Rate this article:
Average rating:
Total votes: 0
Advanced practice nursing is becoming popular, because it offers more autonomy, a more desirable work schedule and, in many cases, better compensation than basic nursing positions. Of the 2.2 million working nurses in the US, about 9 percent are advanced practice nurses (APNs).
Among those attracted to advanced practice are registered nurses (RNs) who have been in traditional nursing positions and feel the need for change. Advanced practice has also become attractive to those who have an interest in science and may or may not have started college and received a degree, but aren't interested in staff nursing positions in hospitals.
For these individuals, traditional baccalaureate nursing education followed by at least one year of staff nursing experience before applying to a master's degree program for advanced practice nursing is too long a route. They desire a master's degree inclusive of training and clinical experience that's tailored for their desired role.
But the key question many ask: Is the APN who has never been responsible for a floor full of patients recovering from surgery or being treated for serious illness as prepared and competent as the APN who has clinical experience as a registered nurse?
The Traditional Route
The requirements for entry into most APN programs are:
- · A baccalaureate degree (minimum).
- · A registered nurse license.
- · One year of acute care nursing experience.
Programs for clinical nurse specialists, nurse practitioners, nurse midwives and nurse anesthetists are developed to build upon basic nursing skills by teaching advanced assessment, pathophysiology, pharmacology and clinical decision making. Role development is also embedded in these programs, because the student must become a relatively independent problem solver.
Many believe that something is missing if APNs don't have the opportunity to embrace nursing as practicing RNs before advanced practice. They believe the meaningful experiences as an RN help in decision making, caregiving and patient rapport-building as an APN. These attributes cannot be gained by the limited clinical and simulated lab experiences while in school.
Marilyn Edmunds, president of Nurse Practitioner Alternatives in Education, a continuing education company, says, "one of the biggest problems with omitting experience as an RN is a political reason. We have been able to say to physicians, legislators, insurance commissioners and others that NPs actually have similar levels of experience as physicians do -- we just prepare in a different way."
However, we may lose APN candidates who never make it back to school. Life experiences can get in the way of devoting time, energy and funds toward graduate school once one has a job as an RN.
Additionally, students and graduate APNs who have worked as RNs first may be somewhat tainted by the RN role and have a difficult time with APN role development. “Combined RN/advanced practice grads do not get as much exposure to the negative aspects of nursing and come out with a more positive view of providing primary healthcare,” says Margaret McAllister, associate professor at the University of Massachusetts at Boston.
Direct Path to Advanced Practice
A number of advanced practice programs are now considering applications from students who are still in, or have just finished, baccalaureate programs. Some schools have developed tracts like the BSN/MSN degree, where students are accepted and work toward completing both degrees without a break to practice as an RN.
Kathleen Becker, assistant professor at Johns Hopkins University School of Nursing, says that these students "are some of the brightest and most articulate students in the class." She stated that the students who get accepted must maintain a 3.0/4.0 average in undergraduate nursing courses to stay in the program. Statistics show that these BSN/MSN students do just as well through the program, if not better, and pass certification exams at the same rate as traditional APN grads.
Another advantage of this type of program is that it could increase the number of people entering nursing. A combined BSN/MSN degree and a career in advanced practice nursing may be more desirable to the science-minded applicant than a career in staff nursing with the potential to go back to school for an advanced practice role.
One disadvantage is that these APNs may lack confidence in some of their clinical skills. While they may do very well in the educational programs, they may have difficulty assimilating into clinical practice.
Is There an Ideal Model?
While the potential disadvantages from a lack of RN clinical experience is a significant consideration to both the individual APN as well as the legitimacy of the entire role, the potential advantages to the nursing profession are also important to consider. Leaders on both sides of the discussion voice that clinical experience within nursing programs is key to the confident and competent graduate. Building more time for clinical experience into programs or requiring an internship before completion have been suggested as viable alternatives.
Admission of appropriate candidates into the different program options is also important. Can we predict if candidates possess both the intellectual fortitude and clinical intuition that will make them successful APNs? Admission committees must focus on criteria for candidates that will increase the likelihood of success as competent advanced practice clinicians.
Sandra Nettina, MSN, APRN, BC, ANP, is a nurse practitioner in Maryland. She is the editor of both Medscape's Topics in Advanced Practice Nursing eJournal and the Lippincott Manual of Nursing Practice.
Reprinted with permission from Medscape Nurses. © 2003, WebMD, Inc. See other Nurses Week expert columns on Medscape Nurses.