CRNP: The perfect occupation?

np_wannabe · Feb 3, 2007

Hello Brad.

I just wanted to comment on a couple of things....obviously the RN with 28 years of experience hasn't been looking into NP schools lately. The two largest schools in Florida are allowing BSN students to progress directly into an NP track, provided that you are licensed and meet all other admission criteria (GRE score, GPA, etc...). So, I wouldn't put too much stock into what she has to say.

As far as comparing NP to PA....I also looked very extensively in PA school. The primary differences between NP and PA school is the intense study of human biology that you find in PA school (very appealing) along with the diversity of jobs you are eligible for (because you study the entire body with about a dozen different clinical rotation sites--no specializations or tracks).

I, too, am married and have two small children. My husband is the sole "breadwinner." For me to go to PA school means that my husband would have to quit his job, we would move, and I would not only be out of work for two years, but would have to take out major student loans to pay for it (and I still haven't finished paying off my loans from my first run through school!)

When I compare that to being out of school for one year (accelerated BSN), work, and have my employer pay for NP school--and NOT have to move....it's hard to beat.

Although the training is COMPLETELY different, many offices employ NPs and PAs to do the same exact job, same title, same job responsibilites....with only a small discrepency in the pay (PA's usually make a little more).

I hope this helps.

Good luck!!!

Advanced Practice Columnist / Guide · Feb 3, 2007

Hi Brad!

First off, good luck on your career plans. I think it's admirable to look forward into one's future and envision the direction one wants their career to head to. I am little troubled by your thread title when you posed the question "CRNP: the perferct occupation?". I am just saying this because as an acute care NP of 2 1/2 years, I think the NP field is far from perfect.

There's so much variation in our roles, there's differences in the way the states view our scope of practice, the certification boards that govern our credentialing are far too many, and there's always the undeniable push from some physician groups to limit our quest to full practice autonomy. There's even that looming discord over whether we should be doctorally-prepared or stay at the master's degree level of education. I'm sure I didn't even mention all the gripes NP's have over this profession.

But do I love being an NP? Absolutely! all these barriers aside, I am happy that I am able to contribute more to my patients' recovery by being able to do more than what an RN's job description allows me to do. As an ICU NP, I love the mental challenge of having to analyze physiological changes happening with my patient in order to come up with the right order for a treatment be it a medication drip or a mechanical device. I love it when everything works out and a fresh heart surgery patient is able to leave the ICU.

Am I financially rewarded enough? it depends on what you feel is adequate. I hate to answer with a cliche of "money is not everything". However, I am able to pay my mortgage, own a car, and live comfortably. I definitely make more money now than when I was a staff nurse. Although many nurses in roles other than NP (even staff RN's) can claim to earn as much as I do or even more but do they make as much because they basically work everyday to earn overtime? maybe so. Do I like what their roles entail? probably not.

Do I get respect from colleagues in the healthcare field such as physicians and other nurses? I think the fact that I was hired as an NP to do the roles that I do is a show of respect for the NP role from my collaborating physician. However, to earn respect as a clinician is something I have to earn and work for. To earn the respect of ICU nurses? it's exactly the same way. I'm sure you've heard many ICU nurses say bad things about a resident physician who rotated in the unit and was terrible. Bottomline is, you have to know what you are doing to earn that respect.

Typical working conditions? I have alluded to the varying roles NP's have. But the common denominator is that most NP's work long hours. That's the nature of the health care profession. Regardless of whether you're in a clinic or hospital, you have to spend time talking, assessing, and examining your patient. Shortcuts can be disastrous. You will end up working late - there's no other way around that.

You had a lot more questions many of which I know I didn't address. I hope others will shed light on them. The moral of my story is that the NP field may sound appealing at first, but you have to really examine if this is what will make you professionally and personally happy. Make sure that your mind's been cleared of unrealistic expectations of the role before you proceed.

Josh L.Ac. · Feb 4, 2007

Typical working conditions? I have alluded to the varying roles NP's have. But the common denominator is that most NP's work long hours. That's the nature of the health care profession. Regardless of whether you're in a clinic or hospital, you have to spend time talking, assessing, and examining your patient. Shortcuts can be disastrous. You will end up working late - there's no other way around that.

I have a question about your pay:

If NPs work such long hours, then does the increase in hours, when compared to the usually 36 hours for a RN, mean that the increase in pay for the NPs is less than it seems?

I'm using the stats from salary.com for the median income for an ER nurse and an ER NP. The median for an ER staff nurse is $57K and for the ER NP it is $80K. At first the difference seems significant, but if the NP works more hours (and has more years of experience as a RN), then does that difference in income really reflect a higher level of education and responsibility?

core0 · Feb 4, 2007

I have a question about your pay:
If NPs work such long hours, then does the increase in hours, when compared to the usually 36 hours for a RN, mean that the increase in pay for the NPs is less than it seems?
I'm using the stats from salary.com for the median income for an ER nurse and an ER NP. The median for an ER staff nurse is $57K and for the ER NP it is $80K. At first the difference seems significant, but if the NP works more hours (and has more years of experience as a RN), then does that difference in income really reflect a higher level of education and responsibility?

This is a supply and demand question. The RN salary is dicated by the supply of RN's willing to do ER (high burnout rate) and the demand for ER RN's. I would say that the Salary.com rates are actually pretty low. A new grad ER nurse in our market makes about that much.

In our market the ER market tends to be mostly PA's, but the NP's are usually in the $60-70k range with a bonus. This is salaried, but the ER is one of the few places that you generally get more money for working more hours since it is shift work. Also remember that academic centers are more likely to have people on a hourly rate (or extra money for hours over 40). In private practice you mostly work on salary plus bonus. This is essentially dicated by collections and job market. Some markets such as California and Texas are more likely to give a NPP a greater percentage of their collections than States in the midwest for example. The other issue is that there is a finite amount the market will bear. At some point it becomes cheaper to higher a new grad than pay for greater experience. If you look at NP/PA salaries they rapidly rise for the first 2-4 years then level off. The other issue you see between RN and NP salaries is there are relatively more NP students seeking jobs/position and competitors for the jobs. This along with the cap on salary imposed by collections limits NPP pay.

David Carpenter, PA-C

Home Health Columnist / Guide · Feb 4, 2007

since you live in pa, np regs:

section 8.2. scope of practice for certified registered nurse practitioners.--(a) a certified registered

nurse practitioner while functioning in the expanded role as a professional nurse shall practice within the scope of practice of the particular clinical specialty area in which the nurse is certified by the board.

(b) a certified registered nurse practitioner may perform acts of medical diagnosis in collaboration with a physician and in accordance with regulations promulgated by the board.

(d) nothing in this section shall be construed to limit or prohibit a certified registered nurse practitioner from engaging in those activities which normally constitute the practice of nursing as defined in section 2.

(8.2 added dec. 9, 2002, p.l.1567, no.206)

section 8.3. prescriptive authority for certified registered nurse practitioners.--(a) a certified registered nurse practitioner may prescribe medical therapeutic or corrective measures if the nurse:

(1) has successfully completed at least forty-five (45) hours of coursework specific to advanced pharmacology at a level above that required by a professional nursing education program;

(2) is acting in collaboration with a physician as set forth in a written agreement which shall, at a minimum, identify the following:

(i) the area of practice in which the nurse is certified;

(ii) the categories of drugs from which the nurse may prescribe or dispense; and

(iii) the circumstances and how often the collaborating physician will personally see the patient; and

(3) is acting in accordance with regulations promulgated by the board.

(b) a certified registered nurse practitioner who satisfies the requirements of subsection (a) may prescribe and dispense those categories of drugs that certified registered nurse practitioners were authorized to prescribe and dispense by board regulations in effect on the effective date of this section, subject to the restrictions on certain drug categories imposed by those regulations. the board shall add to or delete from the categories of authorized drugs in accordance with the provisions of section 8.4.

http://www.dos.state.pa.us/bpoa/lib/bpoa/20/nurs_board/nurseact.pdf

looking at career builder.com ( philadelphia inquirer newspaper job search), over 60 np positions posted; about 30 for pa's. need to look at your area of state to see hiring trends. as the #3 state educating nurses, i've seen an explosion of np positions within my health system in past 3 years.

more importantly, think getting you feet wet as rn and seeing clinical areas you develop an interest in will help guide your future aspirations. may nurses want to work in one are in school but after practice find an interest in totally different area. but not pegging yourself into a specific education path soon after graduation, you will find one that provides the utmost in personal and professional career satisfaction.

caldje · Feb 4, 2007

Looking at Career Builder.com ( Philadelphia Inquirer newspaper job search), over 60 NP positions posted; about 30 for PA's. Need to look at your area of state to see hiring trends. As the #3 state educating nurses, I've seen an explosion of NP positions within my health system in past 3 years.

Three things real quick, just as an fyi, nothing more. Physician assistants in PA have just gotten a law change that will allow more autonomy in PA. It seems that as soon as laws change job opporunities go up.

A job posting for a NP will OFTEN take a PA.

Career builder is not the best source for jobs re: midlevel providers. I suggest a source that is used to target the type of provider you are looking at. I dont know many PAs who search monster, or career builder, for good career information. Try PAworld.net for more jobs with more acurate job descriptions. Some salaries on there are below national averages, which is to be expected.. employers start low. They also have NP jobs. However, I have found that MANY jobs come from going to meeting and talking to docs who never would have posted a job but when they find out you are competent and decent to be around are ready to hire you on the spot.

There is NO perfect ocupation in my opinion. and the thought will leave you very dissapointed.

Advanced Practice Columnist / Guide · Feb 5, 2007

I have a question about your pay:
If NPs work such long hours, then does the increase in hours, when compared to the usually 36 hours for a RN, mean that the increase in pay for the NPs is less than it seems?
I'm using the stats from salary.com for the median income for an ER nurse and an ER NP. The median for an ER staff nurse is $57K and for the ER NP it is $80K. At first the difference seems significant, but if the NP works more hours (and has more years of experience as a RN), then does that difference in income really reflect a higher level of education and responsibility?

Yout first statement is correct in certain situations. You have to look at this as a case-to-case basis. In my case, since both NP's and RN's are employed by the hospital, the salary grade for an NP is higher than the salary grade for an RN, thus, giving us a higher salary in the end. Now if the RN spends most of their days off working overtime, their pay may end up being close or even more than ours. The advantage for us NP's is that we are also entitled to overtime pay where we work.

If you compare a clinic NP who is in a salaried position with an RN who is paid hourly with overtime and shift/weekend differential benefits, the RN may also end up earning more even though the hours spent working may not be that different.

This is something RN's need to think about if pay is a major factor in deciding on pursuing advanced practice nursing careers. You may end up being disappointed.

Brad_RN_Student_PA · Feb 5, 2007

Thanks everyone for your input! Keep the advice coming.

Josh L.Ac. · Feb 6, 2007

Yout first statement is correct in certain situations. You have to look at this as a case-to-case basis. In my case, since both NP's and RN's are employed by the hospital, the salary grade for an NP is higher than the salary grade for an RN, thus, giving us a higher salary in the end. Now if the RN spends most of their days off working overtime, their pay may end up being close or even more than ours. The advantage for us NP's is that we are also entitled to overtime pay where we work.
If you compare a clinic NP who is in a salaried position with an RN who is paid hourly with overtime and shift/weekend differential benefits, the RN may also end up earning more even though the hours spent working may not be that different.
This is something RN's need to think about if pay is a major factor in deciding on pursuing advanced practice nursing careers. You may end up being disappointed.

Thanks for the input [you too David]. It seems like there is many factors to take into account when looking for a job as a NP.

[/thread derail]