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]

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.

There has been some negativity, the entire debate revolves around a group of people, that for personal and subjective reasons, think another group of people are a detriment to the profession.

The end goal is basic competency to enter practice. DE graduates that are practicing NPs have demonstrated that basic competency by passing their national certification board exams just like RNs do passing the NCLEX. If we want to go beyond that, then we need a new metric to measure.

Along those lines, how much prior CNA experience do you think should be required for RNs prior to graduating?

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'.

It is all based on emotion because there is zero data to support it. If we were to have this same debate about dimploma or ADN-RNs vs BSN/MSNs without any data, do you think some people would get emotionally charged about it?

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.

There's the rub isn't it: how do you be completely different in your role without causing a divide. I agree this is part of the issue it seems that RNs want APRNs to be "one of them" yet in in function they are not able to be.

At that point why not PA school, for sure?

There are lots of reasons to choose NP over PA and even MD/DO.

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.

It is not fair to anyone to have novice RN NP students trying to go to school part time, work full time in their new RN role, and do NP clincials to learn a different role all at the same time.

[BostonFNP, APRN]

BostonFNP, I said it is beneficial, I didn't use the word necessary. Learn to read, big shot.

You know what, I misread, sorry my mistake. I assume you don't have any sources then just an opinion?

[Polly Peptide, BSN, MSN, RN, APRN]

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.

Coming from the insurance industry, I can verify that there was certainly a period of time where they required billing from an MD/DO "provider ID" in order to reimburse. Obviously they came around. I'm not sure why they would have reimbursed NPs for a time and then stopped...that is a bit strange. Perhaps they were making sure they were in line with the NP practice authority in the state. Something could have happened with a patient/BCBS subscriber, they were challenged for approving something, etc. Rules are always written in blood.

[BostonFNP, APRN]

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.

Overly simplistic explanation:

Independent Practice Association (IPA) is a group of independent providers that group together essentially to contract with managed care organizations. The IPA handles negotiating annual contracts with the MCOs for reimbursement.

Incident-to is a type of billing in which the NPP "bills under" the physician in order to receive the full physician reimbursement rate rather than the NPP rate. In this scenario the NPP does not need to be individually credentialed with each MCO but does have to remain within the guidelines of incident-to billing. If the NPP bills directly for services they need to be credentialed and contracted with each individual MCO.

[Oldmahubbard]

In 2007, in NY, to my knowledge, BCBS was the only major insurance plan that did not credential NPs. I remember it vividly, because I had to do leg work to credential with other companies. And yes, the practice was a designated BCBS provider.

It is hard to imagine how much health care has changed since then, and especially mental health care. In 2007, your visits could be declined if the patient had already used up their 12 annual sessions.

We have largely gained parity with physical health, and experienced NP's in NY have been independent for 3 years.

[FullGlass, BSN, MSN, NP]

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.

I do appreciate your concern. I am very humble about being a new NP. And I am open to, and grateful for, constructive guidance from anyone who can provide it. In addition, I am carefully selecting my first position based on where I can get the best training and ramping up support.

[guest769224]

Really? That was pretty childish and unnecessary.

Please report me so I learn a lesson.

[guest769224]

My point is that I stated I believe RN experience should be required before becoming an NP.

And that in some situations it can be very helpful. It's only my opinion.

You know what, I misread, sorry my mistake. I assume you don't have any sources then just an opinion?

Yes, Boston, I even quoted it for you so you don't miss it this time. It's my opinion.

[BostonFNP, APRN]

Yes, Boston, I even quoted it for you so you don't miss it this time. It's my opinion.

Thank you for sharing your opinion.

[Skippingtowork]

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.

If they're new, how "good" should they be? And would it not be helpful to strengthen the NP program rather than increase RN experience? What you learn as a provider is different to what you learn as an RN. Provider role training is more important in building knowledge and confidence. I'm saying this as an NP with many years of nursing experience.

But here's the other thing. I must have my head in the sand somewhere, because, in real life, I have not engage in or overheard this conversation (and my hearing is good). The only way I know about the possibility of no bedside experience is by how young they are.

[SpankedInPittsburgh, DNP, RN]

That is an excellent point. How are the nurses on the unit to know if an NP has experience as a bedside nurse besides to ask them? I have plenty of experience and my answer might be "what difference does that make?" or an oldie but a goodie "what are you writing a book?"

[Jules A, MSN]

If they're new, how "good" should they be?

Done answering the exact same question.

But here's the other thing. I must have my head in the sand somewhere, because, in real life, I have not engage in or overheard this conversation (and my hearing is good). The only way I know about the possibility of no bedside experience is by how young they are.

Perhaps psych specific but everyone knows everyone's business. We ask it all the time when a new name shows up. It used to be to get a feel for their background based on the units they worked and see who you might know in common.