[dad2one]

Hello everyone,
I'm a 29 year old male who is contemplating entering nursing. I have a BA in History and for a while was considering Medical School, but have decided that nursing (with an eye specifically on Advanced Practice Nursing at some point) may be better. I ahve some questions for anyone that could help me out with info on Advanced Practice Nursing.

I've worked in two different hospitals as a CNA over the past four years and I've worked with a lot of RNs and a lot of MDs, but relatively few APRNs. The first hospital was a private hospital Telly unit and one of the practices that regularly took care of pts there was made up of one MD and 4 NPs. We also had a CNS that did mainly education.

The second was an emergency dept in a Level I Trauma center (University teaching hospital). I didn't encounter any APRNs here. I also did some elective rotations in the OR at both hospitals and worked a bit with CRNAs.

So, having said all that, here are my questions:

What is the scope of practice for each of these three (NP, CNS, CRNA)? That is, is what they do more similar to an MD or to an RN? Diagnosis, treatment, prescriptions etc.

What are they allowed to do as compared to RNs and MDs (prescribing drugs, narcotics, procedures - intubation, central vascular access, artial line insertion etc.)

I'm very interested in critical care/trauma/emergency medicine and would like to work as an RN in one of these areas before proceeding to advanced practice. I'm also very interested in flight nursing.

When I was considering Medicine, I was interested in anesthesiology and Emergency Med for the procedurces and the management of critically ill patients. Is this something that is available to an APRN?

My ideal advance practice situation would be working in an ICU alongside MDs/PAs, rounding on patients, making decisions (in collaboration with others) on treatment and getting to do lots of "hands on" care (procedures). On of the things that I really like about nursing is the hands on care (starting IVs, NG tube insertions etc.) that most MDs I've observed (especially in Private practice) tend to not do much of.

Any help that you could offer would be GREATLY appreciated!

Thanks,
Bryan

[meandragonbrett]

Bryan,
Welcome to the board! Regarding scope of practice for APRNs, you'd have to check your individual state laws. In some states, the BON and BOM both regulate APRNs. Also, the scope of practice for CRNAs is pretty much the same throughout the entire country. CRNAs can practice independently on an anesthesiologist. If you'd like more information about CRNA scope of practice, check out the AANA's website (aana.com). Once again, welcome to the board!

[CRNAsoon]

Bryan,

In the CTICU where I work, the NP's and CNS's work in collaboration with the MD's. They make treatment decisions, write orders, and do invasive procedures. As I'm still new, I sometimes get them mixed up and forget who's who. Scope of practice probably varies by facility, state, and specialty area, though.

CRNAsoon

[BigDave]

As a CNS and ANP (primary care) I have had a couple of jobs.

After graduation, I was working as a NP doing primary care. Hated it. The respect from the docs was nice and the autonomy was nice...finally getting to be in the driver's seat was nice, and a bit stressful at times (put a 19yo in the hosp for a ulcer thanks to the Prednisone that I gave for an asthma exacerbation). The part that I disliked was the emotional baggage that many of our regulars had and the inability of patients to take care of minor issues at home. When I was a kid it took my mom 4 days to take me in for a broken wrist...only after my teacher sent a note home stating that I could not move my fingers.

I am a CNS on the surgery floors now. The job has ended up being mostly administrative (research, teaching, writing protocols, etc.).

Yes, there are advanced practice nurses doing cool clinical things. (The Air Force tells me what and how to work at the moment.) The job market is fairly tight on these from what I'm hearing. What works best is to be working as an RN in the area that you want and network with some docs who like your work. After graduation from the NP program you may get them to sign you on.

CRNAs have much more freedom in the marketplace. I think that I read in this forum that there are still expected to be around 5000 CRNAs short in 2010. That is one of the many reasons that I hope to start school again next Fall.

Please make sure what you want to do early. Shadow people in their speciality, ask questions. Test the job market. I think I wasted around 5 years with going to NP school...

[emergence artist]

Bryan,
First of all, nursing is not a substitute for medicine. Most people who do nursing want more to do with patients than their MD counterparts(speaking in generalizations, of course). Docs spend little time with patients ultimately and even less time with family. A nurse anesthetist's life can be wonderful--the best of many worlds with time to build a family and have a profession you love. It is highly scientific and at the same time highly patient centered. Find something you are passionate about and make a living doing it...yeah right. I'd be parasailing in the Islands if that were the case. Seriously, a good career counselor may be of use in a time like this. Good luck with the search. As a man, nursing has been very good to me. Although sometimes you have to have a tough skin to take the ribbing.
Hope you find what you're looking for.