Brave or just stupid?

  1. 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.
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  2. 158 Comments

  3. by   Neuro Guy NP
    I suppose it's doable but in the southeast I think it may be tough. I live in the northeast and clear 150k easily thank goodness. Part of these low offers is because many times we are tied to physicians by needing "collaboration". We'll leave that debate for another post.

    I'm a professor at a well renowned university here in the northeast as well, so I will give you the same advice I give to any prospective NP student who has minimal RN experience. I don't necessarily think it is the most ideal thing to go into NP school without RN experience HOWEVER, I would consider admitting such a student to the acute care NP program IF AND ONLY IF you work in an ER or ICU full time for the entirety of the program, preferably in a hospital that provides a nurse 'residency'.

    The students that are in this boat that are under my advisement are conditionally admitted because my university states that upon the advisor's discretion, a student may be required to work those RN hours to meet the NP program's experience requirement. Therefore, each semester, such a student is required to bring in proof of employment in a critical care setting.

    I think this is important because to a degree NP school does presume a level of knowledge upon entry. For example, unlike the PA programs, NP school will not rehash microbiology, anatomy, etc.

    Sorry for the detour, but the long and short of it is that in Mt opinion, you should only proceed to NP school now if you will be able to work as an RN and get that valuable experience. Otherwise, take your time, get some RN experience under your belt and apply later.

    There will be other thoughts to this issue, so stand by for those and make your decision after you've heard different viewpoints.
  4. by   offlabel
    I think the idea of the advanced practice nurse is predicated on the experience that nurses bring being taken to the next level. The paradigm falls apart if that backround is lacking. Otherwise you have less than what PA training does, because there the assumption is that there is no meaningful patient care experience and the training reflects that deficiency and makes up for it. So in effect, the RN with no background takes a double hit in an NP program.

    If you insist on going into a midlevel type of training program without this background, at least go to PA school in fairness to yourself and your patients.
  5. by   ksisemo
    Thank you, Neuro Guy.

    I initially intended to complete the program full-time the entire length, which would prevent me from working as a nurse during the program. From what I understand, the specialty (or Master's) component is so rigorous, it is simply not feasible to work for most people. As well, the school discourages it. And until recently, the program required that students without nursing experience complete the program full-time, straight through.

    However, they have recently changed this to allow the specialty/Master's portion to be completed part-time, thus allowing the student to work as an RN. The program does not require this, but considering my lack of experience, perhaps it would be a good idea. My only fear was that I would lose momentum or that I wouldn't learn as well if I wasn't fully immersed in my program. However I can see that this could be cancelled out by actual real-life experience as a nurse, especially if the job was in my specialty (which is AG-ACNP, btw).

    Because my school allows people without nursing experience, some of your specific concerns as a professor wouldn't apply. My school did require those prerequisites that you mentioned, however - in which I obtained a 4.0. My school also required a GRE...I see many on here bemoaning the fact that so many schools are forgoing this requirement.

    I just wonder how much a truly top-ranked school might help make up for the inherent deficiencies a new NP will have due to lack of experience? If I am motivated, smart, a quick-learner, working in my strengths...AND am learning it all within a program recognized nationally as one of the best...can I overcome these challenges?

    As far as the money: $150K isn't the be-all, end-all. But I would like to think that I'm gonna break $120 or $130K. It just seems crazy.
  6. by   ksisemo
    Quote from offlabel
    I think the idea of the advanced practice nurse is predicated on the experience that nurses bring being taken to the next level. The paradigm falls apart if that backround is lacking. Otherwise you have less than what PA training does, because there the assumption is that there is no meaningful patient care experience and the training reflects that deficiency and makes up for it. So in effect, the RN with no background takes a double hit in an NP program.

    If you insist on going into a midlevel type of training program without this background, at least go to PA school in fairness to yourself and your patients.
    Why? Are you insinuating that PA school is superior? Or because most PA schools require x number of patient care hours before applying?

    I would like to know why well-respected B&M nursing schools across the country are continuing to make a path for non-nurses to become "advanced practice nurses," if it is so wildly inappropriate. Either it is all about the money (and there just aren't enough nurses to recruit from, which I don't believe), or it is a misnomer at this point.

    Most likely, the profession should require something similar to PA schools (prior experience and/or add'l clinical hours). But for some reason, they have not done it.

    I was interested in PA school. I like the education model as well as the amount of required clinical hours. However, I cannot move and we have just one in this area that accepts about 40 students per year out of 1000 applicants. It simply was not feasible. My choice at this point was to make the best of the options available to me.
  7. by   Jules A
    Quote from ksisemo
    I would like to know why well-respected B&M nursing schools across the country are continuing to make a path for non-nurses to become "advanced practice nurses," if it is so wildly inappropriate. .
    The almighty dollar.
  8. by   BCgradnurse
    I went to a Masters Entry NP program at a very well respected B&M school. I've been practicing as a NP for just under 8 years now. I did not work as a RN during or after my program. It just wasn't feasible. I worked in another area of health care for 20+ years so did not enter nursing completely wet behind the ears.

    I am a successful and well respected NP in my area. I precept NP students, and have found that previous RN experience is not necessarily relevant to success as an NP. I've had seasoned RNs who struggled, and students with no NP experience who have been rock stars. I've also seen the opposite. It's very individual. I would much rather have a student with no RN experience who can think critically,take initiative, and seek excellence than an RN with 20 years experience who cannot switch their mindset to the provider role. I think RN experience is always valuable, but is not imperative to be a good NP. It's a very different role. I use very little of what I learned in the RN program in my day to day practice. I believe those who want to be an Acute Care NP should have some hospital experience.

    You should not be discouraged by those who feel you cannot succeed as a NP without RN experience. There can be more than one path to the same destination. Work hard and do as many clinical hours as you possibly can. I wish you the best of luck.
  9. by   ksisemo
    Quote from BCgradnurse
    I went to a Masters Entry NP program at a very well respected B&M school. I've been practicing as a NP for just under 8 years now. I did not work as a RN during or after my program. It just wasn't feasible. I worked in another area of health care for 20+ years so did not enter nursing completely wet behind the ears.

    I am a successful and well respected NP in my area. I precept NP students, and have found that previous RN experience is not necessarily relevant to success as an NP. I've had seasoned RNs who struggled, and students with no NP experience who have been rock stars. I've also seen the opposite. It's very individual. I would much rather have a student with no RN experience who can think critically,take initiative, and seek excellence than an RN with 20 years experience who cannot switch their mindset to the provider role. I think RN experience is always valuable, but is not imperative to be a good NP. It's a very different role. I use very little of what I learned in the RN program in my day to day practice. I believe those who want to be an Acute Care NP should have some hospital experience.

    You should not be discouraged by those who feel you cannot succeed as a NP without RN experience. There can be more than one path to the same destination. Work hard and do as many clinical hours as you possibly can. I wish you the best of luck.
    Thanks for the encouraging reply.

    I do believe that I will get out what I put into it. I suppose my larger concerns have been about legitimate deficiencies in knowledge due to lack of experience (is there only so much I can teach myself, if I can't get enough out of school and clinicals), as well as the amount of negativity I see from the nursing community regarding its own profession. I want to be a competent, skilled, respectable clinician and member of a healthcare team; and some of the things I read are downright disconcerting. I want to make sure I can overcome these issues...I do believe I can find a way, in spite of the fact that the path may not be ideal.

    Perhaps I should really consider getting the Master's portion part-time so that I can work as an RN (hopefully in a hospital setting). I'm glad that's now an option.
  10. by   BCgradnurse
    Not to be discouraging, but many hospitals will not hire you as a part time RN if you tell them you are in a NP program. They do not want to put all that time and effort into training you only to have you jump ship in 2 years. You may have better luck in a LTC facility or outpatient setting.
  11. by   ksisemo
    Quote from BCgradnurse
    Not to be discouraging, but many hospitals will not hire you as a part time RN if you tell them you are in a NP program. They do not want to put all that time and effort into training you only to have you jump ship in 2 years. You may have better luck in a LTC facility or outpatient setting.
    Makes sense...the LTC setting would offering some higher-acuity patients I would think.
  12. by   SopranoKris
    OP, I was a career changer, too. I originally wanted to be a PA and decided to go to a community college to get my RN so I could quickly get hands-on patient care experience. The ADN only takes 2 years (3 if you don't have any pre-reqs, like Anatomy, Physiology, Micro, etc.) and it was affordable, so I was able to pay using my own savings. Once I became an RN, I started learning more about NPs and their scope of practice. I am now an ICU nurse. I can honestly say, in my area, the ICUs & ERs only want to hire ACNPs who already have an ICU/ER background as an RN. You've never been a nurse on the unit. There is so much you learn in the ICU that is beneficial to your education as an NP later. Just being around the patients and knowing that raspy sound is a cuff leak in an endo trach. When to start titrating pressors. How to effectively manage multiple drips along with CRRT. How to interpret ABGs and see how changing vent settings affects the patient. Getting ACLS certified and actually participating in codes. Being able to assist when your patient is having an art line inserted, central line, intubation, managing chest tubes, etc. These are all things that are difficult to learn from simply reading in a book. Nurses are at the bed side a full 12 hour shift. Even in your NP clinicals, you aren't going to get the deep, hands-on, in-depth experience you would get as a nurse with your patients. I personally feel having some experience as an RN first will make you a better provider. Just my personal opinion and what I see in the real world.

    Now, that is not to say that you can't or won't be successful. As previous posters have stated, there have been good direct-entry NPs with no prior RN experience. I just know that it's difficult to land that first job without any ICU/ER experience if you're trying to break in to the ACNP field. I would put out some feelers with the hospitals in your area to see if they hire direct-entry ACNPs. You don't want to go through all that time & money and not be able to land the job you want.

    As far as salary, new NP grads don't earn as much as experienced NPs. The NPs in our area average any where from $98K to $120K, depending on the type of acute care practice. Cardiology seems to pay a higher salary than the other specialties in our area (midwest). The hospital when I work takes in to consideration your prior RN experience if you're a new grad NP seeking your first job. Something to keep in mind.

    I definitely don't want you to feel discouraged. It's great that you're getting a chance to pursue what you really want to do. I'm glad I made the career change decision. I just want you to realize what you might be facing in real world when you're ready to start looking for your first ACNP job. Research your job market, call some local hospital HRs and see what they have to say about direct-entry NP grads.
  13. by   offlabel
    Quote from ksisemo
    Why? Are you insinuating that PA school is superior? Or because most PA schools require x number of patient care hours before applying?

    I would like to know why well-respected B&M nursing schools across the country are continuing to make a path for non-nurses to become "advanced practice nurses," if it is so wildly inappropriate. Either it is all about the money (and there just aren't enough nurses to recruit from, which I don't believe), or it is a misnomer at this point.

    Most likely, the profession should require something similar to PA schools (prior experience and/or add'l clinical hours). But for some reason, they have not done it.

    I was interested in PA school. I like the education model as well as the amount of required clinical hours. However, I cannot move and we have just one in this area that accepts about 40 students per year out of 1000 applicants. It simply was not feasible. My choice at this point was to make the best of the options available to me.
    I'm an APRN myself, so it's not as if I'm crowing about it, but no, I'm not insinuating PA training is better, I'm stating it directly. I work with both PA's and NP's and as unpopular as it sounds, where I am (surgery) the PA's are head and shoulders above the NP's in skill and knowledge. Taken as a whole, head to head comparisons of PA v NP programs would not be very complimentary toward the NP side. That's why it is absolutely critical for NP schools to be very persnickety about meaningful nursing experience before advanced practice. Individual practices can make up for the short fall, but that takes at least a year and a half, IME.

    PA programs are taught in the medical model with more active participation of physician instructors, which is just not the case otherwise. In fact, nursing model and nursing theory is a mainstay of too many NP programs.

    Before I find a severed horse's head in my bedroom, of course I'll say that there are plenty of very talented, smart, skilled and knowledgeable NP's that practice everywhere, but that is in part because of the experience they bring to the table and in spite of the short comings of NP training as a whole.
  14. by   GGirll22
    If you can dream the career you want go for it. It won't be easy but it is in your heart.

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