that. I had an Ivy League education for my initial BA, followed by success in a very difficult and demanding career. Then I applied to Hopkins and UCLA for the Accelerated BSN and got accepted by both, which are extremely selective programs. My classmates were equally accomplished. I completed my ABSN and MSN in 3.5 years. Does that strike you as the achievement of a dumb person?

In contrast, I have seen numerous threads on this forum declaring that an ADN is sufficient and RNs should not be required to have a BSN. And, I will add, many of these posts are very poorly written, demonstrating the author is uneducated. So, who is dumbing down nursing?

[FullGlass, BSN, MSN, NP]

Rich, E. R. (2005). Does RN experience relate to NP clinical skills?. The Nurse Practitioner, 30(12), 53-56.

Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178-183.

Pellico, L. H., Terrill, E., White, P., & Rico, J. (2012). Integrative review of graduate entry programs in nursing. Journal of Nursing Education, 51(1), 29-37.

Hart, A. M., & Bowen, A. (2016). New nurse practitioners' perceptions of preparedness for and transition into practice. The Journal for Nurse Practitioners, 12(8), 545-552.

Faraz, A. (2017). Novice nurse practitioner workforce transition and turnover intention in primary care. Journal of the American Association of Nurse Practitioners, 29(1), 26-34.

Steiner, S. H., McLaughlin, D. G., Hyde, R. S., Brown, R. H., & Burman, M. E. (2008). Role transition during RN-to-FNP education. Journal of Nursing Education, 47(10), 441–447

Rich, E. R., Jorden, M. E., & Taylor, C. J. (2001). Assessing successful entry into nurse practitioner practice: a literature review. The Journal of the New York State Nurses' Association, 32(2), 14-18.

Pasarón, R. (2013). Nurse practitioner job satisfaction: looking for successful outcomes. Journal of Clinical Nursing, 22(17-18), 2593-2604.

Brown, M. A., & Olshansky, E. F. (1997). From limbo to legitimacy: A theoretical model of the transition to the primary care nurse practitioner role. Nursing research, 46(1), 46-51.

Cusson, R. M., & Strange, S. N. (2008). Neonatal nurse practitioner role transition: The process of reattaining expert status. Journal of Perinatal and Prenatal Nursing, 22(4), 329–337.

Kelly, N. R., & Mathews, M. (2001). The transition to first position as nurse practitioner. Journal of Nursing Education, 40, 156–162.

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.

I did exactly what you are planning to do - ABSN then MSN immediately afterward. The Hopkins MSN program had both experienced RNs and those of us who started immediately after BSN studies. I did not see any evidence that the experienced RNs did better in school. I worked with most of my classmates on health assessment (physical exam, etc) and the experienced RNs were just as nervous and struggled just as much as the rest of us students. Our MSN curriculum was rigorous, but it focused on primary care, as I am a primary care NP. There was nothing in it that assumed RN experience, but it did assume BSN studies.

[WestCoastSunRN, MSN, CNS]

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!

Well I am lucky... in my current job, yes. But I have certainly had my fill of being chewed up and spit out by a physician here and there over the years. Yes, I know competent providers (in the way of clinical competency) who are no fun to work with. So obviously I wasn't saying only 'nice guys' are good providers.

As for 'ultimate competency', I agree it can't be established during the first few clinical interactions -- again that is not what I was saying (competent doesn't = expert -- but you can tell somethings right off the bat with new providers) -- if it were, it would seem I didn't know much about the subject at hand.

But you have asserted that my (and other RNs who are not providers -- but ARE still your nursing colleagues) thoughts on any of this subject matter are not equal to someone who has actual experience in NP education. So that pretty easily disqualifies me and those other RNs from being taken seriously in this discussion.

As an APN, I would hope that you would care and have a vested interest in what is happening at the bedside (even though you are not there). I would hope that you would be VERY interested in the education of nurses at any level. I would and do welcome that interest. I expect it of you because we are both nurses (I don't care whether it's just a job or a 'calling' either -- irrelevant) -- so I expect each of us to be equally vested in the health of the profession.

Not to mention the wisdom of evaluating nursing education from different angles to hopefully avoid the naval-gazing and myopia that can happen when only one segment of nursing gets a voice on issues that pertain to the entire profession.

[Wuzzie]

In contrast, I have seen numerous threads on this forum declaring that an ADN is sufficient and RNs should not be required to have a BSN. And, I will add, many of these posts are very poorly written, demonstrating the author is uneducated. So, who is dumbing down nursing?

Careful there my friend. Whether you meant to or not this was insulting to ADNs. Do you think diploma nurses are dumbing down nursing even more?

[Wuzzie]

This really sums up the crux of the issue for most RNs that have a "problem" with DE APRNs.

The major factor when it is all boiled down is that it is a personal issue (which we should all understand because it is such a polarizing issue).

1. Practicing RNs have put years of time and effort and blood and sweat and tears into their practice of nursing, and understandably, they want all that to "mean" something. This is where the first incorrect assumption is made: DE APRNs stand as a monument to that experience/effort not "meaning" anything. It is absolutely wrong. The role and practice and art of being an RN is completely independent of APRN practice. APRNs could go away and the importance of nursing would remain. In this specific case, it seems most RNs opposing DE APRN programs seem to equate "RN experience not necessary" with "RN experience not important". All experience is important and it makes all of us the health care practitioners we are (both nursing and non-nursing).

Very salient point Boston. I believe that much of the pushback from bedside RNs regarding DE APRNs is that in their interactions with some of them they have been made to feel as if they are just peons in the nursing hierarchy. For people who worked very hard to get where they are and continue to work very hard in what they do that can sting a bit. It is rather unpleasant to be summarily dismissed on the basis of education alone with disregard for experience and the knowledge that comes from said experience. I have seen it happen on occasion and I was talked down to once. It didn't bother me much because I have a rather unique range of experience that includes functioning at an advanced level. Rather than turning it into a pissing match I just let the person bury herself.

In contrast, I have seen numerous threads on this forum declaring that an ADN is sufficient and RNs should not be required to have a BSN. And, I will add, many of these posts are very poorly written, demonstrating the author is uneducated. So, who is dumbing down nursing?

This is a perfect example of what I'm talking about. Whether intended or not the arrogance that comes through statements like this is bound to get people's hackles up. Sure there are some less than stellar nurses of all levels of education but by and large most nurses are intelligent, critically thinking beings who really do know their stuff and a whole lot more.

[BCgradnurse, MSN, RN, NP]

In contrast, I have seen numerous threads on this forum declaring that an ADN is sufficient and RNs should not be required to have a BSN. And, I will add, many of these posts are very poorly written, demonstrating the author is uneducated. So, who is dumbing down nursing?

I really, really hope this was just poorly written on your part. Otherwise, this comment was rude and uncalled for, and does nothing to bolster your credibility.

[Oldmahubbard]

My negative opinions about direct entry are based solely on my intuition, I must admit, not on any objective evidence.

I know a few NP's who don't impress me, and they all had at least some RN experience.

I will provide an anecdote from a few years back. I was employed as a PMHNP by a physician in private practice and started noticing my checks, which were based on insurance reimbursement, were dropping. Our office manager looked into it and discovered that BCBS had stopped reimbursing for NP services.

We learned that there had been a serious issue with an NP, and the company was holding up on NP reimbursements while they figured it out. Can you imagine if BCBS stopped paying for NP visits? it would put everyone out of business.

We never found out what the issue was, but a couple of months later, the reimbursements came in. Ultimately they decided that one bad apple didn't spoil the whole bunch.

[BostonFNP, APRN]

In contrast, I have seen numerous threads on this forum declaring that an ADN is sufficient and RNs should not be required to have a BSN. And, I will add, many of these posts are very poorly written, demonstrating the author is uneducated. So, who is dumbing down nursing?

You have a good education and are excited about a new career as an NP. Let me give you some unsolicited advice: this is a humbling job with a steep learning curve. You need to be starkly aware at all times that despite being smart and having a good education you are an absolute novice. Egos kill people in this job. Be humble and take all the help you can get while avoiding alienating the very people you may depend on in your first few years.

[FullGlass, BSN, MSN, NP]

Deleted post

[BostonFNP, APRN]

It is rather unpleasant to be summarily dismissed on the basis of education alone with disregard for experience and the knowledge that comes from said experience. I have seen it happen on occasion and I was talked down to once.

It should never get lost in these discussions the importance of the role of the RN. The RN is the last line of defense and the most hands-on of any healthcare profession. The expertise of nursing should not be diminished by any type of comparison to the APRN role. We need expert RNs just like we need expert providers. They are independent of one another: an expert RN does not imply an expert APRN and and expert APRN does not equal an expert RN.

As far as the arrogance we have seen on display from "providers" (of all kinds), it is unfortunate. I do think the APRN/provider role requires some degree of arrogance to be effective but the limit needs to be a clearly delineated line because just past it on the other side is lethal overconfidence.

This job finds a way to humble me just when I start to think I am pretty good at it; and I know it does many/most/all good providers. I would never presume to tell an RN how to do their job; they know far more about it than I do. I learn from them and I hope they learn from me, but at the end of the day, I count on them as a vital part of my job.

I have heard arrogant providers say to RNs that "they write the orders and the RNs follow them" and this is the biggest pile of insecure BS I have ever heard. The plan of care is a synthesis of expertise from both nursing and advanced practice (and PT and pharm and social work et al).

[Oldmahubbard]

Thank you for the perspective you bring.