RN Unit for Unknown NP Specialty? - page 2

by MBAWkg2bNP 2,078 Views | 16 Comments

I am currently a government employee working as a high level finance professional. Although my work is generally enjoyable, I do not find it fulfilling for a multitude of reasons that I won't go into here. In addition, I have... Read More


  1. 1
    Quote from kms673
    MBA: I would relocate.

    This is a extremely contentious issue, so I wish you the best of luck on this highly personal path and any backlash you may encounter.
    Same to you KMS, the one thing I learned in life is that you have to do what is best for you. I've seen alot of people get put through the crapper (for lack of a better word) only to come out on top, while the naysayers continue to stew in negativity. At the end of the day we only walk in our own shoes and we have to blaze our own paths and of course live with the outcomes of our decisions. Right, wrong, or indifferent, such is life. I wish you all the best! I hope to be able to read more of your journey (if you stick around here) in the months to come.
    CrufflerJJ likes this.
  2. 2
    I was in a very similar situation as you, so I thought I'd share my experience. I was an attorney before going to nursing school, so I had a prior demanding career, and I was in my 30s. I had no healthcare experience prior to starting nursing school. I did a 15 month accelerated BSN (ABSN) program. I think as a second career student, we have an advantage in terms of disciplined study time, but I found it to be a big transition to understand how to think like a nurse. It was just so foreign from what I had done previously in my life, even though my prior job was almost all critical thinking, the context was just so different. Not to mention the content that we were learning was all new to me. I think it would be really hard to do a direct entry program and not give yourself time to absorb the information and develop the "6th sense" that you need in nursing. Plus financially it's better to get your BSN and then work while getting your NP degree.

    As for your experience in different areas in nursing school and knowing what you want to do as an NP, I think it's unlikely that clinical will help you much. Most of your clinical time will be spent doing adult med/surg. There are tons of areas out there that you will never see as a student. I think the best thing you can do while in school is try to decide if you like working with adults or kids or both. And then try to get some ICU time to see if you like critical care. The ED and ICUs will give you the most exposure to a wide variety of conditions. If you don't like critical care, then try to find a floor that gets a wide variety of patients. I think you learn the most and the fastest in the ED or ICU, so that would be my recommendation. No matter where else you go, that knowledge will help you.

    Let me explain what I mean a little better about why the ICU gives you better experience (and I assume the ED would be similar but I don't work there). When I worked on the floor, we had very little contact with the MDs or NPs. So what I was learning was from the other nurses I worked with. Which is fine if you are just focused on bedside nursing, but if you're trying to figure out what an NP does and if you'd like their job, it doesn't help you. When the MDs rounded on the floor, the extent of my conversation with them (if I talked to them at all) consisted of "Any changes today?" I rarely focused on lab results (many patients didn't have daily labs), almost never looked at the actual x-rays or CT scans, I only read the radiologist's report.

    Whereas, in the ICU, we present rounds everyday to our MDs and NPs. We are expected to know and understand our patient's disease or injuries, have looked at our x-ray, know if our breathing tube is in the right place, know if our feeding tube is gastric or transpyloric, and also read the radiologist's report to know if there is anything to mention in rounds. If our patient is on steroids, but doesn't have any GI prophylaxis ordered, we bring that up. We calculate the maintenance fluid rates the patient should be getting and bring it up if they are getting too much or too little. If they are on formula feeds, we calculate how many calories they are getting. We talk about their sedation and pain medication, and if they are getting too much or too little. Almost all of our patients have at least daily labs so we talk about all of the labs and discuss any abnormals, why we think they are abnormal (if we know) and what we might be able to do about it. We analyze our blood gasses and think about if our ventilator settings are adequate, or is the patient alkalotic due to diuretics, and it isn't a respiratory issue at all. In sum, we look at everything about our patient, and think about every system for every patient. It is a completely different level of thought than what is required on the floor. And it is exactly what any NP needs to be thinking about for their patients (at least any inpatient NP).

    Primary care is very different, but none of this knowledge would hurt. It is so helpful when you're in NP school, and you're already used to thinking in this way. Also in the ICU, you get to work with more areas in the hospital, so you can get a better feel for what the other areas do. You spend time in MRI and CT, you get patients from the ED, send and receive patients from the OR, and send and receive patients from the floors. You generally get a lot more exposure to different stuff.

    I did what it sounds like you're thinking of doing. I did an ABSN, got a job and then applied for NP school. I've done school part-time while continuing to work full-time. I will have 3 1/2 years of full-time nursing experience when I graduate from NP school. I feel that this has worked out really well. I've had enough time to learn what I need to get by and do well in my program. Another 5 years of bedside experience would be nice, but definitely not essential for success. However, any less experience and I think I'd be really struggling to get through school. I still struggle to remember everything, and more bedside experience would probably make this easier, but I can manage ok without it. But without my bedside experience, there's no way I'd be able to remember all of the drugs, all of the diseases and all of the labs that I should know.

    As an older student who had good grades in my ABSN program, and who knows how to write a good cover letter and resume, I did not have any difficulty getting a job. In fact, when I graduated the job market was worse than it is now, I got the first job I applied for and it was a highly competitive residency position. It may take a little networking, but I'm sure you can get into the specialty you want when you're done with school.

    Sorry this got to be so long! I hope it's helpful as you consider your career change. I know switching to nursing was the absolute best thing I've done in my life. Good luck to you
    MBAWkg2bNP and CrufflerJJ like this.
  3. 0
    Quote from HouTx
    Question - who is hiring NPs without any experience?? In my part of the country, it isn't happening - not even in the Doc-in-the-box clinics. The other issue with direct entry NP.. unless you get a BSN as part of the program, it may be very difficult to obtain a license in other states due to their legal requirements for RN licensure.

    If you don't actually want to work as an RN, wouldn't PA be a better option? Not being snarky, just wondering about the reasoning process.
    HouTx,

    If you live where your username suggests, then we're neighbors, and I have to tell you that THE (blank) HOSPITAL has 2 Vandy direct entry NPs on staff, neither had RN experience, so yes, it's happening in top hospitals out here. I don't know anything about outpatient markets, though.
  4. 0
    Quote from MBAWkg2bNP
    Same to you KMS, the one thing I learned in life is that you have to do what is best for you. I've seen alot of people get put through the crapper (for lack of a better word) only to come out on top, while the naysayers continue to stew in negativity. At the end of the day we only walk in our own shoes and we have to blaze our own paths and of course live with the outcomes of our decisions. Right, wrong, or indifferent, such is life. I wish you all the best! I hope to be able to read more of your journey (if you stick around here) in the months to come.
    As a career nurse will tell you this is heavily debated in the nursing community. Not all are thrilled at the direct entry programs and I think the reason for the big move for DNP required by 2015 for the Advanced Practiced nursing professional. Many beleive that to be able to practice advanced nursing principles you need to have expereince/expertice in the "basics.

    It is difficult to tell you what area of study for in nursing school you will study all areas. You can then decide what specialty you would want....there is one problem.....finding a position.

    There is not nursing shortage as is believed by the general population and the estimates are that 43% of all graduates are unemployed or under employed. The average job search is approximately 18 months. With the economy as it is right now many have flocked to the "nursing land" for the promise of a job which has caused a plethora of grads. Hospitals maybe adding jobs but they are not Licensed positions. Many have decided that with the "PCP" shortage that NP is the way to go and I believe will be the next saturated market.

    Annaiya gave you good advice about the profession and schooling. I wish you the best on your nursing journey.
  5. 1
    Quote from Annaiya
    I was in a very similar situation as you, so I thought I'd share my experience. I was an attorney before going to nursing school, so I had a prior demanding career, and I was in my 30s. I had no healthcare experience prior to starting nursing school. I did a 15 month accelerated BSN (ABSN) program. I think as a second career student, we have an advantage in terms of disciplined study time, but I found it to be a big transition to understand how to think like a nurse. It was just so foreign from what I had done previously in my life, even though my prior job was almost all critical thinking, the context was just so different. Not to mention the content that we were learning was all new to me. I think it would be really hard to do a direct entry program and not give yourself time to absorb the information and develop the "6th sense" that you need in nursing. Plus financially it's better to get your BSN and then work while getting your NP degree.

    As for your experience in different areas in nursing school and knowing what you want to do as an NP, I think it's unlikely that clinical will help you much. Most of your clinical time will be spent doing adult med/surg. There are tons of areas out there that you will never see as a student. I think the best thing you can do while in school is try to decide if you like working with adults or kids or both. And then try to get some ICU time to see if you like critical care. The ED and ICUs will give you the most exposure to a wide variety of conditions. If you don't like critical care, then try to find a floor that gets a wide variety of patients. I think you learn the most and the fastest in the ED or ICU, so that would be my recommendation. No matter where else you go, that knowledge will help you.

    Let me explain what I mean a little better about why the ICU gives you better experience (and I assume the ED would be similar but I don't work there). When I worked on the floor, we had very little contact with the MDs or NPs. So what I was learning was from the other nurses I worked with. Which is fine if you are just focused on bedside nursing, but if you're trying to figure out what an NP does and if you'd like their job, it doesn't help you. When the MDs rounded on the floor, the extent of my conversation with them (if I talked to them at all) consisted of "Any changes today?" I rarely focused on lab results (many patients didn't have daily labs), almost never looked at the actual x-rays or CT scans, I only read the radiologist's report.

    Whereas, in the ICU, we present rounds everyday to our MDs and NPs. We are expected to know and understand our patient's disease or injuries, have looked at our x-ray, know if our breathing tube is in the right place, know if our feeding tube is gastric or transpyloric, and also read the radiologist's report to know if there is anything to mention in rounds. If our patient is on steroids, but doesn't have any GI prophylaxis ordered, we bring that up. We calculate the maintenance fluid rates the patient should be getting and bring it up if they are getting too much or too little. If they are on formula feeds, we calculate how many calories they are getting. We talk about their sedation and pain medication, and if they are getting too much or too little. Almost all of our patients have at least daily labs so we talk about all of the labs and discuss any abnormals, why we think they are abnormal (if we know) and what we might be able to do about it. We analyze our blood gasses and think about if our ventilator settings are adequate, or is the patient alkalotic due to diuretics, and it isn't a respiratory issue at all. In sum, we look at everything about our patient, and think about every system for every patient. It is a completely different level of thought than what is required on the floor. And it is exactly what any NP needs to be thinking about for their patients (at least any inpatient NP).

    Primary care is very different, but none of this knowledge would hurt. It is so helpful when you're in NP school, and you're already used to thinking in this way. Also in the ICU, you get to work with more areas in the hospital, so you can get a better feel for what the other areas do. You spend time in MRI and CT, you get patients from the ED, send and receive patients from the OR, and send and receive patients from the floors. You generally get a lot more exposure to different stuff.

    I did what it sounds like you're thinking of doing. I did an ABSN, got a job and then applied for NP school. I've done school part-time while continuing to work full-time. I will have 3 1/2 years of full-time nursing experience when I graduate from NP school. I feel that this has worked out really well. I've had enough time to learn what I need to get by and do well in my program. Another 5 years of bedside experience would be nice, but definitely not essential for success. However, any less experience and I think I'd be really struggling to get through school. I still struggle to remember everything, and more bedside experience would probably make this easier, but I can manage ok without it. But without my bedside experience, there's no way I'd be able to remember all of the drugs, all of the diseases and all of the labs that I should know.

    As an older student who had good grades in my ABSN program, and who knows how to write a good cover letter and resume, I did not have any difficulty getting a job. In fact, when I graduated the job market was worse than it is now, I got the first job I applied for and it was a highly competitive residency position. It may take a little networking, but I'm sure you can get into the specialty you want when you're done with school.

    Sorry this got to be so long! I hope it's helpful as you consider your career change. I know switching to nursing was the absolute best thing I've done in my life. Good luck to you
    Annaiya - Thank you tremendously for the insight. I definitely think going into nursing as a second career presents it's own challenges but also benefits. All of the information you provided helps me tremendously and gives me a lot to think about. While I certainly see the benefits to a direct-entry program, I think I would personally feel more confident studying to be a NP having had some bedside experience. Based on what I've read here and discussions with my RN friends and family, they have echoed sentiments similar to yours (i.e. pursuing experience in an ED or ICU, of course subject to finding a position as such). Once I do some introspection and really determine the patient population I am interested in working with, it will help me to focus on the "where?" question.

    Again, I want to say I appreciate your honest response and I am really glad to hear that this change was a change for the better for you!
    Esme12 likes this.
  6. 1
    Quote from Esme12
    As a career nurse will tell you this is heavily debated in the nursing community. Not all are thrilled at the direct entry programs and I think the reason for the big move for DNP required by 2015 for the Advanced Practiced nursing professional. Many beleive that to be able to practice advanced nursing principles you need to have expereince/expertice in the "basics.

    It is difficult to tell you what area of study for in nursing school you will study all areas. You can then decide what specialty you would want....there is one problem.....finding a position.

    There is not nursing shortage as is believed by the general population and the estimates are that 43% of all graduates are unemployed or under employed. The average job search is approximately 18 months. With the economy as it is right now many have flocked to the "nursing land" for the promise of a job which has caused a plethora of grads. Hospitals maybe adding jobs but they are not Licensed positions. Many have decided that with the "PCP" shortage that NP is the way to go and I believe will be the next saturated market.

    Annaiya gave you good advice about the profession and schooling. I wish you the best on your nursing journey.
    Esme, I can certainly understand the 'direct entry' vs 'RN experience first' debate. There are pros/cons to both side but in the end it is an extremely personal decision one has to make. I personally would like some experience before getting a MSN in hand.

    With the economy the way it is, I definitely have alot of concerns about employment, but I also think about whether I want to be sitting on this side of the fence 5 years from now and regretting not taking the leap. It's not an easy decision to make but I feel resolute in knowing I am willing to suffer the consequences of any decision. Thanks for your response!
    Esme12 likes this.
  7. 0
    Absolutely......I wish you the very best on your nursing journey! If you find yourself stuck we have a nursing student assistance section to help with the dreaded care plans....


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