All these NPs making less than RNs?

[2bnpcout]

So recently, I've had quite a few co-workers and friends start graduating from FNP programs. Most were RNs for 4-7 years (not travel nurses, just standard hospital RNs). From talking to them, most have taken a pay cut becoming an FNP.

Kind of discouraging.. I wanted to do a PNP program, but with limited job opportunities, I decided on going the FNP route. Planned to start in January.

This is located about an hour from philly, in the Lehigh Valley, Allentown Area. RNs typically start around 22-24$ an hour here.

Is there a lot of truth to this? Is that common?

[PMFB-RN, RN]

While trazodone can be deliriogenic (as can diphenhydramine) there are actually some studies that support its use with delirium in the regulation of sleep-wake cycles. I use it frequently in combo with an antipsychotic when managing delirium. It is normally a fairly benign drug.

Right, OK but this patient had never had a delious moment in his life before that night. Maybe we have to agree to disagree but making big changes to an elderly patient's sleep medications the very day he is supposed to be admitted for a big surgery is a bad idea and the results are predictable.

Combine it with a new hospitalization, being in a new place, totally altering his routine and we can see what is likely to happen. IMO it would be better to take him off the sleep meds altogether than to give him a new one right before such an event.

[Jules A, MSN]

This is way off-topic, but I would agree with changing a 74 year old off Tylenol PM (it's a Beers criteria drug). Trazodone as been a first-line choice for sleep-maintenance insomnia in the setting of depression that many clinicians use, though I will admit, the data on its efficacy is less-than-impressive. I would absolutely try and get the 74-year old off diphenhydramine. Unfortunately the road is paved with good intentions.

I agree.

The truth is, unless he had something glaring obvious like a raging UTI or withdrawal it can be difficult to know exactly what caused it and it is likely to be a combination, especially as someone noted the confusion of being newly hospitalized. There are so many other things that could have caused his delirium especially since it doesn't sound like this was his first dose of Trazodone. How much was it and what other meds was he on?

We use Trazodone in small doses all the time in elderly for sleep. I feel it is a far better alternative to benadryl or especially Ambien, which I really don't like for anyone. Trazodone only has antidepressant properties at doses much higher than prescribed for sleep, without looking it up I'm thinking like in the range of 200mg. Serotonin syndrome while very unlikely on an insomnia dose is something I'd also consider if he is also on a another med with serotonergic properties.

That said there are absolutely docs that make horrible choices, my personal pet peeve are the damn benzos, but just generally speaking I continue to believe it would serve us well if NPs had more pharm education required before being handed a prescription pad.

[PMFB-RN, RN]

I agree.

The truth is, unless he had something glaring obvious like a raging UTI or withdrawal it can be difficult to know exactly what caused it and it is likely to be a combination, especially as someone noted the confusion of being newly hospitalized. There are so many other things that could have caused his delirium especially since it doesn't sound like this was his first dose of Trazodone. How much was it and what other meds was he on? .

Yes, his first ever dose of Trazodone. Taken at about 9PM, an hour before he arrived to the hospital to be admitted for an early AM surgery. No other med changes.

For those who agree that changing an elderly man's sleep medication the very day he is being admitted to the hospital for a major surgery is the right thing to do. Have you ever worked nights on an acute care ward? My guess is doing so would give you a different perspective on making such changes in those circumstances.

Neither the nurses involved, not the experienced hospitalist who saw him agreed with that decision.

[ghillbert, MSN, NP]

In Pittsburgh at a large hospital system, first NP job (acute care not FNP) pay for my classmates and myself ranged from $32-40/hr. Some experienced/charge/overtime RNs definitely were offered less per hour as NP (and exempt, salaried positions). It can escalate fairly rapidly though - my hourly rate less than 20 months after beginning my first NP job is 21% more than my starting hourly rate.

[Candimk2]

Hey jellojuggler, have you thought about looking at other jobs, instead of the typical M-F clinic? What about hospitalist? Or a NP in a nursing home? I believe those types of jobs are one week on, one week off. I would think as a NP there would be many other options than just working in a clinic M-F. I hate to hear that you are not liking your new role, but I think it may just be the environment that's not a good fit, not so much the now role you've taken on. Just a thought.

[Aniva]

a majority of the time, the NP salary is higher than RN. Personal experience, my salary as NP was definitely much higher than RN.

[Riburn3, BSN, MSN, APRN, NP]

Anecdotes are one thing. National salary averages are another. Just based on national averages, an NP beats a regular RN by over $20k a year. Sure the nurse working overtime in a union facility in California might beat a lot of NPs, but on AVERAGE the NP wins.

[DJTRN]

Does anyone become an NP for any reason other than money? After reading posts sometimes it doesn't seem like it. I've been an RN for almost 9 years and I laugh hysterically when people talk about all the money you can make, while it is true if you compare it to many other industries, however, I never felt compensated well enough and I am in Boston where rates are not bad, even that depends on where you work. (Our market is overly saturated and I won't work for less than $40.00, I know my worth and many companies don't offer crap, but I digress..) At my last full time job, I made 46.30/hr, (i still do but i am per diem now) im in the middle of the pay scale, i worked 7:30 to 4, only day hours with every other Friday off but I'm bored to death with triaging, refills, vaccines, calling results to pts. and often the powers that be try to dumb the RN down by keeping the role limited to tasks that are not very challenging. And this has happened in a few different settings I have worked in. I can't do it anymore I'm not fulfilled in my career. Over the long haul, I see becoming an fnp as way more growth potential throughout the rest of my career than staying as an RN. And by growth I don't mean financial only because eventually an fnp will surpass the RN in that regard as well. Lastly, I will say every NP or even MD that I have the privilege of having a relationship with actually encourages me to obtain the degree because of the increased opportunities that it will afford me...so I just wanted to chime in because I never do....if you don't agree..well... :)

[zmansc, ASN, RN]

Does anyone become an NP for any reason other than money? After reading posts sometimes it doesn't seem like it. I've been an RN for almost 9 years and I laugh hysterically when people talk about all the money you can make, while it is true if you compare it to many other industries, however, I never felt compensated well enough and I am in Boston where rates are not bad, even that depends on where you work. (Our market is overly saturated and I won't work for less than $40.00, I know my worth and many companies don't offer crap, but I digress..) At my last full time job, I made 46.30/hr, (i still do but i am per diem now) im in the middle of the pay scale, i worked 7:30 to 4, only day hours with every other Friday off but I'm bored to death with triaging, refills, vaccines, calling results to pts. and often the powers that be try to dumb the RN down by keeping the role limited to tasks that are not very challenging. And this has happened in a few different settings I have worked in. I can't do it anymore I'm not fulfilled in my career. Over the long haul, I see becoming an fnp as way more growth potential throughout the rest of my career than staying as an RN. And by growth I don't mean financial only because eventually an fnp will surpass the RN in that regard as well. Lastly, I will say every NP or even MD that I have the privilege of having a relationship with actually encourages me to obtain the degree because of the increased opportunities that it will afford me...so I just wanted to chime in because I never do....if you don't agree..well... :)

I made this career change for lifestyle and to fulfill life goals. If it was for money, I would have continued in my past career. So, yea, there are many who do it for something other than money.

[ghillbert, MSN, NP]

Does anyone become an NP for any reason other than money?

I'm sure a vast majority do - not many people go into any nursing field for the excellent money (/sarcasm)... however this post asked about pay which is probably why most of us mentioned it primarily!

Personally, the main reason was further learning and scope of practise - but in taking on MUCH greater responsibility as a provider rather than a nurse, we need to be appropriately compensated (esp compared to RN salary).

[globalRN]

We see a lot of patients with established dx of dementia, who are delirious on admission to hospital for a variety of reasons.

For sundowning, trazadone is one of our choices....starting with low doses if it is a new med. We will also evaluate what meds they currently take and review/revise meds and doses

[TheDude77]

Does anyone become an NP for any reason other than money? After reading posts sometimes it doesn't seem like it. I've been an RN for almost 9 years and I laugh hysterically when people talk about all the money you can make, while it is true if you compare it to many other industries, however, I never felt compensated well enough and I am in Boston where rates are not bad, even that depends on where you work. (Our market is overly saturated and I won't work for less than $40.00, I know my worth and many companies don't offer crap, but I digress..) At my last full time job, I made 46.30/hr, (i still do but i am per diem now) im in the middle of the pay scale, i worked 7:30 to 4, only day hours with every other Friday off but I'm bored to death with triaging, refills, vaccines, calling results to pts. and often the powers that be try to dumb the RN down by keeping the role limited to tasks that are not very challenging. And this has happened in a few different settings I have worked in. I can't do it anymore I'm not fulfilled in my career. Over the long haul, I see becoming an fnp as way more growth potential throughout the rest of my career than staying as an RN. And by growth I don't mean financial only because eventually an fnp will surpass the RN in that regard as well. Lastly, I will say every NP or even MD that I have the privilege of having a relationship with actually encourages me to obtain the degree because of the increased opportunities that it will afford me...so I just wanted to chime in because I never do....if you don't agree..well... :)

I decided to go to NP school for several reasons, and yes, money was one of them. Other included lifestyle change, family time...making my own hours if working out of an outpatient office (I am PMHNP), and wanting to learn more and be on the provider side.

I think a lot of people talk about the money because of the cost of education. If I am spending tens of thousands to educate myself, I want it to pay off.