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.

[BostonFNP, APRN]

Our office manager looked into it and discovered that BCBS had stopped reimbursing for NP services.

FWIW as a practice owner, this is not the whole story. It would be illegal for BCBS to simply stop reimbursing for NP services. Most NP's in private practice bill incident-to anyways, but I can honestly say they didn't tell you the right information.

[FullGlass, BSN, MSN, NP]

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.

My sincere and deep apologies if I offended anyone. I have nothing but respect and admiration for RNs and strive to always demonstrate that as a clinician and as a patient. And I have never asked an RN if she is a BSN or ADN, because I don't care.

My point is that there is a logical inconsistency here. If someone thinks a graduate school-prepared APRN is somehow dumbing down nursing, then logically they would feel the same way about an ADN RN.

Finally, I do not understand why DE NPs detract from RNs. They do not. Nursing is the most respected and trusted profession in America. DE NPs have not changed that. Standards for education and training change in all professions over time. That doesn't diminish the achievements of the previous generations.

Even medical schools are trying to produce more primary care providers and are implementing 3 year programs for primary care docs. That doesn't diminish the medical profession. When I go to the MD blogs and forums, they are very supportive of this. They aren't putting down the graduates of these new programs.

[djmatte, ADN, MSN, RN, NP]

Perhaps the frustration lies in the method of piggybacking on a profession and then treating them as if you aren't one of them (or straight up insulting them for grammar on an internet post). You said it yourself, you're a "provider". I'm sure if someone offered you provider school, that is what you'd go for. You don't give two rips about that RN in your name and act as if you're nobly saving everyone (mostly your own) time by skipping the practicing as a nurse part. But in the long run, I'd rather an RN actually work as an RN and understand their peers even if they practice is a stepping stone than not. Because in the end they still represent some of the most educated levels of our ranks. CV ICU sees that on the regular with CRNAs and in most cases those students have been in other parts of the hospital as well . In reality, you are part in parcel on why this profession will be saturated in 8 years. Not all nurses are destined to be at the bedside for their whole career. Some decide to improve their institutions and move up to management. Others become charges or specialize in different procedures. Meanwhile some see problems they want to help in their communities our patient populations and move to advance practice. But it's our nursing experience that guides us in those directions. And it isn't just current secondary baccalaureate holders that can get into de. I see University of Michigan bsn students getting pipelined just a fast. As you eloquently stated "that ships sailed" and you are more than happy to be right on it. If you wanted to have nothing to do with nursing as you indicate, I'm thinking PA school world have been a better fit.

[FullGlass, BSN, MSN, NP]

Perhaps the frustration lies in the method of piggybacking on a profession and then treating them as if you aren't one of them (or straight up insulting them for grammar on an internet post). You said it yourself, you're a "provider". I'm sure if someone offered you provider school, that is what you'd go for. You don't give two rips about that RN in your name and act as if you're nobly saving everyone (mostly your own) time by skipping the practicing as a nurse part. But in the long run, I'd rather an RN actually work as an RN and understand their peers even if they practice is a stepping stone than not. Because in the end they still represent some of the most educated levels of our ranks. CV ICU sees that on the regular with CRNAs and in most cases those students have been in other parts of the hospital as well . In reality, you are part in parcel on why this profession will be saturated in 8 years. Not all nurses are destined to be at the bedside for their whole career. Some decide to improve their institutions and move up to management. Others become charges or specialize in different procedures. Meanwhile some see problems they want to help in their communities our patient populations and move to advance practice. But it's our nursing experience that guides us in those directions. And it isn't just current secondary baccalaureate holders that can get into de. I see University of Michigan bsn students getting pipelined just a fast. As you eloquently stated "that ships sailed" and you are more than happy to be right on it. If you wanted to have nothing to do with nursing as you indicate, I'm thinking PA school world have been a better fit.

I'm not going to apologize for my education and career choices. There is nothing stopping prospective NPs from obtaining RN experience. And RN experience is generally required for acute care APRN positions, as well as school admissions. However, no one here has provided a good reason or evidence for this to be the case for primary care.

Yes, I did know from the get-go that I wanted to be an NP. So what? Should that now be forbidden?

Yes, I am a primary care provider. How on earth does that affect you, or any RN, for that matter? Am I taking away your job? Am I trying to work in a hospital? No to both. How many RNs even work in primary care? Very few. (I consider school nurses to be primary care). There is no bedside nursing in primary care.

Yes, the ship has sailed and I am a happy passenger. Unless there is evidence that DE NPs who work in primary care, do not provide good care, then the ship isn't turning back.

And as for the "saturation" fear mongering. HHS has projections, which are just estimates. As I previously explained, it is hard to have accurate projections more than 5 years out. If an oversupply of primary care providers develops, then the best will be ok. In most non-healthcare professions, there is an oversupply of candidates, but the best still get jobs. As for NPs, if an oversupply develops then it is the fault of our profession for not demanding rigorous admissions and accreditation standards, as well as eliminating for-profit schools. I would also argue than a surplus of NPs would be good, as this way only the best will get hired. A surplus would also force people to think carefully before pursuing an NP career.

My goal is to reassure NP students and future NP students that direct entry is a viable career path and that they can get a good NP job w/o RN experience. I do not expect to change the minds of RNs and NPs who believe otherwise. However, I am not going to allow negative posts on this topic to go unchallenged.

Oh, and BTW, I just got another job offer today. And I have a final interview tomorrow for yet another good NP position. One more in-person interview next week, and then I will make a decision. All the disapproval expressed here does not negate my job offers.

I am not egotistical, but I am self-confident, a critical quality for any health care provider. Am I nervous about my first job? Of course, because I want to provide safe and effective care, just as any new grad NP would be.

Finally, and the original point of the original post plus my article on NP job search - if you can't get an NP job, then you can't be an NP, whether or not you have RN experience.

[BostonFNP, APRN]

Perhaps the frustration lies in the method of piggybacking on a profession and then treating them as if you aren't one of them (or straight up insulting them for grammar on an internet post). You said it yourself, you're a "provider". I'm sure if someone offered you provider school, that is what you'd go for. You don't give two rips about that RN in your name and act as if you're nobly saving everyone (mostly your own) time by skipping the practicing as a nurse

The frustration is futile; DE program have been around for 40 years and they have increased exponentially: taking personal offense to a long established career track does nothing but leave you feeling like less than you are. DE programs, and APRNs in general, do not in any way diminish the importance and expertise of RNs in the many setting in which they work at the top of their license.

The term provider gets used frequently and it is not designed to be an insulting term; it describes the role in which (most) APRNs work. It is vastly different from the bedside role that many RNs work in, and as such, has an entirely different path from novice to expert.

APRN need to have a desire to function in the provider role to be effective and happy in their job. In many ways they need to define themselves by it. Many people do in fact choose between MD/DO and PA and NP school with the intent of ultimately functioning in that role. Nursing should do everything in it's power to recruit those people.

And while no one has mentioned it here, there is another "good side" to DE programs that do not require RN experience: it reduces turnover in bedside positions, decreases nurses cost of employment, and opens up more jobs for RNs.

[Oldmahubbard]

BCBS didn't "stop" reimbursing, it was a delay, while they investigated an incident. It was accurate at the time and this was 10 years ago.

Keep in mind, it is not unusual to be reimbursed several months later, even 6 months later is not that rare.

[djmatte, ADN, MSN, RN, NP]

And while no one has mentioned it here, there is another "good side" to DE programs that do not require RN experience: it reduces turnover in bedside positions, decreases nurses cost of employment, and opens up more jobs for RNs.

Trust me there isn't a shortage of jobs out there for RNs . There's a shortage of experience, but that has little to do with advance practice. You aren't "saving" anything.

[BostonFNP, APRN]

Yes, I am a primary care provider. How on earth does that affect you, or any RN, for that matter? Am I taking away your job?

My goal is to reassure NP students and future NP students that direct entry is a viable career path and that they can get a good NP job w/o RN experience.

I am not egotistical, but I am self-confident, a critical quality for any health care provider. Am I nervous about my first job? Of course, because I want to provide safe and effective care, just as any new grad NP would be.

Take a minute, step back, and think about things.

You are not a PCP yet, you haven't started work.

You are fresh out of school.

You have zero real-world practice experience in ANY kind of nursing.

This thread has called other posters as not having the experience or expertise about NP preparation and role, but have you thought about whether you have the requisite experience or expertise to be so boldly "reassuring"?

To be completely honest, while I am on your side of this debate, your posts come across as over-confident not self-confident, and anyone who has spent a day practicing in the real world in any nursing role understands that over-confidence is dangerous, far more dangerous than a lack of confidence.

If you want to be safe starting practice and progressing from a novice to an experienced provider, be humble and allow those people around you to help guide you on your way. I think if you re-read these posts in a few years you will cringe. FWIW. Good luck.

[BostonFNP, APRN]

BCBS didn't "stop" reimbursing, it was a delay, while they investigated an incident. It was accurate at the time and this was 10 years ago.

Keep in mind, it is not unusual to be reimbursed several months later, even 6 months later is not that rare.

Were you billing incident-to or direct? Were you part of an IPA?

[WestCoastSunRN, MSN, CNS]

The frustration is futile; DE program have been around for 40 years and they have increased exponentially: taking personal offense to a long established career track does nothing but leave you feeling like less than you are. DE programs, and APRNs in general, do not in any way diminish the importance and expertise of RNs in the many setting in which they work at the top of their license.

The term provider gets used frequently and it is not designed to be an insulting term; it describes the role in which (most) APRNs work. It is vastly different from the bedside role that many RNs work in, and as such, has an entirely different path from novice to expert.

APRN need to have a desire to function in the provider role to be effective and happy in their job. In many ways they need to define themselves by it. Many people do in fact choose between MD/DO and PA and NP school with the intent of ultimately functioning in that role. Nursing should do everything in it's power to recruit those people.

And while no one has mentioned it here, there is another "good side" to DE programs that do not require RN experience: it reduces turnover in bedside positions, decreases nurses cost of employment, and opens up more jobs for RNs.

I agree with you, Boston. It's futile to have angst toward the primary care DE programs and actually I don't see brash negativity (and certainly not abuse) in this thread from any poster toward DE, just questions and hopes surrounding if those programs are actually producing nurses. In terms of rigor, I think ALL types of nursing programs should be competitive and attract the best and brightest. They need to produce nurses who are really ready to practice. That has also been central to this discussion.

-- While several us nod our heads at the idea of DEs skipping out on nursing status to get to provider status, I don't see a ton of emotion behind that. That's important. There have been valid, logical concerns about DE and other NP programs brought up here sans any 'hard feelings'.

A nurse practicing medicine can be a beautiful thing. It can only happen with advanced practice and, as you have pointed out so well, it should be done in utmost humility. And those nurses should be given the best preparation possible. Your idea of throwing out undergrad nursing courses in the DE programs, so as to focus on advanced clinical skills is understandable, but I fear it would cause a greater divide, with DE APRNs being even further distanced from their RN colleagues. At that point why not PA school, for sure?

But I do wonder about the good side being that more experience would stay at the bedside. There are all sorts of factors in that, so I'm not sure how much the 'stepping stone' issue weighs in all of that. But it's an interesting thought.

[Oldmahubbard]

The practice was a 2 person part-time venture that had been open for about a year at that point.

I am not familiar with the terms IPA or incident to.

Again , we did get reimbursed, but BCBS was looking very closely at NPs -was the impression I got.

[guest769224]

Absolutely necessary based on what? We are all scientists here, cite your sources and we can engage on them.

BostonFNP, I said it is beneficial, I didn't use the word necessary.