You should be out practicing better one liners.
Advise on NP route
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i have the education and the experience, but the other commenter only has experience and subpar NP education. Of course they are going to be pro experience. That's all they know. NP school seems really intense if that's all you have.
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My NP school is one of the top 50 in the nation and a R1 research school.
It sounds like you're letting anti nurse militants put THEIR chip on YOUR shoulder.
Don't let them do that.
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I agree, nursing leadership needs to do more to increase standards. But its our job to tell prospective students the right thing and not get suckered into the fast track hype. And until standards go up and things change, we need experienced RNs becoming NPs, not people that fast track through.
And if your so smart and academically inclined compared to your peers, then why arent you in med school? Your one of those guys that thinks they're smarter than everyone else in nursing, yet is a walking contradiction, because you are a nurse. I've met people like you and they typically are the worst clinicians.
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Im certain you aren't implying that anyone that has the best intellect behind them will always choose to go on to become physicians, leaving the dregs to go to nursing, because what would that say about yourself? No... You just decided like I did that you wanted to be an NP. I chose my path through nursing for a lot of pertinent reasons, and there are plenty of reasons why being a physician isn't for everyone. It's a good path, but I don't drink all the coolaid put in front of me. It is what it is. But the last place I would look to lay blame for problems is at the door of the poor souls who want to transition as fast as possible out of something they aren't interested in. Place the blame with the folks in charge that can raise the barriers to entry, like the experienced nurses themselves that DONT agree with you that only nurses with experience need apply. It's not the inexperienced folks that are forcing themselves on the system, it's nursing itself, man.
I freely admit that although I'm a competent nurse, the nursing world (as far as its academics, research, and culture) are often an uncomfortable fit for someone that is steeped in the hard sciences.
Like it or not, NP school is the critical weak link to the NP profession to a greater degree than all the young ones that THE NURSING educational apparatus is churning out all by themselves, because without it, we would just have nursing experience leading directly to on the job training for NPs. If experience were as critical to that process as you insist, we could skip NP school altogether (or make it greatly abbreviated) if someone had fantastic experience behind them as an RN.
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You dont get it. We need experienced RNs + solid NP education and even then, it may not be enough to produce competent providers... Whatever man, to each their own. Like I said, no skin off my back. Ill be fine because I know that employers prefer experience because they too understand the value of it.
I'm not excited about the thought of direct entry folks coming through the pipeline, because I do give a bit of deference to what nursing experience provides, but come on... Languishing for 5 years as a floor nurse before you can learn new skills? Nah. If you master something, tackle something brand new.
Glass half empty response... Nope, FNPs are getting pretty cheap. Employers will find the point on the graph where the arcs of cost and experience intersect to suit them best. Then they might want to run with that unfortunately. Maybe the DNP will be the barrier that constricts the market a bit, but you don't like that because it's not tied to the RN experience you promote. Conversely, I hate the DNP because it's more of the same stuff that needs to leave the basic NP coursework.
You know what will improve the quality of NPs much more than requiring more experience that they hate? Improving academic rigor.
You know what will improve the quality of NPs much more than requiring more experience that they hate? Improving academic rigor.
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I am actually for more academic rigor which is why im considering med school. But again, until academic rigor comes, we want to make sure the best and most experienced RNs are becoming NPs.
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Or we could just leave them safely supervised by actual doctors
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Different debate. We are not talking about independent practice but about the lowering standards of NP students and schools...but you know what, you may be right with these green NP students with no experience. Its hard to argue independent practice when this is happening.
Independent practice for NPs is here to stay, and will continue to expand by the year like it has.
So you think it would be easier for schools to pick up the pace a bit on their academics vs telling them to cut their funding by reducing the number of "green" nurses significantly? Surely you are dreaming. You may be right in a way, because the current crop of nurse educators are not up to a high enough standard to provide it... at least not enough of them to keep things going
The issue here isn't anti-nurse militants influencing me (most of them are drinking a different kind of coolaid), its the fact that I'm actually in class experiencing faculty that pass for the top of their field who are taking my money and are more interested in me spending more time to go out and find a citation to support my answer to a question about general medical practice that is common knowledge to most good students. Imagine a question for a med student like "explain pulmonary embolism, and cite the 4 sources in APA". You know how many difficult exam's I've taken in my NP school career? Less than the number of multimedia community awareness presentations I've been required to put together... by a significant number. And my university is one of the top schools in the nation for NP. My friends in other institutions have similar situations, but they don't know what really hard coursework is because none of them ever took an o chem test, or a biochem test, or memorized every physical feature of the brain for a neuroanatomy class... they just took nursing courses. I'm not saying I'm particularly smart, but lots of information has passed in front of my eyes over the course of my academic career, so I know the landscape.
So how much experience bedside does an RN need to have before they should look to improve their lot in life? My 5 years means I'm still green? Me cutting my teeth taking boatloads of patients in understaffed ER's and medical floors (along with time in ICU) doesn't equate to the high standards of an ICU nurse of 8 years taking 2 patients? I can keep someone alive for 12 hours on a pristine ICU just as good as the next nurse, but can the ICU nurse get pulled to a general medical unit and keep 5-8 patients going and spot the 1, 2, or 3 that are going to tank before shift change the next day? Not all experience is equal, which we all know. And the things that make a good nurse these days is laughable compared to years past. Management (other nurses unfortunately) want to see folks that will cater more toward customer service entirely, and be fine with wearing a tracker that ensures they spend 30 seconds in front of a sink before they leave a room. Honestly, if someone can stand to stay on the floor longer than a few years without deciding to move up in the world, more power to them, but it just might say more about them than it does about the "green" folks that want to stretch out and do more.
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Agreed. The education is atrocious. I don't give two beans for any course with "nursing" in the title. The didactic and clinical curriculum for NPs needs massive overhauling.
If you're so fixated on nursing experience and the redeeming interpersonal qualities of nurses don't become a NP. There are plenty of nursing unit positions available.
FNP_BLIX, I think we would agree on way more than we would disagree, so I don't want to take things to the edge of the abyss as far as being contrarian. I'm perturbed about the notion of masses of inexperienced folks chasing the provider role. I've seen it in PA education with them moving away from experience requirements, and I'm comforted by certain aspects of the nursing pathway that encourage at least a bit of experience. Most of the folks I know going back to school are nurses with over 3 years of experience when they start applying, and that seems to be a good place to start that process, and I've yet to personally meet someone who started school that didn't have 2 years bedside. I'm sure they exist, and I'm not saying otherwise. Direct entry programs aren't even directly comparable to some of the programs out there that cater to RNs working the floors, because the DE programs have some high standards from the few I've looked into.
I was conflicted about posting some of the stuff I did, because I don't want to give the impression that NP's don't have access to the tools to be decent providers. But I think that the things that make them decent aren't necessarily their RN level of experience. Clinging to that provides a false sense of security, especially when that nurse is outside of the zone of their past experience.... which is something that they should expect to frequently encounter in their new role as an NP. I think RN's should prepare themselves to respect that new role they are pursuing, and not assume that the things they saw with RN eyes are going to play out like the RN saw it at the time.
Nursing forums are filled with complaints that every nursing unit seems to have a full complement of folks in NP school. But can you hold that against the RN's? Who wants to stay there and spend 12 hours documenting minutiae, interspersed with being treated like its a privilege by their admin? I like healthcare... its my thing, but I provide a lot more labor than what I feel I'm worth when I'm nursing or supervising a unit. There are definite perks... great ones... but I'm finding myself more and more in situations where I am left trying to decide if what they are paying me is really worth what I am doing compared to some of my friends in other industries. If we don't want to see new grads fleeing for the exits after 2 years, lets make the workplace better. I know thats mostly the problem of the folks in charge at the hospitals and not other NP's, but its a valid issue.
I was conflicted about posting some of the stuff I did, because I don't want to give the impression that NP's don't have access to the tools to be decent providers. But I think that the things that make them decent aren't necessarily their RN level of experience. Clinging to that provides a false sense of security, especially when that nurse is outside of the zone of their past experience.... which is something that they should expect to frequently encounter in their new role as an NP. I think RN's should prepare themselves to respect that new role they are pursuing, and not assume that the things they saw with RN eyes are going to play out like the RN saw it at the time.
Nursing forums are filled with complaints that every nursing unit seems to have a full complement of folks in NP school. But can you hold that against the RN's? Who wants to stay there and spend 12 hours documenting minutiae, interspersed with being treated like its a privilege by their admin? I like healthcare... its my thing, but I provide a lot more labor than what I feel I'm worth when I'm nursing or supervising a unit. There are definite perks... great ones... but I'm finding myself more and more in situations where I am left trying to decide if what they are paying me is really worth what I am doing compared to some of my friends in other industries. If we don't want to see new grads fleeing for the exits after 2 years, lets make the workplace better. I know thats mostly the problem of the folks in charge at the hospitals and not other NP's, but its a valid issue.
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I can agree with mostly everything you said. I can see how some RNs may have a hard time from breaking from that paradigm of being an RN. But I still hold that once they do (assuming they have that problem to begin with), they become great providers. I think we both can agree that we are for more academic rigor. I, and I think you too, are also for having a minimum requirement upon entry into NP school. I feel like people should at least have 2 years. I think that's adequate time to get proficient at your role as an RN and then work toward that next step.
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I think we can agree about more than we disagree, and not a single one of us is immune to confirmation bias.
I'm glad there are nurses willing to see both sides. Good luck to all of you in your schooling.
I'm glad there are nurses willing to see both sides. Good luck to all of you in your schooling.
Under the vast majority of circumstances, a new BSN RN would have 2 years behind them as an RN before they graduated and started as an NP anyway, provided they work as an RN, which most seem to be eager to do.
A good portion of the chip on my shoulder towards some experienced NPs I've met had much more to do with personality conflict that might have been due to underlying nurse-on-nurse violence vs experience issues.
One NP thought that their RN management role in their previous life meant that their stale RN clinical skills (made even more stale by that person being in management for so long before even becoming an NP) were on par with my skills as an actively practicing RN....especially on an RN subject.
Another NP with plenty of RN experience walked by a relatively healthy patient that I had just done a complete physical assessment on and said from 10 feet away and in passing without even coming near the patient "you had better put some ears on that persons chest because that guy sounds wet".... Thanks boss, but I got this... I just listened to him with my stethoscope, and there wasn't even stridor, which I might have believed that one could hear from 10 feet away. Maybe that NP wanted to impress us with mad skills.
So my overall impression is that having tons of experience as a crappy RN before you become an NP doesn't change once you put on the white coat.... you are still a crappy RN, and quite possibly a crappy NP. For some folks, they think the NP makes them super RN.
A good portion of the chip on my shoulder towards some experienced NPs I've met had much more to do with personality conflict that might have been due to underlying nurse-on-nurse violence vs experience issues.
One NP thought that their RN management role in their previous life meant that their stale RN clinical skills (made even more stale by that person being in management for so long before even becoming an NP) were on par with my skills as an actively practicing RN....especially on an RN subject.
Another NP with plenty of RN experience walked by a relatively healthy patient that I had just done a complete physical assessment on and said from 10 feet away and in passing without even coming near the patient "you had better put some ears on that persons chest because that guy sounds wet".... Thanks boss, but I got this... I just listened to him with my stethoscope, and there wasn't even stridor, which I might have believed that one could hear from 10 feet away. Maybe that NP wanted to impress us with mad skills.
So my overall impression is that having tons of experience as a crappy RN before you become an NP doesn't change once you put on the white coat.... you are still a crappy RN, and quite possibly a crappy NP. For some folks, they think the NP makes them super RN.
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People who feel the most powerless, nurses for example, react by trying to exert power over people they feel are easy targets; newer nurses, students, ect. It's both a psychological coping mechanism and a form of bullying. Try not to let those toxic people get to you. Some of them hang out on SDN because it's a great place to be an awful person anonymously. Just get through school and find an awesome, supportive environment to work in. That's what I'm trying to do.
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Nobody gets to me, and I'm in a great work environment overall. However, I think its understandable for newer nurses to enter the nursing environment and gain power over their situation by finding an exit strategy. I feel like most nurses go into the field with a willingness to see how nursing pans out for them. Before long they come to the conclusion that since there is clearly a better way than persisting in a job that can ultimately seem dead end (despite significant perks) they will seek out that other way. In the beginning of my career, there wasn't anything compelling me to want out other than my own long term goals, but knew I needed to lay the groundwork for the day that I would want to make the move up to NP. It makes sense to do that as soon as possible, and I encourage every new nurse to take that approach.
The day will come when a motivated RN will want to be unchained from the nursing work environment. But to tell a nurse that they should stick around longer on the obscure assertion that it will contribute to them being a better provider seems cruel and arrogant. Unless someone wants to clearly lay out what specific skills one will gain by obtaining more floor experience that will be of universal benefit to the young nurse when they become an NP, I won't sign on to that nonsense. I'll counter any such assertion by saying that if we have such a pathway now laid out, then a nurse can seek out those kinds of experiences and then be even better able to move on up to NP that much quicker.
If someone wants to make a case for competency based advancement, cool. But simple seniority "paid your dues" advancement is bunk.
The day will come when a motivated RN will want to be unchained from the nursing work environment. But to tell a nurse that they should stick around longer on the obscure assertion that it will contribute to them being a better provider seems cruel and arrogant. Unless someone wants to clearly lay out what specific skills one will gain by obtaining more floor experience that will be of universal benefit to the young nurse when they become an NP, I won't sign on to that nonsense. I'll counter any such assertion by saying that if we have such a pathway now laid out, then a nurse can seek out those kinds of experiences and then be even better able to move on up to NP that much quicker.
If someone wants to make a case for competency based advancement, cool. But simple seniority "paid your dues" advancement is bunk.
I agree. You also have to remember that there are a lot of nurses for whom nursing is a second or third career. Nurses who can work in other jobs seldom stay on the floor - there simply is no incentive to stay. For these nurses like myself, being a floor RN is demeaning (due to customer service and management dictates), and often financial suicide. Any RN with an ounce of motivation is looking for an exit strategy - given the right environment, NP and/or CRNA wins every time. Until the reality of floor nursing changes drastically, nurses will chase NP degrees until the market becomes over saturated. New nurses who are not confident in their role as floor nurses are the most motivated to leave - at least if you get an NP degree you won't have to run around all day, stressed out and worrying about losing your license. Many hospitals are opening up positions for NPs in their outpatient clinics - Monday through Friday jobs, no lifting or cleaning patients, no running around, mentorship by physicians - who wouldn't want a job like that? Even for those NPs with minimal RN experience, there are NP jobs to be had in less desirable locations as well as NP residencies.
I also agree with PAMAC about science background. There is a huge difference in the cognitive skills of nurses with a strong science background as opposed to those whose most rigorous coursework is nursing classes - it is my experience that both in nursing school as well as on the floor, those with a science background are far more likely to succeed. I have worked with nurses with over twenty years experience as floor nurses with NP degrees who candidly admit that they never felt comfortable as providers and returned to the floor, conversely I also have also worked with very sharp novice nurses with a strong science background who quickly decided that hospital nursing was a dead end (often in the first six months) and successfully moved on to practice as NPs. There is a reason that PA and medical schools demand science prerequisites rather than healthcare experience - even PA schools are lowering their experience requirements and choosing students with high science GPAs. Science background, the ability to assimilate and integrate scientific concepts is the foundation for any successful provider. Like PAMAC and Old Psych Guy, I never bought the ivory tower nursing Kool Aid - I am enrolled in a psych np program so that I can control my career rather than dance to the tune of hospital administrators.
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You are all referencing one nursing role, that of the floor nurse, and implying that all nursing falls into this category.
In critical care a nurse with one year of experience is barely safe in practice. If moving onto a critical care NP role this lack of background is terrifying.
There's a lot more to nursing then floor nursing, you can't paint "nursing" with so broad a brush. There are areas where experience is vital.
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Then you shouldn't have become a nurse and you should have stuck with your first or second career. If you are not okay with being an RN, then you shouldn't become an NP. Experience is just as vital as the science background. And the sciences that we get in nursing is plenty. How often are you actually directly applying the concepts of physics 1 & 2 in situations where you need to be able to identify the difference between diphtheria and strep throat and how to treat one or the other?
Don't get me wrong, I'm not saying that science is not important. I too believe standard admission requirements should go up in that regard - in addition, a minimum amount of years of experience as an RN requirement (at least 2 years of RN experience [plus a BSN or related bachelors of science degree] prior to admission into any NP program). Right now, the evidence shows, and I believe, that the science we get is actually enough to do the job because of the experience that we bring to the table. And because most APNs don't have residencies, we heavily rely on the experience that we get as RNs in our respected areas...Currently, the average NP has 10-11 years of experience as RNs before becoming NPs. They enjoy great outcomes that are comparable to that of physicians. We don't want that strength of our profession to change by more diluted providers... Once again, I hold that until more academic rigor comes, we need to maintain that experience requirement in our NP students.
I just have to ask, if you wanted to understand more in depth science behind what we do in medicine, then why didn't you go to PA school or medical school??? My guess is that you likely chose nursing because you knew it would be somewhat less rigorous and be a less intense path compared to PA school or medical school, and that the pay off would be good, especially this being your 3rd career or whatever.. Yet you're here complaining that we don't get enough science. You see how this doesn't make sense? So quit while your ahead and go to PA school. We don't need unexperienced, money hungry NPs in our profession. We need experienced, intelligent RNs becoming NPs. Experience is one of the best assets RNs bring to the NP profession.
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This is true. Again, until more academic rigor comes we need the best, most experienced, and intelligent RNs becoming NPs. If they have a strong science background, that's a plus. But still, they need that RN experience.
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Actually, nursing is a co-career. I do prn work while doing a 8 - 5 job in my first career. Sometimes the prn work is paid, sometimes I volunteer at a free clinic. Second, I will be taking a pay cut to work as a psych NP. I too would like to go to medical school - I have the hard science prerequisites and just need to take the MCAT. You are correct to state that PA school or med school would be a better fit culturally. However, at my age I may not obtain a medical school seat and I can do at least part of the NP program while working hence my decision to enroll. I will not "quit while I am ahead and go to PA school" nor I am an "inexperienced money-hungry NP" student. I realize that you are passionate about wanting NP students to have experience - I am simply pointing out factors that drive nurses to NP programs. I do not share your view that nurses receive enough science background to practice independently - other nurses, PAs and physicians have echoed these same sentiments on this site as well. I am not suggesting that every nurse should skip working as an RN and go straight to an NP program - I am merely stating that years of experience as a RN does not necessarily make a better NP candidate. I am aware that acute care nurse practitioner programs usually require two years of acute care experience and I do not disagree with that requirement. You may not like the fact that I disagree with your position but I will continue in my NP program and pursue my career as I see fit. In the future, you might find that people respond more positively towards your opinions if you don't jump to conclusions about their background and/or intentions.
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I think you are strongly undervaluing RN experience. Having years of recognizing patient deterioration and putting into effect physicians plans of care is extremely valuable.
We don't actually have to have a opinion based discussion on this topic. A study published this year states "Being employed in a general healthcare setting (p≤0.004) and a higher literature study report grade (p=0.001) were associated with a higher study success rate." and "Conclusion: In advanced nurse practitioner education, study success rate seems associated with the student's cognitive abilities and work field." (Bossema, Ercolie, Meijs & Tineke, 2017) Hard science proficiency and previous education was not a factor that improved success rates of the NP student. I realize this study was in Europe, and it might slightly confound, however it was a strong study and the outcomes are relevant.
Reference:
Bossema, Ercolie R. ; Meijs, Tineke H.J.M. ; Peters, Jeroen W.B. ;
Nurse Education Today, October 2017, Vol.57, pp.68-73
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Thanks for the share. This further substantiates our view that supports the value of RN experience for the prospective APN student.
I apologize for jumping to conclusions regarding your background. However, I just think you (and many new gen nurses) undervalue the importance of RN experience as a prerequisite for NP school...All advanced practice nurses (i.e., NPs, CRNAs, CNMs, & CNSs), should have a minimum RN experience requirement for entry into their programs. Because we don't have residencies, and as you state, academic rigor, RN experience will remain a cornerstone for producing strong APNs, and is at the very least, something all APNs should have.
Spud bunny said it well. And everyone in hospital nursing dances to the tune of administration, not just the folks on the general med floors. When I talk about nursing, I'm talking about all nurses on all the floors. When I'm rolling in the ICU, I'm dealing with many of the same edicts coming down from above. And even though I love my coworkers and all of my bosses, the aspects of nursing that make it harder every year aren't going to change.
And Blix, the statement you keep on making about folks who shouldn't have gone into nursing if they didn't want to be RNs for a long time.... Guess who doesn't agree with you on that one.... Nursing... All of nursing. If they agreed with you, the process would be flowing the way that you insist it is so critical. But as it stands, new folks can find NP schools to apply to, and not just the ones that are complained about.
And Blix, the statement you keep on making about folks who shouldn't have gone into nursing if they didn't want to be RNs for a long time.... Guess who doesn't agree with you on that one.... Nursing... All of nursing. If they agreed with you, the process would be flowing the way that you insist it is so critical. But as it stands, new folks can find NP schools to apply to, and not just the ones that are complained about.
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We should find a better study than one from Europe. So many aspects of care between the continents aren't congruent... Socialized medical care vs the US system is one example. You are taking civil service vs private sector essentially. That's before you even get to the training processes.
I think most folks agree on the notion that some RN experience is necessary, but maybe not on how much. Nursing care isn't even the same beast in many ways that we experienced even back during paper charting. And even the direct entry NP programs are set up different than your typical NP schools. They take much better students, and have an approach to instruction that is different from places like my program. even if NP schools had higher academic admission standards, that would go a long way towards producing better providers. PA school is competetive to get into because everyone, including folks with non science backgrounds or healthcare experience, wants to get in to it. But overall, if it weren't for that fact, I think most intelligent students would find PA school totally workable.
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The study is fine, I'm sure you can find the time to read it before you choose to ignore it. :/
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Pamac, nursing is very disorganized and fragmented so you cant make the statement that "all of nursing disagrees with me". Its inaccurate and just a load of crap. Most nurses actually would agree on all the points I've made. On average, NPs have 10-11 years of RN experience and the AANP wears that number like a badge of honor...I think You're complicating this way more than it needs to be and I feel like your arguing just for the sake of arguing. I just don't understand how you can undervalue RN experience so much...Again, until we have more academic rigor and more standardization across the board, you can't sit there and tell me that some RN experience is maybe okay. Its a must and is what gives us an edge when compared to the PA profession and physicians (in some setting and outcomes of measure). Experience as RNs is what gives us a unique perspective to medicine and healthcare and allows us to hone basic assessment and history taking skills among many, many other things...certain things are just not learned in RN or NP school and that is what RN experience gives us.
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Eh. I'd like a citation on the average amount of RN experience an average NP has, 10-11 years seems high. Also, I do not know any NPs that brag about the amount of RN experience they have, unless they're a brand new NP. Once you have NP experience, that is all that matters to employers/coworkers - how many years of NP experience you have. I also find it surprising how important you feel RN experience is and how that ensures our competency as NPs. I can't help but wonder - are you a practicing NP? Many many NPs have RN experience in a completely unrelated field. I'd find this argument about how essential RN experience is far more believable if RNs could only apply to NP school in their field of practice (ie: peds RNs can only apply to peds, L&D to WHNP or CNM, etc.) Right now we have school nurses applying to ACNP programs, as if their skills will remotely translate. NP experience/training is far, far more important than relying on variable RN experience and instead of attempting to beef up RN requirements for NP school I think we are far better off increasing NP student clinical hours and making the coursework more rigorous. Perhaps postgrad residencies will become more and more the norm as well.
Also, if you're interested in having a data driven discussion, the only study in the US to have examined this found that RN experience was not related to NP experience as measured by NPs themselves and physicians. I keep meaning to dig that study back up and cite it.
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Cite it, I'm interested.
I know that PA schools are looking less at previous experience because a PA school administrator stated proudly that research indicates that outcomes for them are more highly correlated to grades. I've come across a couple research pieces that support that, for what it's worth. But I'm not interested in dueling studies because then we'd have to look at studies that indicate that life experience in general correlate with better NP performance, etc. Correlation isn't causation. And European practice environment isn't the US practice environment. One obscure study isn't going to sway me because I'm not disputing that RN experience isn't helpful. The real question is whether it is helpful enough to make a compelling case that an RN should languish in nursing on the floor vs moving on to better circumstances. If it's only a slight advantage, then no need. So unless your study from Europe shows a large disparity, then why focus on requiring 10 years experience rather than tightening up educational quality standards, or even clinical hours... After all, clinical hours are hours of pertinent experience (probably the most pertinent experience).
I'm genuinely (FNP Blix) questioning the notion that 10-11 years as an RN is reasonable or even preferable to expect. And who cares if the average NP had 10 years in as an RN? The industry and education establishment still nurtures folks that come in with far less. My guess is that number will continue to decrease as more RNs take advantage of expanding educational opportunities that weren't available in the past. It used to be that going back to school was harder for a new grad RN, especially with the way your young mantra pervasive to nursing.
Things have even changed since I started working, when I was very discrete about my pursuing NP out of concern that it would affect what kind of shifts I'd be assigned, as well as how id be treated by supervisors knowing if be leaving eventually (turns out that I've outlasted most of the other new grads who didn't even pursue NP school, but simply left for other RN work). Now I'm glad to have tons of peers in programs. My facility is even helping us out with tuition reimbursement, and recruiting their RNs (newer grads!) after they become NPs.
I think the point made about unrelated RN experience to what NP specialty one practices is an important one.
I'm genuinely (FNP Blix) questioning the notion that 10-11 years as an RN is reasonable or even preferable to expect. And who cares if the average NP had 10 years in as an RN? The industry and education establishment still nurtures folks that come in with far less. My guess is that number will continue to decrease as more RNs take advantage of expanding educational opportunities that weren't available in the past. It used to be that going back to school was harder for a new grad RN, especially with the way your young mantra pervasive to nursing.
Things have even changed since I started working, when I was very discrete about my pursuing NP out of concern that it would affect what kind of shifts I'd be assigned, as well as how id be treated by supervisors knowing if be leaving eventually (turns out that I've outlasted most of the other new grads who didn't even pursue NP school, but simply left for other RN work). Now I'm glad to have tons of peers in programs. My facility is even helping us out with tuition reimbursement, and recruiting their RNs (newer grads!) after they become NPs.
I think the point made about unrelated RN experience to what NP specialty one practices is an important one.
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So wouldn't NP school be best served by increasing clinical hours rather than requiring more RN experience? Then students would at least be experiencing circumstances that are direct to what their work would be as an NP, rather than working as a caseworker nurse, or on an easy low acuity cardiac Obs unit and biding their time until they have enough Blix approved years of experience? Increasing the clinical requirement would be the easiest of all the options because it could be dictated from top as a requirement for accreditation. Seems better to me than telling RNs to wait it out on the floor.
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Look, I agree that it would be more useful to have more clinical experience as an NP, definitely post masters residencies, and more rigorous training and science requirements. I think even the DNP minimal requirement would be good too, especially since nursing is pushing to produce independent providers nationwide. I too think these hypothetical higher standards for the profession would likely render the mandatory RN experience less important for NP role transition, and when your proposed changes in standards ever happens, may be what it takes to produce a more optimal clinician....However, that has not happened yet, so therefore I advocate for experienced RNs to become NPs. Since we can't really control the rigor of our programs and clinical hour requirements, prospective students can at least make the right decision and ensure that they go through the proper path to become the best NP they can be. And just because one weak descriptive cross sectional study found that prior RN experience had no significant relationship with NP role transition doesn't mean that the flood gates should open up and every one and their mother can become an NP. There needs to be quality control, and since the establishment is not doing that, then I will try to sway every single new grad RN from jumping into the NP profession right away... I'm not saying that prospective NP students should have 10-11 years of RN experience, but for them to at least have 1-2 years full time experience (ideally in the area they will be working in as an NP) before jumping in and becoming a medical provider (that can, by the way, potentially practice independently right out of school).
I've seen so many pathologies in the hospital setting that I have never seen in my NP clinical rotations, that can be applied across all settings. Even in your case, as a psych NP student, experience as an RN in some other "unrelated" setting can actually help you rule out organic causes to altered mental states, among other things. I can't stress enough how important at least some RN experience is because until the changes you proposed happen, less RN experience will spell a more diluted and incompetent provider.
NP students with no prior RN experience don't actually know what it's like to pick up on the subtleties of when something is horribly wrong, or get that daily experience of doing physical assessments and managing care, or reading physicians notes, or learning new drugs, managing vents, titrating pressors, learning new treatment regimens, becoming experts on the implementation side of care, etc., etc. The things we learn as RNs acts a foundation that we build our knowledge on to be better clinicians in our advanced role.
Once again, I hold that if you can't handle being an RN, then don't become an NP. Until standards of NP school go up, we want experienced RNs becoming NPs. Nothing less.
I've seen so many pathologies in the hospital setting that I have never seen in my NP clinical rotations, that can be applied across all settings. Even in your case, as a psych NP student, experience as an RN in some other "unrelated" setting can actually help you rule out organic causes to altered mental states, among other things. I can't stress enough how important at least some RN experience is because until the changes you proposed happen, less RN experience will spell a more diluted and incompetent provider.
NP students with no prior RN experience don't actually know what it's like to pick up on the subtleties of when something is horribly wrong, or get that daily experience of doing physical assessments and managing care, or reading physicians notes, or learning new drugs, managing vents, titrating pressors, learning new treatment regimens, becoming experts on the implementation side of care, etc., etc. The things we learn as RNs acts a foundation that we build our knowledge on to be better clinicians in our advanced role.
Once again, I hold that if you can't handle being an RN, then don't become an NP. Until standards of NP school go up, we want experienced RNs becoming NPs. Nothing less.
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What a few of us are trying to explain is that not every nurse out there is managing vents, titrating pressers, or doing many of those other things enough, even after several years. I would wager that most NPs in the history of the profession didn't spend a lot of time as an RN in a critical care environment. Nor will many NP's be managing patients under critical care circumstances either. Further, not all critical setting skills translate to competency elsewhere... like, say, a minute clinic. Hence, I offered my examples of critical care nurses that I wouldn't dream of floating to other units because they have a skill set for a particular kind of sick patient. Even physicians try to stay close to their area of expertise as much as they can. My broad set of exposure to the different units I've worked in makes me adept in ways that plenty of nurses that spent years on only one unit aren't.
The good thing is that most motivated RN's probably take your advice with skepticism, unless they are significantly malleable to suggestion, in which case they probably should spin wheels a bit and stay put for a while.
And trying to make the case that a DNP is a better path to clinical competence is highly questionable. For one, the extra coursework has very little to do with learning additional skills involved in actual patient care. For two, ask a bunch of mastered prepared NPs what they think of the DNP and its relation to quality of the care they would provide.
You work really hard to dance around solutions that are easily implemented by nursing governing bodies. Raising the requirement for clinical hours could take place by edict as a criteria for accreditation. Revising the national board exams to cover more rigorous study could take place in short order as well. Institutions would have to adapt to the new reality. Your solutions are less palatable, take much longer, and cater to your own biases. And one weak study showing experience to not be a major factor is one more study than you have proving that 5 years as an RN is better than 10 years in terms of success as an NP.
The good thing is that most motivated RN's probably take your advice with skepticism, unless they are significantly malleable to suggestion, in which case they probably should spin wheels a bit and stay put for a while.
And trying to make the case that a DNP is a better path to clinical competence is highly questionable. For one, the extra coursework has very little to do with learning additional skills involved in actual patient care. For two, ask a bunch of mastered prepared NPs what they think of the DNP and its relation to quality of the care they would provide.
You work really hard to dance around solutions that are easily implemented by nursing governing bodies. Raising the requirement for clinical hours could take place by edict as a criteria for accreditation. Revising the national board exams to cover more rigorous study could take place in short order as well. Institutions would have to adapt to the new reality. Your solutions are less palatable, take much longer, and cater to your own biases. And one weak study showing experience to not be a major factor is one more study than you have proving that 5 years as an RN is better than 10 years in terms of success as an NP.
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I'm in a FNP program, without exaggeration over half of the class are current ICU nurses. My sample says differently.
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Doesnt matter if everyone works ICU or not. In my mind, I draw a lot of experience from the times I've worked on the floor and at the nursing home years ago. And as FNP, that experience is so valuable, especially in a setting like the minute clinic or urgent care where I'm running my own ship. There will always be that occasional patient that walks in with very subtle abnormalities that you just dont learn in NP clinical, but as an RN. And regarding the study, what you said is not actually true. All the studies out there that compare NP outcomes to physician outcomes include highly experienced NPs with RN experience. You're justifying the flood gates to be opened up to a bunch of inexperienced, likely incompetent new graduate NPs just because of one descriptive cross sectional survey with tons of limitations...just stop, your just debating to debate but your just full of crap. You made descent suggestions ealier but the fact is non of them have been realized so until then quit pretending like RN experience isnt a vital part of competent NP practice...until more rigor is actually a reality in APN schools, then dont try to sell me on the notion that RN experience is not impactful.
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deleted480308
can we get that citation on 11yrs avg experience?
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I actually can't find that study or anything that gives me the average number of years of experience a NP has as an RN. I thought I had that but I will have to dig it up.
However, I can tell you that the average NP has 11 years of experience (not specified if RN or NP or both) and that the average age of an NP is 49 suggesting they seek advanced practice roles later in life. Furthermore, most of the studies that suggest great outcomes of NPs in clinical practice have experienced NPs as their sample.
sb247, you should agree with me on this (that RN experience is important) since you love to site our direct admission programs as fuel to debate me on our supposed incompetence.
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you misunderstand me altogether.....I state you shouldn't be independent because doctors are the standard of medical care
The reason I ask for a citation about the 11yrs is because you've been wrong about claims before. The reason I pointed out the brevity of the NP training is because you were trying to pin an argument on how long it it. I don't think 25yrs as an RN makes someone any more qualified to be doing the full evaluation and diagnosis and treatment plan of a patient....that's simply not what RNs do. It's the actual training to do those things that makes someone ready to do them.
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I agree that better training would be optimal to make more consistent, better clinicians. And I'm not saying an RN needs 25 years of experience to be able to move forward with NP training. My point during this debate has been that because rigor in our schools has not really improved yet, and until it does, NPs at the very least should have some (1-2 years full time experience) RN experience, ideally in the field they will be working, prior to NP school admission...unfortunately some of my colleagues don't seem to think so and think that fast tracking students through NP programs with no real change in academic rigor and with even less RN experience makes no difference in producing competent, quality NPs.
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To be clear on the physician opposition to NP practice, there is a direct correlation between MD resistance and lawsuits and NP's starting to treat insured patients. Physicians did not care about patient safety when NP's cared for the uninsured, they only developed a conscious when it hit their bottom line. In reality there's 50 years of research all saying the same thing; NP's are safe, which is one of the many reasons the physician lobby continues to lose every serious attempt to restrict NP practice. Feel free to keep putting lipstick on that pig.
The reason this is a topic of debate is that the literature appears at times supports both arguments. I would suggest you all read this study, open access, Exploring the Factors that Influence Nurse Practitioner Role Transition here's a statement from it "In contrast, prior RN experience was neither a promoter nor inhibitor of NP role transition. Of note, caution is needed when making conclusions about this finding, as there is conflicting results in the literature on the influence of prior RN experience. For example, previous NP-focused research highlights the importance of RN experience and suggests that it is beneficial to NP role transition.1,3,28 However, studies have reported that new NPs found NP clinical experience to be beneficial during role transition.8,9 This finding adds to the body of NP role transition research and may be of use in informing and helping to frame the discussion on providing the appropriate experiences to NPs." (Barnes, 2015)
This debate should be evidence based, opinions will get us nowhere.
Reference:
Barnes, H. (2015). Exploring the Factors that Influence Nurse Practitioner Role Transition. The Journal for Nurse Practitioners : JNP, 11(2), 178–183. Redirecting
The reason this is a topic of debate is that the literature appears at times supports both arguments. I would suggest you all read this study, open access, Exploring the Factors that Influence Nurse Practitioner Role Transition here's a statement from it "In contrast, prior RN experience was neither a promoter nor inhibitor of NP role transition. Of note, caution is needed when making conclusions about this finding, as there is conflicting results in the literature on the influence of prior RN experience. For example, previous NP-focused research highlights the importance of RN experience and suggests that it is beneficial to NP role transition.1,3,28 However, studies have reported that new NPs found NP clinical experience to be beneficial during role transition.8,9 This finding adds to the body of NP role transition research and may be of use in informing and helping to frame the discussion on providing the appropriate experiences to NPs." (Barnes, 2015)
This debate should be evidence based, opinions will get us nowhere.
Reference:
Barnes, H. (2015). Exploring the Factors that Influence Nurse Practitioner Role Transition. The Journal for Nurse Practitioners : JNP, 11(2), 178–183. Redirecting
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Yes, this is the descriptive cross sectional survey we were referencing earlier. This study is what Pamac and company are using to justify their rationale for undervaluing RN experience and opening up the doors even wider to even less experienced RNs to practice as NPs. There's just no real data at all to support this shift in mentality, and plenty of data out there that suggests the benefits of RN experience. Even this study recognizes it's own weaknesses and calls for caution when making assumptions about RN experience not being beneficial for NP practice...It's just better to error on the side of caution and really promote that minimum 1-2 years of full time RN experience before NP school. My position will never change on that until we see actual change in our curriculum, more clinical hours, residency programs, etc. Until then, I will continue to promote experienced RNs to become NPs. We already have great outcomes as providers (whether supervised or independent), and I don't want that to ever change because of diluted, fast tracked NPs with nil RN experience...
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You tell him IKnowImnotadoctor! sb247 has been a pain in my rear end for nearly a month now arguing that NPs are not competent providers, with no data to substantiate his claims.
The only thing that is hard to argue against him on is the justification of independent practice with this wave of unexperienced NPs coming into practice. There may need to be some requirement (e.g., 2 years of supervisory or collaborative arrangement) before independent NP practice in the states where we are licensed is permitted. I know some states already do this actually.
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much like you want the inexperienced RNs to prove they can be NPs with better/real studies......I want you to prove independent NP practice with the same
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This is not similar because there is one study that offers conflicting data on the importance of RN experience in NP role transition. This one study is only a descriptive cross sectional survey and doesn't come close to arriving to any conclusions...On the other hand, I have provided you with plenty of data in the other thread and proved that there is a wealth of data (hundreds of studies) out there showing that experienced NPs practice equal to that of physicians in certain outcomes of measure and in certain settings. One of the studies that I gave you in fact was a randomized trial published by the American Medical Association..So no, this is not the same thing.
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“The contention that (nurse practitioners) are less able than physicians to deliver care that is safe, effective and efficient is not supported by the decades of research that has examined this question,” said the Institute of Medicine in its 700-page The Future of Nursing: Leading Change, Advancing Health, published in 2011.
Chuck Moran, spokesman for the Pennsylvania Medical Society, could not point Watchdog.org to a single study that showed negative patient results under expanded nurse practitioner roles. He instead pointed to polling.
Nurses: Regulations hamper health-care efficiency in Pennsylvania
Here's the 700 page report in the IOM supporting my position:
https://www.nap.edu/read/12956/chapter/1#xv
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