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The Nurse Becoming Podcast 

#077 My Thoughts on Direct Entry NP Programs (You Might Be Surprised!)

There are a lot of opinions out there about Direct Entry NP Programs. A lot of nurses take a traditional path…

Nursing school → bedside → NP school…

Whereas some people (such as myself 🙋🏻‍♀️) take a non-traditional learning path, typically consisting of completing a non-nursing bachelors to direct entry NP.

Is there a right or wrong way to go about becoming an NP? I don’t think so. That said, I do have pretty strong opinions about this. 

Which is why, today, I’m giving you my unpopular take on Direct Entry NP Programs. I’m discussing:

  • My personal experience completing a direct entry NP program
  • Observations about these programs and the calibre of education level
  • Skepticism, stigma and judgement surrounding these kinds of programs, and my opinion about the arguments against direct entry programs.

    And more.

In an industry where professionals can tend to “look down” upon alternative education paths, my observations may challenge your thinking. 

I hope that you find this different perspective refreshing. 😃

 

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My Personal Experience Completing a Direct Entry NP Program

I was recently interviewed on a podcast, which I do fairly often, and I got this question from one of the interviewers, who said,

“Now Amanda, I’ve heard of these programs where people can go right into a combined nurse and NP program after having a bachelor’s degree in another field and have no medical experience at all. They can go straight through and become an NP in three or four years time. What do you think about these things?”

I laughed to myself and also on the episode because I got the sense that the interviewer was hoping to hear that I wasn’t a fan of these programs, but maybe didn’t know that I am a product of a direct entry program!

I went to Yale University. I went to a direct entry program, it was a direct entry master’s program designed for those who had a non nursing bachelor’s degree. 

The program itself was about 18 months of an intensive RN program (clinicals, didactics, etc.) and rolled right into a two year full time, immersive, in-person, nurse practitioner program. 

This was a very robust program that really attracted a caliber of students that I couldn’t believe! Some of them had expansive previous careers as attorneys and global health specialists, and counselors, and just about any other career that you could think of! It was a very competitive program. I was surprised that I got in, but this was not an easy program by any means. It had very high admission standards, very high graduation standards, and had a nearly 100% success rate of board examination and job-finding for graduates. This continues to be a very highly respected program. 

I write this, to start, because I think that there’s this assumption that anything that’s fast, or anything that is non-traditional is automatically of a different caliber, or automatically attracts people who are looking for an “easy button”. That’s actually not the case.

 

The Non-Traditional Nurse Practitioner Path

Instead of becoming an RN through an associate’s or bachelor’s degree program, eventually getting a bachelor’s of nursing, working at the bedside for a certain number of years, and then deciding to go back to NP school, there is another path…

The non-traditional path is getting a non nursing bachelor’s degree, completing prerequisites if necessary, and entering a direct entry masters or direct entry doctoral nurse practitioner program. (The doctoral programs weren’t around back when I started.) 

A direct entry program means that you are admitted directly to this combined program that will not only provide your RN training and your BSN or your nursing certificate, but will also have you continue into the NP, masters or doctoral program.

 

My Observations About Direct Entry Programs

A little disclaimer: What I’m inviting you to do at this point, is to have an open mind as I go through this, because I’m trying to challenge any preconceived notions that you may have about these programs. 

Because if you haven’t noticed, I think that our community of nurses, our professions, we tend to be a little bit more skeptical.

If you are considering a direct entry program, these, for the most part, are mostly in person, full time immersive programs that are very high caliber. 

I’m pretty sure most of the Ivy League schools have one. Three of the programs that I applied to were Ivy League programs. By the way, I don’t want to sound elitist, because that was certainly not a factor in my decision making. I just think that that says a lot about the quality of NP education for direct entry programs. 😃 

The other thing too, is think about the timeline of someone who’s going through a program like this. 

I think that there is a level of maturity that comes with people who are deciding to go into a direct entry program… Because for the most part, these are folks who at least have a bachelor’s degree, meaning they’re likely going to be at least 22 years old. And there is a level of maturity that comes from going through a bachelor’s program, graduating and then deciding to change your path and go into something different; it’s definitely not an easy choice! 

 

PhDs or Physician Associate colleagues have a very similar path. 

The majority of PhDs receive a bachelor’s degree. Not necessarily in a medical field, but usually something medical-adjacent, whether it’s pre-med or biology, but it’s not a nursing degree or a clinical degree by any means. And then they enter a master’s PA program, which is usually in-person, usually immersive, usually full time, and they usually graduate and become PAs in their mid to late 20s. 

You could argue that the quality of PA education in many instances is better than what NP education is. Anecdotally, the PDAs that I’ve worked with have always been of tremendous high quality as providers – especially when they graduate, they are ready to hit the ground running! Something I’ve observed is that they’ve had extraordinary academic and clinical experiences before graduation, they’ve had a systematized and standardized rotation process. They received excellent education, and they are highly respected and high quality providers. Yet, there doesn’t seem to be the same stigma as there is for direct entry NPs.  🤔

 

Experience Levels – Could RN Experience Hurt Your Ability to be a Great NP?

The other argument that I hear a lot is that “nurses should have several years of experience before becoming nurse practitioners in order to be high quality NP”.

While I think that RN experience can absolutely make you a better NP, I don’t think that it’s required. I don’t think that you have to have tons of RN experience to become an NP. I think physician associates and physicians are great examples of that, as well as the many masters entry or direct entry programs, NP graduates that are out there, doing high caliber, great work…. just maybe being stigmatized. 

Now, I do want to also present this anecdote that many years of RN experience could potentially hurt someone’s transition from RN to NP. 

Now, this is anecdotal. This is what I have observed in my 10 years of practice. When I’ve seen NPs who have had more than 10 years of nursing experience before becoming NPs, they’ve actually had more of a struggle switching to the NP role than those who have had less than 10 years. 

Obviously there could be different reasons for that, but the NP process, the medical provider, diagnostic and plan process is different than the nursing process. And it’s a different mindset. It’s also a different set of priorities when you’re in that provider role than when you are in a nursing role. And I think that the longer that you do something a certain way and solidify habits, the harder it can be to break and change into a new habit. 

In my opinion, there is not a linear correlation between your years of RN experience and your quality as an NP.

 

But, NP Education Has A Problem

Now, Direct Entry programs are not typically the ones with issues. What I’m talking about is there are a lot of online NP programs (that usually are for people who are already nurses) and this is where we as a profession are seeing issues with the quality of education

I’m not saying all online programs are bad. There are some very high quality online programs. But there are some online programs that are for profit institutions that have a 100% acceptance rate that do not properly qualify people who are wanting to become NPs. They also may not have rigorous standards for their education program. And those are the types of programs that I have a problem with, and that I see being detrimental to our profession. The majority, if not all of direct entry NP programs are immersive and in person, or at least in a hybrid format, where you’re having direct oversight of your clinical skills, and all the things that you need to ensure that it’s a high quality educational program. 

 

Final Thoughts on Direct Entry NP Programs

I’ve seen and heard enough times throughout my career that direct entry NP programs are “terrible and trash”. I’ve heard statements like, 

  • “How could someone possibly learn this so quickly?”
  • “You need to have five, ten, 15 years of RN experience first in order to be a high quality provider.” 

I just don’t agree that those are fair blanket statements. So I hope that by providing some perspective from my experience, and some anecdotal opinions that I’ve had throughout my career and throughout working with hundreds of nurse practitioners can encourage you to please have an open mind when it comes to your direct entry NP colleagues. If you’re a traditional path NP, or if you’re a bedside RN, working with NPs, just have an open mind as to how that person was educated. What is really the most important thing is the quality of the provider that they are at that moment, because ultimately, can they take excellent care of their patients here and now? The answer does not always relate back to the path that they took. 

If you want to jump in on this discussion, I welcome your thoughts. You can shout me out on Instagram @TheResumeRx or send me a direct message.  I would love to hear from you. 


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