Brave or just stupid?

[Polly Peptide]

I am yet another mid-life career-changer. I've been afraid to even post on this board, as I believe I will get attacked by all the nursing traditionalists. But I would like the opinions of the experienced, and I can't get them without putting myself out there. Besides, if I am going to tread this path, I need to develop a thick skin.

I've wanted to work on the clinical side of healthcare for most of my life. Since I was a kid, I wanted to BE something – CRNA, radiologist, ER doc, pharmacist, nurse practitioner. The various options cycled through my mind, but I just KNEW I was going to grow up to be one of these. I've always been fascinated by the human body, disease processes, how the mind works, even down to nerve impulses and what causes that movement from neuron to neuron. I have always wanted to know the why.” Just what” has never been good enough.

I got to college and my dad didn't believe I could handle pre-med/medical school. It took the wind out of my sails. I didn't even understand I could apply for student loans. I did what he told me, got my business degree, and got out.

Within two years of graduating, I wanted to go back to school. However, I soon got married and my husband wasn't ready. Then I landed a lucrative job on the business side of healthcare, in a sales role. I liken this to golden handcuffs.” The money was great, but it made it more difficult for me to go back to school. I was the bread-winner.

Then we had children, making it nearly impossible to go back at that time. Sure, I could go, but it seemed extraordinarily selfish. Yet again, I put it off.

By this time, we had moved back home, to an area with a couple of very good nursing programs. In addition, there was a PA program and a very good B&M NP program, which included an option for those without nursing experience. That became very appealing to me, as the years flew by.

To make a very long story a little shorter, now that my children are a little older, I finally got it together and applied to that MSN program. I also applied to an accelerated BSN program. I quit my job and started taking pre-requisites. Ultimately, I got into both programs. I was torn: the MSN program was my dream (highly-ranked and I could start doing what I really wanted sooner); but I had heard that having a BSN could be more flexible and perhaps better for me as it relates to getting RN experience first. As of now, I plan to attend the MSN B&M school this fall.

Here comes the BIG BUT – I read this board and it scares me. Am I being completely irresponsible by becoming a nurse practitioner when I have not been a nurse? I recognize my lack of experience as a nurse, believe me. I am, however, not green.” I have been a working business professional for 17+ years. While I absolutely do not have clinical experience, I do have something of value, in both life experience and business acumen, to bring to the table. As well, my work was in healthcare and I've acquired a fair amount of knowledge along the way.

I have a lot of confidence in the school that I've chosen. They are one of the top-ranked institutions, as well as my specialty being extremely highly-ranked. My preceptors are selected for me; the clinical hours are high; I have the option to specialize further (which adds to my clinical hours); I believe if any school is going to prepare me, considering my lack of experience in this area, they are one of the best. I also fully expect there to be a large learning curve. But am I being completely naïve?

This is something I have always wanted to do. I am no longer in my 20s or 30s. I don't want to spend years and years starting over with a BSN, and then going back later for another degree. It seems to be not only additional time but additional money. Is it reasonable to think that I can gain experience as an NP and become competent, even without RN experience first? I am more than willing to work hard, ask questions, know what I don't know, seek help from peers, and put forth diligent effort. In fact, I look forward to it.

The last thing that I think about is: I see so much written on this board about salary. I am actually in a position where I do not have to work. However, I will say it again – this is something that I WANT to do. And even though I don't have to work, I am not looking to do this for charity. I would like to be paid what I'm worth. I recognize that I will initially be an inexperienced NP, but that won't be the case for long. Am I crazy to think I can make $150K at some point? I see $80-90K and it bums me out. It seems ridiculous for the work NPs do. I am in the Southeast. I can go back to my old profession and make $150K easy. I just don't want to.

Sorry for the length. Would appreciate your advice.

[Zyprexa]

Last but not least, my school is in the top 3 for ACNP programs. I am trying not to give TMI, though not sure if it matters. So when you say you can't see a top program allowing this...they actually do.

So I'm guessing your program is the MSN PreSpecialty Entry at Vanderbilt University? Three semesters for the RN (70 credits), followed by three semesters (75 credits) for the MSN ACNP - Hospitalist Track. An estimated cost of $197K. 700 clinical hours for the RN, 630 clinical hours for ACNP, 1,330 hours total. No RN experience required. And then you can prescribe, diagnose,and manage the care of acutely ill patients! Yay!!!

For those you who say, "How is this different from PA school, they go in without prior experience?" let me explain. The OP will complete 1,330 hours, but only 630 hours are at the advanced practice level. The other 700 are just for the RN license, which is about average for a basic nursing education. And we all know how prepared new grad RNs are for practice following graduation.

PA schools have over 2,000 clinical hours, all at the advanced practice level (in addition to a more rigorous medical education).

[Cococure]

I just need get some more popcorn ...this formum reminds me of the nursing station drama that happens ....it always gets personal and no one sticks to the topic at hand...smh

[Ruas61, BSN, RN]

Ruas, any substantive remark or just the sarcasm?

I think my response speaks volumes. This is not worth a reply after this as far as I am concerned.

Carry on!

[allnurses Admin Team]

Let's stop making the comments personal.

Please get back on topic.

[Polly Peptide, BSN, MSN, RN, APRN]

So I'm guessing your program is the MSN PreSpecialty Entry at Vanderbilt University? Three semesters for the RN (70 credits), followed by three semesters (75 credits) for the MSN ACNP - Hospitalist Track. An estimated cost of $197K. 700 clinical hours for the RN, 630 clinical hours for ACNP, 1,330 hours total. No RN experience required. And then you can prescribe, diagnose,and manage the care of acutely ill patients! Yay!!!

For those you who say, "How is this different from PA school, they go in without prior experience?" let me explain. The OP will complete 1,330 hours, but only 630 hours are at the advanced practice level. The other 700 are just for the RN license, which is about average for a basic nursing education. And we all know how prepared new grad RNs are for practice following graduation.

PA schools have over 2,000 clinical hours, all at the advanced practice level (in addition to a more rigorous medical education).

And you're being rude and sarcastic because...?

I don't know where you are getting the cost of the program as that is incorrect. Perhaps you've seen some numbers regarding financial aid suggestions, but this has to do with loan amounts and money people lived on while in school, not tuition (or books, lab costs, etc).

It's funny that you thought you had to explain the difference between my potential training and PA schools, since I had already done so myself earlier in the thread. I'm fairly well researched and still here, reading.

Would you prefer that I find some online school to attend? I'm sure I could become a nurse a lot cheaper and then get my FNP without ever meeting an instructor or having more than a year of experience. Maybe you think that's better and you would change your holier-than-thou tone.

For a bunch of nurses and NPs, many of you don't think highly of your profession or training.

[stickit34]

We don't think highly of our training because it is severely lacking already without people entering into direct-entry programs getting ready to prescribe to human beings, especially the most critically ill. I've said it numerous times, and other have as well. We've submitted complaints to the boards, but you know, money will always win in the end.

Do yourself a favor and do the PA route. You'll benefit from a rigorous curriculum and clinical experience. I myself am registering for my final classes for pre-requisites for medical school, because once you realize that you don't know enough, you don't want it to come at the cost of someone's LIFE.

[Bluebolt]

For a bunch of nurses and NPs, many of you don't think highly of your profession or training.

NPs are great but the training/education is admittedly lacking and many nurses understand that. Some of the negativity you're hearing is because you're trying to go from A to Z as fast as possible bypassing the real nursing school/nursing experience which is a huge portion of preperation for NP school.

With a lacking NP education and clincal hours it's expected to have years of experience and clinical skill before you start the program. The program is meant to develop and enrich preexisting knowledge. Most people agree that even the enrichment should be more rigourous with more academic and clinical requirements. Many nurses and NPs are voicing concern (sometimes unkindly) about going into an APRN role so quickly without the preexisting knowledge to make it a very safe choice. You would get these same responses by MDs if the invented a fast-track 2 year Med School with a 3 month residency and then you come out practicing as a physician, you have to expect that.

The point people keep making about PA school is simply that their program is designed for students without previous medical profession education and experience. Their program is designed to teach you everything within two years from scratch, which is why they have so many clinical hours and strenuous coursework. NPs are expected to start the program with a minimum of 2 years of medical education including clinical rotations then have years of clinical practice experience.

My advice is just to go do what you've made your mind up on doing and try to be the safest provider you can. As NPs continue to get more autonomy and independent practice there will probably be stricter regulations and admissions into NP program in the near future. MDs will rip them apart in legislation if they can pull up examples of people going from no clinical experience and education to practicing like an MD independently in 2-3 years. In order to continue to make progress for the NP field they will have to shape up the programs and expectations by a large margin. So in the meantime jump on an opportunity that you have before you while it's still possible.

[Zyprexa]

And you're being rude and sarcastic because...?

Not my intention to come across as rude, only to show how quickly someone can became a NP without any RN experience. It is very frightening that direct entry schools would allow someone to go from being a new grad RN to advanced practice nurse in three semesters with no nursing experienced required. That was my point.

I don't know where you are getting the cost of the program as that is incorrect. Perhaps you've seen some numbers regarding financial aid suggestions, but this has to do with loan amounts and money people lived on while in school, not tuition (or books, lab costs, etc).

I calculated the tuition from the credit hours and the cost per credit hour on the school's website. The cost per credit hour that I found was $1308 for graduate school, I could not find the cost per credit for undergrad, so I estimated. My point here was to emphasize the cost of going from nursing student to NP in six semesters, and how much students are willing to pay to do this.

It's funny that you thought you had to explain the difference between my potential training and PA schools, since I had already done so myself earlier in the thread. I'm fairly well researched and still here, reading.

I think comparing direct entry NP programs with PA programs is an important part of this discussion. I was simply providing another perspective to what you already gave.

Would you prefer that I find some online school to attend? I'm sure I could become a nurse a lot cheaper and then get my FNP without ever meeting an instructor or having more than a year of experience. Maybe you think that's better and you would change your holier-than-thou tone.

I'm not sure why you think that I think this would be better. It's your money, and you can spend it how you would like. I'm not a fan of entirely online NP programs either.

If I were you, I would get my associates from a community college, work as an RN in the ED/ICU for a year, and then do an ASN-MSN bridge program (at Vanderbilt) while continuing to work on a PRN basis. Yes, this would take longer (4 years as opposed to 2 years), but the knowledge and critical thinking skills you would gain working as an RN would be invaluable.

From reading your posts, I saw that you are planning to work as an RN while in the MSN program part time. That is great, but would it allow you to gain sufficient experience? You would not be able to work full time, and hospitals generally do not hire new grads part-time or PRN, especially not in critical care settings.

For a bunch of nurses and NPs, many of you don't think highly of your profession or training.

Maybe we don't think highly of people with no nursing experience being allowed (heck, encouraged) to become advanced practice nurses with only 600 clinical hours. I think very highly of competent nurses and NPs.

[Polly Peptide, BSN, MSN, RN, APRN]

Not my intention to come across as rude, only to show how quickly someone can became a NP without any RN experience. It is very frightening that direct entry schools would allow someone to go from being a new grad RN to advanced practice nurse in three semesters with no nursing experienced required. That was my point.

I calculated the tuition from the credit hours and the cost per credit hour on the school's website. The cost per credit hour that I found was $1308 for graduate school, I could not find the cost per credit for undergrad, so I estimated. My point here was to emphasize the cost of going from nursing student to NP in six semesters, and how much students are willing to pay to do this.

I think comparing direct entry NP programs with PA programs is an important part of this discussion. I was simply providing another perspective to what you already gave.

I'm not sure why you think that I think this would be better. It's your money, and you can spend it how you would like. I'm not a fan of entirely online NP programs either.

If I were you, I would get my associates from a community college, work as an RN in the ED/ICU for a year, and then do an ASN-MSN bridge program (at Vanderbilt) while continuing to work on a PRN basis. Yes, this would take longer (4 years as opposed to 2 years), but the knowledge and critical thinking skills you would gain working as an RN would be invaluable.

From reading your posts, I saw that you are planning to work as an RN while in the MSN program part time. That is great, but would it allow you to gain sufficient experience? You would not be able to work full time, and hospitals generally do not hire new grads part-time or PRN, especially not in critical care settings.

Maybe we don't think highly of people with no nursing experience being allowed (heck, encouraged) to become advanced practice nurses with only 600 clinical hours. I think very highly of competent nurses and NPs.

I just feel that going to my school's page and scouring through it in order to try to make a point about how much I'm "willing to pay" (or others) in order to supposedly be an NP faster was unnecessary.

Worse you are perpetuating incorrect information. The cost per credit hour is public info but you've got the credits screwed up, making this number completely inflated.

It's more than just being willing to pay more for for a "faster" route...I am willing to pay a bit more for a good education, period. I get your point about getting my ADN somewhere and then going back for my MSN. Maybe...I will consider it.

As far as me working during my program, I am talking of working FT. I will have to see what works, but I have the option of stretching the MSN curriculum out 3 years, which may allow FT work.

[Zyprexa]

While I'm not sure that my research was unnecessary, I apologize if I misunderstood the tuition/credit hours. Also please note that many of my previous comments were not in regards to you personally (as I do not know you), but the direct entry NP program. If you are able to gain experience while in the program, FT as you mentioned, then that changes everything in my opinion. I have nothing against people who specifically want to be NPs, as long as they gain relevant nursing experience in the process. If NP education was like PA school, I don't think direct entry NP would be an issue.

Best of luck!

[Polly Peptide, BSN, MSN, RN, APRN]

While I'm not sure that my research was unnecessary, I apologize if I misunderstood the tuition/credit hours. Also please note that many of my previous comments were not in regards to you personally (as I do not know you), but the direct entry NP program. If you are able to gain experience while in the program, FT as you mentioned, then that changes everything in my opinion. I have nothing against people who specifically want to be NPs, as long as they gain relevant nursing experience in the process. If NP education was like PA school, I don't think direct entry NP would be an issue.

Best of luck!

Frankly, I agree with you about the PA/NP school comparison. I've done it myself. My original desire was to go to PA school. But after evaluating my options, knowing I cannot move, I decided that I was more likely to achieve the same end goal of being a provider (midlevel, if you want to call it that) if I allowed myself to go the NP route. We have only one PA school in this area. They are quite small and admit around 40 students per year (out of 1000 or more applicants). My chances of getting in just weren't great. So I pursued this path and got into my school of choice.

Perhaps I can make up for the difference by working during my education, as I've said. This whole discussion has got my mind in a mess.

[WKShadowNP, DNP, APRN]

Ultimately, you will need to identify the option that best aligns your means and ends. Only you can decide which route works best for you and how you can achieve those goals. No matter which choice you make there will be supporters and detractors. One path may be more difficult and have a steeper learning curve than the other.

I would absolutely loved to go to med school. A nurse asked me yesterday if I considered it. I honestly told her I did but not at the expense in money and time at this point in my life. I still want to learn and grow in my knowledge, but I just won't be doing it that way. I am extremely satisfied with my current NP role and there is a plethora of growing I'm doing that I know would be farther from reach if I did not have my professional background. But where that experience gets sacrificed for some may make a different for someone else.

You have to make it work for you.

Good luck and enjoy the journey.