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.