Conflicted

Ruby Vee, BSN · Oct 21, 2016

Whew! You've got a lot of variables in your decision.

First, let me say that bedside experience is the best thing you can have before entering NP school. I've worked with some of those NPs who have never spent time at the bedside and it is difficult. So many of them feel that their education puts them on a social strata above the mere bedside nurse and don't bother to listen to assessments, gut feelings or the voice of experience. A good NP will gather information wherever she can, including from the bedside nurse who has been with the patient for 46 hours this week.

NICU is a specialized area, and I'm not sure how easy it is to transfer out of that specialty as an NP. Can you do an extra practicum in seven years when you cannot STAND another underweight baby, shiney parent or needle stick on a neonate? If you decide you like the. Critical care aspect but not the babies, how hard is it to switch to an adult ICU? L & D? A clinic position? Some people are happy as clams for 40 years; others have to move around every few years. Which are you?

School can be done while pregnant, although it seems like a helluva lot of work. A close friend went to NP school over four years and delivered three healthy children during that time. Of course she had a husband with a high 6 figure income and a nanny or two. But it can be done with family support and the support of the ladies at church.

I'm afraid my personal stories may not be that helpful. I hated hated HATED nursing, and went to school to be an MBA. I worked full time, went to school full time and made lots of contacts and had some attractive job offers. As graduation neared, I had an epiphany -- I really didn't want to give up the ICU. School was more fun that anything else I could have done with the time or they money at that time, so I don't regret getting the MBA. But I can see where, with today's cost of tuition, if you finished a degree, incurring mountains of debt it would be damned awful to then find out you hate the job for which this degree has prepared you. Or in the words of my fecund friend, "I could have saved myself the time, aggravation and the debt and been just as happy staying here in the ICU.

The only story I have that could help you is this one: I wanted babies. I waited because I was young and my marriage was shaky. Then I got uterine cancer at 25 and the baby option was gone. Have your family, if that's what you want, and work the other stuff around that.

Hope this helps.

Libby1987 · Oct 21, 2016

You love your job and you're well on your way to becoming proficient. Having a job you can easily pull off and enjoy while raising a family is pretty ideal.

Unless you already have the future father of your children, choose to have kids with someone who can provide the health insurance and then work perdiem. A friend of mine made a very high wage working perdiem in the NICU choosing her own schedule while her fire fighter husband received outstanding benefits from his employer. She had the best of both worlds, great career and a flex schedule for her family.

Luckyyou, BSN, RN · Oct 21, 2016

I have yet to take care of vented baby by myself, give vasopressors or successfully get an IV in (though I have a few attempts).

Now is not the time to be taking on an advanced practice role. Also, what kind of unit are you in where you've been off of orientation for that long without a vented kid or even a little dribble of dopamine or something? Are they few and far between? Perhaps a different unit where that kind of thing is common would be helpful to experience before you're taking on the role of managing the care for those patients?

Coffee Nurse, BSN, RN · Oct 21, 2016

It is something I am passionate about and find fulfilling.

This, to me, is enough of a reason to stick with a job. And with some experience and seniority built up -- depending on the unit -- you should be able to get off some of those nights and holidays.

I also worry about the experience I am getting. I currently have nine months of experience in a level 3 with more than half being off orientation. I have yet to take care of vented baby by myself, give vasopressors or successfully get an IV in (though I have a few attempts).

If you haven't yet, this is the time to advocate for yourself to your charge nurses and manager. Explain that you want to grow and improve, and ask if there's anything they think you need to do before you start taking on more acute patients. Sometimes there's reservations they may have that haven't been communicated to you. Sometimes charge nurses only ever view certain people as competent to take on "sickies," and they need a push to realize you want to get in the game.

I look at the people going directly into np school without experience and am baffled. Maybe they are smarter than me, but I am terrified. NNPs practically run the unit and if the most senior nurse can't do something, it falls back on the NNP. I want to do right by these babies and be proficient.

You're right, and I think those people are wrong. I don't think it's that they're smarter than you, I think it's a case of them not knowing what they don't know. Especially for NNPs, you need to have a solid foundation of bedside knowledge before you even start to think about taking on an advanced practice role.

At the same time, I want babies of my own. I am 25. The program is almost three years. If I start next year, I will finish at 28/29. If I wait another year, it will be 29/30. I want two kids with the option of a third and feel the clock ticking.

This is a decision about priorities only you can make. When I was younger, I thought I'd be married with kids by 30. Well, I'll be 31 in a couple months, and I've only just got married, with no kids on the horizon for at least a couple years. I haven't gone back to school, but I am living and working in a foreign country, with more world travel under my belt than some people get in a lifetime. God willing, I'll still get my couple kids too - I'm certainly not an unusual demographic to be my age and childless so far. 25 is younger than you might feel it is right now.

cleback · Oct 21, 2016

If you are close to starting a family right now, would you be up for starting a family then waiting until the kids are in school to apply to NNP program? I am in an adult gero NP program... just had our first child this summer and hoping for two more before I graduate. Not going to sugar coat it--sometimes it really sucks. I was discharged from the hospital at 0830, had to run to school to give a presentation at 0900, then go back to the hospital to pick up the kiddo. I know others who have started their families during the program, so it's doable. But I also know a lot of women who waited until the kids were older and more independent, which seems like a smart option.

I just would be hesitant to wait to start a family. You really don't know what could happen and you may need to have time to get pregnant. GL!

ThePrincessBride, MSN, RN, NP · Oct 21, 2016

Now is not the time to be taking on an advanced practice role. Also, what kind of unit are you in where you've been off of orientation for that long without a vented kid or even a little dribble of dopamine or something? Are they few and far between? Perhaps a different unit where that kind of thing is common would be helpful to experience before you're taking on the role of managing the care for those patients?

The acuity just hasn't been there. Also, because there is such a high turnover rate, we have plenty of people on orientation. People on orientation get first dibs at higher acuity patients so they may get the exposure. Meanwhile, those of us just out of orientation are being stuck with feeder-growers and bubblers...they make up most of the unit. Other people have complained about the lack of acuity. For a level 3 unit, it often feels like a level 2/special care nursery.

ThePrincessBride, MSN, RN, NP · Oct 21, 2016

Ruby, thank you so much for your insight. I appreciate it.

I agree that bedside experience is crucial for advance practice nurses. I feel that the two-year full-time work requirement for NNPs is necessary. However, I am seeing some of my old classmates already applying for NP school, and some coworkers applying to other programs straight out of getting their RN license.

NICU is very specialized. NNPs would basically have to start all over if they wanted to switch specialties, and many would have to go back to bedside and get adult experience. I kept my med-surg job for that particular reason. I see many NICU nurses get burned out, tired of the inpatient schedule, etc, but are stuck because they never got the med/surg /adult experience.

Part of me thinks I would be happy with NICU forever...but then circumstances change. I can't say for sure.

With an MBA, don't you get more versatility? Did you ever get tired of ICU and decide to go into management or hospital administration, or did you always do bedside care?

You are right. School has gotten more expensive. The program I am looking into would put me at least 35k in the hole (unless I switch to a job with better tuition reimbursement) and it would have taken three years of my life. That's another reason I am leaning towards waiting another year after I have received more acute care experience.

I am so sorry to hear what you went through. I couldn't imagine going through something like that ever, especially no.

Whew! You've got a lot of variables in your decision.
First, let me say that bedside experience is the best thing you can have before entering NP school. I've worked with some of those NPs who have never spent time at the bedside and it is difficult. So many of them feel that their education puts them on a social strata above the mere bedside nurse and don't bother to listen to assessments, gut feelings or the voice of experience. A good NP will gather information wherever she can, including from the bedside nurse who has been with the patient for 46 hours this week.
NICU is a specialized area, and I'm not sure how easy it is to transfer out of that specialty as an NP. Can you do an extra practicum in seven years when you cannot STAND another underweight baby, shiney parent or needle stick on a neonate? If you decide you like the. Critical care aspect but not the babies, how hard is it to switch to an adult ICU? L & D? A clinic position? Some people are happy as clams for 40 years; others have to move around every few years. Which are you?
School can be done while pregnant, although it seems like a helluva lot of work. A close friend went to NP school over four years and delivered three healthy children during that time. Of course she had a husband with a high 6 figure income and a nanny or two. But it can be done with family support and the support of the ladies at church.
I'm afraid my personal stories may not be that helpful. I hated hated HATED nursing, and went to school to be an MBA. I worked full time, went to school full time and made lots of contacts and had some attractive job offers. As graduation neared, I had an epiphany -- I really didn't want to give up the ICU. School was more fun that anything else I could have done with the time or they money at that time, so I don't regret getting the MBA. But I can see where, with today's cost of tuition, if you finished a degree, incurring mountains of debt it would be damned awful to then find out you hate the job for which this degree has prepared you. Or in the words of my fecund friend, "I could have saved myself the time, aggravation and the debt and been just as happy staying here in the ICU.
The only story I have that could help you is this one: I wanted babies. I waited because I was young and my marriage was shaky. Then I got uterine cancer at 25 and the baby option was gone. Have your family, if that's what you want, and work the other stuff around that.
Hope this helps.

ThePrincessBride, MSN, RN, NP · Oct 21, 2016

If you haven't yet, this is the time to advocate for yourself to your charge nurses and manager. Explain that you want to grow and improve, and ask if there's anything they think you need to do before you start taking on more acute patients. Sometimes there's reservations they may have that haven't been communicated to you. Sometimes charge nurses only ever view certain people as competent to take on "sickies," and they need a push to realize you want to get in the game.

That could be the case, but there just aren't many super sick babies and when there are, they end up with the more senior nurses.

I do like traveling as well and if I don't go to grad school next year, I will use some PTO to take a few international trips. Might as well!

Ruby Vee, BSN · Oct 22, 2016

Ruby, thank you so much for your insight. I appreciate it.
I agree that bedside experience is crucial for advance practice nurses. I feel that the two-year full-time work requirement for NNPs is necessary. However, I am seeing some of my old classmates already applying for NP school, and some coworkers applying to other programs straight out of getting their RN license.
NICU is very specialized. NNPs would basically have to start all over if they wanted to switch specialties, and many would have to go back to bedside and get adult experience. I kept my med-surg job for that particular reason. I see many NICU nurses get burned out, tired of the inpatient schedule, etc, but are stuck because they never got the med/surg /adult experience.
Part of me thinks I would be happy with NICU forever...but then circumstances change. I can't say for sure.
With an MBA, don't you get more versatility? Did you ever get tired of ICU and decide to go into management or hospital administration, or did you always do bedside care?
You are right. School has gotten more expensive. The program I am looking into would put me at least 35k in the hole (unless I switch to a job with better tuition reimbursement) and it would have taken three years of my life. That's another reason I am leaning towards waiting another year after I have received more acute care experience.
I am so sorry to hear what you went through. I couldn't imagine going through something like that ever, especially no.

I never got tired of the ICU or regretted not using my MBA. I never regretting getting the MBA, either, because it kept me busy and focused at a time when I was leaving an abusive marriage and might otherwise have been floundering. I had classmates who thought I was brilliant, contacts who offered me great jobs and friends who kept me from feeling the loneliness I might otherwise have dealt with at the time; I was blessed.

There were a couple of times over my career when I thought I might want to leave the ICU -- once I got over it and the second time, I took a job teaching CNAs. I loved the teaching (except for the hours) but my time in clinical on my unit with the CNAs reminded me that ICU was my first love. I worked through the semester and went back to the ICU just in time to work Christmas Day with all my ICU buddies. I loved it! (OK, that makes me weird, but my husband was working with all of HIS buddies, so maybe not that weird!).

Your former classmates who are going through NP school now may find themselves without adequate experience or clinical judgement when they become independent NPs, and they will certainly find themselves lacking in respect from the RNs who have been at the bedside for a few years. Be proud of yourself that you are not emulating their poor example.

You're relatively new in NICU now, and that's an uncomfortable place to be. When you were on orientation, you got the sick babies, but now that. You're off orientation, they go to the orientees. You haven't been there long enough to even be a preceptor yet. Once your management and colleagues are sure of you and your desire to stay for awhile (because frankly, why waste the 'good assignments" on someone who is only going to leave relatively soon instead of advancing a nurse who may stay and become a senior nurse and preceptor?) you will start getting the more challenging assignments. The trick is to stop talking about your NP aspirations and behave as though you're going to stay for years and years. Then you will become one of the nurses groomed for precepting, charge and challenging assignments. After you've reached that level and enjoyed it for awhile, you'll be ready for the NP role.

Ruby Vee, BSN · Oct 22, 2016

That could be the case, but there just aren't many super sick babies and when there are, they end up with the more senior nurses.
I do like traveling as well and if I don't go to grad school next year, I will use some PTO to take a few international trips. Might as well!

Travel! You will never regret the time and money you spent on travel, and you learn so much. You may never be in a position to travel again, so if you are now, take advantage.

It is so cool to go to the movies and see places we've been (or might like to go.). We decided to go to Paris on an impulse after watching a Pierce Brosnan movie shot partially in Paris. We went in January, it was cheap and there were no lines. Best of all, the weather inside the museums was still great!