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.

[amzyRN]

I would only invest in it if you think you can get a job at the end. I suppose you can relocate, then transfer. NP jobs in CA are pretty competitive. Most good MSN programs require RN experience to even get in. Do your research first and if you are willing to relocate, go for it. I would need to make at least 150K for me to invest the money for the masters. Most are at least 60K plus your expenses while you're in school. RNs in CA make 120K plus, I would hope an NP would start at 150K.

[Mavrick, BSN, RN]

Sell your soul to the devil...... It's been a great career.

Well you have already proved your priorities.

I am getting sick of training "advanced degree" NPs with no basic experience. They are trying to get their experience off my 35 years in the trenches and I only do it for the comfort and safety of my patients. I have no desire to support your career change because you just don't consider IRL patient experience "feasible", (a purely financial decision).

Your highly-ranked school does not give a hoot about how well prepared you are to practice your craft so long as you have paid them in advance. Fog a mirror, sign a check and a shiney new NP is minted. Your future employer will be much less impressed with your school's ranking than you are.

I, of course, don't know you, your humility or lack thereof. But some fancy-ass NP had the nerve to use her book-learnin' to tell a PACU nurse with over 15 years experience how to administer the anti-emetics Reglan and Zofran. The one they hired to replace her is just as clueless. Some chronic pain patients NEED a PCA when it's more about the CONTROL than the PAIN.

Your school is not in the business of selling nursing experience. In my opinion, which you asked for by way of posting on this open nursing forum, experience is not optional.

[FolksBtrippin, BSN, RN]

OP, you originally wanted to go to medical school, but did not go because your father did not believe that you could hack it.

Now you are finally getting the chance to make your dream come true. There are going to be people who say you can't hack it again, maybe for different reasons. That's not about you, it's about them.

I didn't read all the posts. But I did read one from an NP who did the same thing you want to do, and is doing fine. I suggest you focus on that.

I ask that you look at the actual research that's been done on outcomes and draw your conclusions from there. Be critical, but you can't discount research just because it's "nursing research".

My highly respected B&M school does not require RN experience for admission to nurse practitioner programs. It does require a BSN, but you do not have to get experience as a nurse before you are accepted to the program. My school, however, does not offer an MSN. NP programs are DNP only. DNP is something to consider.

As far as the money goes, there is a very wide range of salaries for NPs. You have good business acumen. You will be in the higher salary range so long as you don't fall prey to the opinions of others.

[MarionT]

Like you I will no doubt catch grief for supporting you in this post, oh well, c est la vie. People think a lot of things and verbalize a lot of things, for a lot of personal reasons and/or life's experience good and bad or prejudice. My hat is off to you, in that you have done your family thing. You took a not so wanted career and provided for your family the best way you could, this is now your time to satisfy you passion. Take the step forward as far as the learning curve yes it's a steep one at that. Don't worry about not having the clinical nursing background. If you have the fortune to have Physician mentors that are willing to take the time to teach and not just show you but really have a passion for catching you when you start to fail and then explain why then teach you the difference, how to avoid those pitfalls, and improve the outcome, you will do just fine.

I have spent over 40 years in medicine military and civilian and have the pleasure to have known nurses that have taken the path of Advanced Practice and non medical types that take the role of a Physicians Assistant that go on to be a learned and respected part of the medical community. Likewise I have known those that, well they have moved on to different camping ground. The long and short of this is take the challenge and go with it don't worry what you don't know. There are a great many things in medicine you will never know, just take those things and skills you have they will be the tools to change the don't knows into "so that is what that is or does" now I know and understand. Keep feeding the passion the rest will follow.

to quote some of Dr. Seuss

"Oh the places you go"

"Congratulations!

Today is your day

Your off to grate places

your off and away

You have brains in your head

You have feet in your shoes

You can steer yourself

In any direction you choose.

You're on your own and you know what you know

And you are the guy who will decide where to go"

Good luck.

[Barmherzigkeit]

I'm making a life / career change as well in my 50's, and will be starting an Accelerated BSN program in May, but if the schools in my area offered a program like the one you are entering, I'd go for it. Good luck to you in the program of your choice.

[3ringnursing, BSN]

Like you I will no doubt catch grief for supporting you in this post, oh well, c est la vie. People think a lot of things and verbalize a lot of things, for a lot of personal reasons and/or life's experience good and bad or prejudice. My hat is off to you, in that you have done your family thing. You took a not so wanted career and provided for your family the best way you could, this is now your time to satisfy you passion. Take the step forward as far as the learning curve yes it's a steep one at that. Don't worry about not having the clinical nursing background. If you have the fortune to have Physician mentors that are willing to take the time to teach and not just show you but really have a passion for catching you when you start to fail and then explain why then teach you the difference, how to avoid those pitfalls, and improve the outcome, you will do just fine.

I have spent over 40 years in medicine military and civilian and have the pleasure to have known nurses that have taken the path of Advanced Practice and non medical types that take the role of a Physicians Assistant that go on to be a learned and respected part of the medical community. Likewise I have known those that, well they have moved on to different camping ground. The long and short of this is take the challenge and go with it don't worry what you don't know. There are a great many things in medicine you will never know, just take those things and skills you have they will be the tools to change the don't knows into "so that is what that is or does" now I know and understand. Keep feeding the passion the rest will follow.

to quote some of Dr. Seuss

"Oh the places you go"

"Congratulations!

Today is your day

Your off to grate places

your off and away

You have brains in your head

You have feet in your shoes

You can steer yourself

In any direction you choose.

You're on your own and you know what you know

And you are the guy who will decide where to go"

Good luck.

I love the good Dr. (Seuss that is)!

[Polly Peptide, BSN, MSN, RN, APRN]

OP, have you considered going to Medical school? Just because your father discouraged you before does not mean you couldn't achieve becoming a doctor now.

What area do you see yourself working in if you do go the NP route? ICU? ER? drug store clinic? Medical? Surgical? Other?

I wish you well however you choose to proceed.

I have considered medical school. This post has me re-considering it. I have some problems though. Someone called me an empty-nester, and that's not the case, yet. My kids are 11 and 13. I would need to spend another year or two getting the rest of my pre-reqs and preparing for/taking the MCAT. That's fine. However, I cannot move. I can't uproot my kids. We are committed to being in this town, not only for my children but for my husband's job. There are a couple of med schools here...I would have to limit my application to just the two of them. One, I have to admit to myself, I probably wouldn't get in. The other, well, I might have more of a chance, just based upon the average GPA and MCAT scores, but the admission rates are still low, due to the sheer amount of applications.

However, my second concern, should I get past this hurdle, is the Residency Matching Program. I just can't move to any place in the country I should get matched to. Let's say I even do this in the minimum amount of time I could accomplish it, my daughter would still be in high school at this point. It's not something I want to do, nor would I want to move far away from my son, as he is likely to be in school somewhat locally. I still have my family as priority.

As far as working as an NP, I am very interested in the ER, but I need experience. I would also need my FNP in addition to the ACNP. Surgery interests me as well, and my school allows us to sub-specialize in various surgical paths. I would also consider certain higher acuity specialties, which would allow hospital rounding and such. I don't think I want to be in an OP clinic all day, but a balance of both would be nice. I see people seem to think ACNP assumes an ICU job, and that's not the case. Yes, ICUs hire ACNPs, but ACNPs are not only in the ICU.

[Polly Peptide, BSN, MSN, RN, APRN]

Yes, I obtained my ADN and then got hired in to a nurse residency program. The condition of the program was that I had to complete the BSN within 2 years of hire date. However, my employer reimbursed me for the tuition for my BSN. I was able to work full time and take BSN courses full time. When I finished the residency program, I was hired on in the ICU after working on the progressive care respiratory unit with trach/vent patients. I had to get my ACLS certification to work on that unit and that helped me to get my foot in the door in ICU.

I know you say you're not as interested in ICU, but I know our hospital only uses ACNPs for ICU/trauma & ER. FNPs are hospitalists. You can also work in the ER as an FNP if you already have experience as an ICU or ER RN. The "intensivist" certification is more applicable to the ICU, so if that's not what you want to do, I don't think it would be the right route to go. If you're interested in the ER, also know that many require dual FNP/ACNP certification so you can see patients of all ages. ACNPs can only treat patients age 13 & up.

As far as age goes, I was 45 when I finished my ADN. I just finished my BSN in December. I'll be 49 when I finish my FNP program. I wouldn't let age be your defining guide to your career path. I was initially interested in being done as quickly as possible. However, now that I'm an RN, I see the value in having RN experience before embarking on a career as an NP. By the time I graduate, I will have a little over 4 years of experience as an RN, 3 of those in the ICU. If you have the opportunity to work as an RN, I would definitely consider doing so.

I know someone said in a previous reply that MDs aren't required to be PAs or RNs first. True, but the schooling for an MD is not the same as an NP. We are expected to have baseline knowledge gained from being an RN. MDs are schooled as a blank slate. It's comparing apples to oranges. While the NP role is definitely very different from being an RN, the background knowledge you gain, especially if you're going the ACNP route, it certainly a solid foundation. I just know the ACNP curriculum is going to expect that baseline ICU/ER acute care knowledge.

I admire what you've done and think it's pretty incredible you were able to get in the ICU so quickly.

It is not age so much that I am concerned about. I'm sure that's in the back of my mind, but I had sort of locked in on this time in the lives of my children to spend a few years in school, knowing that I could still help them with the last few years of preparing for college and so forth. But perhaps I am limiting myself unnecessarily.

I understand that ICUs strictly hire ACNPs. My program offers various sub-specialties and two specific (optional) tracks: Intensivist and Hospitalist. They only offer those to ACNPs and not FNPs. I'm not sure if that's the new way of things or just how my particular program is handling it. From my research, it would appear that things are moving towards ACNPs in general in the hospital setting. As well, ACNPs are hired in various surgical specialties, and others, like cardiology, endocrine, even IM. I like the flexibility that ACNP offers. Many people talk about FNP as the ultimate in flexibility, but to me, that is only if you want to work with kids and stay primarily OP. I still may be interested in getting FNP some day.

You state at the end, "I just know the ACNP curriculum is going to expect that baseline ICU/ER acute care knowledge." I guess my program, since it allows non-nurses, is set up to deal with those of us who don't. I am very interested in learning how they do it. I have a friend who went through this program as a non-nurse, straight out of undergrad at that, and she had a job offer upon graduation with one of her preceptors (in IM). It wasn't her dream job, but who cares? I'm not expecting any first job to be The One. For the whole story though, she turned it down, went to work as an RN in LTC, and got a job as an NP that she really loves after a year.

Ultimately...I do think what you've done is ideal.

[Polly Peptide, BSN, MSN, RN, APRN]

Well you have already proved your priorities.

I am getting sick of training "advanced degree" NPs with no basic experience. They are trying to get their experience off my 35 years in the trenches and I only do it for the comfort and safety of my patients. I have no desire to support your career change because you just don't consider IRL patient experience "feasible", (a purely financial decision).

Your highly-ranked school does not give a hoot about how well prepared you are to practice your craft so long as you have paid them in advance. Fog a mirror, sign a check and a shiney new NP is minted. Your future employer will be much less impressed with your school's ranking than you are.

I, of course, don't know you, your humility or lack thereof. But some fancy-ass NP had the nerve to use her book-learnin' to tell a PACU nurse with over 15 years experience how to administer the anti-emetics Reglan and Zofran. The one they hired to replace her is just as clueless. Some chronic pain patients NEED a PCA when it's more about the CONTROL than the PAIN.

Your school is not in the business of selling nursing experience. In my opinion, which you asked for by way of posting on this open nursing forum, experience is not optional.

How have I proven my priorities exactly? And what do you think they are? I like how you edited my statement to remove certain things. Also, I did quit that job to pursue this, so...

I find it interesting that you think I am getting anywhere "on your back." You've worked hard and I've worked hard. You also made your own choices, just as I have. If you (or anyone) decided to join the ranks of those in MY former industry, and suddenly became very successful, I can't imagine standing around and complaining that you were only able to do so because of the inroads I had forged over the decades.

Your comments seem to me to be more about pride. I think we would get a lot further if EVERYONE dropped it and helped one another (you and the fancy-ass NP).

Look, I agree that the standards for NP school are too low. I don't like it either. It doesn't mean that I think I will make a bad NP. Just because I am disappointed in the standards and am concerned about it as a whole does not mean I am personally going to bail.

[HikingNinja, BSN, MSN, DNP, RN, APRN, NP]

A few things:

Have you checked with local physician's groups, hospitals, etc. to see if they'll even hire you as an ACNP without RN experience? Where I'm from, ACNP's must have RN ICU/ER experience. Or they simply don't get hired. In the ER, we've hired FNP's who were med/surg first with no critical care experience. But that was unusual. It does make sense though because in the ER mostly FNP's & PAs complete the rapid medical exam and run the fast track area.

Honestly, all NP programs are the same. Some are more organized than others. Rankings, IMO, mean nothing and when you graduate most employers only care if you are licensed and what experience you have. It's really the practicum experiences that teach you what you need to know. I'd thoroughly research the practicum sites they use. Maybe interview the preceptors, ask to talk NP's who have graduated from the program.

If you ever plan to move or do travel assignments say after your kids are out of the house and the husband retires. You won't be able to in Oregon or Colorado. These are two states that require RN experience to grant an NP license. There may be others and this seems to be popping up now as a trend.

You will have to fight tooth and nail for respect, anywhere that may hire you. In my experience, those entering the NP field without having "paid their dues" as a nurse first are treated quite poorly by other nurses.

I am currently wrapping up my NP program. I am a mid career changer too. IMO my RN experience has been invaluable. In my previous career I thought I was organized and had mad critical thinking skills. You don't really know what critical thinking is until each and every decision you make could kill someone. Whole different ballgame. I am extremely thankful I spent these past 8 years in critical care.

[sunny time]

take the job seriously but dont take you position as an educator to seriously. just keep your mouth shut and do the job. dont take it home with you leave the job at the door when you exit to go home

[Polly Peptide, BSN, MSN, RN, APRN]

A few things:

Have you checked with local physician's groups, hospitals, etc. to see if they'll even hire you as an ACNP without RN experience? Where I'm from, ACNP's must have RN ICU/ER experience. Or they simply don't get hired. In the ER, we've hired FNP's who were med/surg first with no critical care experience. But that was unusual. It does make sense though because in the ER mostly FNP's & PAs complete the rapid medical exam and run the fast track area.

Honestly, all NP programs are the same. Some are more organized than others. Rankings, IMO, mean nothing and when you graduate most employers only care if you are licensed and what experience you have. It's really the practicum experiences that teach you what you need to know. I'd thoroughly research the practicum sites they use. Maybe interview the preceptors, ask to talk NP's who have graduated from the program.

If you ever plan to move or do travel assignments say after your kids are out of the house and the husband retires. You won't be able to in Oregon or Colorado. These are two states that require RN experience to grant an NP license. There may be others and this seems to be popping up now as a trend.

You will have to fight tooth and nail for respect, anywhere that may hire you. In my experience, those entering the NP field without having "paid their dues" as a nurse first are treated quite poorly by other nurses.

I am currently wrapping up my NP program. I am a mid career changer too. IMO my RN experience has been invaluable. In my previous career I thought I was organized and had mad critical thinking skills. You don't really know what critical thinking is until each and every decision you make could kill someone. Whole different ballgame. I am extremely thankful I spent these past 8 years in critical care.

My information about willingness to hire has come from recent grads of the program who have remained local and had job offers upon graduation, in spite of lack of RN experience (usually with their preceptors). I also know it's not all roses and some have graduated, worked as an RN, and after that experience, THEN gotten their NP jobs.

What about the idea of going PT during the MSN portion in order to work as an RN? Would that be enough? I realize it's not as much as others, and maybe more is always better, but could it at least provide that essential experience as well as getting me over the hump of complete and total disrespect/disdain from my peers?