Advice about going into nursing

NurseGirl525, ASN, RN · Jul 3, 2015

You need to understand that there is a huge difference between a medical assistant and a nurse. There is a difference between the medical model of thinking and the nursing model of thinking. The medical model is looking at the disease, diagnosing it, and treating the disease. Your doctor treats the disease itself. A medical assistant assists the doctor in this role. They pretty much just work in doctor's offices and clinics. They have an extremely limited scope of practice.

A nurse on the other hand, treats how that patient is responding to the disease. They treat the person. What does this patient need at this moment? It is a different way of thinking. There is a LPN and RN. The LPN has a more limited scope of practice than a RN does and there is a difference in pay. But, if you have to work during school, you may want to start out as a LPN because it's going to be hard to find a program to fit your needs. Some schools do have part time and evening LPN programs. It depends on how much you have to work and what hours you work. Some of the people in my cohort work. Mostly as techs and CNAs so they don't have the 9-5 schedule. Many work nights and go to school during the day or they work weekends. Every RN program I have ever seen is during the day and you have a clinical schedule during the week. There may be a couple out there but they are scarce.

You need to look what the requirements are for schools, and what kind of jobs are in your area. You are going to have to get your RN first and then work your way up to a NP. There are direct entry programs out there. From what I have seen though, those are frowned upon by employers. Most schools, like you to have some bedside experience before going for your masters or doctorate. If you think about it, you can't really master a skill unless you practice it a lot first. So you need to look at these requirements first.

You say you will be strapped on cash. How are you planning to pay for this? With your previous degrees, do not expect to be able to get financial aid. It may be hard to even get federal student loans. So you will need to look at all of this when looking at schools. You will need to look at what you can afford.

I'm surprised with the degree you hold now you are forced to work in cubicles. I would think you would have many options with your kind of degree. Maybe you have not found the right job yet. Many people are going to tell you to do an ABSN program. But they are hugely expensive and you will be looking at around 21 credit hours each semester and long clinical days. If you have to work, I don't know if that will be the right fit for you. I'm also going to advise you to shadow a nurse for a day so you can see what you are getting yourself into. I'm not sure you have researched the role of a nurse and what all they do. I would hate to see you to pay for a program and then realize you don't like nursing. It would be flushing money down the toilet.

CogNeuroGuy · Jul 3, 2015

Thanks for the feedback.

I am very familiar with the differences between those who approach treatment of patients via a medical model vs. a holistic model, I even looked into going the PA route. I have been researching this for the past 2 years as I completed my master's. I will be able to get financial aid, so I am not worried about that. In terms of employment with what I currently have, it's very difficult. Even when one tries to apply my education to a business background, it seems like they know you are fudging your education, and that's exactly the responses I get from some people I network with. Besides that, I don't want to be in a business environment, otherwise I would have gone into a business-oriented background 7 years ago. I went the route I did to potentially become a psychologist. That is probably one of the most competitive occupations to get into, and many people don't realize that. They don't realize that psychologists are working for the same pay and insurance benefits that master's level practitioners bill for, it is a real problem. Many of my mentors were lucky enough to get out of private practice to work for a hospital or to teach as a professor, but then again, getting those jobs are even more competitive. When the national average for employment of psychologists is 14% and declining, things are not looking pretty. Insurance companies can't find the clinical utility in offering reimbursement for psychological assessments because they are very expensive and time consuming. Due to some of these reasons, this is why you will see an average psychologist who spent 4 years of undergrad, 5 years of doctoral training plus 2 more years of post-doctoral training just to get licensed only making $65-70K for the first 5-10 years of practice. I used to work in a private practice and worked with NPs and really enjoyed seeing them work, especially the pay they got for a third of the education a psychologist must go through.

I will be working in private practice when I move to Florida as well as some at The Cleveland Clinic doing neuropsychological assessments. Both will be part time opportunities. This alone wont be sufficient in being exposed to what nurses go through. I would highly doubt one day would provide me even with the most valid scope in what nurses deal with on a daily basis.

NurseGirl525, ASN, RN · Jul 3, 2015

Thanks for the feedback.
I am very familiar with the differences between those who approach treatment of patients via a medical model vs. a holistic model, I even looked into going the PA route. I have been researching this for the past 2 years as I completed my master's. I will be able to get financial aid, so I am not worried about that. In terms of employment with what I currently have, it's very difficult. Even when one tries to apply my education to a business background, it seems like they know you are fudging your education, and that's exactly the responses I get from some people I network with. Besides that, I don't want to be in a business environment, otherwise I would have gone into a business-oriented background 7 years ago. I went the route I did to potentially become a psychologist. That is probably one of the most competitive occupations to get into, and many people don't realize that. They don't realize that psychologists are working for the same pay and insurance benefits that master's level practitioners bill for, it is a real problem. Many of my mentors were lucky enough to get out of private practice to work for a hospital or to teach as a professor, but then again, getting those jobs are even more competitive. When the national average for employment of psychologists is 14% and declining, things are not looking pretty. Insurance companies can't find the clinical utility in offering reimbursement for psychological assessments because they are very expensive and time consuming. Due to some of these reasons, this is why you will see an average psychologist who spent 4 years of undergrad, 5 years of doctoral training plus 2 more years of post-doctoral training just to get licensed only making $65-70K for the first 5-10 years of practice. I used to work in a private practice and worked with NPs and really enjoyed seeing them work, especially the pay they got for a third of the education a psychologist must go through.
I will be working in private practice when I move to Florida as well as some at The Cleveland Clinic doing neuropsychological assessments. Both will be part time opportunities. This alone wont be sufficient in being exposed to what nurses go through. I would highly doubt one day would provide me even with the most valid scope in what nurses deal with on a daily basis.

Well, you stated that you wanted to start out as a MA. That is why I wanted to tell you about the difference. And I'm going to ask, have you already done the second degree appeal and told you would get it even with a masters, and the fact you haven't applied to schools? I'm telling you this because I have most people get denied and very few win second degree appeals, even at the associate degree level. Once you get a Bachelor's in anything else your financial aid is pretty much gone. I know if you further your degree like you did, you can get it. But there is also a cap. So if you have hit that cap, don't count on it.

You think being a psychologist is competitive? It's nothing compared to nursing. Nursing is nothing but competitive from the start of prereqs, to getting in a school, to finding a job. It's all about competition. Some states say they have a 47% new grad unemployment rate. I fortunately live in a state where that's not an issue but I would look at Florida if I were you. Getting into NP school is very competitive and there are a ton of graduates right now. A ton. Everybody and their brother wants to be a NP right now. I'm also trying to understand where you are getting a NP has a third of the education of a psychologist. You yourself state you have a masters degree. You didn't go to get the doctorate. A NP can be a masters trained or doctoral trained. Most places are leaning toward the doctoral trained. That schooling is a total of 8 years for a DNP. By your calculations, the doctoral psychologist goes through 11. It's not a third.

You stated that you had no clinical health care experience so I was trying to inform you of options and what the different scopes of practice are. There is no reason to get defensive or argue with me. I was trying to be helpful and give you things to think about before making the leap.

CogNeuroGuy · Jul 3, 2015

While I appreciate your input, I am not arguing, I am simply letting you know the available facts.

At the moment, if I were to apply to any second degree bachelor's program (e.g. TWU, FAU, FIU, etc.) these programs will grant you federal aid (e.g. loans) that fall under your designated program (since I would be applying for a second bachelor's, they would pull from my available undergraduate loans I haven't used). As a graduate student, you don't use loans from the undergraduate category, they pull it from the graduate category. So, I only spent $45K for undergrad, I still have $15-16K I could use towards funding a second bachelor's. If I were to wait 3 years for us to move back to Texas to attend TWU, I could afford the tuition alone with this amount.

Secondly, the "cap" you are referring to is $130K, this combines the total amount one gets from undergraduate + graduate loans. If one attends professional school (e.g. law, medical, dental, pharmacy, etc.) that cap is bumped up to $224K. Again, I have available funds, the question here is where would I go to complete a second BSN.

In terms of education, I don't think you fully appreciate the extent of employment vs. suitable employment vs. debt ratio when it comes to completing a Ph.D./Psy.D. to become a psychologist. Ph.D. programs in clinical or counseling psychology have an acceptance rate somewhere between 3-7%. Most programs will have 150+ applicants in a year. Aside from this, to be competitive for admissions, one should have a 3.7+ and a GRE of 1100+ (old scale). On top of this, one needs to have research experience, simply applying straight out of undergrad without posters or publications will put you at the bottom of the list, even for bottom 20% programs. Psy.D. programs accept larger classes, and depending on the school, they have an acceptance rate between 20-45%. However, rather than having your degree paid for like the Ph.D. in clinical or counseling psychology, one has to pay for the degree itself. Current Psy.D. tuition nationwide ranges between $150-250K for the whole program...this is just tuition, this doesn't count how much one will need to take out in loans to pay bills, etc (because you won't be working in the doctoral program, not until your 4th or 5th year, and at that rate, you might be making $20K a year).

The research I have done on acceptance rates in the respective second/alternative BSN programs are somewhere between 30-75%. For NP master's programs (since the current trend is to migrate NPs to the DNP eventually and master's level trained NPs are grandfathered), one can alleviate even taking the GRE for admissions if one has a prior master's in some NP programs, such as Yale's (which I have). I am not downplaying the NP route at all, its the exact opposite, I feel that I would be better suited to provide mental healthcare via the NP route vs. being a psychologist. Again, taking into consideration the employment vs. suitable employment vs. debt ratio, the NP route would be the most optimal track to go. Considering starting salaries in psychiatric NP range from $75-90K (depending on location) with an employment rate 30% greater than for a Ph.D./Psy.D. psychologist, there is a reason why the NP/PA profession is lucrative. I have several psychologist friends who are going back for a PA or NP just to have an increase in their salary due to the fact that they would make more as a PA or NP than as a current psychologist.

It seems like you took my comments personally, and you shouldn't. I am laying out the available facts. I am unaware of how long the DNP would take, but considering one is still able to attend a master's program to become a NP to practice and hold a NP license and be paid at a NP rate vs. a psychologist who HAS to have a Ph.D. to obtain a license (the term Psychologist is a legally protected title only reserved for those who have received a Ph.D. in clinical, school or counseling psychology). Again, I do appreciate your advice, I was simply providing you with an answer to some of the "introspective" questions you presented for my journey.

umbdude, MSN, APRN · Jul 3, 2015

If you want to be a psych nurse, working as a mental health tech would give you good exposure. If you want to work in neurology, consider working as a CNA on a neurology floor or any medical unit. You'll get plenty of direct patient care experiences in either one.

Good luck

CogNeuroGuy · Jul 6, 2015

Great advice. I suppose I should look into how long the CNA process could take. :)