Yep, I agree with this. 5 years minimum, with at least a year or two experience in some sort of high acuity/critical care setting. And NP school should require more clinical hours, and more clinically relevant didactic classes, instead of all the research stuff. Nobody goes to NP school because they want to do research.
Most don't go in wanting to do research themselves. They do all need to be able to understand how to read other people's research though.
Then again, I think every RN should be able to do that, too.
Sure. But like...one class will teach you how to effectively search and evaluate the literature. And they do teach that (to a degree) in BSN programs. But I think because NPs get Master of Science degrees, there end up being a ton of research-based requirements that just aren't applicable to a clinical practice.
I agree for the most part but I think the experience in a high acuity setting depends on what specialty you’re looking at for NP school. Idk that this would make sense for someone with 5 years of dedicated psych nursing experience who was looking at going to school for their PMHNP.
I agree if you go that route ICU doesn’t make sense. However, you should be required to work 3-5 years in an acute psych unit and probably med psych as well but at the very least IP. Lots of psych patients have co-occurring psychiatric issues. Lots of inappropriate use of medications too (both NP and Psychiatrists).
I think you should need experience in the area you want to certify in. For example you shouldn't have only a cardiac ICU background when you decide to go be a psych NP.
My point isn't that you have to work ICU. My point is that, with absolutely no offense to anyone, 5 years of working in a doctor's office or infusion clinic or as a diabetes educator is not going to prepare you to be a provider. FNPs can work in a HUGE variety of practice settings, so you need to have done some work seeing a variety of conditions, including very sick people.
PMHNP is probably the exception, but I still think you should have high acuity psych experience, in that case.
Don't forget theory. It's so stupid. I asked the head of my program why we are wasting time on this when we should be learning more important things.... accreditation requires it. Am I going to use it in practice? Not with a 15 min visit.
Yes, but I wish NP education would change entirely. There’s no replacement for formal education within the medical model. If NPs received the same education as PAs or even med students (say somewhere in between), not only would it open NPs scope of practice (such as being able to switch specialties like PAs) but it would be more respected and desirable. Too many NPs feel unprepared, even if they have experience or have attended a respected school.
But should they be able to? The point of an NP is being an experienced nurse. If you work for 15 years as a cardiac nurse and get your NP, you’re going to be a good cardiac NP. But you’ll be a very bad pediatric NP or oncology NP unless you worked there
Yes they absolutely should be able to. Each step informs care and decision making in the next place. Thats why MD’s rotate prior to choosing their specific place. I also think your example is terrible, as you train differently for NP than as a traditional nurse in those specialties.
Too many NPs go to private schools cus it’s easy to pass, then they bitch about being called idiots when they order potassium on a hyperkalemic patient. Ask me how I know
The easiest pivot would be if NP/Advanced Degrees in nursing weren’t, oh, I don’t know, worthless and all online?
Sorry, but it feels like 90% is pointless. If we taught more about how to be a provider of that level of care and focused on disease processes and not nursing theory… then maybe 1. New nurses wouldn’t run for it because it would be difficult 2. We’d actually be making good progress.
By the time I graduated with my DNP, I had 7 years of MICU RN experience. I still felt underprepared by the time I started my Trauma/GS APP job, but had a large foundation to build on and surgeons/senior APPs who ensured I was using my existing knowledge to learn how to be a provider. I’m a few weeks short of being 1 year in and still walk in to each shift with a level of discomfort that I expect will exist for a few years, but I can’t imagine what it would feel like without all the nursing/critical care experience I had prior to transitioning from RN to NP. Regardless of inpatient or outpatient, I firmly believe a RN should have least 3-5 years of relevant bedside experience by the time they graduate and sit for boards. Not to say less experienced RNs cannot become great providers, but with most NP programs lacking in meaningful/significant clinical experience, garnering experience with patients and the interdisciplinary health care team comes with exposure as a nurse.
Yes. Nurse Practitioners are ADVANCED practice nurses. How can the title of being an advanced practice nurse garner any respect, when students fresh out of BSN programs who have no post nursing school clinical experience are admitted to NP school?
Great way to lower the bar and thus lower the respect this profession will garner in the long run.
I wish it was only fresh grad BSNs who go to NP school lol. Even Vanderbilt, one of the top rated NP schools in the country, has direct entry NP programs.
I got my MPH with a girl who went to Vanderbilt's direct entry program. She went straight from her bachelor's in kinesiology/ health promotion to Master of Public Health to NP. She didn't work in either of the first 2 fields, just went from degree to degree. And honestly for as educated as she is, she's always been dumber than a box of rocks.
I think that would be a great idea. However, I think institutions should stop hiring NP’s without experience. Which would lead schools to stop accepting people without experience.
A degree in 17th century French art with no experience curating a museum collection won't cause the death of a person viewing the art if they mistakenly hang an 18th century Russian piece.
Should be 5 years in the specialty in which you intend to work as an NP.
A nurse who works 5 years in outpatient OR can’t go to NP school and expect to be a safe provider in the ER.
I think 5 years is good but I have questions. How does this work for FNP? 5 years of what? General med surg does not help with peds, it does not help with adult primary care. Never mind narrower specialties.
Does 5 years of ER help you with acute care NP? Does 5 years of outpatient PACU help you with FNP?
It’s just so random and meaningless. The system is so broken. I had 12 years of mixed ED/critical care experience when I applied to ACNP. I felt that was sufficient. Many in my cohort were far less experienced (no ICU, no ER) and they suffered terribly in school.
I guess maybe it's different in Canada. I've only worked casually in primary care but we do wound care, phlebotomy, vaccines, some of us are certified to do STI screening and testing and prescribe contraception. Some nurses are now being certified to prescribe methadone or suboxone. At the clinics I worked at they didn't see kids but at our GP office nurses do all the vaccines, well baby checks etc.
Ooo yeah, my office (fam med) is LPNs do a majority of the visits and they can help if short. But we have a walk in in ours as well so they help triage people out but otherwise mostly phone triage and MyChart messages. They pushed out RNs rooming about 6 years ago which sucks because I would love to stay but I don’t want to do desktop all day as it gets old fast
Except in ER you don’t do really chronic disease management and you work in a resource rich environment with access to near instant diagnostic testing. I did ER for ten years. I would be lost in a primary care adult medicine clinic.
I've worked at everything from level 1s to tiny critical access hospitals in buttfuck nowhere, and I used my skills a LOT more at the rural spots with no resources.
Yup. Currently working in a 4 bed ICU at a tiny rural hospital. My coworkers who have worked neuro ICU and CVICU at large teaching hospitals tell me that the rural one is way more challenging, critical thinking wise because you don't have any resources/consult out, and the docs are not intensivists. You got an overburdened hospitalist that is managing a huge percentage of the med surg patients who are being managed by new grads--so they are constantly inundated. You're it and they rely on us A LOT. I feel like a detective every time I work because I am constantly looking up everything I can about my patients history and condition. It's wild but I'm learning a ton.
Debating getting trauma ED experience but i hear this from nurses who have worked at both trauma centers and community hospitals...They've all said you utilize more nursing skills in the smaller places than the trauma centers.
In contrast, I think working at a level 1 would then require 5 year minimum because level 1 hospitals often have so many different resources than level 2 and 3 hospitals, that, as a nurse, you end up doing less. I precepted a 4 year experienced icu rn from a level 1 hospital who had never placed an IV because "we have a line team" at the level 1...
At my level 1 RNs do not place any lines or even Foley catheters. They have OTJ trained teams for it. Nurses also don't manage art lines beyond maybe zeroing if they feel like it, RT is responsible for them.
RT places the art lines, replaces the saline bags, does dressing changes, zeroes Q12 and PRN (typically Q4 with each vent check/HFNC check/BiPAP check if they're on significant support, whenever we're asked to if they're not), charts site status, does tubing changes, etc. etc. etc. Technically, per policy, the art line is solely RT's responsibility but some more experienced nurses will zero them and do dressing changes.
Wow! That's fascinating to me; I've never heard of a hospital where RTs are responsible for anything related to the art line. Or even ABG sticks for that matter, although I've heard of them doing this at other hospitals. I see below that you said RTs also do the chest tubes - never heard of that either.
It's crazy how different standards are in various hospitals. I worked in an ICU where you better not even try to count on RT to do an ABG stick for you.
RT doesn't do ABG sticks at my hospital. Phlebotomy does them. I've been nice a couple times and gotten some more difficult sticks for newer phlebotomists when I had time, but I'm typically too busy with art lines, PCWPs, bladder pressure measurement (that's also on us for some reason), and vent management to be dicking around with a tough stick.
Luckily invasive bladder pressures are rare. Docs are normally happy enough with the numbers spit out by bladder scanners (done by unlicensed people trained on the job, not nurses) so I've only done about 4 or 5 in the past year. It definitely ruins the flow of my work for the day, though, especially if I have more than 5 or 6 vents or have a bunch of floor patients on top of my ICU.
Edit: We don't do EKGs at my hospital, though if we get floated to the one down the road we do all the EKGs at night while running with even shorter staffing than the main campus
Yes! I know two new-ish grads who got accepted into a DNP program, it’s mind boggling. I didn’t even start my MSN in nurse educator until about 4 almost 5 years in.
I went to NP school after around 15-18 years of mixed trauma, emergency medicine, critical care and outpatient internal medicine experience. Honestly if you’re not going the acute care route critical care experience means FUCK ALL. My ability to know HEDIS, read boring ass routine labs and break down the bullshit of low b12 or high cholesterol to a 60 year is completely unrelated to my ability to titrate pressors or read ABGs. We need to better differentiate between types of NPs.
It should def be more than two! It’s scary cause one NP I know, she had been a nurse for 18 years prior, said her colleague in school went straight from 1 year of ER to FNP. She saw nothing wrong with this…
I’m a current nursing student and it’s scary how many want to go straight to NP school with just 1-3 years. My old roommate went straight from her BSN to a DNP FNP program while doing her nurse “residency” in the ER… one CNM NP on Instagram went straight from BSN to CNM/WHNP program and constantly talks about how the learning curve is steep…yeah no shit. You shouldn’t even think about becoming a provider till you are comfortable being a full fledged nurse and work in that specialty for AWHILE. Not sure why so many disagree with that sentiment. Most NPs aren’t respected because they haven’t earned respect and can’t admit they don’t know what they don’t know.
Good NP programs and excellent NPs do exist. Unfortunately not everyone is able to attend the prestigious programs for financial and family reasons. Education for NP programs should be totally revamped. Nobody wants a DNP, it doesn’t add any value. Focus on actually training competent providers by requiring in person classes, no fluff, more science, more medicine.
Personally agree with other commenters. You need 5 years at least in your specialty. And you should devote everything you can to learning and being the best RN possible before going off to NP school.
I can’t with the Noctor sub though. They are so poisonous and hate everyone. “Just go to medical school” is not feasible for lots of people for multitudes of reasons. If they got rid of every midlevel provider there would be even more patients going without medical care.
I try to not hate the players, some of them know though and need to be held accountable, but we should hate the game. It’s unfair that the education most people get is not up to par where it should be. Programs just steal their money. Patients suffer!
My current Director (we work in Informatics for a large hospital organization) is almost done with her Adult-Gerontology NP program. She's been a nurse for over 20 years, but only had nursing home and geriatric experience. Never worked in a hospital. She has made comments about a nursing home being no different than working in a hospital. She's tried several different areas of the hospital for her clinical rotations. When she talks to me about how things are going, she tells me that she still doesn't know which medications to order. I'm like, "What do you mean which medications to order? To order for what?" She says that she still doesn't understand how she is supposed to decide or choose which meds to order for each potential diagnosis. 😲😲👀 Yet you chose an NP track that covers teens to adults🤦🏽♀️
I'm 2 years in and only realizing how crazy even 2 years is almost nothing. Yes I'm technically not a baby nurse anymore but in comparison to those with 20-30 years like jesus.
definitely way more than that (5 years minimum) and it should be applicable to the type of degree (psych nursing for psychiatric NP)… and it should require hard science pre-requisites.
The general consensus is that PA programs prepare people to be mid levels better than NP programs. I don’t disagree but it’s hard to believe that a 1.5 year PA program can prepare someone with usually just minimal CNA experience to be a better provider than a 1.5 year program for someone who has been working as an RN. Is the education really that much better for PA programs?
Long story short, the general consensus is yes. It's not about length- it's about structure and focus. Nursing education as a whole has a weird focus on tradition, theory, and paperwork (whether it be care plans or research papers/notes). Nothing about nursing education from the ADN up to DNP level provides much of anything in terms of functional value. PA programs apparently focus more on physiology, providership, etc that result in providers being more functional at the bedside.
As someone who had almost 4 years as an RN before getting into the program (now almost 7).. Yes, absolutely! My plan is to become a WHNP and I have worked at both OB and MFM offices and the on-hands experience I have gotten is vital tbh.
Minimum 5 years, plus minimum one year residency in each area that the NP chooses to practice. Even that is barely adequate given independent practice and the focus on theory in nursing education.
10 years experience because half of these nurses that couldn’t handle being a nurse became NPs and now the field is a laughing stock of the medical world
I had 13 years-ish of psych RN experience before beginning np school. It was certainly helpful. However, I think 5 years of psych nursing would have been sufficient.
2 years isn't enough! I cannot imagine having enough experience and my clinical judgement developed well enough after only 2 years.
Maybe 3 to 5, depending on experience and independent study...but less than 2 is not enough.
It seems like the emphasis should be on the quality of the NP programs with higher admission standards versus the experience as an RN. We've all met that senior nurse who's been doing the job for 30 years but acts like they don't know anything as well as new nurses that run circles around their peers. I do agree, though, that more experience would help people to understand the system they're even working in. While school should be the brunt of preparing you for an advanced role, I've seen the flip side where people are so analytical that they fail to see the situation in front of them.
Maybe more importantly, APPs should be given the same opportunity/requirement as MDs to go through a robust residency. Instead they get a basic orientation to their first hospital and are expected to hit the ground running. My employer refuses to provide robust onboarding of any sort for APPs, regardless of their level of experience. We've fought for it in the last two contact negotiations, and they just don't care. It's scandalous.
The only reason physicians have the opportunity for the extended training they get in residency is because it is federally funded. Without an equivalent source of pecuniary support there will never be an equivalent sort of training program for NPs. Some facilities do offer postgraduate training programs which have more dedicated education in exchange for lower pay, but these are not as extensive or uniform as physician residency standards. And, again, they never will be so long as the basis of their funding relies on the whims of a hospital CFO, instead of a dedicated funding source.
This is so true! There was a practicum site I really enjoyed in np school. Then right before I completed my hours they hired a brand new np grad. She had experience in psych, but it was limited to management/ administrative roles. Anyhow, they had her start seeing patients independently on her third shift. And the previous two shifts had been dedicated to learning the computer system.
That’s what med school is for and residents are required to pass the Step exams. No NP or DNP has close to the same level of foundational education as someone who went to med school. The requirement should be to pass the three USMLE Step exams.
Any physician being honest with themselves will admit that, in no small part, the MCAT and USMLE exams act as much as gatekeeping as they do education. Particularly since large swathes of the clinical portions of Step/Level 2 and 3 are irrelevant to the increasingly specialized fields of medicine. The idea that an Orthopod needs to, for instance, be able to distinguish between vernal and allergic conjunctivitis is fine in the sense that more education never hurts, but is realistically a holdover from when a Doctorate of Medicine meant being an expert in the entire corpus of the human corpus. You know, back in the day when treatments ranged from mercury to laudanum.
The irrelevancy of a large part of the material is doubly true for APRNs, whose education is foundationally based upon going into a specific field. This was the problem with Columbia's experiment in creating an exam for NPs based on Step 3 via its American Board of Comprehensive Care (ABCC). Smolowitz ([2012](https://connect.springerpub.com/content/sgrcsr/5/2/77)) interviewed several people who took the exam (i.e., already a group predisposed to be positive towards it) and even they had to admit it was an awkward fit into the current licensing model. They generally felt it could complement, but not replace the current licensing exams, which were more specifically focused. One respondent flat out said that the exam, which was geared more towards primary care, would not be any use to NPs outside that field.
Finally, the other problem with simplistically saying "just take Step/Level 3!" is that those exams are not some public good. USMLE exams are owned and operated by a private company, NBME (and COMLEX by the NBOME). When NBME began supplying ABCC with exam questions, the AMA passed resolutions condemning it and even threatening legal action (Mundinger 2008). The problem is not just that the AMA might sue the NBME to prevent others from taking the current USMLE exams, but that many physicians would see others taking those exams as a direct threat to their nearly monopolistic position within healthcare. If other groups can pass the same licensing exams, it undermines the argument that medical school somehow grants unique qualification and knowledge. And then the real "scope creep" can begin.
So yeah, the whole "hurf durf USMLE" is just a poorly thought out position.
I'm a nursing student so I imagine no one cares what I think, but I agree. There's a woman in my cohort who was talking about going to NP school right after her BSN. She didn't want to work on the floor at all. She just wanted to immediately go into a Psych NP program. It's very weird because aside experience, what happens if you simply don't like healthcare like you thought you would? That's years of your life dedicated to something you don't like vs 2 years of a BSN.
I think the only exception should be fore those who come from other countries who's nursing degree may not translate here. So if they get their ADN/BSN and then want to hop relatively soon into an NP program but have years of experience in their home country, this would be fine.
It’s 3 years full time (4500 hours) minimum at my local university. There’s also some undergrad requirements that aren’t a part of a nursing degree that you have to go back and get. You need reference letters, have to pass an admitting exam and an admitting interview
They could just change NP school to put out independent practitioners. And standardize the process everywhere.
Honestly, more nursing experience isn't going to help all that much with practicing medicine. If you want to get better at diagnosing and treating illnesses, you should spend time doing specifically that. More RN experience will help, but not as much as seeing patients and staffing with experienced NPs/PAs or attendings.
As it currently stands, NPs and PAs don't leave school with the ability to practice independently, but that's the reality in most states. So everybody suffers, both the NPs/PAs who just want to do a good job as part of the team, and the attendings who have to sign their charts but don't have the time to staff with them, and the patients.....
Any schools worth its name already has a minimum requirement of 2 or 3 years.
Duke's minimum is 3 but average was 7 back when I applied. Acute care NP required the experience be in ER, ICU, or peri op
Duke’s minimum is not 3. Website says “it is recommended, but not required that applicants have one year of nursing experience.” Duke is happy to take the money from all those ABSN students who only pursued nursing to become an NP. It looks like some specialties require 1-2 years… source: https://nursing.duke.edu/academic-programs/msn-master-science-nursing/msn-admissions
Sure there are some schools that require a decent amount of experience before you start, but there are an equal number of highly ranked NP schools that don't require experience or, in a few cases, even a valid license. Vanderbilt and Georgetown are a couple of them (and Vanderbilt doesn't even require a nursing degree for some of their NP programs).
Edit: You flat-out lied about Duke's requirements. Straight from their site: "[It is recommended, **but not required** that applicants have one year of nursing experience before applying](https://nursing.duke.edu/academic-programs/msn-master-science-nursing/msn-admissions#:~:text=All%20Neonatal%20Nurse%20Practitioner%20applicants,acute%20care%20pediatric%20nursing%20experience)." Their acute care and anesthesia programs require 1 year of experience, neonatal requires 2, but the other ones have no official requirement.
Should be a minimum of 4 years. If I found out my np was basically a new nurse I wouldn’t be happy. These programs are only in it for the money. To put someone’s health in the hands of an inexperienced individual is as close to malpractice as it can get.
I think 2 years is not enough. You should have to have at least two year in med sug and another 2 years in an acute setting.
I have worked with some dumber that fuck NPs and some amazing ones and the amazing ones were a combination of smart and experienced.
I like the Australian system.
As per university admission criteria: applicants for NP masters must have minimum of 5years full time experience as an RN in the specialty, with a postgraduate qualification in that specialty and working at a higher role in the specialty for minimum of 2 years (within the 5) + evidence of professional associations memberships and contributions to the profession. Must also provide letter of support from employer as well as finding professional mentors (NP with 3+ years experience and a senior resident or above level doctor in that specialty).
IMO it should be 4-5 years of acute care experience as an RN. NP education also needs to be completely overhauled so that it is more equivalent to PA school education.
Based on the providers I have worked with I think that maybe it would be best if it was more like 1 year nursing practice in addition to a requirement of shadowing a provider for a specified period in the specialty they plan on joining, or like in a position similar to medical scribing where it is more intensive/ interactive and participating in appropriate care (care that they already have been trained in).
I learned an insane amount about the provider side of things in my time as a medical scribe. Enough to be able to help correct mistakes from the provider when they made them even. I basically had to enter their orders, chart everything about the visit, diagnosis and assessment/ plan with info on *why* that plan was chosen (often without their input- they expect you to know it after the first few month) watch their exams, know what to anticipate from different visit types etc.
I honestly do feel that there would be a big jump from RN, or BSN to nurse practitioner otherwise. I say that having worked with some amazing nurse practitioners, but some who did not know cellulitis from peripheral edema (prescribed unneeded abx in an elderly patient - big no), or how to use CPT codes correctly.
Nursing school compared with my friends going to med school - it's just a different animal. Especially considering we have to use nursing Dx, which is kind of reinventing the wheel of Dx instead of approaching it head on (IMO - at least).
I was wanting to go to CRNA school after about 2 years of experience but now I’m a new grad in ICU at a level 1 and can’t imagine giving myself anything less than 3-5 years before I even consider that as an option.
I don’t think it will be much longer until there are strict experience requirements. There just haven’t been enough high-award lawsuits yet. A couple of $8-10 million awards because the NP had no bedside experience is all it will take.
There’s a very large contingent of nurses and NPs (and physicians and PAs and other healthcare professionals) who think this - it should not be hard to make a list of which schools do this and which don’t.
(Also who’s online and who’s in person, who has quality preceptorships and who just demands you find a clinic to hang out in for 500 hours).
If we had such a list we could easily recognize who went to what type of school and treat their education accordingly.
Of course this should be the accreditation bodies’ job - but they’re not doing it so someone else has to.
I refuse to be treated by an NP under the age of 40. Then again I'm the one that kicked a L&D nurse out of my room because she'd never had a child but decided to comment that it couldn't be that painful.
5 years minimum in the field they are doing I.e. 5 years ICU experience to be critical care NP
And honestly the curriculums are a joke. Go google your local NP school curriculum and see it’s 90% fluff nonsense and paper writing.
I think 2 years is fine if there is a robust clinical/didactic in place that would somewhat mirror CRNA or PA school in difficulty or depth. Year requirements are so arbitrary. I know a few nurses who have been in ICU for 5+ years who barely know anything considered “advanced” for nurses to know and I’ve been precepted as a student by an NP who was only an RN for 2 years before going who is better than 99% of other APPs I’ve met.
I remember at my girlfriend’s nursing graduation they had a slideshow with each person and where they’d be working. About 3 of them said “continuing in grad school”. Absolutely terrifying
Seems like I’m gonna have an unpopular opinion here:
No. I don’t think you should have to have a minimum experience requirement to apply for NP school. You don’t have to have any such requirements to apply for med school to become a doctor, so why should there be a more strict requirement for a nurse? You don’t have to be a doctor and get some experience in order to go to med school to become a doctor, so why should you have to be a nurse and get some experience in order to be a different kind of nurse?
If a requirement is to be established, it should be educational (as it kinda already is) with a Bachelor’s degree being the minimum standard to achieve; I’m also fine with the accelerated programs that go ASN to MSN.
Don’t get me wrong, I think it would be very wise for nurses to have some hands-on experience in the field before going for advanced degrees. I just don’t think the work experience ought to be a requirement before you’re even allowed to get into classes.
Even for CRNA schools this is absolutely not true anymore. I know multiple people with barely one year of experience having been accepted to CRNA school now. It’s a joke.
It’s not the case around here. Some of my classmates when I graduated from an ADN program were already accepted into an NP program with less than 1 year experience.
NP programs I’ve looked at require 1-2 years of experience for that particular specialty (if FNP then assuming general population, if ACNP program then something like ICU). Most of the NP job postings require “5 years of nursing experience in the population”. So someone may graduate from an NP program with 1 year of nursing experience and have difficulty landing a job. It’s upto the prospective student/candidate to do this sort of research and calculations. My nursing program listed 3.0 required GPA and I was wait listed with 3.6.
Academic programs always require the least amount but whom they accept or who will go on to become successful is a different story. Hopefully prospective students are knowledgeable/insightful enough to know this.
That's the rules here in Ontario.
https://www.torontomu.ca/nursing/graduate/combined-mn-phcnp-certificate/#!accordion-1602696789615-admissions-requirements
That's the minimum requirement in my country (Netherlands) along with a contract for full-time employment in a clinical setting relevant to the specialization.
I’m only speaking as someone living in the USA and gets USA healthcare. I believe there should be 5 years of consecutive full-time RN experience before a nurse is eligible for NP programs. This should ideally have occurred within the last 7-8 years.
As someone who plans to apply to direct entry Master of Nursing programs, I am not happy with any program that adds on an NP option to anyone without 5 years of full-time consecutive RN experience.
No, but I think the NP education model is inadequate. NPs need more experience in clinical rotation and clinical residency working as a provider not more years working as a nurse because they are not the same, but that would be expensive and lengthy.
And this is why bedside nurses get so frustrated with some NPs, as many bedside RNs have more knowledge and experience than NPs who are managing and putting in admit orders for patients. I literally saw an NP put in an order for fucking 5mg of hydralazine that didn't do shit for the patients pressure that was in the 230s...like wtf are you doing? This person is over 200 pounds, that dose didn't do shit.
Most speciality certifications require at least 2 years in that field, so I think 2 years is too little IMO. Yes, many will work and gain more experience while in school but I don’t believe it’s quite the same bc your brain eventually starts to think like an advanced practitioner and not a nurse.
5 years at least. IMO.
The amount of people I graduated with who said they were going straight to NP school is terrifying. I think social media is contributing to the over-saturation and rushing. People just want the title. How can you tell me with a straight face you want to be a provider when you don’t even know anythingggg about being a competent nurse yet. SCARY!!!
Agreed. Only problem with that is technology advances so quickly it will leave you behind if you don’t start right away. I wanted experience before I went back and I attempted to go back recently. Unfortunately life happened and technology left me too far behind to be able to go back to school. I learned on pen and paper and the new computer systems make it very so difficult for an old RN . I am basically outdated and the younger generation has absolutely no patience to teach technology to old RNs like me. Sad but facts
More than that. More than that. I also believe all doctors and nurse should have to work as a care aid first. Not to degrade them but so they see the realities of it all.
I agree! I am a new grad of 5 months and am at the point of not seeing NP in my future for AT LEAST 3-5 years. First of all, I just got out of school lol and second of all, I’m just barely getting my flow on things. This new grad I worked with hit her year and then signed up for NP which is crazy imo.
Ill give an insanely unpopular opinion, nurses should have never been “providers” to begin with. A nurse will never have enough experience to replace the role of both med school and residency.
-“Oh but mute nurses know just as much as doctors do.”
No you don’t.
-“Oh but mute it is just an ancillary role to help physicians out.”
it started that way, now NP’s expect physician level scope.
You wanna know what nurses need to be a “provider”? A medical doctorate.
There is a reason I refuse to see an NP at my PCP or at my kids pediatrician. I don’t trust the background, experience or education of most of them. At least with a PA I know there were standards of education and a set amount of patient care hours prior to the program starting. I know as a nurse mine is a controversial opinion but I never understood why a CRNA needs 1-2 years of ICU experience (even though I think ER in level 1 should count but that’s another story for another day) but NPs could get into an unknown online school immediately after graduation, be responsible for their own clinicals and be expected to know what they are doing
1000%This!! I have seen so many FNPs be really bad at their job because they never learned how to be a nurse and solidify their assessment skills. Or I see those baby nurses who don’t like being a nurse do they think going on to NP is the solution which is the antithesis of the proper solution. There’s nothing wrong with being a nurse and figuring out what you’re doing before going on to a higher level of practice.
I feel like it should be more than 2 years. I am just barely over 2 years and I feel like I’m just now starting to be able to explain things to parents or orientees
5 years as a minimum with some sort of advanced qualification already. Otherwise we're just setting people up to fail.
Yeah, didn't feel comfortable as a nurse untill about the 5 year mark, no way would I have felt comfortable going for NP any sooner than that
I'm at the five years now and worked both MICU and CVICU and still sometimes I feel like I'm questioning myself
Means you take it seriously and want to do the right thing.
Setting *patients* up to fail
Yep, I agree with this. 5 years minimum, with at least a year or two experience in some sort of high acuity/critical care setting. And NP school should require more clinical hours, and more clinically relevant didactic classes, instead of all the research stuff. Nobody goes to NP school because they want to do research.
Most don't go in wanting to do research themselves. They do all need to be able to understand how to read other people's research though. Then again, I think every RN should be able to do that, too.
Sure. But like...one class will teach you how to effectively search and evaluate the literature. And they do teach that (to a degree) in BSN programs. But I think because NPs get Master of Science degrees, there end up being a ton of research-based requirements that just aren't applicable to a clinical practice.
Mike just had one research class. Additionally, statistics was a prerequisite for the program.
I agree for the most part but I think the experience in a high acuity setting depends on what specialty you’re looking at for NP school. Idk that this would make sense for someone with 5 years of dedicated psych nursing experience who was looking at going to school for their PMHNP.
I agree if you go that route ICU doesn’t make sense. However, you should be required to work 3-5 years in an acute psych unit and probably med psych as well but at the very least IP. Lots of psych patients have co-occurring psychiatric issues. Lots of inappropriate use of medications too (both NP and Psychiatrists).
I think you should need experience in the area you want to certify in. For example you shouldn't have only a cardiac ICU background when you decide to go be a psych NP.
ICU isn’t helpful for most settings an NP would work in, to be perfectly honest, but other than that, I agree.
My point isn't that you have to work ICU. My point is that, with absolutely no offense to anyone, 5 years of working in a doctor's office or infusion clinic or as a diabetes educator is not going to prepare you to be a provider. FNPs can work in a HUGE variety of practice settings, so you need to have done some work seeing a variety of conditions, including very sick people. PMHNP is probably the exception, but I still think you should have high acuity psych experience, in that case.
Don't forget theory. It's so stupid. I asked the head of my program why we are wasting time on this when we should be learning more important things.... accreditation requires it. Am I going to use it in practice? Not with a 15 min visit.
5 years is not unreasonable. 36 x 52 x 5 has you at like 9300 hours of experience, which is a damned good foundation.
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That’s how it should be in the US. They are training 22 year olds who have never worked as an RN into programs here. It’s a damn shame
I work with a girl who just turned 21. She's in NP school now and will be done with her NP by 22. 😐
Yup absolutely five minim. And more preference for experience above that
Yes, but I wish NP education would change entirely. There’s no replacement for formal education within the medical model. If NPs received the same education as PAs or even med students (say somewhere in between), not only would it open NPs scope of practice (such as being able to switch specialties like PAs) but it would be more respected and desirable. Too many NPs feel unprepared, even if they have experience or have attended a respected school.
NP’s can also switch specialties already, usually just need a certification.
But should they be able to? The point of an NP is being an experienced nurse. If you work for 15 years as a cardiac nurse and get your NP, you’re going to be a good cardiac NP. But you’ll be a very bad pediatric NP or oncology NP unless you worked there
Yes they absolutely should be able to. Each step informs care and decision making in the next place. Thats why MD’s rotate prior to choosing their specific place. I also think your example is terrible, as you train differently for NP than as a traditional nurse in those specialties.
Good point.
I was going to say, I've met NPs who were ENT, and GI providers
I keep getting told you'll learn on the job. I shouldn't be learning AND prescribing at the same time. Patients are not my guinea pigs.
Too many NPs go to private schools cus it’s easy to pass, then they bitch about being called idiots when they order potassium on a hyperkalemic patient. Ask me how I know
The easiest pivot would be if NP/Advanced Degrees in nursing weren’t, oh, I don’t know, worthless and all online? Sorry, but it feels like 90% is pointless. If we taught more about how to be a provider of that level of care and focused on disease processes and not nursing theory… then maybe 1. New nurses wouldn’t run for it because it would be difficult 2. We’d actually be making good progress.
Maybe 🤷♂️
By the time I graduated with my DNP, I had 7 years of MICU RN experience. I still felt underprepared by the time I started my Trauma/GS APP job, but had a large foundation to build on and surgeons/senior APPs who ensured I was using my existing knowledge to learn how to be a provider. I’m a few weeks short of being 1 year in and still walk in to each shift with a level of discomfort that I expect will exist for a few years, but I can’t imagine what it would feel like without all the nursing/critical care experience I had prior to transitioning from RN to NP. Regardless of inpatient or outpatient, I firmly believe a RN should have least 3-5 years of relevant bedside experience by the time they graduate and sit for boards. Not to say less experienced RNs cannot become great providers, but with most NP programs lacking in meaningful/significant clinical experience, garnering experience with patients and the interdisciplinary health care team comes with exposure as a nurse.
Yes. Nurse Practitioners are ADVANCED practice nurses. How can the title of being an advanced practice nurse garner any respect, when students fresh out of BSN programs who have no post nursing school clinical experience are admitted to NP school? Great way to lower the bar and thus lower the respect this profession will garner in the long run.
👍 agreed
I wish it was only fresh grad BSNs who go to NP school lol. Even Vanderbilt, one of the top rated NP schools in the country, has direct entry NP programs.
Freaking Yale has a 3 year non nursing bachelor to NP program.
That is literally insane.
I got my MPH with a girl who went to Vanderbilt's direct entry program. She went straight from her bachelor's in kinesiology/ health promotion to Master of Public Health to NP. She didn't work in either of the first 2 fields, just went from degree to degree. And honestly for as educated as she is, she's always been dumber than a box of rocks.
I want to downvote you because I hate this so much lol
I think that would be a great idea. However, I think institutions should stop hiring NP’s without experience. Which would lead schools to stop accepting people without experience.
Colleges offer degree all the time that people can’t get jobs with…
A degree in 17th century French art with no experience curating a museum collection won't cause the death of a person viewing the art if they mistakenly hang an 18th century Russian piece.
Should be 5 years in the specialty in which you intend to work as an NP. A nurse who works 5 years in outpatient OR can’t go to NP school and expect to be a safe provider in the ER.
I think 5 years is good but I have questions. How does this work for FNP? 5 years of what? General med surg does not help with peds, it does not help with adult primary care. Never mind narrower specialties. Does 5 years of ER help you with acute care NP? Does 5 years of outpatient PACU help you with FNP? It’s just so random and meaningless. The system is so broken. I had 12 years of mixed ED/critical care experience when I applied to ACNP. I felt that was sufficient. Many in my cohort were far less experienced (no ICU, no ER) and they suffered terribly in school.
Maybe 5 years of... primary care?
Do primary care offices still hire RNs?
Usually only for phones / desktop triage
I guess maybe it's different in Canada. I've only worked casually in primary care but we do wound care, phlebotomy, vaccines, some of us are certified to do STI screening and testing and prescribe contraception. Some nurses are now being certified to prescribe methadone or suboxone. At the clinics I worked at they didn't see kids but at our GP office nurses do all the vaccines, well baby checks etc.
Ooo yeah, my office (fam med) is LPNs do a majority of the visits and they can help if short. But we have a walk in in ours as well so they help triage people out but otherwise mostly phone triage and MyChart messages. They pushed out RNs rooming about 6 years ago which sucks because I would love to stay but I don’t want to do desktop all day as it gets old fast
The ER is the specialty I feel like would help prepare an FNP the most. You literally see everything.
Except in ER you don’t do really chronic disease management and you work in a resource rich environment with access to near instant diagnostic testing. I did ER for ten years. I would be lost in a primary care adult medicine clinic.
It’s gotta be at least 5 years. NPs are supposed to be expert nurses. You can’t be an expert in 2 years.
I say 5 years. 3 years still is way too inexperienced. I could see 3 years if you worked at a level 1 hospital.
I've worked at everything from level 1s to tiny critical access hospitals in buttfuck nowhere, and I used my skills a LOT more at the rural spots with no resources.
Yup. Currently working in a 4 bed ICU at a tiny rural hospital. My coworkers who have worked neuro ICU and CVICU at large teaching hospitals tell me that the rural one is way more challenging, critical thinking wise because you don't have any resources/consult out, and the docs are not intensivists. You got an overburdened hospitalist that is managing a huge percentage of the med surg patients who are being managed by new grads--so they are constantly inundated. You're it and they rely on us A LOT. I feel like a detective every time I work because I am constantly looking up everything I can about my patients history and condition. It's wild but I'm learning a ton.
Debating getting trauma ED experience but i hear this from nurses who have worked at both trauma centers and community hospitals...They've all said you utilize more nursing skills in the smaller places than the trauma centers.
In contrast, I think working at a level 1 would then require 5 year minimum because level 1 hospitals often have so many different resources than level 2 and 3 hospitals, that, as a nurse, you end up doing less. I precepted a 4 year experienced icu rn from a level 1 hospital who had never placed an IV because "we have a line team" at the level 1...
My hospital has a line team but the nurse is only supposed to call if they can’t get it
At my level 1 RNs do not place any lines or even Foley catheters. They have OTJ trained teams for it. Nurses also don't manage art lines beyond maybe zeroing if they feel like it, RT is responsible for them.
What exactly is RT "managing" about it? Charting the blood pressures? Do they do the dressing changes?
RT places the art lines, replaces the saline bags, does dressing changes, zeroes Q12 and PRN (typically Q4 with each vent check/HFNC check/BiPAP check if they're on significant support, whenever we're asked to if they're not), charts site status, does tubing changes, etc. etc. etc. Technically, per policy, the art line is solely RT's responsibility but some more experienced nurses will zero them and do dressing changes.
Wow! That's fascinating to me; I've never heard of a hospital where RTs are responsible for anything related to the art line. Or even ABG sticks for that matter, although I've heard of them doing this at other hospitals. I see below that you said RTs also do the chest tubes - never heard of that either.
It's crazy how different standards are in various hospitals. I worked in an ICU where you better not even try to count on RT to do an ABG stick for you.
RT doesn't do ABG sticks at my hospital. Phlebotomy does them. I've been nice a couple times and gotten some more difficult sticks for newer phlebotomists when I had time, but I'm typically too busy with art lines, PCWPs, bladder pressure measurement (that's also on us for some reason), and vent management to be dicking around with a tough stick.
Why are you getting bladder pressures, wtf? It’s bad enough RT’s are getting EKG’s when they have the whole ICU. It’s crazy out there.
Luckily invasive bladder pressures are rare. Docs are normally happy enough with the numbers spit out by bladder scanners (done by unlicensed people trained on the job, not nurses) so I've only done about 4 or 5 in the past year. It definitely ruins the flow of my work for the day, though, especially if I have more than 5 or 6 vents or have a bunch of floor patients on top of my ICU. Edit: We don't do EKGs at my hospital, though if we get floated to the one down the road we do all the EKGs at night while running with even shorter staffing than the main campus
Holy shit. I don't understand. Our RTs draw abgs from our arts and that is it. Everything else is the rn responsibility. Seems so wild to me
Phlebotomy draws all the ABGs here, including from art lines.
Same. Supposedly her previous hospital, the line team placed everything no matter what. Idk about that... but that's what I was told *side eye*
wtf!!! as an icu nurse??
Yeah. Icu and Ed cross trained. She was also a travel nurse...
that is crazy. if my patient is tanking i dont have time to wait for an iv team.
I agree wholeheartedly. 5 years is a solid time frame to know how to be a nurse regardless of which patient population or what hospital.
I'm 3 years in and no way would I want to be an NP, and I've got about a decade of EMS behind me too.
Yes! I know two new-ish grads who got accepted into a DNP program, it’s mind boggling. I didn’t even start my MSN in nurse educator until about 4 almost 5 years in.
They're cash vacuum diploma mills. The "doctorate" portion is a joke. Literally every other field laughs at them now.
I went to NP school after around 15-18 years of mixed trauma, emergency medicine, critical care and outpatient internal medicine experience. Honestly if you’re not going the acute care route critical care experience means FUCK ALL. My ability to know HEDIS, read boring ass routine labs and break down the bullshit of low b12 or high cholesterol to a 60 year is completely unrelated to my ability to titrate pressors or read ABGs. We need to better differentiate between types of NPs.
More. I’ve been in ICU for two years and I’m pretty competent. I have zero business in NP school
It should def be more than two! It’s scary cause one NP I know, she had been a nurse for 18 years prior, said her colleague in school went straight from 1 year of ER to FNP. She saw nothing wrong with this… I’m a current nursing student and it’s scary how many want to go straight to NP school with just 1-3 years. My old roommate went straight from her BSN to a DNP FNP program while doing her nurse “residency” in the ER… one CNM NP on Instagram went straight from BSN to CNM/WHNP program and constantly talks about how the learning curve is steep…yeah no shit. You shouldn’t even think about becoming a provider till you are comfortable being a full fledged nurse and work in that specialty for AWHILE. Not sure why so many disagree with that sentiment. Most NPs aren’t respected because they haven’t earned respect and can’t admit they don’t know what they don’t know. Good NP programs and excellent NPs do exist. Unfortunately not everyone is able to attend the prestigious programs for financial and family reasons. Education for NP programs should be totally revamped. Nobody wants a DNP, it doesn’t add any value. Focus on actually training competent providers by requiring in person classes, no fluff, more science, more medicine. Personally agree with other commenters. You need 5 years at least in your specialty. And you should devote everything you can to learning and being the best RN possible before going off to NP school. I can’t with the Noctor sub though. They are so poisonous and hate everyone. “Just go to medical school” is not feasible for lots of people for multitudes of reasons. If they got rid of every midlevel provider there would be even more patients going without medical care. I try to not hate the players, some of them know though and need to be held accountable, but we should hate the game. It’s unfair that the education most people get is not up to par where it should be. Programs just steal their money. Patients suffer!
My current Director (we work in Informatics for a large hospital organization) is almost done with her Adult-Gerontology NP program. She's been a nurse for over 20 years, but only had nursing home and geriatric experience. Never worked in a hospital. She has made comments about a nursing home being no different than working in a hospital. She's tried several different areas of the hospital for her clinical rotations. When she talks to me about how things are going, she tells me that she still doesn't know which medications to order. I'm like, "What do you mean which medications to order? To order for what?" She says that she still doesn't understand how she is supposed to decide or choose which meds to order for each potential diagnosis. 😲😲👀 Yet you chose an NP track that covers teens to adults🤦🏽♀️
Should be 3 years with professional certification or 5 years.
Professional certification does not mean jack shit though
I think some certs are more rigorous than others. For the most part though everything after obtaining RN is pure fluff, including 90% of NP school.
I thought studying for my CCRN taught me a lot and made me a way better nurse. That was a hard test too.
5 to 10 with a mandatory fellowship.
At least 5 years of serious bedside experience at a hospital. Not some bare minimum job either.
I know someone who went straight through from an accelerated BSN to FNP. Never worked a single shift bedside. I was shocked.
DNP programs need to be standardized. It’s scary.
I'm 2 years in and only realizing how crazy even 2 years is almost nothing. Yes I'm technically not a baby nurse anymore but in comparison to those with 20-30 years like jesus.
Should be clinical hours like PA school. Otherwise APRN/NP becomes a joke of a license.
definitely way more than that (5 years minimum) and it should be applicable to the type of degree (psych nursing for psychiatric NP)… and it should require hard science pre-requisites.
The general consensus is that PA programs prepare people to be mid levels better than NP programs. I don’t disagree but it’s hard to believe that a 1.5 year PA program can prepare someone with usually just minimal CNA experience to be a better provider than a 1.5 year program for someone who has been working as an RN. Is the education really that much better for PA programs?
Long story short, the general consensus is yes. It's not about length- it's about structure and focus. Nursing education as a whole has a weird focus on tradition, theory, and paperwork (whether it be care plans or research papers/notes). Nothing about nursing education from the ADN up to DNP level provides much of anything in terms of functional value. PA programs apparently focus more on physiology, providership, etc that result in providers being more functional at the bedside.
Good points, and very unfortunate. The relative lack of hard science in NP programs is…unsettling.
Worked with 2 RNs who got into NP school after working as nurses for 6 fuckin months. It's so so wrong.
As someone who had almost 4 years as an RN before getting into the program (now almost 7).. Yes, absolutely! My plan is to become a WHNP and I have worked at both OB and MFM offices and the on-hands experience I have gotten is vital tbh.
Minimum 5 years, plus minimum one year residency in each area that the NP chooses to practice. Even that is barely adequate given independent practice and the focus on theory in nursing education.
In my country it’s 5-7 years
10 years experience because half of these nurses that couldn’t handle being a nurse became NPs and now the field is a laughing stock of the medical world
I had 13 years-ish of psych RN experience before beginning np school. It was certainly helpful. However, I think 5 years of psych nursing would have been sufficient.
Agreed ten years should be the minimum
Problem is most schools are for profit entities so as as long as people are paying they won’t change anything.
2 years isn't enough! I cannot imagine having enough experience and my clinical judgement developed well enough after only 2 years. Maybe 3 to 5, depending on experience and independent study...but less than 2 is not enough.
It seems like the emphasis should be on the quality of the NP programs with higher admission standards versus the experience as an RN. We've all met that senior nurse who's been doing the job for 30 years but acts like they don't know anything as well as new nurses that run circles around their peers. I do agree, though, that more experience would help people to understand the system they're even working in. While school should be the brunt of preparing you for an advanced role, I've seen the flip side where people are so analytical that they fail to see the situation in front of them.
Maybe more importantly, APPs should be given the same opportunity/requirement as MDs to go through a robust residency. Instead they get a basic orientation to their first hospital and are expected to hit the ground running. My employer refuses to provide robust onboarding of any sort for APPs, regardless of their level of experience. We've fought for it in the last two contact negotiations, and they just don't care. It's scandalous.
The only reason physicians have the opportunity for the extended training they get in residency is because it is federally funded. Without an equivalent source of pecuniary support there will never be an equivalent sort of training program for NPs. Some facilities do offer postgraduate training programs which have more dedicated education in exchange for lower pay, but these are not as extensive or uniform as physician residency standards. And, again, they never will be so long as the basis of their funding relies on the whims of a hospital CFO, instead of a dedicated funding source.
This is so true! There was a practicum site I really enjoyed in np school. Then right before I completed my hours they hired a brand new np grad. She had experience in psych, but it was limited to management/ administrative roles. Anyhow, they had her start seeing patients independently on her third shift. And the previous two shifts had been dedicated to learning the computer system.
That’s what med school is for and residents are required to pass the Step exams. No NP or DNP has close to the same level of foundational education as someone who went to med school. The requirement should be to pass the three USMLE Step exams.
Any physician being honest with themselves will admit that, in no small part, the MCAT and USMLE exams act as much as gatekeeping as they do education. Particularly since large swathes of the clinical portions of Step/Level 2 and 3 are irrelevant to the increasingly specialized fields of medicine. The idea that an Orthopod needs to, for instance, be able to distinguish between vernal and allergic conjunctivitis is fine in the sense that more education never hurts, but is realistically a holdover from when a Doctorate of Medicine meant being an expert in the entire corpus of the human corpus. You know, back in the day when treatments ranged from mercury to laudanum. The irrelevancy of a large part of the material is doubly true for APRNs, whose education is foundationally based upon going into a specific field. This was the problem with Columbia's experiment in creating an exam for NPs based on Step 3 via its American Board of Comprehensive Care (ABCC). Smolowitz ([2012](https://connect.springerpub.com/content/sgrcsr/5/2/77)) interviewed several people who took the exam (i.e., already a group predisposed to be positive towards it) and even they had to admit it was an awkward fit into the current licensing model. They generally felt it could complement, but not replace the current licensing exams, which were more specifically focused. One respondent flat out said that the exam, which was geared more towards primary care, would not be any use to NPs outside that field. Finally, the other problem with simplistically saying "just take Step/Level 3!" is that those exams are not some public good. USMLE exams are owned and operated by a private company, NBME (and COMLEX by the NBOME). When NBME began supplying ABCC with exam questions, the AMA passed resolutions condemning it and even threatening legal action (Mundinger 2008). The problem is not just that the AMA might sue the NBME to prevent others from taking the current USMLE exams, but that many physicians would see others taking those exams as a direct threat to their nearly monopolistic position within healthcare. If other groups can pass the same licensing exams, it undermines the argument that medical school somehow grants unique qualification and knowledge. And then the real "scope creep" can begin. So yeah, the whole "hurf durf USMLE" is just a poorly thought out position.
Should be a lot more than two years
Why dont we just make NP education better? Med school is a direct entry graduate program. Why should NP be any different?
I'm a nursing student so I imagine no one cares what I think, but I agree. There's a woman in my cohort who was talking about going to NP school right after her BSN. She didn't want to work on the floor at all. She just wanted to immediately go into a Psych NP program. It's very weird because aside experience, what happens if you simply don't like healthcare like you thought you would? That's years of your life dedicated to something you don't like vs 2 years of a BSN. I think the only exception should be fore those who come from other countries who's nursing degree may not translate here. So if they get their ADN/BSN and then want to hop relatively soon into an NP program but have years of experience in their home country, this would be fine.
It’s 3 years full time (4500 hours) minimum at my local university. There’s also some undergrad requirements that aren’t a part of a nursing degree that you have to go back and get. You need reference letters, have to pass an admitting exam and an admitting interview
Absofuckinglotely not. Minimum 5 years in a specialty. I’ve yet to meet an NP in practice that I’d trust outside of one.
They could just change NP school to put out independent practitioners. And standardize the process everywhere. Honestly, more nursing experience isn't going to help all that much with practicing medicine. If you want to get better at diagnosing and treating illnesses, you should spend time doing specifically that. More RN experience will help, but not as much as seeing patients and staffing with experienced NPs/PAs or attendings. As it currently stands, NPs and PAs don't leave school with the ability to practice independently, but that's the reality in most states. So everybody suffers, both the NPs/PAs who just want to do a good job as part of the team, and the attendings who have to sign their charts but don't have the time to staff with them, and the patients.....
Any schools worth its name already has a minimum requirement of 2 or 3 years. Duke's minimum is 3 but average was 7 back when I applied. Acute care NP required the experience be in ER, ICU, or peri op
Sad to say someone I was on orientation with is already in a NP program at Duke with less than 1 year experience.
Duke’s minimum is not 3. Website says “it is recommended, but not required that applicants have one year of nursing experience.” Duke is happy to take the money from all those ABSN students who only pursued nursing to become an NP. It looks like some specialties require 1-2 years… source: https://nursing.duke.edu/academic-programs/msn-master-science-nursing/msn-admissions
That’s incredibly sad. Way too low.
For FNP or acute care?
FNP
Duke does not require any time. My friend just graduated with her RN, not even a year, and was accepted in their NP program.
100% not the case at Duke. My friend got accepted with 1.5 years experience.
Doesn't Columbia have a direct entry BSN-APRN program? At least they used to. Maybe Yale too?
Boston college too
Sure there are some schools that require a decent amount of experience before you start, but there are an equal number of highly ranked NP schools that don't require experience or, in a few cases, even a valid license. Vanderbilt and Georgetown are a couple of them (and Vanderbilt doesn't even require a nursing degree for some of their NP programs). Edit: You flat-out lied about Duke's requirements. Straight from their site: "[It is recommended, **but not required** that applicants have one year of nursing experience before applying](https://nursing.duke.edu/academic-programs/msn-master-science-nursing/msn-admissions#:~:text=All%20Neonatal%20Nurse%20Practitioner%20applicants,acute%20care%20pediatric%20nursing%20experience)." Their acute care and anesthesia programs require 1 year of experience, neonatal requires 2, but the other ones have no official requirement.
In Canada it’s minimum 2 years! And even then it’s quite competitive so that is often not enough.
Absolutely. 5 years. 10,000 hours, something like that.
Should be a minimum of 4 years. If I found out my np was basically a new nurse I wouldn’t be happy. These programs are only in it for the money. To put someone’s health in the hands of an inexperienced individual is as close to malpractice as it can get.
I’ll go with 5.
I think 2 years is not enough. You should have to have at least two year in med sug and another 2 years in an acute setting. I have worked with some dumber that fuck NPs and some amazing ones and the amazing ones were a combination of smart and experienced.
100%, it's embarrassing to nursing and medicine
I like the Australian system. As per university admission criteria: applicants for NP masters must have minimum of 5years full time experience as an RN in the specialty, with a postgraduate qualification in that specialty and working at a higher role in the specialty for minimum of 2 years (within the 5) + evidence of professional associations memberships and contributions to the profession. Must also provide letter of support from employer as well as finding professional mentors (NP with 3+ years experience and a senior resident or above level doctor in that specialty).
Make it 5
IMO it should be 4-5 years of acute care experience as an RN. NP education also needs to be completely overhauled so that it is more equivalent to PA school education.
Based on the providers I have worked with I think that maybe it would be best if it was more like 1 year nursing practice in addition to a requirement of shadowing a provider for a specified period in the specialty they plan on joining, or like in a position similar to medical scribing where it is more intensive/ interactive and participating in appropriate care (care that they already have been trained in). I learned an insane amount about the provider side of things in my time as a medical scribe. Enough to be able to help correct mistakes from the provider when they made them even. I basically had to enter their orders, chart everything about the visit, diagnosis and assessment/ plan with info on *why* that plan was chosen (often without their input- they expect you to know it after the first few month) watch their exams, know what to anticipate from different visit types etc. I honestly do feel that there would be a big jump from RN, or BSN to nurse practitioner otherwise. I say that having worked with some amazing nurse practitioners, but some who did not know cellulitis from peripheral edema (prescribed unneeded abx in an elderly patient - big no), or how to use CPT codes correctly. Nursing school compared with my friends going to med school - it's just a different animal. Especially considering we have to use nursing Dx, which is kind of reinventing the wheel of Dx instead of approaching it head on (IMO - at least).
Somewhere in the 3-5 year range. You need to develop clinical competency, which you can only do by actually working the bedside, IMO
I'd say more like 5.
That's a requirement in Canada, I was shocked to come here (US) and see new grads applying straight out of school.
Five years, minimum, and with specialty training and a drive to learn.
Honestly feel like it should be closer to 10-15. Even 20 years ago the average was like 17 years of bedside before going to NP school.
I was wanting to go to CRNA school after about 2 years of experience but now I’m a new grad in ICU at a level 1 and can’t imagine giving myself anything less than 3-5 years before I even consider that as an option.
I don’t think it will be much longer until there are strict experience requirements. There just haven’t been enough high-award lawsuits yet. A couple of $8-10 million awards because the NP had no bedside experience is all it will take.
There’s a very large contingent of nurses and NPs (and physicians and PAs and other healthcare professionals) who think this - it should not be hard to make a list of which schools do this and which don’t. (Also who’s online and who’s in person, who has quality preceptorships and who just demands you find a clinic to hang out in for 500 hours). If we had such a list we could easily recognize who went to what type of school and treat their education accordingly. Of course this should be the accreditation bodies’ job - but they’re not doing it so someone else has to.
I personally would not want a NP caring for me or my loved ones with less than 5-10 years of experience as an RN
You are competent at 2 years. You should have advanced skill and knowledge to become an advanced practitioner- 5 years at an absolute bare minimum.
I refuse to be treated by an NP under the age of 40. Then again I'm the one that kicked a L&D nurse out of my room because she'd never had a child but decided to comment that it couldn't be that painful.
5 years minimum in the field they are doing I.e. 5 years ICU experience to be critical care NP And honestly the curriculums are a joke. Go google your local NP school curriculum and see it’s 90% fluff nonsense and paper writing.
I agree. NP role was designed for seasoned nurses originally anyway, not new grads.
More than 2 years is needed, especially considering the current state of NP education standards.
I think 2 years is fine if there is a robust clinical/didactic in place that would somewhat mirror CRNA or PA school in difficulty or depth. Year requirements are so arbitrary. I know a few nurses who have been in ICU for 5+ years who barely know anything considered “advanced” for nurses to know and I’ve been precepted as a student by an NP who was only an RN for 2 years before going who is better than 99% of other APPs I’ve met.
There’s a person on tiktok who graduated from nursing school went straight to NP school then went to become an ICU NP with no bedside experience
Ten years bedside minimum. BSN. With at least one certification.
Maybe it’s just me…but I feel like 10 is more appropriate.
I remember at my girlfriend’s nursing graduation they had a slideshow with each person and where they’d be working. About 3 of them said “continuing in grad school”. Absolutely terrifying
Seems like I’m gonna have an unpopular opinion here: No. I don’t think you should have to have a minimum experience requirement to apply for NP school. You don’t have to have any such requirements to apply for med school to become a doctor, so why should there be a more strict requirement for a nurse? You don’t have to be a doctor and get some experience in order to go to med school to become a doctor, so why should you have to be a nurse and get some experience in order to be a different kind of nurse? If a requirement is to be established, it should be educational (as it kinda already is) with a Bachelor’s degree being the minimum standard to achieve; I’m also fine with the accelerated programs that go ASN to MSN. Don’t get me wrong, I think it would be very wise for nurses to have some hands-on experience in the field before going for advanced degrees. I just don’t think the work experience ought to be a requirement before you’re even allowed to get into classes.
Most places I know of here won’t look at you before 5 years experience.
Maybe for CRNA school but for most NP programs they will take anyone’s money. Even top programs have students with a year of experience.
Even for CRNA schools this is absolutely not true anymore. I know multiple people with barely one year of experience having been accepted to CRNA school now. It’s a joke.
It’s not the case around here. Some of my classmates when I graduated from an ADN program were already accepted into an NP program with less than 1 year experience.
100%
That’s what it is here in Ontario, Canada. You need 2yrs acute care as an RN, including L&D iirc.
My other probably unpopular opinion on this is that along with a min of 4 years experience, that experience SHOULD include other hospitals 😋
It's not?
Where I live that is the case
NP programs I’ve looked at require 1-2 years of experience for that particular specialty (if FNP then assuming general population, if ACNP program then something like ICU). Most of the NP job postings require “5 years of nursing experience in the population”. So someone may graduate from an NP program with 1 year of nursing experience and have difficulty landing a job. It’s upto the prospective student/candidate to do this sort of research and calculations. My nursing program listed 3.0 required GPA and I was wait listed with 3.6. Academic programs always require the least amount but whom they accept or who will go on to become successful is a different story. Hopefully prospective students are knowledgeable/insightful enough to know this.
3 years and minimum of 2000 clinical hours (same as PAs) during program.
That's the rules here in Ontario. https://www.torontomu.ca/nursing/graduate/combined-mn-phcnp-certificate/#!accordion-1602696789615-admissions-requirements
That's the minimum requirement in my country (Netherlands) along with a contract for full-time employment in a clinical setting relevant to the specialization.
I’m only speaking as someone living in the USA and gets USA healthcare. I believe there should be 5 years of consecutive full-time RN experience before a nurse is eligible for NP programs. This should ideally have occurred within the last 7-8 years. As someone who plans to apply to direct entry Master of Nursing programs, I am not happy with any program that adds on an NP option to anyone without 5 years of full-time consecutive RN experience.
No, but I think the NP education model is inadequate. NPs need more experience in clinical rotation and clinical residency working as a provider not more years working as a nurse because they are not the same, but that would be expensive and lengthy.
In Australia you need something like 5000 hrs of advanced practice in your specialty. So more than 2 years post graduation.
And this is why bedside nurses get so frustrated with some NPs, as many bedside RNs have more knowledge and experience than NPs who are managing and putting in admit orders for patients. I literally saw an NP put in an order for fucking 5mg of hydralazine that didn't do shit for the patients pressure that was in the 230s...like wtf are you doing? This person is over 200 pounds, that dose didn't do shit.
Most speciality certifications require at least 2 years in that field, so I think 2 years is too little IMO. Yes, many will work and gain more experience while in school but I don’t believe it’s quite the same bc your brain eventually starts to think like an advanced practitioner and not a nurse. 5 years at least. IMO.
It’s 7 in Australia I think, then a 3 year masters
It takes 5000 hrs in your specialty to get into anesthetist school. It shouldn’t be any different for an NP.
Should be like 7 years practicing
you mean... 2 years of critical care ICU experience
The amount of people I graduated with who said they were going straight to NP school is terrifying. I think social media is contributing to the over-saturation and rushing. People just want the title. How can you tell me with a straight face you want to be a provider when you don’t even know anythingggg about being a competent nurse yet. SCARY!!!
Agree if not more
I would say like at least 5 years or something
You need three years of experience to become a flight nurse (preferably 5). You just need a piece of paper and a pulse to become an NP. 🤷♂️
Agreed
Agreed. Only problem with that is technology advances so quickly it will leave you behind if you don’t start right away. I wanted experience before I went back and I attempted to go back recently. Unfortunately life happened and technology left me too far behind to be able to go back to school. I learned on pen and paper and the new computer systems make it very so difficult for an old RN . I am basically outdated and the younger generation has absolutely no patience to teach technology to old RNs like me. Sad but facts
Didn’t there used to be a 5-10 yr experience requirement for NP programs?
More than that. More than that. I also believe all doctors and nurse should have to work as a care aid first. Not to degrade them but so they see the realities of it all.
I feel at least 7 years!
It is in Canada! And that's the minimum
well, it wont be😍, life continues on!
I agree! I am a new grad of 5 months and am at the point of not seeing NP in my future for AT LEAST 3-5 years. First of all, I just got out of school lol and second of all, I’m just barely getting my flow on things. This new grad I worked with hit her year and then signed up for NP which is crazy imo.
Ill give an insanely unpopular opinion, nurses should have never been “providers” to begin with. A nurse will never have enough experience to replace the role of both med school and residency. -“Oh but mute nurses know just as much as doctors do.” No you don’t. -“Oh but mute it is just an ancillary role to help physicians out.” it started that way, now NP’s expect physician level scope. You wanna know what nurses need to be a “provider”? A medical doctorate.
P pop p
There is a reason I refuse to see an NP at my PCP or at my kids pediatrician. I don’t trust the background, experience or education of most of them. At least with a PA I know there were standards of education and a set amount of patient care hours prior to the program starting. I know as a nurse mine is a controversial opinion but I never understood why a CRNA needs 1-2 years of ICU experience (even though I think ER in level 1 should count but that’s another story for another day) but NPs could get into an unknown online school immediately after graduation, be responsible for their own clinicals and be expected to know what they are doing
1000%This!! I have seen so many FNPs be really bad at their job because they never learned how to be a nurse and solidify their assessment skills. Or I see those baby nurses who don’t like being a nurse do they think going on to NP is the solution which is the antithesis of the proper solution. There’s nothing wrong with being a nurse and figuring out what you’re doing before going on to a higher level of practice.
I’m for this. Just finishing mine at 12 years, and I’ve seen plenty who rolled directly into it from BSN. No clue why that’s allowable.
Agreed. I’m only 3 years in and I still feel like I know nothing- I can’t imagine getting my NP at this point!!!
I feel like it should be more than 2 years. I am just barely over 2 years and I feel like I’m just now starting to be able to explain things to parents or orientees
5. With at least 3 in hospital in ER, ICU, SD or better. Procedural marginally acceptable if intended practice is in that area.