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]

The PA courses aren't full semester courses. This is just the block-style of the medical model compared to the integrated style of the nursing model.

A PA program has more total credits but it also geared to those with no formal medical or nursing education.

Neuroscience, emergency, and dermatology are all included in the NP education under the integrated approach.

That's actually helpful information. I still believe the NP curriculum needs to be beefed up but I'm glad to know they include these things.

Are you sure FNP programs cover emergency medicine?

[zmansc, ASN, RN]

Future - With your extreme dissatisfaction with the NP educational system, and absolute conviction of the inferiority and absolute doom of the NP profession in general, maybe the PA program would be more to your liking.

I can't speak for all FNP programs, I know there are some that have more EM than others in the programs. My FNP program does not specifically cover EM in that there is no EM specific class, nor a EM specific clinical rotation. We do cover the dx and tx of acute illnesses in our classes about each population as we progress in the didactic portion of the program. Anyone can do up to 30% of their clinical rotation in "other settings", that could be EM or any other specialty that they find interesting and they hope to specialize in, although we are reminded that the program goal is to educate primary care providers. EM is one of those that I am considering for that final portion of my clinical rotations, but I also have a couple others that I'm debating on too, so I haven't decided if I will do some or all of that 30% in EM. If you wish to compare programs based on the critical care components, comparing it to the ACNP program at UNM might make it more comparable.

I think another difference, at least between the UNM PA program and my FNP program (Again, I have not reviewed every program of either kind, so I can't say it's a difference in all programs) is that the PA programs breaks your education down into small blocks, this includes your clinical settings. This particular PA program is likely to have you in clinical settings all over the state for short periods of time (several weeks, usually less than 8 if memory serves me correctly), so there is a chance for disjointed monitoring as you go from site to site. I know several graduates who mentioned this was an issue with some of their classmates, although they all said it got resolved in the end. With my FNP program they try to have you setup with one primary preceptor, you may pick several secondary preceptors, but they want one that will be there with you over the long haul, who can monitor your progress from start to finish and work with the supervising faculty member to coordinate any issues as they arise. I think this model is more likely to identify and correct issues earlier.

Again, many differences between the models, I don't think one is the only or best solution, each individual should choose the model that works best for them.

[futureeastcoastNP]

Future - With your extreme dissatisfaction with the NP educational system, and absolute conviction of the inferiority and absolute doom of the NP profession in general, maybe the PA program would be more to your liking.

I can't speak for all FNP programs, I know there are some that have more EM than others in the programs. My FNP program does not specifically cover EM in that there is no EM specific class, nor a EM specific clinical rotation. We do cover the dx and tx of acute illnesses in our classes about each population as we progress in the didactic portion of the program. Anyone can do up to 30% of their clinical rotation in "other settings", that could be EM or any other specialty that they find interesting and they hope to specialize in, although we are reminded that the program goal is to educate primary care providers. EM is one of those that I am considering for that final portion of my clinical rotations, but I also have a couple others that I'm debating on too, so I haven't decided if I will do some or all of that 30% in EM. If you wish to compare programs based on the critical care components, comparing it to the ACNP program at UNM might make it more comparable.

I think another difference, at least between the UNM PA program and my FNP program (Again, I have not reviewed every program of either kind, so I can't say it's a difference in all programs) is that the PA programs breaks your education down into small blocks, this includes your clinical settings. This particular PA program is likely to have you in clinical settings all over the state for short periods of time (several weeks, usually less than 8 if memory serves me correctly), so there is a chance for disjointed monitoring as you go from site to site. I know several graduates who mentioned this was an issue with some of their classmates, although they all said it got resolved in the end. With my FNP program they try to have you setup with one primary preceptor, you may pick several secondary preceptors, but they want one that will be there with you over the long haul, who can monitor your progress from start to finish and work with the supervising faculty member to coordinate any issues as they arise. I think this model is more likely to identify and correct issues earlier.

Again, many differences between the models, I don't think one is the only or best solution, each individual should choose the model that works best for them.

I think even disjointed, constantly changing clinical monitoring is preferable to finding your own, completely unvetted clinical preceptor. I'm sure in many cases, it's basically the blind leading the blind. I'm sure some of the lesser (for profit!) programs will let new grad NPs precept their students - how educational! /sarcasm

Also, I am not completely disenchanted with the NP education model. I think REPUTABLE schools graduate wonderful, competent providers. Places like Columbia, UCSF, Johns Hopkins, UPenn, Duke, Simmons, etc. I think PA education is OVERALL better because they have more standardization and thus no diploma mill type programs like Walden or Phoenix. I think an NP student who attends one of the better programs is just as competent as any PA. I only plan on attending a top program, so I honestly don't feel the need to go a different route - I'm quite confident in the programs I am considering. I do think that Walden, etc grads will eventually run into problems, though.

[iluvgusgus]

Just throwing this out there....if you thrive on the adrenaline of emergency situations why dont you apply for Flight RN? I saw a posting for that at my hospital and I thought that sounded very cool but you need A LOT of critical care experience,EMT training etc. which I dont currently have but it is something to work toward possibly one day. I am thinking about going to PA school or getting ARNP but I also think that these positions will one day also become "tedious" as well and the thought of going to school for it doesnt exactly excite me. Not saying that this is why you want to further your education, but once you increase your income you increase your standard of living and so you will always try to live beyond your means, that is just human psychology and economics, so maybe it is more important for people to do something they are genuinely passionate about than making more money.

[Dranger]

That's actually helpful information. I still believe the NP curriculum needs to be beefed up but I'm glad to know they include these things.

Are you sure FNP programs cover emergency medicine?

You have to realize the the fast paced nature of PA programs, while they aren't semesters the block material covered is the same amount of a semester just in a short amount of time. Sink or swim. I know a buddy who is in the Army IPAP program who says he barely gets enough time to eat and sleep let alone a phone call. I have never heard of this pace or rigor in NP programs when many are part time or at your own pace.

PA programs are geared to people with previous medical experience, in fact many require it. My local program has a mean age of 31 and requires 5000 hours HCE. So I wouldn't say most PA grads are taking their first swim in healthcare.

PAs thrived in EM where I worked and all could intubate flawlessly, last time I checked most FNP programs do not cover intubation which is a staple in EM. I would be very suspicious of a NP program claiming EM training with no live/dummy intubation.

Also with more direct entry NPs that former nursing education/experience that Boston stated above, goes out the window...

[BostonFNP, APRN]

You have to realize the the fast paced nature of PA programs while they aren't semesters the block material covered is the same amount of a semester just in a short amount of time. Sink or swim. I know a buddy who is in the Army IPAP program who says he barely gets enough time to eat and sleep let alone a phone call. I have never heard of this pace or rigor in NP programs when many are part time or at your own pace. PA programs are geared to people with previous medical experience, in fact many require it. My local program has a mean age of 31 and requires 5000 hours HCE. So I wouldn't say most PA grads are taking their first swim in healthcare. PAs thrived in EM where I worked and all could intubate flawlessly, last time I checked most FNP programs do not cover intubation which is a staple in EM. I would be very suspicious of a NP program claiming EM training with no live/dummy intubation. Also with more direct entry NPs that former nursing education/experience that Boston stated above, goes out the window...[/quote']

How busy a "buddy" is doesn't prove a point. I am sure everyone has their own anecdotal tales about PA and MD and NP students. Everyone's situation is unique; I am sure your buddy in the Army program had no other obligations while he was attending school?

Historically, PA programs and NP programs alike have required 1,000 hours of direct patient care experience. For better or worse many programs in both models have removed or reduced this requirement.

Grossly equal numbers of PAs and NPs work in EM; few of these NPs are ENPs, so most (like PAs) are educated as generalists. There have been several studies in ED, UC, NICU, and ICU areas demonstrating PAs, NPs, and resident physicians are all similar in their outcomes. If you have some conflicting data, please share so we can all read it.

All NPs with hospital privileges need to be ALCS (or equivalent) certified and are trained on basic intubation; a simple skill that can get very difficult in a hurry. Personally I had two live intubations as a student (which is abnormal) and had plenty of time intubating dummies in skills labs as well as ACLS training.