RN Unit for Unknown NP Specialty?

kguill975, MSN, APRN, NP · Feb 5, 2013

Hi,

I don't think I've ever thought about this before. Generally, nurses know what populations they like or don't like from their clinical rotations in nursing school. There are so many areas (i.e. pedi vs adult, ambulatory vs acute vs critical, medical vs surgical, etc.) I personally knew that I didn't like working with sick children, and I didn't want to only see patients in the clinic, since I've always worked in a hospital. Based on those things, I didn't do an FNP program, nor an adult primary care program. ACNP was the only way to go for me, and since I had only worked in the OR my entire career, it had to be surgical. Let's see what others think. Good Luck to you.

brithoover · Feb 5, 2013

You are getting a little ahead of yourself. Becoming an RN is a long journey. Focus on this before worrying about NP. You will experience a variety of specialties in RN clinicals and will then know what to pursue later on for NP

kms673 · Feb 5, 2013

MBA,

I too am a government employee, so I felt compelled to respond to your post. I am currently applying to NP programs for Fall 2013.

My first question would be....do you see yourself working as an RN first, or is your goal to go directly to working in an NP role? Most people who do the latter have a clear idea of their specialty before beginning school, but since you are still working on your pre-reqs, it is possible to figure out your specialty, before applying, through sound research and introspection.

To answer my question, you may want to consider the current job market for new RNs (info that can be gleaned from perusing the CAREERS section of this forum). Many new grads are finding it tough to find jobs, and nearly impossible to get into specialty units like L&D. So "finding your specialty" by working as an RN might be difficult.

If you want to explore the NP profession, I would recommend:

-reading articles from nursing organizations and university publications about possible paths

-doing "informational interviews" with NPs to gather info about their specialties.

-shadowing NPs to get an idea of their day-to-day work

-volunteering at both hospitals and outpatient facilities to see if these environments suit you

-ponder how the skills gained from your current profession can be utilized in your new career

-look at how the educational paths match your natural qualities (from your post, you seem ambitious, enjoy a challenge, critical thinker, autonomy?)

I hope this helps!

MBAWkg2bNP · Feb 5, 2013

kguill975- Thanks for your response. I understand that working in the various areas through clinicals will drive much of any nurses decision to work in a specific area, followed closely by where they actually end up getting employed (which might not have been their first choice). I have also seen quite a few stories where nurses thought they wanted to work in 'X' unit because they loved it during their clinicals and then hated working there as a full time RN. It seems with the NP path, specializing is the way to go but it also limits you to a specific field.

kms673 - If I had to lay out a plan (albeit tentative) I would say that I'd finish an accelerated BSN program, then find a job (however long that takes) working as a RN and applying for a part-time NP program while I work. Therefore by the time I complete the NP program, I would have atleast 3 years of RN experience. Do you work as a RN for the government? I have heard of direct entry NP programs but they seem to be few and far apart, it also seems that they require a similar length of time to completion as going accelerated BSN to NP, but you are not bringing income in for the duration of the program.

Your second point regarding the job market is in part why I'm asking this question. Through my searches I have seen alot of jobs in this area and certainly for some units more than others (ED for example). I also see alot of new nurses who ONLY want to work NICU or med/surg, or Peds, etc and certainly that will limit their job options and the length of their search. I guess the reverse of my initial question is are there any units that one would work that would not lend itself to working as a NP? OR are there some units where your experience is more diverse in nature and therefore will still help you develop a wide enough skill base to make your transition to a speciality NP easier later on?

I am certainly following your advice by doing sound research :yes: by not just reaching out to you all but also to the RNs I know (I don't know any NPs personally but have some contacts out to get in touch with one...or a few). I also have my application in to volunteer for a position with direct patient contact and am waiting to hear back on their current schedule. Thanks for your thoughts and responses!

birthoover - I appreciate your comment but respectfully disagree. I am not a 20 year old trying to figure out my life. I have a family, mortgage, bills, and a career and I want to absorb as much information as I can before I pursue this change and impact my family. So, I don't think it is " getting ahead" of myself to ask for opinions from professionals in a field I am pursuing, particularly on a path that will take me out of my own comfort zone and take me out of the workforce for a period of time. I do agree and recognize that through clinicals I will be exposed to a variety of environments and experiences but I still don't think that in and of itself trumps hearing people's personal experiences.

kms673 · Feb 5, 2013

kms673 - If I had to lay out a plan (albeit tentative) I would say that I'd finish an accelerated BSN program, then find a job (however long that takes) working as a RN and applying for a part-time NP program while I work. Therefore by the time I complete the NP program, I would have atleast 3 years of RN experience. Do you work as a RN for the government? I have heard of direct entry NP programs but they seem to be few and far apart, it also seems that they require a similar length of time to completion as going accelerated BSN to NP, but you are not bringing income in for the duration of the program.
Your second point regarding the job market is in part why I'm asking this question. Through my searches I have seen alot of jobs in this area and certainly for some units more than others (ED for example). I also see alot of new nurses who ONLY want to work NICU or med/surg, or Peds, etc and certainly that will limit their job options and the length of their search. I guess the reverse of my initial question is are there any units that one would work that would not lend itself to working as a NP? OR are there some units where your experience is more diverse in nature and therefore will still help you develop a wide enough skill base to make your transition to a speciality NP easier later on?
I am certainly following your advice by doing sound research by not just reaching out to you all but also to the RNs I know (I don't know any NPs personally but have some contacts out to get in touch with one...or a few). I also have my application in to volunteer for a position with direct patient contact and am waiting to hear back on their current schedule. Thanks for your thoughts and responses!

MBA,

I work in government in a health/non-nursing capacity, and am currently applying to direct entry programs. Regarding your comment that direct entry programs may be "few and far between", I urge you to check out the forum Direct Entry Programs 2013 - it can give you a good idea of the array of programs there are around the country.

Regarding the length of programs: the program that I am applying to is two years long. Say you went to an accelerated program that was a year, it took you 6 months to find a RN job (a conservative estimant I believe), 6 months to apply for a NP program, and 3 years to complete, we are now looking at 5 years compared to 2. But, as you mentioned, you would be working (less loans), so its really a cost versus time issue.

Regarding unit experience: since I am not a RN, I am not an expert on this. I would say that any hospital unit nursing experience is valuable experience for NP preparation, especially if you want to continue in an inpatient setting when you are an NP. But who knows? That's why I mentioned volunteering. I volunteered in a hospital and realized that it was not the place for me - which is why my specialty is focused on outpatient care.

Most outpatient NPs I have spoken with conclude that NP work and RN work are completely different skill sets. But in terms of acute care/working in a hospital, I think the positions are more closely aligned.

But get advice from a good mix of RNs, NPs with RN experience, and directly-entry NPs. Don't be afraid to knock on doors or email people you don't know. From my experience, they all have incredibly different perspectives.

HouTx, BSN, MSN, EdD · Feb 5, 2013

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.

MBAWkg2bNP · Feb 5, 2013

kms673, I'll definitely check out the direct-entry thread. From my research on here I have seen opinions on both sides of the coin (i.e. experience vs direct-entry). As you pointed out there are definitely pros/cons to each, and alot of it has to do with personal circumstances and personality. Are you applying to programs in your area? Or will you have to potentially relocate upon acceptance?

kms673 · Feb 5, 2013

HouTx: Great Points......all part of the research I suggested.

kms673 · Feb 5, 2013

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.

MBAWkg2bNP · Feb 5, 2013

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.

Annaiya, NP · Feb 5, 2013

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:)