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.

[PANYNP]

Interesting. I definitely understand the differences between the medical and nursing model, and the focus on holistic care in the latter. I wonder if it's an issue in her particular school, or a matter of the lack of experience.

It seems like you are encouraging me to get an FNP certification rather than ACNP, as if it's not really 'necessary.' My POV, right or wrong, was that the ACNP program would get me the 'most training', as it relates to bedside nursing, that I could possibly get...considering I lack the bedside nursing experience. Yes, it is NP training. But FNP would focus on entirely different skills and settings, and I would never see certain things if I went that route. By choosing to specialize in ACNP, I can at least be trained in the higher acuity patients and settings. If I want to work in a specialty clinic, I can still do so. But at least I will have been exposed.

I was just hunting through my school's website and discovered that they have started a new DNP/Critical Care Fellowship for new MSN ACNP grads. The school, in conjunction with the affiliated teaching hospital, is allowing new grads to enroll in the DNP program while also working a paid fellowship in Critical Care. THAT is very appealing. I know, I know, they want my money. But it would benefit me too, in extra training.

Oh - no, I'm not encouraging you to do an FNP program. Just attempting to note that there are differences between acute care and primary care training, as to where skills are best utilized.

Re DNP: There are schools that have moved away from offering strictly master's degrees in favor of DNP as entry to advanced practice. There also are schools that have reversed this stance, and have returned to offering master's degrees as a terminal degree, in addition to DNP.

I also teach in a DNP program (I'm a PhD NP) so from that perspective, I can say (my own opinion) that it still may take another 10 years or longer until the MSN vs DNP tension settles itself.

In my geographic area of Western New York, DNPs are being employed as faculty members and doing a day/week of practice and FT practice during the summer in order to match the salary earned as a staff nurse, who can earn OT, holiday differentials etc.

The few DNPs who are in practice (in my locale) in the hospital or affiliated clinics have the same starting salary and earning trajectory as an MSN-prepared NP or CNS - since you earlier had expressed concerns about earning potential.

[PANYNP]

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!

Congratulations on your new job!

You want to keep in mind that when you go to recertify as an FNP, you will need to demonstrate that your work experience is in primary care, as that is your education and training. Have a plan for how you will address working in an acute care/critical care setting when you have been educated in primary care.

Hospital systems will hire warm bodies to fill their slots, without concern for how these folks will maintain certification.

There always is a liability issue hanging over your head if you are practicing outside your educational scope of practice should an untoward event occur.

Perhaps some other primary care NPs who are practicing in acute or critical care can comment.

[Jules A, MSN]

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

Excellent point and in all honesty the path all of us with a NP license have taken is a short cut bypassing the rigors of medical school so imvho to then short cut the short cut is frightening.

OP I much appreciate your putting yourself out there and considering this regardless of the fact that I'm sure you will go on to get your NP without RN experience. I can't honestly say I wouldn't do the same if I had the option. The take home is please understand the schools could give a rip if you are competent. In my brief experience n=2 despite their excellent reputations the education was marginal at my most generous.

[Neuro Guy NP, DNP, PhD, APRN]

Interesting. I definitely understand the differences between the medical and nursing model, and the focus on holistic care in the latter. I wonder if it's an issue in her particular school, or a matter of the lack of experience.

It seems like you are encouraging me to get an FNP certification rather than ACNP, as if it's not really 'necessary.' My POV, right or wrong, was that the ACNP program would get me the 'most training', as it relates to bedside nursing, that I could possibly get...considering I lack the bedside nursing experience. Yes, it is NP training. But FNP would focus on entirely different skills and settings, and I would never see certain things if I went that route. By choosing to specialize in ACNP, I can at least be trained in the higher acuity patients and settings. If I want to work in a specialty clinic, I can still do so. But at least I will have been exposed.

I was just hunting through my school's website and discovered that they have started a new DNP/Critical Care Fellowship for new MSN ACNP grads. The school, in conjunction with the affiliated teaching hospital, is allowing new grads to enroll in the DNP program while also working a paid fellowship in Critical Care. THAT is very appealing. I know, I know, they want my money. But it would benefit me too, in extra training.

ACNP all the way if you're do inpatient work. Consensus model is gaining traction in a lot of places, especially here in the northeast, so marinate on that.

[CrunchRN, ADN, RN]

Sell your soul to the devil. Sales. For the big health insurance companies.

Really, I'm grateful to them though. It's been a great career.

Ah yes. I may suck at that LOL.

I believe you can do it. PA's often have no background in medicine and do fine. Of course if you ask nurses they will say it is better to be a nurse 1st and it would give you great experience. However, in the role of provider there is a lot learned from nursing that will not necessarily apply.

Have you asked this question in the NP forum?

[BCgradnurse, MSN, RN, NP]

Sisemo,

I sent you a PM.

[amzyRN]

I'm an ER nurse and the NPs in my ER don't do a lot of interesting things in my opinion. I've never seen NP or PA do a central line or chest tube. They mainly treat the clinic patients who come in, all the sick kids that come in and cough and barf and give us all kind of fun germs. I suppose if you want to do primary care, then working in an ER as an NP might be your thing. I would want to do something where I get to use my brain more, like working in an ICU or cardiology practice or something. I don't know yet though. It's definitely something I am going to explore more realizing that I am going to have to move away from such intense physical labor. My back is starting to have issues now.

My personal opinion is that having a year as an RN couldn't hurt. If I hadn't worked as an RN, I might try to go be a primary NP and hate it. Just make sure you know what you are getting into before investing a lot of money. I've known people to lose a lot of money and time in the pursuit of education that they were unable to use in the end, either didn't get a job or hated the job they got in the end.

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

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?

Here's the one for Oregon. Still looking for Colorado.

Oregon Secretary of State Archives Division

[Jules A, MSN]

PA's often have no background in medicine and do fine.

Serious question: do you know how many clinical hours PAs are required to have?

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

Serious question: do you know how many clinical hours PAs are required to have?

I know this question was directed at a different poster. The two year Masters PA programs I am familiar with (or just over two years) require just under 2000 clinical hours. My DE NP program of about the same length will be shy of that by around 400-500 hours I believe. I could be slightly off on the latter, but this is close.

On a different note...I had a very interesting conversation with a doctor friend of mine this evening. He's a pulmonologist at our local magnet hospital. I asked his opinion on what I was doing, if it was smart, whether I could get a job with no experience as an RN, etc. He told me I would have a job with him as soon as I graduated. In fact, he said they cannot hire enough NPs right now, and ACNPs are sought after. He told me he thought the school was way too expensive, but it was still a great plan and a great job. And again, most importantly, he would hire me.

It was just a relief to hear. And encouraging.

[SopranoKris, MSN, RN, NP]

Serious question: do you know how many clinical hours PAs are required to have?

Most PA programs require 2000 or more clinical hours. PA differs from NP in that the rotations are similar to med school rotations. PA students have ER, Surgery, Psych & Specialty rotations that NPs do not get. Both NP & PA have rotations in Family Medicine, Peds, OB/Gyn & IM. The didactic is also more rigorous (think condensed med school).

[Jules A, MSN]

I know this question was directed at a different poster. The two year Masters PA programs I am familiar with (or just over two years) require just under 2000 clinical hours. My DE NP program of about the same length will be shy of that by around 400-500 hours I believe. I could be slightly off on the latter, but this is close.

On a different note...I had a very interesting conversation with a doctor friend of mine this evening. He's a pulmonologist at our local magnet hospital. I asked his opinion on what I was doing, if it was smart, whether I could get a job with no experience as an RN, etc. He told me I would have a job with him as soon as I graduated. In fact, he said they cannot hire enough NPs right now, and ACNPs are sought after. He told me he thought the school was way too expensive, but it was still a great plan and a great job. And again, most importantly, he would hire me.

It was just a relief to hear. And encouraging.

Wow you are getting 1,600 clinical hours in NP school? Please consider the DNP capstone thing IS NOT clinical hours despite their asserting it is. In my personal experience NP clinical hours are usually 500 which is way too few especially because if precepted by a NP in most cases it will be lighter and more "nursey" than the 2,000 of PA students.

Excellent news about the job offer however again consider that many employers could care less if you are competent as long as you are certified and willing to take a salary significantly less than they would have to pay a MD.

I'd also wonder if he knows exactly how many pharmacology credits required like 6-8? My medical director about lost his dentures when I told him how few we were required to have prior to prescribing.