Brave or just stupid?

[Polly Peptide]

I am yet another mid-life career-changer. I've been afraid to even post on this board, as I believe I will get attacked by all the nursing traditionalists. But I would like the opinions of the experienced, and I can't get them without putting myself out there. Besides, if I am going to tread this path, I need to develop a thick skin.

I've wanted to work on the clinical side of healthcare for most of my life. Since I was a kid, I wanted to BE something – CRNA, radiologist, ER doc, pharmacist, nurse practitioner. The various options cycled through my mind, but I just KNEW I was going to grow up to be one of these. I've always been fascinated by the human body, disease processes, how the mind works, even down to nerve impulses and what causes that movement from neuron to neuron. I have always wanted to know the why.” Just what” has never been good enough.

I got to college and my dad didn't believe I could handle pre-med/medical school. It took the wind out of my sails. I didn't even understand I could apply for student loans. I did what he told me, got my business degree, and got out.

Within two years of graduating, I wanted to go back to school. However, I soon got married and my husband wasn't ready. Then I landed a lucrative job on the business side of healthcare, in a sales role. I liken this to golden handcuffs.” The money was great, but it made it more difficult for me to go back to school. I was the bread-winner.

Then we had children, making it nearly impossible to go back at that time. Sure, I could go, but it seemed extraordinarily selfish. Yet again, I put it off.

By this time, we had moved back home, to an area with a couple of very good nursing programs. In addition, there was a PA program and a very good B&M NP program, which included an option for those without nursing experience. That became very appealing to me, as the years flew by.

To make a very long story a little shorter, now that my children are a little older, I finally got it together and applied to that MSN program. I also applied to an Accelerated BSN program. I quit my job and started taking pre-requisites. Ultimately, I got into both programs. I was torn: the MSN program was my dream (highly-ranked and I could start doing what I really wanted sooner); but I had heard that having a BSN could be more flexible and perhaps better for me as it relates to getting RN experience first. As of now, I plan to attend the MSN B&M school this fall.

Here comes the BIG BUT – I read this board and it scares me. Am I being completely irresponsible by becoming a nurse practitioner when I have not been a nurse? I recognize my lack of experience as a nurse, believe me. I am, however, not green.” I have been a working business professional for 17+ years. While I absolutely do not have clinical experience, I do have something of value, in both life experience and business acumen, to bring to the table. As well, my work was in healthcare and I've acquired a fair amount of knowledge along the way.

I have a lot of confidence in the school that I've chosen. They are one of the top-ranked institutions, as well as my specialty being extremely highly-ranked. My preceptors are selected for me; the clinical hours are high; I have the option to specialize further (which adds to my clinical hours); I believe if any school is going to prepare me, considering my lack of experience in this area, they are one of the best. I also fully expect there to be a large learning curve. But am I being completely naïve?

This is something I have always wanted to do. I am no longer in my 20s or 30s. I don't want to spend years and years starting over with a BSN, and then going back later for another degree. It seems to be not only additional time but additional money. Is it reasonable to think that I can gain experience as an NP and become competent, even without RN experience first? I am more than willing to work hard, ask questions, know what I don't know, seek help from peers, and put forth diligent effort. In fact, I look forward to it.

The last thing that I think about is: I see so much written on this board about salary. I am actually in a position where I do not have to work. However, I will say it again – this is something that I WANT to do. And even though I don't have to work, I am not looking to do this for charity. I would like to be paid what I'm worth. I recognize that I will initially be an inexperienced NP, but that won't be the case for long. Am I crazy to think I can make $150K at some point? I see $80-90K and it bums me out. It seems ridiculous for the work NPs do. I am in the Southeast. I can go back to my old profession and make $150K easy. I just don't want to.

Sorry for the length. Would appreciate your advice.

[Ruby Vee, BSN]

She is going to do it anyway. She came here to get us to say what she was planning is a good idea. We don't, (we who are NPs with actual real life NP experience,) so she keeps trying to refute what we say. She is just annoyed that we don't think her high-dollar school can make up for real-life nursing experience. The only thing I will say (and I mean this totally sincerely) is I hope she does not kill or seriously damage someone due to lack of real-life nursing experience. We all make mistakes, but experience can allow you to mitigate those mistakes somewhat.

This post deserves to be "Liked" a few dozen times. Unfortunately, I can only like it once.

[Ruby Vee, BSN]

Unfortuately, you have never yet even set foot on a critical care unit. You have NO IDEA what it's really like and just how much knowledge you need to have in order to keep these unstable patients alive. I went from a step-down unit to the ICU thinking it was going to be a few more drips to titrate and participating on the code team. Boy, was I wrong. You have to have extensive knowledge of pathophysiology and how your interventions will affect this patient and what could possibly go wrong. Not only that, but you need to know what you'll SEE in the patient when complications arise. You can't wait until late signs appear to take action.

I, too, am a career changer in my 40s. I would strongly suggest getting your RN at a community college and then work as an RN while you're doing NP school. That way, you're getting some experience on the actual floor. If you've never seen a patient start crumping, how are you going to recognize it as an NP? It's all fine to try to justify not getting RN experience until something adverse actually happens. I want to keep my patients safe. I want to feel secure that I have a good, solid foundation before embarking on NP. 2 years in the grand scheme of things isn't an insanely long period of time. There are RN to MSN programs out there, so you needn't put off pursuing NP. The only reason why I did the BSN right after the ADN was that it was a requirement of my employer and they paid for it. It only took me a year to complete (I took a 6 month break from school inbetween getting the ADN and starting BSN).

If you were going more on the FNP office setting side, I'd have less concerns. Most reputable ACNP programs require a minimum 1 to 2 years experience in ICU before starting the program. I can't understand why they'd allow DE in to ACNP. For those of us who actually work in the ICU, it's scary to us because we are with these patients every day. We see firsthand what happens when knowledge is lacking. I work at a teaching hopsital for a Big 10 university and do you know how often the nurses catch the residents making incorrect orders or prescribing a drug in the wrong amount? Quite often. If we didn't know what we were doing, those patients could be harmed. They're still "puppies" learning how to be doctors and they've had MANY more clinical hours that you'd ever get in a DE NP program. That's why there are so many people concerned about this route of education. You simply to do not have the baseline knowledge you need never having been an RN on the ICU. You can't learn ICU experience from a book, you simply can't.

As an ICU nurse who has worked with NPs with no bedside experience, I'm frightened for the patients the OP will encounter, for all of the reasons you state.

[Ruby Vee, BSN]

You're right, I've never been an RN in the ICU. But I HAVE been lucky enough to shadow an ACNP in the ICU, who was also on the Rapid Response team for the hospital. So saying I've never "stepped foot" in a critical care until is inaccurate. Don't get me wrong, I know shadowing gives no actual experience.

I can't quite figure out why people are ignoring my comments about working during my MSN year. I'm saying that I'm now considering working during that portion, so that I CAN gain at least some experience.

People are also making the assumption that I want a job in a critical care right when I come out of school. This is faulty. I would like to be trained in this area, but I don't necessarily feel the need to work there. ACNPs are employed in a variety of settings, not just ICUs.

Last but not least, my school is in the top 3 for ACNP programs. I am trying not to give TMI, though not sure if it matters. So when you say you can't see a top program allowing this...they actually do.

If you came here looking for consensus that what you're doing is a good idea, you didn't get it. Yes, you did get some folks saying that they did it and they're doing great. I'm wondering what their colleagues think about how "great" they're doing. I'm not saying it's impossible to take the short cut and still (eventually) become a competent NP. I'm just saying it's unlikely in the extreme that it will happen without a few patients along the way coming to harm; even to great harm. You still want to take the short cut. I'm am profoundly grateful that I won't be working with you when you graduate from your "top school." My department (in a large, famous teaching hospital) makes it a policy not to hire NPs who took your short cut after some truly horrifying experiences with NPs who did.

[Ruby Vee, BSN]

So if a tree falls in the forest, and no one is around to hear it...

Let me ask you this: is there not a point at which a practicing with NP with no prior RN work can feel that they, too, are experienced? Let's say you have an NP with 10 years of experience, all as an NP; and another NP with 10 years of experience; 5 as an RN and 5 as an NP: do you believe that the former is less competent than the latter? Or actually, is it vice versa? Or are they equal? At what point does the lack of RN experience no longer matter? Or will you guys argue that it will ALWAYS matter?

I don't believe you can fairly say that having RN experience will always matter. In the beginning, certainly. Over time, these things must level out. Perhaps if you are an RN that happened to gain experience in a variety of settings, and now as an NP you will use that background in a single specialized area, then the advantage may always exist. But what if your RN experience was limited to OP clinics and your NP specialty requires critical care skills? Your NP experience will be the more important of the two.

I honestly think this is a gap that may be able to be closed in a relatively short period of time. Even those programs that require experience before going on to advanced degrees (MSNs and CRNA programs) only need a year or two.

I am playing devil's advocate, because I still believe experience is better. Which is why I think I will work after getting my RN, and do the MSN portion part-time. The program does not let me take time off in-between, though. I have to plow through.

You don't know what you don't know. Experience matters. The gap may be closed in a decade, but how much harm will you do to your patients in the mean time? You don't know what you don't know.

You're an articulate writer, and possibly quite intelligent. But you don't know what you don't know and you don't get that.

[Jules A, MSN]

You don't know what you don't know. Experience matters. The gap may be closed in a decade, but how much harm will you do to your patients in the mean time? You don't know what you don't know.

You're an articulate writer, and possibly quite intelligent. But you don't know what you don't know and you don't get that.

But the real problem, imo, lies with the schools telling her and a bazillion others "absolutely just pony up $50,000 and you too can be a NP." It will be interesting to see how this all shakes out a decade or so down the road. Remember Alina Health's ad?

"Allina Health does not hire new grads from all academic institutions. Many proprietary on-line schools do not meet Allina Health's standards due to the minimal oversight of the student's clinical experience, the high faculty/student ratio, and the lack of focus on national certification standards in the curriculum."

Ruby Vee will you be sharing your concerns with the CCNE? There is only a few days left for the survey.

https://allnurses.com/advanced-practice-nursing/np-programs-preceptors-1099548.html

[BCgradnurse, MSN, RN, NP]

But the real problem, imo, lies with the schools telling her and a bazillion others "absolutely just pony up $50,000 and you too can be a NP." It will be interesting to see how this all shakes out a decade or so down the road. Remember Alina Health's ad?

"Allina Health does not hire new grads from all academic institutions. Many proprietary on-line schools do not meet Allina Health's standards due to the minimal oversight of the student's clinical experience, the high faculty/student ratio, and the lack of focus on national certification standards in the curriculum."

Ruby Vee will you be sharing your concerns with the CCNE? There is only a few days left for the survey.

https://allnurses.com/advanced-practice-nursing/np-programs-preceptors-1099548.html

Not all schools will take any paying customer. Some are like that, but there are respectable programs who do adhere to national standards and have a rigorous admission policy. I know of several who accept less than 10% of applicants. So, you can't make sweeping generalities.

Jules-I've also seen you disparage the so called "Mommy Hours" in several posts. What's wrong with wanting to have a balance between life and work? Not all of us want to be at work either physically or mentally 24/7. You can be an excellent provider and keep up with new advances without trying to mimic a resident's schedule. Those that want their lives to be all work may be better off at medical school.

[stickit34]

I would highly suggest you pursue a PA path, and here's why.

NP schools are already lacking in education in terms of pathophysiology, pharmacology, science courses, clinical hours, etc. Add to this the lack of RN experience and you have a recipe for disaster. NP schools, no matter the rankings, are businesses, and will do whatever they can to appeal to the consumer until they are limited otherwise. That's why PA and medical schools are fewer and stricter- their governing bodies restrict and regulate their education. Ours provides extremely vague dialogue for schools, allowing them freedom to do and admit whomever they please. Schools do not care about patient safety, they care about money.

Nursing seems like it's all roses until you're in the trenches. Out of my nursing class of 20, only 10 are still nurses because they couldn't standing nursing in practice. Even fewer are still in the ICU. How do you know you will like nursing until you are exposed to what our profession is all about? The premise of the nurse practitioner is that it's an advanced practice nurse with years of experience. There are things that can't be taught with shadowing and classrooms - the chaos of a code (and you're running it), the sense that a patient is about to have an MI, diabetic ketoacidosis, encephalopathy, meningitis, etc. When you're responsible overnight solely for this patient and have to determine when to call the physician for help (just as an RN, not even an NP at this point). Keeping them stable or at least alive until help gets there. Coping with their deaths, and encountering the families in the morning afterwards. This is just a teaspoon of what I encountered in med-surg, and I am grateful for every moment! I can't even fathom what's to be expected in the ICU.

With your background, you're more suited to be prepared in the PA role to get a full understanding and exposure in the clinical area. You can still have a practice that is warm and empathetic as a PA. That is not solely for NPs.

Just of note, I am about to graduate my family nurse practitioner program in June. I have five years of experience in med-surg, pediatrics and emergency nursing, and honestly, I wish I did more. I've exceeded what was required of my clinical hours by 200 hours, and it's still not enough to have me feeling fully prepared for practice. Part of that could be imposter syndrome, but part of me sincerely believes it's the lack of exposure and training to the art of practicing medicine, because as an advanced practice nurse, that's what you're doing.

[bnw6385]

Somewhat off topic, but someone has to say it. To the bedside RNs here, your work is much appreciated. I got out of that as soon as I could. I have been a critical care NP for 3 years now and an ACNP for nearly 6 years total. New grad NPs should be watched pretty closely, agreed. However, that is up to the NP, PA, M.D., or DO, the NP is collaborating with. It is your job to clarify orsers. There may even be things you can teach an NP because no one knows everything. All that being said, the things I habe seen and been asked by critical care nurses are truly horrifying and downright dangerous. These were the same CCRNs walking around acting like their you know what was top notch. When corrected, they got defensive as opposed to learning from errors, even though it was done respectfully. Granted, the floor nurses are leaps and bounds scarier and likely kill people on the regular, but for RNs to come in the NP section and act like they know it all and how to do our jobs better than many of us is...frustrating...to put it lightly. The job is totally different, barely even nursing anymore. The thought processes are entirely reversed. The knowledge base is miles beyond RN teaching. Sure, it takes APPs time to get there, but until you're there, the RNs like the one who called the OP a sellout (paraphrasing) just need to keep quiet.

[Wuzzie]

Somewhat off topic, but someone has to say it. To the bedside RNs here, your work is much appreciated. I got out of that as soon as I could. I have been a critical care NP for 3 years now and an ACNP for nearly 6 years total. New grad NPs should be watched pretty closely, agreed. However, that is up to the NP, PA, M.D., or DO, the NP is collaborating with. It is your job to clarify orsers. There may even be things you can teach an NP because no one knows everything. All that being said, the things I habe seen and been asked by critical care nurses are truly horrifying and downright dangerous. These were the same CCRNs walking around acting like their you know what was top notch. When corrected, they got defensive as opposed to learning from errors, even though it was done respectfully. Granted, the floor nurses are leaps and bounds scarier and likely kill people on the regular, but for RNs to come in the NP section and act like they know it all and how to do our jobs better than many of us is...frustrating...to put it lightly. The job is totally different, barely even nursing anymore. The thought processes are entirely reversed. The knowledge base is miles beyond RN teaching. Sure, it takes APPs time to get there, but until you're there, the RNs like the one who called the OP a sellout (paraphrasing) just need to keep quiet.

I find it difficult to believe, given how shockingly arrogant you sound when describing your fellow nurses (especially floor nurses), that you are capable of respectfully correcting anyone.

[Ruas61, BSN, RN]

Somewhat off topic, but someone has to say it. To the bedside RNs here, your work is much appreciated. I got out of that as soon as I could. I have been a critical care NP for 3 years now and an ACNP for nearly 6 years total. New grad NPs should be watched pretty closely, agreed. However, that is up to the NP, PA, M.D., or DO, the NP is collaborating with. It is your job to clarify orsers. There may even be things you can teach an NP because no one knows everything. All that being said, the things I habe seen and been asked by critical care nurses are truly horrifying and downright dangerous. These were the same CCRNs walking around acting like their you know what was top notch. When corrected, they got defensive as opposed to learning from errors, even though it was done respectfully. Granted, the floor nurses are leaps and bounds scarier and likely kill people on the regular, but for RNs to come in the NP section and act like they know it all and how to do our jobs better than many of us is...frustrating...to put it lightly. The job is totally different, barely even nursing anymore. The thought processes are entirely reversed. The knowledge base is miles beyond RN teaching. Sure, it takes APPs time to get there, but until you're there, the RNs like the one who called the OP a sellout (paraphrasing) just need to keep quiet.

You are miles beyond for sure.

[bnw6385]

It is easy to be respectful and professional in the workplace, Jules. I have no problem doing so. I am not surprised at the reaction here, though. It is funny, however, that you would react this way, but when RNs are insulting all of our colleagues and speaking as to how fantastic they are, you seem to find no problem with it. I was speaking to the FACT that I have constantly had to keep RNs from seriously hurting patients, and when covering floors, feel like half my job is keeping those nurses from killing their patients. I educate and correct, with respect, but it does not mean that I do not remember what happened. Unfortunately, I entirely understand where RNs would and do lose autonomy. Since becoming an NP, I have been thoroughly disappointed at the lack of critical thinking skills. When those calls are not being directed my way, but going to physician who are seeing that on a more massive scale, it hurts the nursing profession as a whole and is utterly embarrassing. It then is no wonder they seek to limit NPs. Call me what you like, but I will not sugar coat this outside the workplace to make people feel better. Call me a coward for doing it here. That is okay, as well. I have a thick skin. I also habe the guys to call things as I see them...at least in an arena where I won't be fired.

[bnw6385]

Ruas, any substantive remark or just the sarcasm?