Future of Nurse Practitioners

[Lightning Rose]

I'm passionate about cardiology and am considering being an outpatient cardiac nurse practitioner, but I hear the NP profession is looking quite grim (supply more than exceeds demand, grossly underpaid, overworked, etc.). What's the future looking like for NPs, particularly those in an outpatient cardiac clinic? Is there a light at the end of the tunnel? Or should I look for something else? I have my BSN, four years of bedside under my belt, and am studying for my CVRN, if that helps. Also when and if I go to NP school, it will be a brick-and-mortar. Thank you so much for the responses!

[Goldenfox]

The future of NPs is highly variable but ultimately looks positive. That said there are a few caveats. NP education is highly variable ranging from excellent to abysmal. There is still a hodge podge of standards governing educational programs but generally the regulation is quite loose (at least compared to other professional programs) not at all unlike medicine was when it established itself in the United States. NPs are going through the same concerns were just a couple centuries later to the party. Likely, things will slowly sort themselves out and, just like our medical counterparts, NPs will be recognized and an integral and indispensable part of the healthcare system.

I want to point out that there is no such thing as a cardiac nurse practitioner. There are NPs who work in cardiology settings both inpatient and outpatient. You may think I'm splitting hairs but I would suggest that, unlike physician cardiologists, there is no single, recognizable way to demonstrate one is professionally prepared to practice in cardiac setting. This can swing both ways. I can mean that one can land a job in cardiology without undergoing any specific educational or professional preparation and leverage prior experience, NP training, and formal or informal mentorship to be a successful provider. But it can also mean that one's experience is less transferable because there is not standardized way to demonstrate competence and work experience can be viewed very subjectively.

That being said, NPs have forged successful roles for themselves in nearly every area of healthcare. Nonetheless, geographic and political factors play a major role in determining the opportunities available for NPs. The more flexible you are, the more likely you are to find a match to your professional goals. Some places are insistent on using NPs in a primary care capacity even in specialty clinics (such as cardiology), require specific certifications/licensure (acute vs primary care, adult vs family vs peds), and work schedules/responsibilities, and earning potential.

Part of your post is incorrect. Nearly every specialty area in medicine has advanced certification programs for clinicians who don't have board bona fides but want to specialize. This includes cardiology. Here is just one example:

About Us | Cardiovascular Credentialing | ABCMCertification.com - American Board of Cardiovascular Medicine

Some reputable brick and mortar universities even offer the CV subspecialty in their program.

Cardiovascular Subspecialty

Some of these NP certification programs are more stringent than others. I remember looking into the one for dermatology some time ago but I was not qualified because they require 3,000 clinical practice hours in the field before they will allow you to apply to take the certification exam. I have seen that other certification programs have similar requirenments, which, I believe, is a good thing.

[Goldenfox]

NP education is not a bad thing if you really want to be a clinician and you have completely ruled out medical school as an option. Look for a good school that has an excellent training program AND won't put you into ridiculous amounts of student loan debt. If this is truly your passion, research it very carefully first. Just know going in that you're probably not going to make the big bucks working as an NP if you're working for somebody else, and if you're in an area where there are already a lot of NPs it may be very difficult to get a job at all. Are you flexible with moving to where the opportunities are?

I will be honest, if I was a younger person just starting out today or with just a few years in, I would not go to NP school now---unless I was planning to open my own business later on. Entrepreneurship is an area that precious few NPs ever even think about. It is also an area that very few educational institutions even mention in NP programs. The glut is mostly with the family NPs. Many don't really want to be clinicians, they just don't want to do bedside nursing anymore. Your own drive and attitude will play a role in your success. That you plan to specialize is a plus.

[Dodongo, APRN, NP]

The glut is mostly with the family NPs. Many don't really want to be clinicians, they just don't want to do bedside nursing anymore.

Yes, this... so unfortunate.

[Spadeforce]

not sure on the salaries but those IT nursing jobs looked pretty tight.

[pro-student]

Felt like I was reading a pseudothesis going through this post lol. Too many fancy words like "integral, caveat, indispensable, etc etc, with no data to back it up.

WOW! It's interesting to me that would criticize my use of "fancy words" in the same post as you bemoan the decreasing standards of NP education. (I think that's what you were doing. It was a little difficult to navigate the typos and poor grammar.) APRNs are prepared at the graduate level and I don't see a problem with vocabulary that matches that educational level. I don't think intellectualism and nursing are incompatible.

Part of your post is incorrect. Nearly every specialty area in medicine has advanced certification programs for clinicians who don't have board bona fides but want to specialize. This includes cardiology. Here is just one example:

About Us | Cardiovascular Credentialing | ABCMCertification.com - American Board of Cardiovascular Medicine

Some reputable brick and mortar universities even offer the CV subspecialty in their program.

Cardiovascular Subspecialty

Some of these NP certification programs are more stringent than others. I remember looking into the one for dermatology some time ago but I was not qualified because they require 3,000 clinical practice hours in the field before they will allow you to apply to take the certification exam. I have seen that other certification programs have similar requirenments, which, I believe, is a good thing.

The examples you give don't refute my claim. There is still no SINGLE, STANDARD way for an NP to demonstrate competence in a specialty area like cardiology. The fact that you provided links to two different sources should make that clear.

Also, the board you provided a link for would not be considered "board certification" as utilized by physicians. When they speak of board certified cardiologist they are referring to someone who as undergone certification by the American Board of Internal Medicine after completing both an internal medicine residency and cardiology fellowship.

My point is there is no similar credential that is universally recognized for NPs in cardiology but there is a hodge podge of certificates, exams, continuing education, NP residencies/fellowships that one can pursue. I will concede that the link you provided does refer to "cardiac nurse practitioner" but is not widely recognized and is fairly obscure.

[KansasFNP]

I live and work in Kansas. I am educated as a FNP did an extended residency in EM, then became ENP certified. Own and operate my own locums company. I provide emergency department coverage for 6 hospitals across the state. I had to cut back on working because there was too much work and not enough me. I am well respected by my PA and physician colleagues. I make great pay, have excellent flexibility and see no signs of this slowing down. I am very happy to have extended my education and am proud to have advanced my nursing skills. I routinely perform high-level tasks including interpretation of rad testing, placement of ETs, central lines, and chest tubes. I love my job. I do not share the sentiment of many on this post or on this website and would just remind everyone that one experience is not the experience of all.

[kttyliz]

I am a PNP, and I admit that I am somewhat overworked, forced to see way too many patients per day. However, the pay is much better than bedside. My stress as a PNP is much different than bedside in the NICU, but there is definitely more responsibility. I lose sleep over my patients now regularly, whereas I rarely had sleep issues while working in the NICU as an RN, even when working nightshift!

[TheAnguishedNurse, LPN, RN]

I live in central IL - plenty of jobs here

That's what I thought, especially if you go to the more rural areas where it's hard to draw physicians in to work. We have huge needs for the rest of the state ,but if NPs continue to stay in Chicago, there is going to a bit of market saturation. Chicago, really unless you are going to work in the urban areas (which is where I grew up) there is many places to maintain work. Almost need to take the Teach For America approach to nursing, as there are grants for such things, at least for the rural low income areas.