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.

[Ruas61, BSN, RN]

It's easy to the climb the mountain when you take the elevator route but you miss the experience.

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

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.

To be clear, I was including the clinical hours in the RN portion of the program as well. I think you have to compare the full DE program (which is all of it, not just the MSN portion) to PA programs, because both are assuming no "real" experience. While many PA programs do require some patient hours, it can be relatively minor. I did have to estimate that portion, so as I said, I could be off. But I know the days I will be in clinical in that part of the program, vs didactic, so I gave it a whirl.

I didn't include DNP.

Some of this could be unfair bc they are clinical hours as a nurse rather than a provider...not sure.

This doctor is quite familiar with the program and has ACNPs working for him that have graduated from it.

Believe me...I fully plan to work as hard as possible to make sure I am responsible and competent. And I know this man personally...I think he would help me get there.

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

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).

Could some of this have to do with the fact that NPs are required to specialize and limited to practice within that scope? Whereas PAs are considered generalists? I mean, a PMHNP is not going to do FNP work; an FNP is not 'supposed' to do ACNP work; a WHNP is not going to do psych. So why indeed would they need clinical rotations (thus adding hours) in all those other specialties?

FNP is the exception in my mind, and I find it strange honestly that the BON has continued to allow this broad FNP scope, when we have all of these specialties. Why have the specialties when technically an FNP can also do Women's Health and Peds and all that. Maybe not acute, but still.

Just some thoughts about clinical hours. If a PA can technically swing between specialties at any time, depending on the supervising doc, then they probably SHOULD get all those clinical hours. NPs would have to go back to school (and get more hours) to do the same.

[LadysSolo]

An adult NP in internal medicine can see children as soon as they hit puberty, as an adult NP I have worked in Internal Medicine, Hematology/Oncology, and Gerontology (Nursing Home practice.) Actually my best preparation for becoming a Nurse Practitioner was the years I spent in the hospital on a Heme/Onc floor - these people were in multisystems failure virtually all the time, and were not on monitors so you HAD to use every nursing skill you had all the time, and be VERY observant, aware of lab changes, condition changes, everything. The two areas I would feel very unprepared to work would be Psych and OB, but these are also two areas I am not especially interested in working in.

[Bluebolt]

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.

The MD offering you a job after graduation saying he thought the school was too expensive translates to, I'm going to be paying you too little for you to pay that back in a reasonable time. lol

MDs looking at bringing an NP into their practice is looking at how much of their workload can you take for the least amount of money from their pocket. Sadly, many MDs look at NPs like an RN who can write their progress note and they can pay 10% more than what an RN would earn.

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

The MD offering you a job after graduation saying he thought the school was too expensive translates to, I'm going to be paying you too little for you to pay that back in a reasonable time. lol

MDs looking at bringing an NP into their practice is looking at how much of their workload can you take for the least amount of money from their pocket. Sadly, many MDs look at NPs like an RN who can write their progress note and they can pay 10% more than what an RN would earn.

I should expect that kind of reply. This man is a personal friend and is also encouraging his daughters to do this same thing which, I doubt, is to take advantage of them.

I totally understand that NPs get paid a lesser amount than MDs. I expect it.

I don't know if you realize, but the fact that MDs would like to pay NPs or any staff member x amount so it helps contribute to their bottom line is NO BIG SURPRISE. It's a business. This is how the rest of the world operates. I have never expected my salary to be someone else's charity.

If for some reason I am not fully happy with what I'm making in my very first NP job, so be it. I will work to get experience, and then leverage that later on.

My school is painfully expensive, but fortunately I will be paying cash for my education. So it doesn't quite hit me the same.

[Workitinurfava, BSN, RN]

Nursing allows you the opportunity to work as a nurse before going for advanced practice. How do you know if it is something you will like to do? The high salary you are quoting, it is based on a nurse that already has experience or no?

[LadysSolo]

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.

[Bluebolt]

I should expect that kind of reply. This man is a personal friend and is also encouraging his daughters to do this same thing which, I doubt, is to take advantage of them.

I totally understand that NPs get paid a lesser amount than MDs. I expect it.

I don't know if you realize, but the fact that MDs would like to pay NPs or any staff member x amount so it helps contribute to their bottom line is NO BIG SURPRISE. It's a business. This is how the rest of the world operates. I have never expected my salary to be someone else's charity.

If for some reason I am not fully happy with what I'm making in my very first NP job, so be it. I will work to get experience, and then leverage that later on.

My school is painfully expensive, but fortunately I will be paying cash for my education. So it doesn't quite hit me the same.

You make a correct point that it's about business and bottom lines. My friends who are NPs start to get rubbed the wrong way when an MD saddles them down with everything they don't like to do and expects them to take on 75% of the workload while making less than half the pay of the provider doing 25% of the work. It was particularly sad when a couple of my ICU RN friends graduated NP school and realized that they would have to take a pay cut to start an NP job because of the low-ball offers MDs were giving. One of them stayed working as an RN to earn enough extra cash to help pay off the student loans for about a year.

NPs seem like an oppressed group and as long as people go into the field with your attitude that it's a business and it's cool for the MD to pay you under market value and give you most of the work, they'll stay oppressed.

I'm training in the anesthesia field where it's true that anesthesiologists usually make $300K to $400K when the typical CRNA isn't making that kind of income. The difference is CRNAs are branching off and doing CRNA only practices and billing insurances themselves, putting them at earning $200K or more. There were even some job postings on gasworks.com for over $250K for CRNAs. I don't mind an anesthesiologist making a little more as long as I'm compensated appropriately for my services too. Besides, soon the healthcare market won't be able to sustain the $400K pay for a service they can get for $200K.

The actual dollar amount is arbitrary, it's just a numerical representation of what you are valued at and what your skills and knowledge are worth. I don't understand why NPs don't seem to value themselves very much and continue to take pay under $100K.

[BCgradnurse, MSN, RN, NP]

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.

How do you know that she came here for approval only? She was looking for some insight and opinions from those who are NPs. There's no need for snark. This "real-life" NP has walked the road she is choosing and has done just fine as an NP. It's not the right choice for everyone, but many have been successful with hard work, smarts, and a willingness to seek every learning opportunity available. Don't be so quick to disparage a path you haven't walked yourself.

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

NPs seem like an oppressed group and as long as people go into the field with your attitude that it's a business and it's cool for the MD to pay you under market value and give you most of the work, they'll stay oppressed.

1) It actually is a business, and I plan to take advantage of that.

2) I don't know where I gave you the impression I was "cool" with an MD paying me under market value. I have no intention of contributing to that issue. Just because I said I might not be thrilled with my salary out of the gate doesn't mean I think it will be less than my value. I have my sights set high.

Here's my plan - earn my keep, do a stellar job, make a bunch of money for the practice, and command a nice wage. I don't think I'll do that by sitting on my laurels, but I also don't plan to be taken advantage of.

[Tacomaboy3]

To be clear, I was including the clinical hours in the RN portion of the program as well. I think you have to compare the full DE program (which is all of it, not just the MSN portion) to PA programs, because both are assuming no "real" experience.

I'm in nursing school now, and I would argue that the quality of clinical hours in RN school IS NOT the same as in PA/NP school. It's hardly experience, more like required exposure or job shadows into different nursing settings. It also doesn't help that our clinical experience is inundated with busy-work assignments that eat up all our time. I am learning and practicing my nursing skills more when working as a CNA/nurse tech than as a student in clinical rotations.

The sad truth is that the number of NP required clinical hours average at about 600 compared to 2,000 in PA programs. That said, I would think that newly graduated PAs enter the workforce better prepared and practiced than direct-entry NPs. I hope you can be the outlier.

Before nursing school, I was looking into ABSN, entry-level MSN-RN and entry-level MSN/DNP-NP programs. I ultimately chose a community college program because it was about 1/7 of the cost of the others. I think you may be getting a lot criticism because you are jumping straight to the top of the nursing career ladder as quickly as you can. For generations, nursing had been a field in which experience granted you opportunities to step up in the job ladder. Start as an LPN or floor RN (med/surg), then gain critical care experience, then charge, then the opportunities really open up: unit manager, assistant nurse manager, nurse manager, clinical educator, house supervisor; or going back to school for a PhD or advanced practice: nurse practitioner, clinical nurse specialist, nurse anesthetist or nurse midwife.

Direct-entry programs are still relatively new, and they've shook the foundation of the nursing career ladder - a non-nurse, in 2-4 years, can now head straight to the top.