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 original post made it clear that I am talking about primary care. In primary care, we don't run IVs, except for a few specialties. Primary care NPs are well trained in advanced pharmacology, patho, assessment, and diagnosis. APRN roles are based on the nursing model, yes. No one is disputing that.
Please note my response was toward someone else and to the overall tone. I have an opinion that even in primary care, bed-side nursing gives you access to years of medical conditions that you may never experience in the short period you go through NP Clinicals. You see first hand the long-term effects of the very conditions you are expected to treat in primary care. Physical assessment is a huge part of bedside nursing. In critical settings you may see advanced situations that aren't helpful in primary care, but in a normal med-surg unit you may see less life-threatening things that can prepare you. I remember the first time I saw the long-term effects of PVD in a patient at the bed-side lower extremities with edema, dark, with some severe ulcers. I didn't see that throughout NP clinical, but I absolutely took care of patients who had severe risk factors for it. Things like that really hit home on the effects of these diseases we are treating. Infinitely more helpful when you see these in primary care if you pursue advance practice.
But my suggestion is the development of direct entry only reinforces MD myths that somehow an NP's aren't experienced enough to meet the independent practice that our governing bodies are pushing for. You no longer have the X amount of clinical years of assessment/management to reinforce you and now only have X amount of HOURS of clinical time. So when they complain that they went through 4 years of med school, x years of residency, x years of specialty, then their claims absolutely hold water even at the simple brand new doctor out of med school level.
And to drive my point home, everyone here is saying FNPs and AGNPs don't need RN experience because they're primary care.
Except, how many FNP and AGNP graduates go to work in an inpatient specialty, rather than primary care. A lot. So not only are they practicing outside of their scope and training as a NP, but they don't even have a bit of RN experience to fall back on.
So that argument doesn't sit well with me.
You bring up a legitimate point. That is practicing outside the scope of their certification. Are both employers and NPs that desperate that they would take a job they're not trained for or hire someone who really isn't qualified to work in that role? That just doesn't make sense to me.
I appreciate your optimism, Full Glass, but I have to wonder if your assertion holds true for the 27 states that currently have a surplus of primary care NPs. I live in one of them, and I do worry about the job market when I do finally get my advanced degree. I haven't yet decided whether I will work for a few years after I get my BSN, or go straight through. I am an older student. Or perhaps I will work as I get my MSN.
Of course, it's predicted that by 2025, ALL states will have a surplus of primary care NPs.
I would think at that point, NP experience will trump RN experience (when looking to hire an NP); all other things being equal, RN experience will trump no experience. I do get the whole "moldable" thing. But again, I am saying, "all other things being equal."
The thing that is blowing my mind is that, in my state, if you consider both the shortage in primary care docs, AND the surplus of NPs/PAs, the net STILL amounts to a surplus of primary care providers by 2025. The numbers don't work like that though, because we aren't allowing NPs and PAs to take the place of MDs (of course). I'm simply making the point.
Sure, I know, you're saying you have to be willing to move. But what if you aren't? What if you can't? What about people with spouses who have jobs and kids in school and...
The market is going to have to self-correct. People who thought about becoming NPs may choose not to. People who are currently NPs may do something different. The people who really want to be there will stay. As well as those that don't have a choice.
You bring up a legitimate point. That is practicing outside the scope of their certification. Are both employers and NPs that desperate that they would take a job they're not trained for or hire someone who really isn't qualified to work in that role? That just doesn't make sense to me.
Take 5 minutes on this forum to see a plethora of would be NPs who "really want to work in such-and-such specialty" but "are afraid of limiting themselves" by choosing a program that prepares them to work in said specialty so they pursue FNP because they "want to keep their options open" but still fully intend to work in that specialty, even though they are now not trained to practice in it.
My area of the country is terrible for it. Tons of FNPs working in the hospitals. Thankfully it is changing and ACNPs are being hired preferentially or exclusively by some groups and the major hospital systems now. But the FNPs that are hired are giving NPs a bad name. I have seen it and have had to explain to other providers why the FNPs don't seem to know what they're doing - it's because they don't.
My tone was factural. I'm not here to debate "should," as that boat has sailed. I'm reporting the reality of the NP job market.
I think that we should all realize that the job market in some places is pretty tight while other markets have more jobs. Much depends on where you live and thats where RN experience might count for more. Also, in some areas of the country, direct entry APRNs are a rarity and might not get hired for that reason - no familarity with it.
I can remember the awful sinking feeling I had when I graduated in 2004, being told there is s surplus of NP's in the area. Thankfully. I did get a job in a roundabout way. Are there really 27 states with an NP (PCP) surplus?
On a related note, it is sad, as a former teacher, to see so many schools continue to admit multitudes of prospective teachers, when the large majority of them will never get a job. I would hate to see NP programs move in that direction.
I see many colleges are now making their outcomes public, ie, actually publishing where their graduates work 5 years later, what they make, and their debt to income ratio.
Also direct entry people already have degrees they are probably still paying for, so adding NP education and more loans, I wonder how this pans out.
Especially when I see many NP's still make less than 100k.
HRSA released a report in Nov 2016 regarding the supply and demand levels of primary care providers by state.
In 2013, some states still had a deficit of providers (such as California), but many, such as TN, had a surplus. TN already had 1000 too many FTE NPs.
By 2025 it is expected that NO state will have a deficit. In fact, 13 states are expected to have a surplus of 1000 or more FTE NPs. One state, TX, is expected to have a surplus of more than 5000 FTE NPs.
The report also discusses PAs and docs. PAs will also impact the number of jobs available to NPs.
This is quite bad news. Only a few years from now, there will be a slew of DNP's who won't be able to get a job, and even if they do, the fact that there is such a glut will result in a low salary.
HRSA released a report in Nov 2016 regarding the supply and demand levels of primary care providers by state.
In 2013, some states still had a deficit of providers (such as California), but many, such as TN, had a surplus. TN already had 1000 too many FTE NPs.
By 2025 it is expected that NO state will have a deficit. In fact, 13 states are expected to have a surplus of 1000 or more FTE NPs. One state, TX, is expected to have a surplus of more than 5000 FTE NPs.
The report also discusses PAs and docs. PAs will also impact the number of jobs available to NPs.
This is specific to PCPs. It is important info.
That's some good insight. I was half considering moving out of Michigan, but those projections expect Michigan NP needs to triple by 2025. Think I may be sticking around :)
Edit to add...read the wrong chart. We will have a surplus. Need to make that money now for sure.
I've been a nurse for over 20 years... probably won't go back to school at this point, but I say thanks for sharing for others in the same place as you in their career. I think many are skipping over the fact that you said Primary Care. Come on people, we all are familiar with Primary Care; the wages for RNs are low, and they don't do much "nursing" except vital signs and shuffle papers.
It's the NP's that gets to do "things"... like see pts., do physicals etc. and the compensation is higher. Personally, I like my doctor's NP better than I do her! I say go for it, and don't ever fear sharing your sucesses because it may help someone else!
Specializes in Psychiatric and Mental Health NP (PMHNP).
So am I.
If you were to spend some time in an ER, you may find many conditions and diagnosis are similar to what's seen in a primary care clinic. And some are not, it is the ER afterall.
i.e. stubbed toe, tooth ache, allergies, fever, headache, nasusea/vomiting, constipation, UTI, etc.
What is your point? Most moms are familiar with those things, too. So what? We're talking about whether RN experience is necessary to be a primary care NP. It is not necessary.
Specializes in Psychiatric and Mental Health NP (PMHNP).
I appreciate your optimism, Full Glass, but I have to wonder if your assertion holds true for the 27 states that currently have a surplus of primary care NPs. I live in one of them, and I do worry about the job market when I do finally get my advanced degree. I haven't yet decided whether I will work for a few years after I get my BSN, or go straight through. I am an older student. Or perhaps I will work as I get my MSN.
Of course, it's predicted that by 2025, ALL states will have a surplus of primary care NPs.
I would think at that point, NP experience will trump RN experience (when looking to hire an NP); all other things being equal, RN experience will trump no experience. I do get the whole "moldable" thing. But again, I am saying, "all other things being equal."
The thing that is blowing my mind is that, in my state, if you consider both the shortage in primary care docs, AND the surplus of NPs/PAs, the net STILL amounts to a surplus of primary care providers by 2025. The numbers don't work like that though, because we aren't allowing NPs and PAs to take the place of MDs (of course). I'm simply making the point.
Sure, I know, you're saying you have to be willing to move. But what if you aren't? What if you can't? What about people with spouses who have jobs and kids in school and...
The market is going to have to self-correct. People who thought about becoming NPs may choose not to. People who are currently NPs may do something different. The people who really want to be there will stay. As well as those that don't have a choice.
Did you read my article? I said to GO WHERE THE JOBS ARE. I also gave extensive instructions on HOW TO FIND WHERE THE JOBS ARE. Guess what, people can sell their house. Kids can go to another school. The spouse can get another job. Did I not say that a new grad NP may have to make a long distance commute? People need to consider the job market when starting a new career. If they aren't willing to do these things, and can't find a job, then that is on them.
If the outlook for NPs is so grim, why are you contemplating becoming an NP? If you are so worried, don't become an NP.
Projections are just projections - they are not fact.
djmatte, ADN, MSN, RN, NP
1,248 Posts
Please note my response was toward someone else and to the overall tone. I have an opinion that even in primary care, bed-side nursing gives you access to years of medical conditions that you may never experience in the short period you go through NP Clinicals. You see first hand the long-term effects of the very conditions you are expected to treat in primary care. Physical assessment is a huge part of bedside nursing. In critical settings you may see advanced situations that aren't helpful in primary care, but in a normal med-surg unit you may see less life-threatening things that can prepare you. I remember the first time I saw the long-term effects of PVD in a patient at the bed-side lower extremities with edema, dark, with some severe ulcers. I didn't see that throughout NP clinical, but I absolutely took care of patients who had severe risk factors for it. Things like that really hit home on the effects of these diseases we are treating. Infinitely more helpful when you see these in primary care if you pursue advance practice.
But my suggestion is the development of direct entry only reinforces MD myths that somehow an NP's aren't experienced enough to meet the independent practice that our governing bodies are pushing for. You no longer have the X amount of clinical years of assessment/management to reinforce you and now only have X amount of HOURS of clinical time. So when they complain that they went through 4 years of med school, x years of residency, x years of specialty, then their claims absolutely hold water even at the simple brand new doctor out of med school level.