I was surprised when I returned to graduate school in nursing after 6 years at the bedside to find that my classmates were often fresh out of undergraduate nursing school with no work experience. Aside from feeling like an old lady, I wondered how they would define the nurse practitioner role without having worked as Registered Nurses. In addition, I felt that my experience shaped my desire to work as a nurse practitioner and gave me a strong background in basic assessment and treatment.

The biggest thing that I learned working as a nurse was just how much I didn’t know. And that was a good thing, because I learned that I needed to ask a lot of questions. I also learned that being aware of the limits of your knowledge made you a great nurse. Sometimes I still drive my coworkers crazy with questions about orders, medications, and treatments. But the truth is that there is so much that is not taught in school. Even if one works their whole life at the bedside, one will still not know everything. That is why you have to be able to think critically and ask questions to be an excellent nurse. It is not always what you know that makes you excellent, it is asking about the things you do not know.

Bedside nursing is hard work and many people who choose nursing as a career do not want to do bedside nursing. I understand that, but sometimes my fellow students seem to think they know everything they need to know. Sometimes a lack of respect for experience comes across. I think it is unintentional, but it sure ruffles my feathers. This is what was innocently said to me one day: “I think it will be harder for you to be a nurse practitioner because you will not be able to break out of your RN mindset. Since I never worked as an RN, I will not have that problem and will adapt better to the Nurse Practitioner role.”

We had some nurse executives speak to our class about leadership, ethics, and other current issues in nursing. One student expressed frustration that no one wanted to hire her as an advanced practice nurse because she did not have any nursing experience. She wanted to know why so many employers wanted experience when she felt her education gave her all the qualifications necessary to do the job.  This individual felt that as a nurse practitioner there was no difference in skill between herself and people who have worked previously as registered nurses.  The nurse leaders responded by saying they understood her frustration, but that in advanced nursing roles one needs credibility and that credibility comes from experience.

The ripple of ghastly exclamations practically reverberated through the class. While I empathize with my classmates’ frustrations, I do see the credibility issue present in nursing today. I think there should be opportunities for people who go straight through undergraduate to graduate programs. On the other hand, my experience working also indicates that many registered nurses are very aware of nurse practitioner experience levels. Many nurses say that they can see a big difference between the skills of nurse practitioners who have worked at the bedside and those who have not. I’ve heard nurses who feel that experience at the bedside makes nurse practitioners better also say that it doesn’t take many years of experience to make the difference. One or two years working as a nurse is usually enough for them to see increased competency in nurse practitioners. Whether all nurses agree with that in an idealistic sense, that reality of the credibility conundrum exists. Credibility from experience matters to many nurses and prospective employers. There are many new graduate nurse practitioners who will demonstrate advanced critical thinking skills despite less direct care experience. On the flip side, there are many experienced Registered Nurses who will struggle with the demands of advanced practice nursing. Even with this in mind there is a credibility issue that a lack of experience presents in many clinical settings.

This issue is magnified when new nurse practitioners with no nursing experience do not seem to understand the value of experience.  To express frustration with the challenge of finding a job is one thing, but to state that there is no difference between yourself and a new nurse practitioner with years of experience is another matter.  At times this failure to understand and respect that credibility from experience can be misconstrued as arrogance by other health care providers.

Even if you choose not to get experience before obtaining an advanced degree, I would encourage you to think about the importance of respecting experience. Recognizing that nurses with experience might know and understand things that you do not will go a long way towards those nurses wanting to work with you.  they will also give you respect for knowing the boundaries of your own experience and not equating education with experience.

Sometimes when I am caught up in the political arena at work or frustrated about something we need to do, something happens that takes me right back to why I am here in this job. That something is often in the form of a 5 year-old boy, who I think is a very old soul.

He has blond wispy hair now that stands on end and brown eyes. When I first met him, he had no hair because he was in the middle of chemotherapy to treat relapsed Acute Lymphocytic Leukemia . This child has a way of setting me right when I least expect it.

One day I was taking care of him and he was having negative side effects from the treatment I was giving him. I was very concerned and was in and out of his room checking on him, calling the physician, and apparently fluttering around him. His blood pressure was running low and his heart rate was elevated. He was not febrile, but he was shivering. As I was taking his blood pressure for the 8th time, he looked at me intently and gently said, “I’m O.K. I promise. You worry too much.”

I was never sure that he was really just referring to my concern over his reaction to his treatment. His statement seemed more of a global assessment of my personality as opposed to his reaction to my vigilance in that instance. Needless to say, he received the rest of his treatment and was fine.

A few months later I returned to work from maternity leave and I was having some challenges getting back into the swing of things. My buddy came in asking for some numbing cream to put over the spot where his port-a-cath would be accessed. Many of the kids have rituals and preferences when it comes to exactly how we do these things, and the nurses have to keep mental track of who likes which dressing. I remembered that he liked a special dressing over his numbing cream because he feels it is easier to get off. I pulled out the dressing and as I was putting it on, I suggested that we fold the corners of the dressing down so he would have less sticky stuff to take off. He looked at me with a big grin and sighed, “You’re awesome.” He was not trying to be overly cute or sweet, but was simply very grateful for this small gesture that made him a little more comfortable. That reminded me why I wanted to be there.

One of my most treasured possessions is a sign this little guy gave me that says, “I heart you, you are kqut. Love, P.” The day he made that for me, we had visited the treasure box and he had carefully chosen a bracelet with some clip-on earrings which he immediately wore. A little later in the day, he was still wearing his jewels, as he called them, only he had further accessorized with an orange feather boa. He reminded me that you just have to be yourself, without pretense, as much as possible.

The thing about this kid is that every single person in the clinic where I work has a story or two about how this child really made them stop and think for a moment.

While we are trying to fix him, he manages to fix us all somehow.