All these NPs making less than RNs?

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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?

Specializes in Adult Internal Medicine.
I have no need to "cite an outcome study that supports this" but will ask how many credit hours of pharm does an average MS program require to prescribe? and how many credit hours does med school require?

I'm not sure why you would ask if all NPs should be removed from anything. Wow.

Why do credit hours matter if NP and MD outcomes are equivocal? Because more must mean better?

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I have no need to "cite an outcome study that supports this" but will ask how many credit hours of pharm does an average MS program require to prescribe? and how many credit hours does med school require?

.

Counting hours isn't going to tell you much. What the NP will have, and the med student will not have, is the experience of administering a wide range of medications to, likely, tens of thousands of patients over years and then closely observing and documenting the effects on patients.

Rather than asking how many hours in class the NP student has, ask how many patients the med student had administered medications to and then closely observed the results before getting prescribing privileges.

Specializes in Internal Medicine.
I have no need to "cite an outcome study that supports this" but will ask how many credit hours of pharm does an average MS program require to prescribe? and how many credit hours does med school require?

I'm not sure why you would ask if all NPs should be removed from anything. Wow.

And where does all this extra pharm lead them? There's a reason why several med schools have cut down from a 4 year to 3 year model.

Regardless of bedside pay, I ABSOLUTELY HATED IT! I'm finishing my FNP in Dec and I am def aware of the long hours I would never go back to bedside. Worst 4 years of my life.

I have been a RN since 2005, and will be sstarting my first FNP job Monday. I am certified. In pediatrics, PALS, ACLS, and BLS certified. I currently work 9a-9p in an ER outside of St. Louis, MO. The hours are usually long, difficult, and by the end of the day, my back has had it. At 29, I feel 99. My base as a RN is $29/hour, my starting hourly wage at my new ortho/spine/pain management office is $40/hour. I will only be working Monday, Tuesday, Thursday with no holidays, weekends, or call. Pretty amazing to me, and as a newlywed, it will be nice to actually SEE my husband instead of passing as one of us is leaving!

Specializes in Family Nurse Practitioner.

Rather than asking how many hours in class the NP student has, ask how many patients the med student had administered medications to and then closely observed the results before getting prescribing privileges.

I agree 100% that the experience of administering medication and observing patients is extremely valuable however that doesn't provide an indepth knowledge of pharmacology. I would still contend that most physicians could be expected to have a broader knowledge based on their additional courses and the time they spend as a resident.

The trend seems to be that schools are admitting NP students with no or minimal nursing experience. My concern is that they don't have the indepth education or the experience and anecdotally speaking the NPs I know who are truly exceptional had vast experience in their specialty prior to becoming an advanced practice nurse.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I agree 100% that the experience of administering medication and observing patients is extremely valuable however that doesn't provide an indepth knowledge of pharmacology. I would still contend that most physicians could be expected to have a broader knowledge based on their additional courses and the time they spend as a resident.

As a full time rapid response nurse I deal with the consequences of physician's lack of experience with medications all the time.

Monday night I got called to see a patient for mental status changes (one of my more common calls). After ruling out the obvious like hypoglycemia, hypoxia, stroke and hypercapnia I started to look into the patient's medications. Now this man had just been admitted and hour before for a planned CAGB in the morning. The first thing I discovered was that he had been prescribed Trazodone to help him sleep by his new family doctor (not a new doctor, just new to this patient). For several years the patient had taken Tylenol PM to help him sleep, but the new physician instead put him on Trazodone. Really doc? You put a 74 year old man who had never taken it before on Trazodone? According to his daughter the patient had taken his regular HS medications before coming to the hospital.

Patient was found walking down the hall nude, dripping blood after pulling his IV out. He had no idea where he was or why he was there. This is a man who had never had a confused moment in his life per his daughter.

Not the first time I had had seen that and not something I can imagine an experienced bedside nurse doing. To be fair the hospitalist I called to update rolled his eyes as well and was like "what was the family doc thinking?".

Specializes in Adult Internal Medicine.

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.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
This is way off-topic, but I would agree with changing a 74 year old off Tylenol PM

Of course, the Tylenol PM has nothing to do with the point I was making.

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.

You may or not take my work for it but Trazodone should not be given to 74 year old men who are, that very night, are going to be admitted to the hospital for a major surgery and will be taking it for the first time ever. The results are predictable.

Counting hours isn't going to tell you much. What the NP will have, and the med student will not have, is the experience of administering a wide range of medications to, likely, tens of thousands of patients over years and then closely observing and documenting the effects on patients.

Rather than asking how many hours in class the NP student has, ask how many patients the med student had administered medications to and then closely observed the results before getting prescribing privileges.

There is significantly more knowledge required to safely prescribe than to simply administer medications. If this argument were true, we would allow prescription authority to med techs, who have built an entire career on simply passing meds.

I am not suggesting that one needs to go through med school to be a safe prescriber although there really is no comparison between an NP and MD/DO program.

Prescribing requires a greater understanding of pharmacology and science and frankly I agree that many NP programs are probably lacking in this area. I graduated from an NP program that had the pharmacology course taught by brand new PharmD residents who had just graduated from their pharmacy programs. Each week we had a new lecturer that would cover the very basics. I would have preferred a greater emphasis and time spent on the development of such a crucial skill.

Of course, the Tylenol PM has nothing to do with the point I was making.

You may or not take my work for it but Trazodone should not be given to 74 year old men who are, that very night, are going to be admitted to the hospital for a major surgery and will be taking it for the first time ever. The results are predictable.

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.

To the OP, I live in the SE. In my area new grad RNs start making 21-25 per hour. New NPs start ~35-45 per hour. I have seen some new NPs that have accepted low salaries (60s-70s) although I think this practice should be generally discouraged and I do not believe it is common. Most of the new NPs I have heard recently are accepting salaries in the 80s in this area. This should reflect an increase for all but the most seasoned RNs. As others have mentioned, RNs that would see a salary decrease when transitioning to an NP role would be at the top of their salary scale only to enter the bottom of the NP salary scale.

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