Can anyone offer insight to a distressed RN?

[MrJrod]

Hey all!

I'm new to the forum and come with a heavy questions for those who can offer advice about shifting gears with my career. Here's a little bit about me:

I'm 29 years old, male with a BSN and I presently work in a busy metropolitan ED. I have about 3 years of experience as an RN with 1 total in SICU and 2 in emergency department nursing. I worked for nearly a decade as a paramedic in a very busy ED. I became a medic early out of high school and had intentions of attempting to get into medical school, but I did not have the financial means to go to school without working full time and my grades suffered. Not to mention I struggled with crippling ADD which is fortunately well controlled now.

I'm writing a post because I have become very disenchanted with my current way of life. I am the type of person that wants to enjoy my work and look forward to my job with pride and a desire to constantly hone and improve my skill. I'm tired of the whole job of bedside nursing because of the nearly complete lack of analytical challenge. My job, no matter the discipline, seems to be centered around redundant and simple tasks as well as time management. I don't feel challenged or stimulated to give a damn about my profession let alone be proud of the things I have accomplished. I live for the 5% of people who actually are having an MI, who actually are the victim of traumatic circumstance, who actually have a reason to be in the ED besides abusing the system for a hot and a cot. Now that I'm done ********, I'll get to the point.

I want to know what kind of satisfaction DNPs or NPs get from their work. I want something to actually challenge my mind for a change. Some line of work where I can THINK about a patient's presentation and try to help prevent, treat and manage disease. I want to know if DNPs or NPs think the work is worth it (School)? Do you feel satisfied every day? Do you truly wake up every morning and loath what you're walking in to, or does the thought of work spur some excitement within you?

My primary concerns regarding the DNP/NP route is the training. Where and when do you learn about medicine, advanced assessment, long term disease management, health promotion, more advanced human anatomy and pathophysiology? All the NP students I have discussed this with describe the same exact, "fluffery" I had to put up with in nursing school, but on some "higher level" involving research. I want to do something in advanced practice nursing, but I'm very concerned about the curriculum.

What about independence in practice? Do you feel that your training prepared you to manage the more complicated patients? I don't want this to seem like I doubt an NPs capabilities, because I know plenty of NPs who were so smart they seemed intimidating to be around. I just question the curriculum that is used to train people who are being trained to function like physicians. Was the cost of your education worth it? Becoming a PA in my area seems like the wisest thing to do, but at the costs here in Minnesota I would be driven so far into debt I would spend the better part of my life paying just the interest off.

As always to forum posts, thanks for your time and consideration. I know the answers will be biased as those perusing a nursing forum to answer a stranger's questions have a passion for nursing to begin with. Nevertheless, I'm desperate for unadulterated input and concrete answers to my questions. Not the typical,"Do what your heart tells you to do. Money doesn't matter if you love what you do." type garbage most spew out at the first opportunity.

[futureeastcoastNP]

You sound like me. I found nursing school very easy, dumbed down, and filled with too much fluff. I found bedside nursing tedious and felt like I was never using my knowledge. I am applying to FNP programs, and like you I am very concerned about the curriculum. There is far too much fluff, and the nursing boards do not regulate programs enough. There is no standardization and there are many horrible for profit schools where you take pre canned classes, study on your own part time, slowly "buying" a degree over 5 years while doing clinicals with any willing Person with an NP license and a pulse. Overall, the profession is going backwards educationally and it's a huge concern. I think all these Walden and Kaplan grads will eventually catch up with us and cause some real problems, as they are an embarrassment to the profession.

Having said that, I think there are about 40 or so NP programs out there that are actually reputable and teach their students real medicine. As long as you attend one of these programs, I think you will be happy with your education and be a competent entry level provider, though you will likely have to do a lot of studying outside of school to understand things on a cellular level like the medical model.

[zmansc, ASN, RN]

You seem to address a number of issues. I'll try to discuss them here:

1) Disenchanted with life. My wife and I both work in our community ED, so I understand the frustration with those who are taking advantage of the system. However, if you choose to stay in medical care, there will always be large amounts of redundant tasks, time management, and tedium. Most jobs have this, the specifics change, but the fact is that if you get good at your job a big part of that is figuring out how to do the tedium so you can focus on the unique, infrequent, exciting tasks and do them better. Many, most nurses I know in the ED live for the 5% of cases that are truly life threatening and will force us to use our skills to the fullest. Having said that, and having had two GSW get dropped of at our door the other day, I can tell you, and you probably already know, that when you get those cases, many want to revert back to the tedium of dealing with the day to day abdominal pains because the stress of the life threatening cases is overwhelming to most. So, there is a balance that seems to emerge and no one ratio or mix is perfect for all.

One of the ways, my wife and I deal with this issue is that we try to think of the people we have served that shift. As ER providers, we see alot of people who are scared of the unknown, in pain, and just want to be fixed. Yep, many times they made bad choices that got them there. Yep, they can often be rude, or short, or frustrated with the system. They might not have insurance, and might be scared to death of how they are going to pay for all this. In short, this is not a routine situation for them like it is those of us working there. So, if we can calm them down, remove some of the anxiety in the process, help them to know that they are going to make it through this, that in and of itself makes you a successful ED RN. Now, if you can take away their pain, treat them like a worthy human being, and identify and/or resolve their health issue, then you are super-human, and deserve to be very proud of your accomplishment. The fact of the matter is that you as an ED RN or as an ED provider (MD/DO/PA/NP) will do this for many patients every day. If you can take pride in it and feel like you are accomplishing something as a RN then you will be able to as a NP. If not, then it probably won't help your disenchantment to be treating these same patients every day as an NP either.

2) More analytical/training. Yes, NP is more analytical than RN which is more than..... The training in all of the things you mentioned is there in the program. Yes, many programs have some amount of "fluff" courses. Depending on the program they may be more or less "fluffy" and you may learn more or less of nothing. Remember that you tend to hear about either the best or the worst of something. So, if you are hearing about the "fluff" because it is what the students/alumni remember or want to talk about than the part they aren't telling you about is the patho, pharm, on, and on, and on. Those courses are there too, just they aren't the ones you are hearing about.

3) Independence/Quality of Education as a Provider. Let's first discuss the quality of education as a provider. Instead of taking anecdotal evidence from individuals who would likely be biased towards their own education, let's look at facts... If the NP education did not produce providers who were capable, then NP providers would produce worse outcomes in their patients. However, study after study shows this to not be the case, so I think we have scientific proof that there is no quality of provider issue, and thus, no quality of education issue. This is not only true for NPs, but as far as I know also true of PAs practice results.

Now, for independence. The real issue here is control over marketplace. It has very little to do with quality of care, as in most states that require a "collaborating physician" or whatever that state calls it, the physician doesn't actually have to see the pt, review the case, or do anything actually medical with the patient. If the patient needs a specialist, the patient still gets referred to the proper specialist, so that's not an issue. Really, the only issue at play is competition. Physicians don't want independent NPs because then they wouldn't be able to keep some of the revenue that the NPs bring into their practices! Who does it benefit? Physicians? yes. Patients? no. NPs? no.

4) Was it worth it? From a financial standpoint I will not make up the costs of my education. I'm too old for that. However, I'm not here to get rich. That's not why I choose this route, this career. I choose it because I wanted to touch people in the most meaningful way I could. I'm currently touching them in some way in my RN job, but as an NP I will be able to touch them in a much more meaningful way. I choose this profession because I want to be able to help people, and that includes the person who is in chronic pain, and has come into the ER for the fifth time in the last three days looking for pain meds. He needs help too. He wasn't born addicted to those meds, he deserves to have his pain controlled and help with his addiction. The ED isn't the right place for that, but he still deserves that much from us.

Healthcare can be a very difficult job emotionally, regardless of your role in it. I hope you are able to identify what is keeping you from being happy and what changes you need to make to become happy. If that is becoming a provider, then go for it, chase your dreams. If it is working with people, than becoming a provider will not change that. Taking the time to try to identify your issues and getting others to help you discuss them is a very good first step.

[futureeastcoastNP]

3) Independence/Quality of Education as a Provider. Let's first discuss the quality of education as a provider. Instead of taking anecdotal evidence from individuals who would likely be biased towards their own education, let's look at facts... If the NP education did not produce providers who were capable, then NP providers would produce worse outcomes in their patients. However, study after study shows this to not be the case, so I think we have scientific proof that there is no quality of provider issue, and thus, no quality of education issue. This is not only true for NPs, but as far as I know also true of PAs practice results.

Now, for independence. The real issue here is control over marketplace. It has very little to do with quality of care, as in most states that require a "collaborating physician" or whatever that state calls it, the physician doesn't actually have to see the pt, review the case, or do anything actually medical with the patient. If the patient needs a specialist, the patient still gets referred to the proper specialist, so that's not an issue. Really, the only issue at play is competition. Physicians don't want independent NPs because then they wouldn't be able to keep some of the revenue that the NPs bring into their practices! Who does it benefit? Physicians? yes. Patients? no. NPs? no.

While I agree these studies are great and prove NPs provide excellent care, they were largely conducted before the greedy for-profit schools began to rise like crazy and pumping out poorly prepared NPs. The NPs practicing during most of those studies went to reputable, not for profit programs, where they practiced in labs, were taught by veteran NPs, and their preceptors were vetted and provided. Things have changed, new NPs from the inferior programs are not the same. They can sit in front of a computer and get their BSN at a for profit, then sit in front of it again and get their NP degree, only leaving long enough to do a few hundred hours of clinicals with whoever they can convince to do it. The negative changes to NP education will likely filter through in the next 5 to 10 yrs and these Walden and Kaplan grads will give the MD groups all the ammo they need to show scientific proof of inferior outcomes from NPs.

All pre-NPs and NP students should take a stand and refuse to give a single dollar to these horrible programs. It will come back to bite us all in the butt one day if we support them.

[zmansc, ASN, RN]

While I agree these studies are great and prove NPs provide excellent care, theywere largely conducted before the greedy for profits began to rise like crazy and begin pumping out NPs. The negative changes to NP education will likely filter through in the next 5 to 10 yrs and these Walden and Kaplan grads will begin to likely show worse outcomes. NP education isn't what it used to be across the board.

That is pure conjecture on your part. They still have to take and pass the same boards and are held to the same standards as everyone else who has entered the profession. You have no concrete evidence to substantiate your assumptions, so let's stick with the facts until you can prove otherwise.

Of course the world has not stood still since this research was done, although the current numbers are not getting worse, so any assumption that it will get worse is just that, an assumption, nothing more, nothing less.

[Dranger]

Dude PA school stat. If you want hard hitting science and a large breadth of medical immersion in a 2 year period without the commitment of med school, go for it. Paramedic background is a huge plus and that is where many PAs come from. I think you will be disenchanted with much of the NP curriculum.

Just came back from a PA info session I went to for fun and I was amazed and what they have to learn in 29 months. Almost 0 fluff and the faculty member was a former RN which made it all the better when answering my questions.

[BostonFNP, APRN]

I love when people that have never been to NP school talk about the "fluff" in NP programs.

[BostonFNP, APRN]

As a practicing NP I can honestly say I would do it all over again in a heartbeat. I love my job and I am much more satisfied with my APN role compared to RN role, it's really not even comparable.

[SHGR, MSN, RN, CNS]

I love when people that have never been to NP school talk about the "fluff" in NP programs.

Right, there are tons of threads here for that. I (most of the way through an APRN program) found that the "fluff" actually is helping me be more insightful about healthcare, our profession, and helping these patients who are not the 5% described. Most of what healthcare is now, is chronic conditions- behavior change- the day-to-day grind- and secondary, even tertiary prevention. The trauma drama is just not the bulk of what we do in health care unless maybe you are a flight nurse.

I have to say, OP, if you are unhappy now, you will likely be unhappy as an NP or as a PA. You will have to deal with this before deciding on your next move.

If your philosophy of health care is that "My job, no matter the discipline, seems to be centered around redundant and simple tasks as well as time management" then you will likely feel the same as an NP or PA as they - at least in primary care- see the same chronic things and the same acute things day in and day out. When you stop seeing the patient as an autonomous, worthwhile human being, then you are done, IMHO (and a nursing theory class might help too).

[Dranger]

I love when people that have never been to NP school talk about the "fluff" in NP programs.

The defensiveness says it all. Compare the two curriculums, it's not that hard to distinguish relevant to irrelevant for a provider role even for a measly BSN/RN. I love how NPs like to view themselves like they are oh so different from their RN counterparts. You are still a nurse.

[BostonFNP, APRN]

The defensiveness says it all. Compare the two curriculums it's not that hard to distinguish relevant to irrelevant for a provider role even for a measly BSN/RN. I love how NPs like to view themselves like they are oh so different from their RN counterparts. You are still a nurse.[/quote']

There is no defensiveness there; it is a statement pointing out the ignorance of some posters giving advice to another member about something hey know absolutely nothing about.

I bet it really ruffles your feathers when you take orders from NPs, as they aren't oh so much different from you huh?

We are still nurses. Nurses trained to function at a higher level than you are. Something perhaps you should respect.

[futureeastcoastNP]

I think it's ridiculous that some posters on this board seem to think they are the only ones capable of classifying what is fluff and what isn't. I'm sorry, but when the course description says it's a course about learning how to do a literature search and the only required textbook is the APA guide, I'm pretty sure I can guess I'm not going to be learning anything clinical. Just as BSN programs have ridiculous fluff courses (which I have firsthand knowledge of), so do NP programs.