Conflicted about advancing to APN

[WestCoastSunRN, MSN, CNS]

Hi all,

So I have been accepted to a well respected DNP program in my state. It is a hybrid program and clinicals are set up for students, although they are able to have input and help shape their clinical schedule if they so desire. They will allow me to either do the first year over two years, or defer my start for a year. Becoming an FNP was always a goal for me since I started nursing back in the late 90's. My specialty area is critical care and most recently I have entered into burn nursing which expands my practice to burns/wounds and pediatrics while still getting to do critical care. There is also the opportunity to become active in community outreach. This job comes with all the stresses of bedside nursing but is in a very supportive environment -- unlike any I've ever worked in before. My work schedule is such that it is possible for me to continue to work it for at least the first year of the program (two years if I spread it that first year over two years). I am having a hard time deciding how to proceed.

The obvious answer, for the moment, is to either start the DNP program part-time this year, or defer it altogether for a year while I figure out burn nursing. That said, I would like to explore the idea of NOT advancing to FNP. For me, FNP was going to be a way to gracefully leave the bedside (and it's physical stresses) and still get to have clinical practice with patients. Obviously I am aware that primary care is very different than critical care, but I thought this would be a welcome change for me when it came time to transition. I'm "young" 40's, in good shape and still enjoy bedside nursing. With my experience it is very likely I will not make the same money as an FNP as I currently make an an RN. Money isn't everything - for sure - but a DNP degree is costly (money, time, effort), so it needs to be part of the consideration. Plus, I'm really happy in my current job. It's still new (honeymoon) phase and really, it's a tough specialty and I know this. So I think about "how long will I want to do this?" But the schedule is such that I can keep working it while doing the DNP program for at least 1-2 years. I have a very full outside-of-work life and so work-life balance is of utmost importance to me. It is also important to me that my work is meaningful, but that it also stays at work. My current pay and schedule are good. I currently live on the west coast and this is a good place for nurses. They are treated better here than other places in the country I've worked. That said, at some point I'd like to move back home (the South) and I know I may not be as fortunate in finding a good, supportive acute-care environment to work in. But that's just a pipe dream right now-- but something I think about.

So do I just scrap the FNP plan and continue on in critical care/burn nursing and enjoy my good pay and good schedule and supportive environment and maybe advance my degree in another way that would open up doors for education or clinical leadership down the road? I could enjoy being a seasoned, solid and knowledgeable resource as opposed to a brand new NP starting out afresh with all the learning curves that will come with that. But I will be tied to an institution as an RN which is currently fine, but if I move might not be so great. Or do I take the leap, continue in my current job for 1-2 years, but go for the FNP and change my career path completely? There are risks either way. I'd love to hear some thoughts from current APN's, or APN students or even RN's who decided against APN for whatever reason. There might be stuff I'm missing or not giving due attention to in thinking on this. Thanks in advance for insights!

[Rocknurse, MSN, APRN, NP]

Sounds like you are reasoning with yourself and quite rightly so. It's a big decision and one only you can make. For what it's worth I will tell you that it's hard. It won't go exactly as you planned it, but it will be challenging and exciting but it will also be stressful and tiring and demanding. I was also a critical care nurse but I made the decision to go into acute care because it's the only thing I can see myself doing. I don't mind if I end up in a specialty but I couldn't bear doing primary care. So far I have managed to keep working and I am fortunate to have a manager who understands what it's like to be in school. Both the director and the assistant director of my department did their master's recently and are both of a similar age to me so they have been exeptional in letting me arrange my schedule around school and clinicals. I work mon-fri office hours so as you can imagine that's not been an easy transition. Unfortunately that also means I have had few days off and sometimes keep going for weeks at a time in order to juggle all the balls.

I will say that there have been many times when I almost gave up. I nearly quit last month in fact when it all got too much, but I have persevered and have one year left of my program. I realize that I have invested too much to give up now and I know that in the future I will be glad i did it. I have a very comfortable life and job, a cozy private office space, excellent independent hours, no weekends, call or nights in my job right now. I wear nice clothes to work and drink coffee all day, and yet here I am contemplating a return to the craziness of the ICU. Why? Because it's in my blood, I crave it and I love the feeling when I walk into the unit. Life changes and nothing is guaranteed and so if informatics as a specialty tanked tomorrow I know that I have a future and a guarantee of sorts of a decent income for life by being an APRN in acute care. I've made lots of sacrifices to do this. I also believe in work/life balance but that has taken a big hit this year. I haven't seen my friends nor partaken in any of my hobbies or kept myself fit. I was run down and exhausted and ended up getting the flu and was off sick for 2 weeks. I was too sick to study and I missed clincials too, and I was a week alte taking an exam that I was convinced I would fail, but I ended up scoring a 93% which was the tipping point for me to realize that I can do this. It has given me time to sit and contemplate what I'm doing and to make the decision to continue but with a promise to myself that I start to take care of myself, find time for fitness and self care and to indulge in some "me" time even if it takes me away from homework. This is our one life and we need to invest in it and enjoy it with one eye always on the future.

This sacrifice is for a finite time only. It will end and life will resume, but if you make the decision to go for it, throw yourself in wholeheartedly and realize that there will be sacrifices and hard work and some difficult decisions. I wish you luck in your decision making. Progress is never a step back, and moving forward will always take you somewhere new.

[Libby1987]

I can't speak to any of the fields in reference but one thing to consider in light of spending time, money and effort for the DNP and then not using it.. If you decide against using the degree, your current position puts you in a better position of paying it off than if you were to use it. Almost a win-win in an unconventional way. And it may seem a total waste but how could education ever be completely wasted?

I think you should defer a year, 1) So you can see how you like your current position after the honeymoon period 2) Throwing in the stress of school may cloud your perception of either.

[Bravemom]

I was an RN for nine years before I graduated as an FNP. I have been a nurse practitioner for six years now. Two in primary care and four years in cardiology. I feel like my work life balance is worse as an np. I work four ten hour shifts per week which are sometimes longer with the charting. Starting in the fall I will have to do hospital rounding on some weekends. My pay is not much more than I could make as an RN with my years of experience. Remember in a clinic job the work never ends. There are always phone calls from patients, refills to review and sign, and other paperwork to do. I feel like there is less flexibility as an NP. I miss being the expert. If I had it to do over again I wouldn't do it. Also since I've graduated and with the flood of online programs the market is saturated and it's hard to find something else. I don't think I had a great idea of the role when I went through school. It was just the next step I thought. Those are just my two cents I know there are plenty of NPs who love what they do.

[WestCoastSunRN, MSN, CNS]

Rocknurse, Yes.... the sacrifice is great, but you are right about it being finite. I'm glad you're pressing on. If I make the commitment then I, too, will need to delve fully in. Thanks for sharing the real-life struggles of it.

Libby, I like your logic! It's true... my current job is a good hedge in this situation -- financially speaking and otherwise. I never thought of it that way.

Bayecheri, Thank you for your honesty. I imagine that is hard for you to feel that way --- that you wouldn't do it again if you had the chance. It sounds like you are enjoying success, but at perhaps a higher cost than you had originally figured on? And that is why I want to be very sure of this before I proceed.