From RN to APRN - How Much Experience Do I Need?

“How much experience do I need before becoming an Advanced Practice Registered Nurse (APRN)?”

If you ask 10 different APRNs you will likely get 10 different answers.

As a nursing instructor and Family Nurse Practitioner (FNP) student myself, this is probably the most frequently asked question I get.

Unlike the MD or PA route, nursing has no standardized way for continuing education. There is no data. No scientifically proven route that supports better patient outcomes. So, that means most of us have to rely on the advice, experiences and personal opinions of others. Oh, and random blog posts like this one.

Let me tell you.

People get fired up about this discussion.

REAL fired up!

alphabet soup

Before we jump in, let’s do a quick refresh on what exactly Advanced Practice Registered Nurses (APRNs) and Nurse Practitioners (NPs) actually are.

• APRNs need at least a master’s degree and include certified nurse-midwives (CNM), certified registered nurse anesthetists (CRNA), clinical nurse specialists (CNS) and nurse practitioners.

• Nurse Practitioners (NPs) specialize in a population focus (pediatrics, family, acute care, psych, adult/gerontology, etc) and work to diagnose and treat health conditions. They emphasis disease prevention, health promotion and health management.

• In other words, every NP is an APRN but not every APRN is an NP.

the great debate

Still with me? If so great! You are probably thinking, “yep, still want to be an APRN over here. Sooo how much experience do I need? Get to the point already!”

I wish I could make this easy for you, but unfortunately there is no one right answer.

Seasoned RNs/APRNs/NPs will tell you at least three to five years at the bedside are needed before you go back. That experience is crucial, necessary and should never ever be overlooked.

New grads rushing back to school without experience has actually left many bedside nurses feeling threatened and/or devalued, to the point where they may bully you into questioning your path. Why hospitals (and our society) fails to value the bedside nurse and why does every young RN want to leave and become an APRN is a whole other post…so let’s stay focused. 

On the other side you have direct-entry APRN programs that push no experience necessary. Nursing students heading into their last semester already applying for APRN specialty programs before they take the NCLEX. If you know you want to be a NP, why wait? The role of the APRN is completely different from the RN anyways, so get in and get out. 

While both sides have reasonable points, a valid question is raised here. How can you be an “advanced practice” nurse without really having “practice”?

My Path to NP

Here’s a quick recap of my healthcare experiences that led me to purse a career as a FNP.

• BS in Physiology and Neurobiology from the University of Connecticut. During these years I volunteered in an ER and worked in research over the summer.

• 2 years of clinical research at the Shirley Ryan Ability Lab (previously the Rehabilitation Institute of Chicago). This is where I was first exposed to NPs and found my passion for community health & primary care.

• Started a 2.5 year grad-entry MSN Nursing program. Continued to work in clinical research through most of it.

• Worked almost 2 years at the bedside on neuro and cardiology inpatient units.

• Started my Doctorate of Nursing Practice (DNP), FNP program.

Right now I have two more years left of the program. I teach as a clinical nursing instructor and work as a community health RN. So, counting my years of clinical research before and during my nursing training, it will be over a decade in healthcare by the time I see patients as a provider.

to learn more on why I decided on the FNP / DNP track, visit my post here.

As someone who heavily considered a direct NP program myself, looking back I am exceptionally grateful for the two years I had to train at the bedside before going back. Truly, those years were invaluable. Which leads me to my general answer to this question.

My advice? Give Yourself Time 

Whether you decide on two years like I did or want more - I really advise you to take at least a year or two off. Give yourself time to build the confidence and critical thinking skills you will need as an APRN. You will learn how to educate, advocate and care for your patients on levels you probably did not know existed.

being a new grad sucks

This is my next reason you should take at least a year before going back.

95% of what you will learn as a nurse does not happen in school, but on your first job as a new grad. That first year of being a new RN is incredibly demanding, stressful and exhausting. For me, it was far more demanding than nursing school. I cannot imagine how I would have handled starting another program on top of that adjustment.

Choosing a population specialty 

Next, even though you may think you know your population focus (pediatric NP, CRNA, FNP, Acute Care NP, midwife, etc)...you also may not really know for sure.

My gut instinct of going the FNP route was spot-on, BUT this isn’t always the case. I know plenty of nurses that thought acute care was their path but after experiencing it at the bedside realized it was too emotionally taxing for them. Or vice versa, some nurses think primary care is their calling but fall in love with the intensity of the hospital and end up finding primary care boring AF. Some are dead-set on midwifery, but later find out they can serve women on a larger scale in community health or general women’s health. And so on, you get the idea.

Maybe you are like me and your gut feeling is right. Maybe it’s not and you change your mind. Either way is OKAY! We should evolve with our experiences. Just be sure to give yourself time so you don’t waste your time, money or sanity pursuing a speciality that is not true to you.

enjoy some time off

Adjusting from being a student to joining the work force is an adjacent that has it’s perks. Make some money and for the love of god, give yourself a break. See your friends. Travel. Have a freaking life! Your career and advanced education will be waiting for you, even if it’s just a year later.

exceptions to every rule

With all this being said, I do believe direct admission programs and going straight from RN to NP can work for some. It really depends on you, the life experience you bring to the field, the program you apply to and of course your motivation, personal readiness and dedication. I am sure there are some brilliant, world changing providers that had little to no RN experience and some nurses that worked at the beside for a decade that aren’t quite as sharp in the APRN role. But, in general I do think there are major benefits to taking your time and getting experience.

I’ll leave you with this: think about how long you have left in your career. Maybe it’s fifteen years or maybe it’s fifty! Why not wait at least a year or two to regroup, hone your skills and be sure you are choosing the right path.

Regardless of when you go back to school, continuing education is ALWAYS an admirable thing to do for yourself and the nursing profession. Props to you for being invested enough in this question to get through this post.

If you are thinking about pursuing a career in nursing, as an NP or FNP I hope this helps! Please reach out with any questions, thoughts, or ideas. Drop me a line in the comments or find me on social media. I’d love to hear from you!

Nursing Clinical During COVID: Your FAQs Answered

We are in a pandemic,

and if you are a nursing student right now, things are less than ideal.

The clinical hours spent at the bedside in a nurse’s education are vital. It’s where you practice those hands-on skills and develop comfort of patient interactions- things you simply cannot teach over zoom or on a mannequin. However since the pandemic, academic institutions and hospitals have had the unprecedented ethical consideration of valuing hands-on clinical education against the risk of COVID-19 exposure for staff and students. COVID is changing the future of nursing education and if you are currently in school, you are the guinea pigs. Awesome...

First, let me tell you that I am so sorry. I’m sorry on top of everything you need to deal with as a nursing student that this is happening. With that being said, you also are getting to learn from the true heroes of this pandemic. You are witnessing the strength of our field and nurses coming together. You are seeing healthcare workers step up, advocate for themselves and their communities. For the first time, healthcare workers are being celebrated for their undeniable dedication for the wellbeing of others and I hope you find inspiration in that.

While questions undoubtedly circle your mind, I hope as a clinical nursing instructor I can provide some insight and advice to your very well justified concerns. These opinions are my own. Always follow the guidance of your own institution or University that is taking your specific community transmission, local and state regulations into consideration. 

FAQs

I’M WORRIED I FORGOT ALL OF MY CLINICAL SKILLS

Don’t fret, you are not alone here. Your clinical instructors are well aware of the pandemic putting the last few months of clinical experiences on hold. Refresh on the most important skills before heading back: checking vitals, PPE, infection control, hand hygiene, safety and the physical assessment. Don’t put too much pressure on yourself to pick up exactly where you left off, and never hesitate to let your instructor know your concerns or ask for help.

IF WE MOVE BACK ONLINE SOON, HOW CAN I MAKE THE MOST OF MY CLINICALS NOW?

Completing complex clinical skills will come over time. As I like to tell my students, you can teach a monkey to start an IV. Right now, stick to the basics I described above, focus on your patient interactions and thinking critically about their disease processes and plans of care. Come prepared and don’t be afraid to ask questions.

For the last few months, patients have been limited with the amount of visitors allowed and probably still are! Use this as an opportunity to be a source of emotional and educational support for your patients that are most likely feeling lonely and isolated. I am sure they will love your extra company and attention. 

WHAT IF ALL OF MY CLINICAL GOES VIRTUAL?

Unfortunately, we on the academic side are preparing for another COVID wave and yes, there is a strong chance we will shut back down and go to remote learning (if your institution hasn’t done so already). Take comfort knowing your faculty is keeping the health and safety of you and your loved ones a top priority. Nursing education is changing and this will most definitely be reflected in training new nurses coming out of the pandemic (hello NCLEX already adapting!). It’s your job to get through nursing school, not figure out how to get clinical hours. Save that problem for your faculty and the nursing board of licensing to figure out.

If and when virtual clinical comes, make the most of it. Come prepared, ask questions and consider a zoom study group.

check out my post here if you are learning remotely

I’M MISSING MY DREAM ROTATION. HOW WILL I KNOW MY SPECIALTY?

One of the most exciting parts about going through nursing school is experiencing the different specialties- peds, L&D, psych, community health, etc. Having an entire specialty rotation cut out of the mix can leave you with a lot of question and uncertainty. My personal advice: chances are if you just have a feeling peds is for you, or you just know L&D is your calling, then you are probably right.

Missing your dream NICU rotation? don’t give up!

BE PROACTIVE. Try to find outside volunteer experiences on these units now if you can or when the pandemic calms down (who knows when that will be). Reach out to those specialty clinical directors at your institution to see if they have any connections with hospitals allowing volunteers or nursing students just to shadow, even for one or two shifts. That may be enough to confirm that specialty is right for you. You can also reach out to find nurse mentors that work in that field. Pick their brains - ask what drew them to that speciality, pros/cons of that work, what a typical day is like, what recommendations they have for volunteer or work opportunities during the pandemic to get more experience.

SHOULD I GET A JOB AS A TECH/CNA TO GET HANDS ON EXPERIENCE?

This may not be a popular opinion but unless you are truly called to start working as a tech or CNA, I would proceed with major caution. Training and working as a tech/CNA is extremely demanding and the pandemic has made it even more challenging. Starting a new job, plus COVID, on top of your nursing course load is probably not a good idea right now.

However, if you are called to this work and want to help fight the good fight against COVID-19, major pat on the back to you. Do not let my opinion stop you. Nursing students that have CNA experience really have a leg-up getting comfortable with patient care and it will definitely help get you a job coming out of this potentially tricky market for new grads. If you are interested, start looking for a job now and maybe train over one of your breaks from school. 

I AM ANXIOUS, STRESSED & WORRIED I MADE THE WRONG DECISION BEING A NURSE

Another thought that is extremely common for nursing students, pandemic or not. Take care of yourself by approaching your immune system holistically- prioritizing nutritious foods, hydration, exercise, sleep and self care. Whether that’s an online yoga class, journaling in the morning, downloading a meditation app like Calm or calling a loved one, find those practices now and stick to them.

However, as the months continue through the COVID-19 pandemic, increasing anxiety and depression is common for many people, especially those in healthcare with higher exposure. Know your limits, give yourself some grace and reach out to your faculty, other students and campus organizations for extra support. Most universities are offering remote counseling and support groups. See the resources at the bottom of this post for more.

I’M ABOUT TO GRADUATE AND FEEL TOTALLY UNPREPARED

Let me let you in on a little secret….Ready?

All nursing students feel completely unprepared heading into their first jobs, pandemic or not. Believe me, 99% of what you learn as a nurse will happen during the first year on the job. While clinical is a great experience to get you ready for that, the amount of learning that will happen in that first month of you working will probably be more than all of our clinicals in nursing school combined. 

When applying for jobs, look for nurse residency programs that support new grads. Discuss your concerns with managers while applying because again, you are not alone. Seek mentors on your unit when you get hired and give yourself some time & patience. Your managers, preceptors and fellow nurses will know you trained during the pandemic and hopefully will give you that extra support and time that you deserve.

I’M WORRIED I WON’T BE ABLE TO FIND A JOB

That’s right, we are in a global pandemic and some nurses are having a hard time finding work. With hiring freezes and stressful work conditions, unfortunately hiring and training new grads is not at the top of many hospital’s to-do lists.

If you have a stable job already and are not itching to start your RN career, my advice is to take a break while you job search. It can take some new grads anywhere from 6-10 months before finding a job anyways (that’s why I say NETWORK, NETWORK, NETWORK when you are in school).

If you are dead set on starting a nursing job right away, try to make as many connections as possible before graduation. Reach out to old clinical instructors, instructors, faculty members about hospitals hiring new-grads. Attend virtual job fairs. If you can’t land your dream job during or after the pandemic, keep your head up. You have lots to learn in the nursing world and there are always opportunities to change units, hospitals or specialties.

I AM WORRIED ABOUT GETTING COVID ON MY CLINICAL SITE/BRINGING IT HOME TO MY FAMILY

If you are going on-site to clinical, you are not alone in your fears or stress. To get you up to speed and make sure you feel as safe as possible, check out my Tips for Staying Safe in Clinical During COVID-19. However, know that your safety is the most important and continue to advocate for yourself and your family. Express any concerns about exposure in clinical you have to faculty members and administrators.

I hope this gives you the support and comfort you need heading into clinicals. Stay safe and please do not hesitate to reach out if you have any specific questions, thoughts or ideas. Feel free to drop me a line in the comments or find me on social media, I’d love to hear from you!

 XOXO,

Jac

RESOURCES

Well-Being Initiative from the American Nurses Association (ANA).

Nurses’ Guide to Mental Health Support Services

The Guide to Sleeping Better and Restoring Energy

Download the Happy App, a nurse-specific platform that gives you access to 24/7 support.

If you feel overwhelmed beyond your limits by sadness, depression, or anxiety, or if you have thought of hurting or killing yourself, call 911. You can also call or text one of these crisis hotlines for immediate response:

Crisis Text Line: Text HOME to 741741 

National Suicide Prevention Lifeline: 1-800-273-TALK (8255) or Live Online Chat . If you or someone you know is suicidal or in emotional distress, contact the National Suicide Prevention Lifeline. Trained crisis workers are available to talk 24 hours a day, 7 days a week. 

SAMHSA Treatment Referral Helpline: 1-877-SAMHSA7 (1-877-726-4727). Get general information on mental health and locate treatment services in your area. Speak to a live person, Monday through Friday from 8 a.m. to 8 p.m. EST.

My RN Report Sheet

Nursing Handoff:

an essential yet terrifying part of your job as a new nurse.

If you have ever felt overwhelmed, unprepared, or straight up shoook during handoff, you are not alone.

Giving a thorough and accurate report during change-of-shift is critical for patients, but it can give any new/student nurse anxiety beyond belief. In my early nursing days there were times I:

• Cried after giving report because my oncoming nurse called me out for not knowing details

• Had eyes rolled at me for taking too long giving report

• Forgot essential bits about my patient while rushing through report for so-called eye rolling

• Been peer pressured to not do it at the bedside

• Stayed an extra hour(+) into the next shift to sort out whatever my oncoming nurse thought was incomplete

Sounds fun, right? After a long 12 hour shift overnight working your tail off, having your report torn into shreds makes your feel like garbage. Handoff can truly feel like the most daunting part of your day as a fresh nurse.

Cue Report Sheets AKA your “brain”. They are common in nursing, especially when you are just starting off, to organize your thoughts and tasks throughout the shift. Yes, it’s called a brain sheet because literally, this becomes your BRAIN.

Print it out, attach it to your care plans and use it as your guide throughout your shift. When change-of-shift comes you have everything you need to know about your patient in an organized fashion. It gets you through your shift- from the moment you get report to the moment you give it.

So here it is, my sacred report sheet. It’s the method I have used for years with patients and what I offer to my student nurses when they are starting clinical.

If you are a little confused, keep scrolling for clarification on abbreviations and formatting.

Basically, I organize my template into sections starting at the top with the most important safety information. I then go down in the way report is typically given/received: chief complaint, history of present illness (HPI) and past medical history (PMH). That then takes you to the head to toe with reminders in each system of things to cover & look out for.

On the right side I keep shift organizing topics: the patient’s plan, test/procedures, anticipated discharge, goals and med passes. At the bottom I always leave space for notes, because at some point you will need to keep track of new orders, critical values, changes in patient status, reminders for charting, education, or hey, even a reminder for you to go drink some water.

Receiving and giving report is an art that will only be mastered with time, organization and practice so do not get discouraged! I hope this template can help organize your thoughts for each patient and remind you what is necessary to ease the handoff process.

If you are a student or new nurse, please reach out with any questions, thoughts, or ideas. I have said it before and I will say it again: there are few career choices as selfless, honorable, and rewarding as becoming a nurse. Keep it up and just know there are millions of nurses that started exactly where you are right now.

Drop me a line in the comments or find me on social media, I’d love to hear from you!

XOXO,

Jac

Why I Became a Nurse

Every path to the medical field is different…

but yes, I am one of those people who always knew I would go into healthcare.

When I was seven years old, my mom got pregnant with my baby sister Julia. For months my twin sister Nicole and I awaited her arrival, ready to be the best older sisters on the planet. On New Years Eve of 1996 Julia joined the family, but unexpectedly was unable to come home from the hospital. Julia was born with a heart complication known as patent ductus arteriosus (PDA), an unclosed hole in the aorta that is supposed to simultaneously close at birth. In other words, she was born with a hole in her heart. After a few weeks, Julia’s heart healed and she was finally able to come home without any further surgeries or medications. My parents said the doctors and nurses saved her life.

From that moment on, I knew I wanted to spend my life doing exactly that for other people and their families. 

baby sis Julia in the middle with a fully healthy and happy heart!

Now, Julia is on the way to becoming a nurse herself! Go Jules!

As I got older I was your typical overachiever- constantly going after the best grades and being the MVP of every sports team. I only cared about two things: becoming a doctor and playing Division I Ice Hockey. During high school I said no to any form of social life, put my nose down, and worked my butt off. My ambition and perfectionist tendencies got me recruited to the University of Connecticut (UCONN, #gohuskies) where I studied on the “pre-med” track. After college I had every plan of going to medical school, but my 3.5GPA and mediocre MCAT score were not enough to get in- crushing my dreams and sense of self worth. 

Getting denied from medical school was the best and worst thing that has ever happened to me. For the first time in my life I was faced with the pure feelings of rejection and failure. I felt like I was letting everyone down (mostly myself) and constantly thought I just wasn’t good enough. This, paired with an ending hockey career and cheating boyfriend, offered the lowest sense of self worth and shame I have ever experienced. At the age of 22 my borderline identity crisis manifested into years of distorted eating and exercise habits (I will be touching more on this on the blog later). It took a few more years of getting help, growing, but mostly un-growing to shift my perspective and step back into my worth.

Since my “Plan A” didn’t work out, I scrambled and decided to take some time off to work in a clinical research lab at The Rehabilitation Institute of Chicago (aka RIC, now the Shirely Ryan AbilityLab). Although I didn’t know it at the time, this was the first step that changed my perspective on myself, the world, and my career…leading me to my true authentic path.

insert inspirational quote about “no wrong turns” and finding your own path

At RIC I worked with patients from all facets of life- every race, background, socio-economic status, you name it, I saw it all. Our lab did not require patients to have insurance, so we attracted many who had no other option for therapy, or healthcare at all. In one hour, I could work with a veteran, an immigrant without documentation, and a PhD college professor. The health disparities- unequal access to quality healthcare, education, and resources I was seeing could not be more apparent. Being from Chicago’s near west side, I had a sense of what social determinants of health looked like, but now the reality was right in my face. Slowly, my curiosity and perspective shifted from the “sick” diagnosis/treatment model, to preventative measures, public health, education, and the systems and policies reinforcing these health disparities.

always in my favorite scrubs FIGS!

During my time in the lab, I also started working alongside nurses and nurse practitioners. I admired the knowledge of the physicians, but the nurses…they were at the bedside really making a difference. Nurses were on the front lines dealing with life-saving stress, but also served as the caretaker, confidant, teacher, and number one advocate. Patients and their families trusted and relied on the nurses during their most vulnerable moments. 

After two years of working at RIC and lots of self reflection, I knew the nursing path spoke much truer to my soul.  I admired nursing’s holistic approach of taking the whole person into account by meeting the physical, emotional, social, and spiritual needs of every patient.  So, instead of reapplying to medical school I put all my eggs in the nursing basket and applied to the University of Illinois Chicago College of Nursing's accelerated Master’s Program. I got in and have not questioned my path since. 

At UIC I was led by a few professors that I will idolize forever. My education was extremely progressive, and besides getting me ready for the bedside, it touched on community health, social justice issues, and social determinants of health- topics I grew a real passion for. Since graduating this program, I have spent two years working at the bedside on a neuro and telemetry (heart monitoring) unit and am now a clinical nursing instructor for bachelors nursing students. I am also in my second semester of the Doctorate of Nursing Practice program at UIC to become a Family Nurse Practitioner. 

Nursing is an incredible career path for many reasons. A steady paycheck, benefits, flexibility, job security, as well as ample opportunities for growth, continuing education, and of course helping people! However, before I keep going, let me make this very clear: nursing is not always glamorous. In fact it is usually anything but glamorous. Working as an RN is incredibly difficult. Nurses work crazy hours, holidays, often overnight, and back to back. It is physically, emotionally, and mentally taxing. Patients, families, and physicians aren’t always nice to nurses. A lot of times, nurses aren’t even nice to nurses. I still get nervous delivering report to a more experienced nurse, and have cried after a shift more times than I can count. Let’s face it, there aren’t many jobs as stressful as watching over the lives of other human beings.

I mean, who doesn’t like working on Christmas?

But, that’s exactly why nursing is so much more than a job. Nursing is a way of life, and being a nurse is like forever being part of a tribe. Unlike other paths in healthcare, nursing is equally an art and a science. It gives you a deep understanding of the body and disease, but more importantly the human condition. There are few career choices as selfless, honorable, and rewarding as becoming a nurse. I will always be grateful for a set of skills that can truly help others, and the endless opportunities to affect individuals, communities and the world.

What I do know for sure is- nursing has allowed me to heal my patients, but it has also given me the space to heal myself. My path to nursing was not a straight line, but let's be real, who’s journey is?

If you are thinking about pursing a career in nursing, you can relate to my story, or if you are also a nurse please reach out with any questions, thoughts, or ideas. Feel free to drop me a line in the comments or find me on social media, I’d love to hear from you!

XOXO,

Jac