Alternative ways to get into a provider role?

[Lemon Bars]

I am currently a medical scribe at a primary care community clinic and I have completed more than enough prerequisites to apply to nursing school. Actually I spent two years applying to physician assistant schools, but admission is so competitive I just can't get in. I scribe for doctors, PAs and NPs, spending all day watching what they do and how they speak with patients. On simpler encounters I can write the diagnoses and treatments including medications into the chart note before the provider even verbalizes what the diagnoses or treatments are. I strongly feel that I could be great in a provider role if I could get the necessary medical training. I do not feel that bedside nursing would be a good fit for me.

I would like to become an NP, a CNS, an RN who does a lot of nurse-only visits, or something along those lines (I'm not sure exactly what a CNS does or if this is a provider role that is being phased out). I am aware that I can complete 2.5 years of nursing school followed by 2 or 3 years of FNP school at a cost of $200,000 or so, but I'm already 44 years old. I'm getting pretty tired of jumping through educational hoops and borrowing money.

My apologies if I give the impression of being lazy. My GPA for the last 2.5 years has been 3.9, so I am working hard at my studies as well as my job. Returning to college and changing careers is just taking a lot more time and effort than I expected. If anyone has any ideas or advice for me I'd be grateful. I have already ruled out becoming an audiologist, speech therapist, physical therapist or dietician, but I am open to other suggestions.

Thank you so much if you read all that! :) P.S. I live in California but would love to move to Oregon or Washington state, or perhaps Colorado.

[llg, PhD, RN]

How much college credit do you actually have? Do you have a bachelor's degree in anything or are you close to a bachelor's in anything? If you are, you could look for a "direct-entry level Master's Degree" program and become an NP. That might be your quickest and cheapest route.

Another option that is available in a few places is the idea of "concurrent enrollment" or "dual enrollment." That option is available in my state (Virginia) and becoming increasingly popular among students who already have a lot of college credit. The get their ADN at a Community College (which is inexpensive) while simultaneously taking courses for their BSN. Most students only have 1 semester left to finish their BSN when they graduate with with their ADN. I know 1 student who is graduating from both programs simultaneously. It both shortens their path and decreases their costs. Then you could do your NP program online while you worked as a nurse -- and have your employer help with the bills.

[KatieMI, BSN, MSN, RN]

First of all, I hope you were not quite serious about writing stuff before provider verbalizes it. Primary care in community clinic may look like piece of cake but in reality it is nothing like it.

Second, you do not have to pay $200000 to become an NP or PA even in California.

You can try dual enrollment as described above if it can be done where you live. You can also bring all your transcripts to local community colleges with ADN and ask what they can do with them. This will probably be the cheapest option in terms of money. If you tried to get into PA school, you should already take quite a few of science credits, so you can even try direct BSN in state university. If money is your main concern and you are planning move anyway, you may want to research markets and schools in places you want to live because the difference in cost can be staggering. But, the thing is, there is no way to provider's level without patho, pharmacology, A&P, labs and clinicals and all the other hard stuff, complete with licensing exam(s).

[Lemon Bars]

I can write pretty much anything into the chart note because nothing is final until after the provider reviews it, bills it and finalizes it. The providers don't mind it the scribes take their best shot at a diagnosis because they can easily change it. In fact, without adding a preliminary diagnosis to the chart, you can't type any information into the assessment. For example, I could add a diagnosis of "cough" or "bronchitis" so that I could type in the provider's instructions such as take antibiotics, push fluids, return if patient has a high fever, etc. Without a preliminary diagnosis I would have to just stand there uselessly if the provider was unsure of or didn't verbalize the exact ICD-10 diagnosis.

Also I do have a bachelor's degree already, but it is in Economics so it is pretty much useless to me. I never did go into business or accounting.

Thank you for your input.

[Psychcns]

Go for it! You are comfortable with a patient care environment and want to have more responsibility. Research the options given above. It is doable; you need to choose a plan. Sciences are only good for five years. Spend as little money as possible. Some of your economic credits will count toward electives. Best wishes!

[applesxoranges, BSN, RN]

If you have a bachelors, you can research for direct entry NP programs. They exist.

My ADN, BSN, and MSN all cost under 100,000. If you are paying close to 200,000 then something is wrong. Even if I went ADN to RN-MSN it would have been close to 70,000.

[PG2018]

My two years of nursing BSN and three years of MSN were

[Lemon Bars]

This thread isn't going the way I hoped that it would. Thank you all for your input. However, what I was really hoping for was some alternative suggestions for career paths that I might not have considered which would allow me to conduct visits with little or no direct participation by a doctor, NP or PA. I was hoping for suggestions such as a "Coumadin RN" who might, for some visits, see a patient and make medication adjustments per protocol rather than working side by side with a real provider. Or "Wellness Nurse" who might talk to a patients about lifestyle changes but doesn't prescribe medication so does not need to be a licensed provider. That is what I meant by a "provider role" (I realize I wasn't clear about that.) Or maybe there is a field out there I had not considered, like podiatry assistant (I already know this one and the pay is too low I think, but I'm using it as an example.) Suggestions like those are what I was looking for, not suggestions about how to pay for a FNP program or get into a direct entry FNP program (I also know about those, and they are very very expensive). I'm trying to think outside the box here.

I do appreciate the responses. If you all have any other ideas, please share them. Thanks!

[NanikRN]

This thread isn't going the way I hoped that it would. Thank you all for your input. However, what I was really hoping for was some alternative suggestions for career paths that I might not have considered which would allow me to conduct visits with little or no direct participation by a doctor, NP or PA. I was hoping for suggestions such as a "Coumadin RN" who might, for some visits, see a patient and make medication adjustments per protocol rather than working side by side with a real provider. Or "Wellness Nurse" who might talk to a patients about lifestyle changes but doesn't prescribe medication so does not need to be a licensed provider. That is what I meant by a "provider role" (I realize I wasn't clear about that.) Or maybe there is a field out there I had not considered, like podiatry assistant (I already know this one and the pay is too low I think, but I'm using it as an example.) Suggestions like those are what I was looking for, not suggestions about how to pay for a FNP program or get into a direct entry FNP program (I also know about those, and they are very very expensive). I'm trying to think outside the box here

I do appreciate the responses. If you all have any other ideas, please share them. Thanks!

Any pt on coumadin is going to want a " real provider" . Or if they don't, i can assure you their insurance will. A title "wellness nurse" is going to want that--a nurse. Cant imagine any visits out there that will let you conduct visits with little or no participation from a Dr pa or NP

There really arent that many shortcuts. And for a very good reason- the stuff you learn in these schools are important.

[Lemon Bars]

Any pt on coumadin is going to want a " real provider" . Or if they don't, i can assure you their insurance will. A title "wellness nurse" is going to want that--a nurse. Cant imagine any visits out there that will let you conduct visits with little or no participation from a Dr pa or NP

There really arent that many shortcuts. And for a very good reason- the stuff you learn in these schools are important.

You are mistaken, NanikRN. There are thousands or millions of healthcare visits everyday that do not involve a doctor, NP or PA at each visit. There are nurse-only immunization visits. There are home health wound care visits. There are visits with Licensed Clinical Social Workers without a doctor present. The coumadin nurse at our clinic has her own office and sees patients without a doctor present. Sure, there is a doctor at the initial visit to put a patient on coumadin and for periodic follow up visits. But there are many visits where a patient sees a nurse or other professional without a doctor, NP or PA present. I just clarified that this is what I meant by a "provider role" in the post above and you quoted my post so you must have read it.

I'm not sure why I'm having such a difficult time getting people to understand my question - should I post it in a different forum instead of the NP forum? Is the problem that readers think I am trying to find a way to practice as an NP without NP credentials? That is not what I wrote. I posted in the NP forum because I thought that perhaps an NP who researched alternate career paths would answer my question and say something helpful like, "Have you ever considered becoming a chiropractor? I almost went to chiropractor school instead of NP school, and what I found was..."

[JMed18]

I can write pretty much anything into the chart note because nothing is final until after the provider reviews it, bills it and finalizes it. The providers don't mind it the scribes take their best shot at a diagnosis because they can easily change it. In fact, without adding a preliminary diagnosis to the chart, you can't type any information into the assessment. For example, I could add a diagnosis of "cough" or "bronchitis" so that I could type in the provider's instructions such as take antibiotics, push fluids, return if patient has a high fever, etc. Without a preliminary diagnosis I would have to just stand there uselessly if the provider was unsure of or didn't verbalize the exact ICD-10 diagnosis.

Also I do have a bachelor's degree already, but it is in Economics so it is pretty much useless to me. I never did go into business or accounting.

Thank you for your input.

I think that it is terrifying when some people don't know what they don't know. If that's what you think goes through the mind of a PCP, you are dead wrong.

[JustBeachyNurse, LPN]

The only way to get into a provider role is to go to school, graduate and pass the licensing & certification exams. The only way to get into nurse consultant roles whether wound care or disease management (such as diabetes educator which requires a BSN, 2 years paid related experience and passing a credentialing exam) is to go to nursing school, graduate, pass the NCLEX work for 2-5 years as a staff nurse to demonstrate competency. What you consider a "provider" such as an office nurse that consults with Coumadin patients or wound care patients are not providers. They are experienced nurses who have proven experience and competency sometimes over a decade of bedside care, earned certification and work under specific standing provider created protocols (not independently). Nurses in those roles did not skip the bedside care component like you want to do.

If you don't want to go to a direct entry NP program perhaps consider paramedic. Medics work "independently" in the field under emergency physician directed medical protocol or in direct consultation with an ED physician. Training is 1-2 years but many states require EMT-B (which can be obtained full time in about 6 weeks).

There are no short cuts or alternative ways to what you consider a provider role.