Advice Appreciated: Which career path to take?

llg, PhD, RN · Nov 11, 2012

Wow. You seem to have done your homework very well. It sounds like you have a very good grasp of the current situation. You have my respect for that.

Unfortunately as you have discovered, there is no quick, easy, and inexpensive path for you. Life doesn't always present you with good options and this sounds like one of those times. You are going to have to choose which unattractive path you want to take. Which set of problems and disadvantages do you want to live with? In similar situations, I usually go with my gut ... bite the bullet ... and prepare to endure whatever hardship I will have to endure to reach my eventual goal.

Would any of your options allow you to work part time while going to school? With your background, you might be able to have enough income to keep the debt down a bit. It might slow down your academic progress, but you would graduate with less debt. Similarly, can you significantly scale back your lifestyle now (live like a college student) to save every penny for a year or two before starting school? Again, the delay is not attractive to you, but might be worth it financially. Perhaps you could take one or two courses at a time while you do that (e.g. pre-req's) to lessen the delay. If I were in your position, that is what I would try to do.

The one (very important) piece of information you left out of your OP is: What is the quality of the schools you are looking. I would choose quality every time.

I am assuming you are not willing to move to another town to pursue your goal. But you know, throughout history, a lot of people have had to migrate to pursue their goals of a better life for themselves. They have suffered temporary hardships to reach their goals. That may be your best option. So you should at least, consider it.

Good luck to you -- whatever you decide.

chuckster, ADN, BSN, RN, EMT-B · Nov 11, 2012

Hi,
I feel like I'm on one of those morning shows....why?
Long-time listener (reader!), first-time caller (poster!) :)
I have my sights set on becoming a mid-level provider, hence I'm wanting to be an NP or PA. While I have a bachelor's degree already, I had mediocre grades (3.1ish gpa) and my degree is in a non-nursing field (engineering) and I graduated in the (late) 1990's.
I have shadowed NP's, PA's, and RN's so I feel good about my interest in the first two fields. I'm also solid in that I would not want a long-term career as an RN - my interests and preferences are more in the NP/PA role.
PA schools are ridiculously competitive and I doubt my chances for getting in are good - and even to have a modest chance it would involve retaking many science courses and getting significant HCE (requiring a certification or job of some sort, like becoming an EMT/CNA first).
With all that in mind, what is the best path to becoming an NP in my situation? I'm aware of both ADN and BSN programs. There are no master's direct entry programs here and the local accelerated BSN programs are at public universities - which I'd have zero chance of getting into I suspect given my past grades.

Getting some experience as an EMT (or CNA) is beneficial in that you will get an appreciation for whether or not you like patient interaction and the role of care provider. It likely will not improve your chances of acceptance into an RN program, though it can help to make your admission essay more attractive. Frankly, it's not clear why you prefer NP over PA, especially given your feeling regarding working as an RN. While there are advantages and disadvantages to each, the PA route should be quicker, especially given your background. Your 3.1 GPA may not automatically make you uncompetitive in terms of admission to a PA program - I'd suggest that you speak with an admissions counselor for whatever PA program you may be interested in. I'd also point out that many RN programs are also quite competitive.

My options seem to be:
Spend 2 years at a community college getting an ADN, then look for a RN-MSN program. Two years and I would still only have an ADN and a non-nursing BSN, although the debt acquired would be modest.
Enter a private-school BSN (traditional) program and spend 2,5 years there while accumulating some sizeable debt - something I am hesitant to do.
I'm concerned about several things in particular:
The job market for new RN grads appears to be horrendous from what I can tell. My background is in IT/software and even with management experience, I find work very hard to come by - like everyone else, I'd like to be in a field that offers me more security.
Is anyone going to hire a new RN and later, a new NP, with no experience?
The other thing of course revolves around the coming DNP issue. Will RN-MSN programs cease to exist or be phased out? Will becoming an NP now require a DNP?
I know the DNP is being pushed and many schools appear to be adopting them quickly.
Thank you for any advice :)

If you decide that the NP is what you want, the ADN-RN-MSN/NP route can be the least expensive, but does have some pitfalls. You are correct to be concerned about the job market for an NP with no nursing experience. In fact, many NP programs expressly require nursing experience as a condition of admission. Even where that's not the case, you will likely face pretty tough going finding a job as an NP with no nursing experience. As you correctly point out, the job market for new RNs is very poor in most parts of the country - it's no better and arguably significantly worse for NPs with no experience.

As you also correctly note, the movement now is to make the DNP rather than the MSN the minimum educational credential for NPs. This is the ANA position and some, but far from all, institutions have adopted it. It remains only a recommendation. You are right to be concerned but keep in mind that the ANA has also been recommending for years that the minimum credential for RNs be the BSN - which also hasn't happened (though given the nursing oversupply, it has moved toward becoming the de facto standard).

I am also a second-degree RN and plan to go on for my MSN (to PMHNP). I did the CC route to RN and had planned on applying directly to an MSN program. I found that it was considerably less expensive to get my BSN in an on-line RN-BSN program rather than take the bridge courses (for non-BSNs) in the MSN program I plan to enroll in however, though it does add several months to the process.

Most importantly, no matter what your decision is, keep borrowing to a minimum. Borrwing $100k to get to NP wil take years to pay back and severely impact your ability to become a homeowner or even get a car loan.

Good luck with your decison.

Garota · Nov 12, 2012

Thank you so much for your responses and thoughts! Both are very helpful and rather thought-provoking too - which is exactly what I hoped for :)

I've spent considerable time researching all this because, well, being 15 years out of college, with a lot of professional/management experience, and a healthy work/life balance - nothing to take lightly in 2012 - I don't want to make a big change without really preparing myself. If I'd done as much research back in college as I'm doing now, I'd have chosen an entirely different career path.

Nursing schools are indeed competitive, particularly from a gpa standpoint. However I've come across 2 local community colleges that only look at GPA for the pre-nursing curriculum (think A&P 1/2, microbiology)...and fortunately I've not taken those courses. Thus I feel very good that being much more mature and focused, I can do well in those courses and get accepted into their ADN programs.

Working while going to school - at least part-time - seems doable in an associates and later, rn-bsn/msn online-type program. So from a debt standpoint, this is attractive, plus at least there's some token chance an employer might help with tuition for improving my would be nursing credentials. Perhaps this is unrealistic?

Meanwhile, I don't know any PA students that have managed to work, even part-time, during their programs. Then too, I'm particularly skeptical that someone employing me as an EMT or CNA (in order to get direct HCE) would help me pay for PA school. Not to mention, my only shot to be a PA would be through a private school (re: expensive ~$70k+). That's all assuming I could get accepted which from my talks with admissions counselors, seems like a slim possibility.

The one thing the PA route offers, I think, is that there is no expectation by and large of previous PA experience for new grad jobs. Many of the PA's I know have gotten their first jobs at facilities where they did their clinicals. In nursing it appears for many new grads they can't find work without experience. From what I am seeing the same holds true for NP's without nursing experience. Worse, you'd likely have more debt and time invested to get to be an NP, only to find yourself unable to work.

The NHSC has programs for loan repayment but here too I wonder about anyone giving you a job without any meaningful nursing experience.

My dream would be to practice independently and have a community/low-income health center and provide basic, primary care services. I've volunteered at such places before and have enjoyed it immensely.

So that leaves me with...

a) go to a CC for an ADN program.

Pros:

Least expensive

Some chance of getting tuition assistance?

Cons:

Takes 2 years, same as PA school, but only nets an associates

Very uncertain job prospects

b) keep taking PA prereqs (many of which coincide nicely with Nursing prereqs) and hope to get accepted somewhere

Pros:

2 years and done

Meets long-term goals for practice and work scope

Better opportunities for new grads

Cons:

Chances of getting in are low

Very expensive ~$70k+

c) go into some other allied health field: physical therpay, occupational therapy, speech-lanaguage, clinical/medical social work

calinursestudent818 · Nov 13, 2012

I'm a pre nursing student myself and like you, I'm overwhelmed with what tough decision it is trying to figure out what the best path is to take that will work for me and not take me a decade to do it. I've spent hours and hours researching different scenarios and outcomes. I have a plan A, B and C lol. Yeah I am an over planner.

I'd say go for a BSN program & skip ADN if you can. What I have discovered in my research is that alot of states are really phasing out ADN's. It would probably be in your best interest to get your BSN, then do BSN to MSN. I've also read in various nursing forums and blogs that for someone who wants to be a NP, working as a RN for 2-3 years FIRST is important. Working in the "trenches" is the optimal stepping stone to becoming a NP. You really shouldn't skip that experience. It will be really really really hard for you to get a NP job with no RN experience (most NP jobs I have seen want you to have 2-3 years as RN, MSN and sometimes other specialty certifications on top of that).

Really check out the RN job market in your area to see what type of nurses (ADN, BSN etc) they are primarily looking to hire and that should help you better choose which path to take. In my state (california), there are a couple of state universities (not community colleges) that have BSN programs. You might see what your state universities have to offer. Some state universities even have accelerated BSN programs. A BSN at a state university will be cheaper than attending a private school for your BSN. Also it might be worth it to bite the bullet and retake a few prereqs/general eds to raise your GPA to better your chances of getting in the nursing school of your choice.

As far as getting employed out of nursing school, it's VERY tough out there but you can try to better your chances by doing an externship while still in nursing school, shadowing a mentor, volunteering at a clinic or hospital a few hours a week while in school, seeking out any special healthcare student programs (some hospitals have these types of programs listed on their volunteering info page of their websites). And ofcourse upon graduation, apply for as many Nurse residency/New grad programs as possible at any and all hospitals near and far that offer them. None of this will guarantee you a job but it doesn't hurt to try your hardest, every little bit helps on your resume.

HTH!

chuckster, ADN, BSN, RN, EMT-B · Nov 13, 2012

. . .
Working while going to school - at least part-time - seems doable in an associates and later, rn-bsn/msn online-type program. So from a debt standpoint, this is attractive, plus at least there's some token chance an employer might help with tuition for improving my would be nursing credentials. Perhaps this is unrealistic?
Meanwhile, I don't know any PA students that have managed to work, even part-time, during their programs. Then too, I'm particularly skeptical that someone employing me as an EMT or CNA (in order to get direct HCE) would help me pay for PA school. Not to mention, my only shot to be a PA would be through a private school (re: expensive ~$70k+). That's all assuming I could get accepted which from my talks with admissions counselors, seems like a slim possibility.
The one thing the PA route offers, I think, is that there is no expectation by and large of previous PA experience for new grad jobs. Many of the PA's I know have gotten their first jobs at facilities where they did their clinicals. In nursing it appears for many new grads they can't find work without experience. From what I am seeing the same holds true for NP's without nursing experience. Worse, you'd likely have more debt and time invested to get to be an NP, only to find yourself unable to work.
The NHSC has programs for loan repayment but here too I wonder about anyone giving you a job without any meaningful nursing experience.
My dream would be to practice independently and have a community/low-income health center and provide basic, primary care services. I've volunteered at such places before and have enjoyed it immensely.
So that leaves me with...
a) go to a CC for an ADN program.
Pros:
Least expensive
Some chance of getting tuition assistance?
Cons:
Takes 2 years, same as PA school, but only nets an associates
Very uncertain job prospects
b) keep taking PA prereqs (many of which coincide nicely with Nursing prereqs) and hope to get accepted somewhere
Pros:
2 years and done
Meets long-term goals for practice and work scope
Better opportunities for new grads
Cons:
Chances of getting in are low
Very expensive ~$70k+
c) go into some other allied health field: physical therpay, occupational therapy, speech-lanaguage, clinical/medical social work

Many CCs offer evening/weekend nursing programs that allow you to work while you attend school. This is the path I chose and I was somewhat surprised to find out that about 1/3 of my classmates were not working. Most of us did work, in many cases (like mine), far more than 40 hours per week. It's not for everyone though.

The big advantage to the ADN route is that it is least expensive path to the BSN. That's not a typo: Even though you will "only" get the ADN, once you are an RN, you can enroll in any one of the many low-cost (relatively speaking) on-line RN-BSN programs. This is also the path the I chose, even though I could have gone directly to an MSN program as a second-degree RN. The total cost for my BSN was less than $15k, which is substantially less expensive than any 4-year BSN program I'm aware of.

The other advantage of the ADN-RN route is that you may be able to find a nursing job upon graduation, which could give you not only experience but may also provide tuition assistance. As you rightly note, the job market for new RNs and particularly ADNs, is not very promising. This varies considerably by geographic region however. Your chances of being hired as an RN are increased significantly by working as a CNA. Every one of my nursing school classmates who was working as a CNA or PCT got hired as RNs once they passed the NCLEX.

There are no PA programs that I'm aware of that have a true part-time option. Our local osteopathic medical college nominally has a part-time PA program that spreads out the student load somewhat by adding an extra semester. Classes are held during the day however, so it's not really an option for most. Still, as you note, the path to PA is only a couple of years, probably significantly shorter than the path to MSN-NP. Another plus: The job market for new grad PAs seems to be much, much better than for new grad RNs. As you note, you need some health care experience such as EMT or CNA to apply to a PA program and you are correct that you will have a tough time finding a job as either that will provide tuition assistance. You could at least take some pre-reqs at your local CC while getting your 1,000 hours of experience however.

Physical and Occupational Therapists seem to be in fairly high demand and working conditions for these jobs tend to be much better than for nurses. Keep in mind however, that the minimum educational credential for these (and Speech Therapy as well) is the Masters degree. I think that I read that PT and OT are both transitioning to the Doctorate as the minimum, so check this thoroughly before starting. Unless you like to live at the poverty level, I would urge you to stay away from social work. A Masters is usually needed but the pay levels are abysmally low. My hat is off to anyone who takes the time and energy - and incurs the expense - to get a MSW kowing that they will be looking at jobs in the $29,000 range, and with limited prospects for advancement to boot.