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.

[offlabel]

"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"

That's all great for the "you". Now what about the patient?

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

One of my hospitalist colleagues and I were discussing our role and what they've collectively experienced with hiring NPs, working with them, and thus now look for. His summary was that he'd rather have and FNP who has RN experience, especially if it was in a hospital setting, critical care (ICU/ED) preferred. My former coworker as an RN and I graduated our respective programs and passed boards around the same time. He actually interviewed right after me for my current position. He is an ACNP and I am FNP. We both have decent backgrounds and experiences, but I was so surprised they didn't take him too (two positions were posted).

He's not hurting, though. Even though he can't see pre-pubescent patients, he's very happy with his current job and learning skills and procedures I'm curious to learn (joint injections, etc...). Plus, our former organization is (finally, for the love of pete) considering adding MLPs to their hospital services. [They've poo-pooed it for 5-6 years when it's brought up.] He did his clinicals there so he probably has an in if he ever wanted to pursue it.

I'm just thrilled to be in my home hospital in this shiny new role and growing exponentially. Plus, I have an unofficial 6 month support system with my coworkers who are all legitimately eager to help me grow. Seriously, this month has been nothing like I envisioned.

But I won't hold my breath.

Every day is an adventure!

Why does your hospitalist friend prefer FNPs over ACNPs? Assuming the same general experience as an RN? Because of the age limitation? Just curious.

Glad you are enjoying your role.

[Bluebolt]

I'm in a BSN to DNP CRNA program right now myself, so I'll throw my two cents into the mix on APRNs. You really need some RN experience before you take on an APRN role. Like many have pointed out how can you be advancing your nursing practice if you have no nurisng practice? Another great point people made is that APRN degrees are not designed for entry level into clinical practice, they are designed different from Med School and PA school assuming you've gone through years of undergrad nursing school and then years of real world clinical learning.

If I was in your place I would go for this new oppurtunity, stick to family practice or something not too clinically demanding, do the last leg of the MSN part time while you work full time for a year or two as an RN gaining a little clinical experience. That way when you graduate you can get a job and practice with a little more confidence. You mentioned being afraid of doing the part time route because you may loose steam. If you're not passionate enough about this to see it through then pick another path. Your decisions and clinical intuition could mean life or death for patients, do the right thing for them. Good luck to you.

[guest769224]

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.

Is it really? That's awesome news. I don't see how that can be enforced though. Do you have any sources or additional information I could read about it?

[Daddie O, BSN, RN]

I'm a BSN student, so my response will be from that perspective. One benefit of the BSN curriculum is the experience of my clinical rotations on different units. Some units that I had been drawn to, I don't care for as much as some units I initially thought I wouldn't be interested in. I've heard that in "the old days" a new grad would work on a Med-Surg unit for a few years to get a well rounded background before moving on to other units. Even now it is tough to get hired as a new BSN grad onto an ICU or ER unit, as most prefer some Med-Surg experience first.

I can't imagine being an ACNP without experience as a RN. I learn so much every day in clinicals, and one of things that drew me to nursing is that there will be opportunity to learn every day. Like you, I am starting a second career, and I do not "have to" work. I am becoming a RN because I am fascinated by human health, and I want to use my compassion and critical thinking skills to try to help people heal. I don't know if we get more than one go 'round on this planet, but for me I think my purpose is to help people. For me, becoming a RN is a calling. Think about why you are entering the field, and do what you think would be best for your patients. Are you decided to go into the program you've been accepted into, and you are here looking for validation, or are you doubting the path in front of you and the responses here are making you rethink entering the program?

When it comes to income, RN pay in California is pretty decent, but NP's usually make less than RN's that work on the floors. Anecdotally, I've heard that NP's have more responsibility for less pay. I've also heard that pay in the southeast is terrible in comparison to out here in California.

[LadysSolo]

Also, regarding salary- I don't know about where you are, but I have 23 years' experience as a floor RN and on top of that 12 years' experience as an NP, and in Ohio I make $82,000/year, that is pretty average out of the hospital setting. In a hospital setting I would make about $100,000. YMMV. Just be a realist going into it.

[JadedCPN, BSN, RN]

It sounds like you've got your mind made up either way. My issue is with the title of your thread - there's nothing brave about what you're doing/thinking of doing. Not to say it's stupid either. Just not brave.

That being said - As others have stated, I personally feel the best option is to have experience as a nurse before going forward to be an advanced nurse - it's in the name itself. But that's not to say that there aren't NPs out there who have done it with no RN experience and are great.

[Jules A, MSN]

Also, regarding salary- I don't know about where you are, but I have 23 years' experience as a floor RN and on top of that 12 years' experience as an NP, and in Ohio I make $82,000/year, that is pretty average out of the hospital setting. In a hospital setting I would make about $100,000. YMMV. Just be a realist going into it.

No way??? I made that as a ADN on the east coast and while I'd guess our cost of living is minimally higher I am shocked that any NP let alone someone with your solid experience would not make more money.

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

It sounds like you've got your mind made up either way. My issue is with the title of your thread - there's nothing brave about what you're doing/thinking of doing. Not to say it's stupid either. Just not brave.

That being said - As others have stated, I personally feel the best option is to have experience as a nurse before going forward to be an advanced nurse - it's in the name itself. But that's not to say that there aren't NPs out there who have done it with no RN experience and are great.

To be honest, I made up the name of the post after some thought, because of the prompt from the site that says something like: come up with a post title that gets attention, so you get responses! My initial title was going to be "Feeling disheartened," because that's how I feel after reading on this board. There is so much animosity towards people taking the path I'm planning, and I get it. There are plenty of bad practitioners out there, some with RN experience and some without. I'm willing to bet that if a study was done, it would lean towards those with less experience overall (RN and NP). And that the ORIGINAL intent of an APN was to go from an RN (with experience) to one in an "advanced practice" role. Yet we have schools making this short-cut available. It seems to me that if they were going to do that, they should have increased the required clinical hours to overcome the shortfall.

So...I don't feel brave. Excited, nervous, eager, concerned. And seeking feedback about whether I can overcome my deficiencies and still be a competent provider, from those who know.

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

I'm a BSN student, so my response will be from that perspective. One benefit of the BSN curriculum is the experience of my clinical rotations on different units. Some units that I had been drawn to, I don't care for as much as some units I initially thought I wouldn't be interested in. I've heard that in "the old days" a new grad would work on a Med-Surg unit for a few years to get a well rounded background before moving on to other units. Even now it is tough to get hired as a new BSN grad onto an ICU or ER unit, as most prefer some Med-Surg experience first.

I can't imagine being an ACNP without experience as a RN. I learn so much every day in clinicals, and one of things that drew me to nursing is that there will be opportunity to learn every day. Like you, I am starting a second career, and I do not "have to" work. I am becoming a RN because I am fascinated by human health, and I want to use my compassion and critical thinking skills to try to help people heal. I don't know if we get more than one go 'round on this planet, but for me I think my purpose is to help people. For me, becoming a RN is a calling. Think about why you are entering the field, and do what you think would be best for your patients. Are you decided to go into the program you've been accepted into, and you are here looking for validation, or are you doubting the path in front of you and the responses here are making you rethink entering the program?

When it comes to income, RN pay in California is pretty decent, but NP's usually make less than RN's that work on the floors. Anecdotally, I've heard that NP's have more responsibility for less pay. I've also heard that pay in the southeast is terrible in comparison to out here in California.

I will be getting clinical hours during the RN portion of my curriculum also. It is more condensed than the BSN program that you are in, likely. I was accepted into an Accelerated BSN program as well, and it was only three months longer than this MSN program. I won't end up with a BSN, but they will award the "RN" after we get through the first portion and take the NCLEX, but I will have been doing clinical hours all during that time, too. I guess I just wanted to clarify that.

I am not looking for validation regarding my desire to become an NP. I've known from an early age that I wanted to do that. I've always had this interest, starting out as an insatiable curiosity in health and disease processes. But over time, I've developed so much compassion towards the human plight. I want to guide and serve people in pain. I believe I can be there for them in their time of need, while also being able to be observant, detailed and investigative. I am excited about being able to work within the nursing model but diagnose and prescribe and plan of care. I used to think I was straight medical - but I do think I am more naturally "nurse-y" than that (as someone else put it).

So I'm not questioning what I want. I was looking for opinions as to whether the PATH I was taking could get me where I want to go, reasonably...with my end goal being competence, ability, sense of urgency, appropriate decision-making, good observation skills, and mutual respect amongst team-members.

[Ruby Vee, BSN]

Yet we have schools making this short-cut available. It seems to me that if they were going to do that, they should have increased the required clinical hours to overcome the shortfall.

So...I don't feel brave. Excited, nervous, eager, concerned. And seeking feedback about whether I can overcome my deficiencies and still be a competent provider, from those who know.

The schools don't really want to spend the time and money involved to improve their program to overcome your deficiencies. They just want to make money. You're willing to pay the money knowing your deficiencies, so why wouldn't they take your money? It isn't as if the schools themselves care whether you will be a good NP or a crappy one. As long as you get licensed, they've got your money and can brag about their licensure rate.

Perhaps you can overcome your deficiencies and still be a competent provider. I won't say it's impossible. I will say it's a long, hard road that won't end when you get licensed and get your first job. What I cannot understand is why someone who understands her own deficiencies, knows she has a lot to overcome (or do you just not believe that part) wants to go ahead on the short cut to a job where she has the potential to ruin people's lives or possibly kill them if she isn't right on top of her practice. I can understand wanting to DO the job. But it seems to me that a job with such potential to hurt people seems worth doing RIGHT. And by doing right, I mean by preparing yourself in the very best way to DO the job. All you're doing is seeking justification for what you want to do anyway.

[Ruby Vee, BSN]

I will be getting clinical hours during the RN portion of my curriculum also. It is more condensed than the BSN program that you are in, likely. I was accepted into an accelerated BSN program as well, and it was only three months longer than this MSN program. I won't end up with a BSN, but they will award the "RN" after we get through the first portion and take the NCLEX, but I will have been doing clinical hours all during that time, too. I guess I just wanted to clarify that.

I am not looking for validation regarding my desire to become an NP. I've known from an early age that I wanted to do that. I've always had this interest, starting out as an insatiable curiosity in health and disease processes. But over time, I've developed so much compassion towards the human plight. I want to guide and serve people in pain. I believe I can be there for them in their time of need, while also being able to be observant, detailed and investigative. I am excited about being able to work within the nursing model but diagnose and prescribe and plan of care. I used to think I was straight medical - but I do think I am more naturally "nurse-y" than that (as someone else put it).

So I'm not questioning what I want. I was looking for opinions as to whether the PATH I was taking could get me where I want to go, reasonably...with my end goal being competence, ability, sense of urgency, appropriate decision-making, good observation skills, and mutual respect amongst team-members.

The PATH you're taking is a short cut. Short cuts almost never award the full benefits of taking the full path.