Considering becoming an APRN

Tegridy · Oct 31, 2021

I am not sure if the juice is worth the squeeze for any advanced practice specialty besides CRNA. If you can deal for a few years the payoff would be much more than NP. CRNA market is much better than NP in most locations, even if you can more easily coast through the process for NP, if the end goal isn't even worth it then why bother.

RNmedic92 · Oct 31, 2021

I appreciate the response, that has been a thought of mine. I fear that NP's will become so replaceable that I would have no job security in the future. I feel like eventually even all of the rural areas will become saturated.

Tegridy · Oct 31, 2021

Not much for jobs in my area for NPs, they still need CRNAS though, I mean it was bad enough for me to go back and slug through med school. take it from me its not worth it being an NP at this point. CRNA would be best option if you are looking to progress, otherwise bedside nursing or trying to get into management.

FullGlass, BSN, MSN, NP · Nov 2, 2021

I disagree with this constant refrain of oversaturation. There is still a great need for NPs, especially in rural areas. Granted, opportunities will vary by location. The key is being willing to relocate. If you don't want to relocate, then try to talk to NPs and employers in your area to learn their hiring needs. I say FNP is the most versatile. There is also a great need for PMHNPs. The advantage of PMHNP is you can work remotely.

I don't agree that NPs are "replaceable." Good employers want to keep good providers! It costs an organization a lot of money to recruit and train providers, so they do not want high turn over. High turn over indicates a crappy place to work.

What is the macro trend right now that will greatly influence demand for NPs? People are moving, in large numbers, because many people can now work remotely. They are leaving the largest, most expensive cities, and moving to smaller cities, towns, and even rural areas! That means demand for healthcare will increase in those areas.

"

The physician shortage is predicted to grow in the next 10 years, which could mean bad news, especially for those living in rural areas.

The good news is, the number of nurse practitioners has grown in the last few years.

“We have a population that is getting older, and so the need for primary care providers is going to increase,” said Holly Jeffreys, head of the nursing department at West Texas A&M University. To make matters worse, the Association of American Medical Colleges (AAMC) predicts that by 2030 there will be a deficit of more than 40,000 primary care physicians. A problem that’s even worse in rural areas. According to Callie Land, family nurse practitioner at Family Care Panhandle, family nurse practitioners have been picking up the slack in care."

https://www.newschannel10.com/2021/06/21/tx-panhandle-nurse-practitioners-helping-bridge-gap-physician-shortage/

"The need for nurse practitioners in Texas has surged in recent years. While every state has a need, none have grown as fast in population as Texas. That expanding population is helping drive the need for more healthcare operations and more nurse practitioners. State leaders understand the issue. The state Legislature formed the Texas Center for Nursing Workforce Studies to better understand the scope of the issue and develop ways to solve the shortage program. The center now projects a shortage of 60,000 nurses in Texas by 2030. Some estimates put that number closer to 71,000. Those who earn a Master of Science in Nursing are prepared for an in-demand career as a nurse practitioner. Federal projections call for an astounding 43.8% growth in the number of nurse practitioners in Texas between 2018 and 2028, far above the national average of 26%.

What Drives Nurse Practitioner Growth in Texas

Many factors drive the need for nurse practitioners in Texas. Like the entire country, the population in Texas is aging, which leads to the need for more healthcare services for seniors.

Population Growth in Texas

Texas ranks as the second most populated state in the country, behind only California. Between mid-2018 and mid-2019, the state’s population grew by 367,000, resulting in almost 29 million people calling Texas home. This is at a time when population growth is slowing across the nation as a whole.

Rural Areas Need Nurses

Texas is home to four of the Top 30 largest metro areas in the United States: Dallas-Fort Worth (4th), Houston (5th), San Antonio (24th) and Austin (30th). The need for nurses in these metro areas is high. However, the state is so large that much of it is still considered low density and rural. Nurse practitioners increasingly provide services to these areas, much like those provided by general practitioner doctors in the past, according to a study published online by the National Institutes of Health.

Rising Number of Chronic Illnesses

As with the rest of the country, Texas residents have experienced an increased number of diagnoses for diseases such as adult-onset diabetes and obesity.

Aging Workforce

Nationwide, the nursing workforce is aging. According to the Texas Medical Center, the largest medical center in the world, the average age of nurses is 56. That means about 25% of workers will retire within 10 years.

Why Become a Nurse Practitioner in Texas?

Becoming a nurse practitioner in Texas has many advantages.

The demand for nurse practitioners is higher than in any other state.

Cutting edge education. HBU is affiliated with the Texas Medical Center, giving students opportunities for experience while they are in the program and career advancement after they graduate.

Big markets for nurses. The Dallas and Houston metro areas both rank in the Top 10 areas for the highest employment of nurse practitioners.

Better salaries. The average annual salary for a nurse in Texas is $111,060, higher than the national average."

https://onlinenursing.hbu.edu/MSN/the-growth-of-nurse-practitioners-in-texas/

"The state’s demand for nurse practitioners is expected to grow 46.3% — from 13,826 in 2015 to 20,227 by 2030. According to the Texas Center for Nursing Workforce Studies, approximately 25% of the demand will not be met. In Texas, demand for certified nurse-midwives is projected to show an unmet need of 80% by 2030. "

https://www.dmagazine.com/healthcare-business/2021/03/solving-texas-nursing-shortage/

Here is a link to a study by the State of Texas:

https://dshs.texas.gov/chs/cnws/WorkforceReports/2020-Updated-Nurse-Supply-and-Demand-Projections.pdf

While this analysis indicates an oversupply of CRNAs and NPs (except for CNMs}, this is a PROJECTION and "Demand projections are based on current national health care use and delivery patterns. As access to care changes and models of care transform, health care use and delivery patterns may change the demand for nurses over time." Please note that Texas is one of the most popular states for people relocating from other states.

This is a very interesting site by the State of Texas:

https://healthdata.dshs.texas.gov/dashboard/healthcare-workforce/workforce-supply-and-demand-projections

The above site indicates a shortage of MDs. So who is going to fill that gap? NPs and PAs.

Finally, if you truly want to be an NP, then go for it. Even if there is actually "oversaturation," the best will get hired. Plan to be one of the best.

I am so sick of the fear promoted on this forum. I plan to be the best and I generally do not have trouble finding a job. There are way more actors and actresses than acting jobs. The best do not let this deter them.

Plan to win and you will win.

Tegridy · Nov 2, 2021

I wouldn't work as a provider for 100k, not worth the risk nor the time it takes to keep reasonably up to date. I would still do CRNA or NP. I agree the best will usually get hired but most NPs are not the "best" and this isn't the business world where you can easily have your metrics and outcomes measured on an individual basis. There is a lot of "suck" in medicine in general and all types of providers can skid by low-key sucking while those who do well technically do not always get the better job. I can't recommend NP school for what it pays vs the amount of work one has to do. They have trouble finding docs to fill primary care spots for 4.5 days a week 250-350k per year because it can be such a headache.

FullGlass, BSN, MSN, NP · Nov 2, 2021

6 minutes ago, Tegridy said:

I wouldn't work as a provider for 100k, not worth the risk nor the time it takes to keep reasonably up to date. I would still do CRNA or NP. I agree the best will usually get hired but most NPs are not the "best" and this isn't the business world where you can easily have your metrics and outcomes measured on an individual basis. There is a lot of "suck" in medicine in general and all types of providers can skid by low-key sucking while those who do well technically do not always get the better job. I can't recommend NP school for what it pays vs the amount of work one has to do. They have trouble finding docs to fill primary care spots for 4.5 days a week 350-350k per year because it can be such a headache.

The average pay for an NP in TX is $111K per year, which is good money. That means a lot of NPs in TX will make more than that. In addition, pay varies by speciality. I do not understand your negativity. I started out in primary care and did not find it stressful. I learned to chart as I went, and was done working by 5:30 pm every day. I didn't have any on call requirements. So when I was done working, I was done. This was far less stressful than my previous business career, when I was expected to be available 24/7.

I think bedside nursing is very difficult and it is a physical job. I have treated a lot of RNs for serious chronic pain due to their job; some have become permanently disabled. NP jobs are not that physical.

I am now working in mental health, and the same is true. I do my 8.5 hours (say 30 minutes over 8 hours for charting and admin) and I am done. I am also making $187K per year now, which I think is very good $.

Again, I am appalled at how many people on this forum seem to think they should be guaranteed a job. We live in a competitive society. I plan to be at the top of my game and to be competitive. People who can't handle that - I have no idea how they expect to get any job. Even someone working a minimum wage job has to apply, go through the seleciton process, etc.

It is not necessary to spend a huge sum of $ to become an NP. There are plenty of reputable state schools that are a reasonable cost. There are also scholarships and loan repayment programs. I know NPs that worked their way through school as RNs and had no debt.

Perhaps you should find another line of work.

Tegridy · Nov 2, 2021

Let's be honest right now anyone will hire any warm body off the street for most entry level jobs..

But nonetheless 100k is a good salary but relative to CRNA its not. Primary care for physicians is a good job compared to most, but relative to specializing or just doing hospitalist work it can be hard to compete (until more recently since places are paying stupid money for physician PCPs). So speaking relative to other medical specialties (ignoring surgical ones) Primary care is still a headache. Relative to most other jobs, it probably isn't. I would do it if I found a gem gig or had to, otherwise nah, hospitalist is more lifestyle friendly, and if you can manage working nights (I don't mind) $$$$$$$$$$$$$ and interesting medical cases

FullGlass, BSN, MSN, NP · Nov 2, 2021

1 hour ago, Tegridy said:

Let's be honest right now anyone will hire any warm body off the street for most entry level jobs..

But nonetheless 100k is a good salary but relative to CRNA its not. Primary care for physicians is a good job compared to most, but relative to specializing or just doing hospitalist work it can be hard to compete (until more recently since places are paying stupid money for physician PCPs). So speaking relative to other medical specialties (ignoring surgical ones) Primary care is still a headache. Relative to most other jobs, it probably isn't. I would do it if I found a gem gig or had to, otherwise nah, hospitalist is more lifestyle friendly, and if you can manage working nights (I don't mind) $$$$$$$$$$$$$ and interesting medical cases

I'm glad you like being a hospitalist. However, many people do not want to work nights, or are unable to, due to other personal obligations.

As I previously stated, I did not find primary care to be a "headache."

Most jobs that pay $100K or more are not easy - if they were easy the pay would be less. There seems to be a perception among many on this site that being an NP is super difficult. It is not. Other professions require far longer work hours, like business executive, lawyer, etc.

There are plenty of NP jobs and specialities with normal hours and little to no overtime.

In terms of stress, I feel that primary care or outpatient specialities are relatively low stress because it is highly unlikely a patient will die on you. That is far more likely to happen in an in-patient setting, which I would find very stressful emotionally.,

Healthcare is a great field and there are plenty of opportunities now and in the future.

RNmedic92 · Nov 5, 2021

On 11/2/2021 at 6:32 PM, FullGlass said:

I'm glad you like being a hospitalist. However, many people do not want to work nights, or are unable to, due to other personal obligations.

As I previously stated, I did not find primary care to be a "headache."

Most jobs that pay $100K or more are not easy - if they were easy the pay would be less. There seems to be a perception among many on this site that being an NP is super difficult. It is not. Other professions require far longer work hours, like business executive, lawyer, etc.

There are plenty of NP jobs and specialities with normal hours and little to no overtime.

In terms of stress, I feel that primary care or outpatient specialities are relatively low stress because it is highly unlikely a patient will die on you. That is far more likely to happen in an in-patient setting, which I would find very stressful emotionally.,

Healthcare is a great field and there are plenty of opportunities now and in the future.

On 11/2/2021 at 11:37 AM, FullGlass said:

I disagree with this constant refrain of oversaturation. There is still a great need for NPs, especially in rural areas. Granted, opportunities will vary by location. The key is being willing to relocate. If you don't want to relocate, then try to talk to NPs and employers in your area to learn their hiring needs. I say FNP is the most versatile. There is also a great need for PMHNPs. The advantage of PMHNP is you can work remotely.

I don't agree that NPs are "replaceable." Good employers want to keep good providers! It costs an organization a lot of money to recruit and train providers, so they do not want high turn over. High turn over indicates a crappy place to work.

What is the macro trend right now that will greatly influence demand for NPs? People are moving, in large numbers, because many people can now work remotely. They are leaving the largest, most expensive cities, and moving to smaller cities, towns, and even rural areas! That means demand for healthcare will increase in those areas.

"

The physician shortage is predicted to grow in the next 10 years, which could mean bad news, especially for those living in rural areas.

The good news is, the number of nurse practitioners has grown in the last few years.

“We have a population that is getting older, and so the need for primary care providers is going to increase,” said Holly Jeffreys, head of the nursing department at West Texas A&M University.  To make matters worse, the Association of American Medical Colleges (AAMC) predicts that by 2030 there will be a deficit of more than 40,000 primary care physicians.  A problem that’s even worse in rural areas.  According to Callie Land, family nurse practitioner at Family Care Panhandle, family nurse practitioners have been picking up the slack in care."

https://www.newschannel10.com/2021/06/21/tx-panhandle-nurse-practitioners-helping-bridge-gap-physician-shortage/

"The need for nurse practitioners in Texas has surged in recent years. While every state has a need, none have grown as fast in population as Texas. That expanding population is helping drive the need for more healthcare operations and more nurse practitioners.  State leaders understand the issue. The state Legislature formed the Texas Center for Nursing Workforce Studies to better understand the scope of the issue and develop ways to solve the shortage program. The center now projects a shortage of 60,000 nurses in Texas by 2030. Some estimates put that number closer to 71,000.  Those who earn a Master of Science in Nursing are prepared for an in-demand career as a nurse practitioner. Federal projections call for an astounding 43.8% growth in the number of nurse practitioners in Texas between 2018 and 2028, far above the national average of 26%.

What Drives Nurse Practitioner Growth in Texas

Many factors drive the need for nurse practitioners in Texas. Like the entire country, the population in Texas is aging, which leads to the need for more healthcare services for seniors.

Population Growth in Texas

Texas ranks as the second most populated state in the country, behind only California. Between mid-2018 and mid-2019, the state’s population grew by 367,000, resulting in almost 29 million people calling Texas home. This is at a time when population growth is slowing across the nation as a whole.

Rural Areas Need Nurses

Texas is home to four of the Top 30 largest metro areas in the United States: Dallas-Fort Worth (4th), Houston (5th), San Antonio (24th) and Austin (30th). The need for nurses in these metro areas is high. However, the state is so large that much of it is still considered low density and rural. Nurse practitioners increasingly provide services to these areas, much like those provided by general practitioner doctors in the past, according to a study published online by the National Institutes of Health.

Rising Number of Chronic Illnesses

As with the rest of the country, Texas residents have experienced an increased number of diagnoses for diseases such as adult-onset diabetes and obesity.

Aging Workforce

Nationwide, the nursing workforce is aging. According to the Texas Medical Center, the largest medical center in the world, the average age of nurses is 56. That means about 25% of workers will retire within 10 years.

Why Become a Nurse Practitioner in Texas?

Becoming a nurse practitioner in Texas has many advantages.

The demand for nurse practitioners is higher than in any other state.

Cutting edge education. HBU is affiliated with the Texas Medical Center, giving students opportunities for experience while they are in the program and career advancement after they graduate.

Big markets for nurses. The Dallas and Houston metro areas both rank in the Top 10 areas for the highest employment of nurse practitioners.

Better salaries. The average annual salary for a nurse in Texas is $111,060, higher than the national average."

https://onlinenursing.hbu.edu/MSN/the-growth-of-nurse-practitioners-in-texas/

"The state’s demand for nurse practitioners is expected to grow 46.3% — from 13,826 in 2015 to 20,227 by 2030. According to the Texas Center for Nursing Workforce Studies, approximately 25% of the demand will not be met. In Texas, demand for certified nurse-midwives is projected to show an unmet need of 80% by 2030. "

https://www.dmagazine.com/healthcare-business/2021/03/solving-texas-nursing-shortage/

Here is a link to a study by the State of Texas:

https://dshs.texas.gov/chs/cnws/WorkforceReports/2020-Updated-Nurse-Supply-and-Demand-Projections.pdf

While this analysis indicates an oversupply of CRNAs and NPs (except for CNMs}, this is a PROJECTION and "Demand projections are based on current national health care use and delivery patterns. As access to care changes and models of care transform, health care use and delivery patterns may change the demand for nurses over time." Please note that Texas is one of the most popular states for people relocating from other states.

This is a very interesting site by the State of Texas:

https://healthdata.dshs.texas.gov/dashboard/healthcare-workforce/workforce-supply-and-demand-projections

The above site indicates a shortage of MDs. So who is going to fill that gap? NPs and PAs.

Finally, if you truly want to be an NP, then go for it. Even if there is actually "oversaturation," the best will get hired. Plan to be one of the best.

I am so sick of the fear promoted on this forum. I plan to be the best and I generally do not have trouble finding a job. There are way more actors and actresses than acting jobs. The best do not let this deter them.

Plan to win and you will win.

Sorry for my delay in responding, busy week of OT. I appreciate such a detailed analysis! Do you believe that the NP market will stabilize in the next 10 years? Everything I have read on this forum and others suggest that the NP market is heading for a huge crash. I understand that forums generally attract people who are unsatisfied and that the best NP's will usually head to the top, but there are so many different types of "best." You have the best clinicians, the best networkers, and the best at being just plain lucky. Not to mention the multitude of factors at play such as area, specialization and school selection. If I enter the NP profession I plan to select a good school, to be prepared to move and to work in more rural locations. Hopefully I can attend a residency. My fear is that one day, that might not be enough to secure a good job. To be specific a job that pays 95k plus and is not abusive.

You seem to be a huge advocate for the profession and you also seem to be well informed about things related to the NP profession. With what you know, do you think FNP or AGACNP is more likely to have job security in the future? I also was wondering if schools like Texas Tech, while reputable by name, but don't provide clinicals for the student are good choices for education?

FullGlass, BSN, MSN, NP · Nov 5, 2021

3 hours ago, RNmedic92 said:

You seem to be a huge advocate for the profession and you also seem to be well informed about things related to the NP profession. With what you know, do you think FNP or AGACNP is more likely to have job security in the future? I also was wondering if schools like Texas Tech, while reputable by name, but don't provide clinicals for the student are good choices for education?

I don't believe that there is going to be some crash in the NP market. That is ridiculous. Are people suddenly not going to need healthcare?

This is why there will be a good demand for healthcare and NPs:

1. Aging population needs more healthcare

2. The increase in chronic disease in our population requires more healthcare

3. The Echo Boom generation is getting into middle age, and they will start to need more health care

4. There is a shortage of primary care MDs, and this is likely only going to get worse.

5. More and more states are providing FPA for NPs, and this number is only going to increase

Rural areas are an excellent choice, especially if you are willing to relocate. Very few providers are willing to work in such areas, and they usually pay a premium to attract providers. This is true in EVERY state. I'm in California and this state pays NPs the most. If you want to live and work in a rural area, it is quite affordable, especially since you would be making excellent $.

I just don't know much about acute care. I would say for ambulatory care these would be the specialties with the most opportunities:

1. FNP

2. PMHNP - you can work remotely! Higher pay

3. Pain management - no one wants to do it so there is a shortage and it pays extremely well

For acute care, I think CRNA is an excellent choice.

I would say do what you love! What are you passionate about?

Also, please do not become an NP just to advance your career. There are many ways for an RN to advance besides becoming an NP. RNs can become specialists, First Assist, case managers, supervisors, managers, and even executives.

Become an NP if you truly want the responsibility and challenge of diagnosing and developing treatment plans for patients. There are many RNs on this forum that regret becoming NPs because they don't want to assess, diagnose, treat, etc., b/c they find it too stressful. I love it!

In the ambulatory care world, most providers work five 8-hr days or four 10-hr days. If you really want to work a 12 hour day, then acute care is the way to go.

Best wishes

Tegridy · Nov 6, 2021

22 hours ago, FullGlass said:

I don't believe that there is going to be some crash in the NP market. That is ridiculous. Are people suddenly not going to need healthcare?

This is why there will be a good demand for healthcare and NPs:

1. Aging population needs more healthcare

2. The increase in chronic disease in our population requires more healthcare

3. The Echo Boom generation is getting into middle age, and they will start to need more health care

4. There is a shortage of primary care MDs, and this is likely only going to get worse.

5. More and more states are providing FPA for NPs, and this number is only going to increase

Rural areas are an excellent choice, especially if you are willing to relocate. Very few providers are willing to work in such areas, and they usually pay a premium to attract providers. This is true in EVERY state. I'm in California and this state pays NPs the most. If you want to live and work in a rural area, it is quite affordable, especially since you would be making excellent $.

I just don't know much about acute care. I would say for ambulatory care these would be the specialties with the most opportunities:

1. FNP

2. PMHNP - you can work remotely! Higher pay

3. Pain management - no one wants to do it so there is a shortage and it pays extremely well

For acute care, I think CRNA is an excellent choice.

I would say do what you love! What are you passionate about?

Also, please do not become an NP just to advance your career. There are many ways for an RN to advance besides becoming an NP. RNs can become specialists, First Assist, case managers, supervisors, managers, and even executives.

Become an NP if you truly want the responsibility and challenge of diagnosing and developing treatment plans for patients. There are many RNs on this forum that regret becoming NPs because they don't want to assess, diagnose, treat, etc., b/c they find it too stressful. I love it!

In the ambulatory care world, most providers work five 8-hr days or four 10-hr days. If you really want to work a 12 hour day, then acute care is the way to go.

Best wishes

I think, or more than likely we both think, correct me if not so, that MOST people who become NPs probably shouldn't since its not an escape from the bedside and many do it for the wrong reasons. Many underestimate the knowledge gap between an RN and a provider and seem to think they "pick it up at work" following orders. But once they hold the candle, they realize it is not so and burn out.

Example: on an ICU rotation we had a couple FNPs who were nurses for a while (maybe they were ACGNP not sure), non the less they had been in healthcare a while, yet, the transition from bedside to provider was still very stressful to them. I think most nurses just underestimate the difference unfortunately and think its easy to call the shots in the hospital.

I still wouldn't want all the responsibility of a provider for sub 100k which is what most people in anywhat desirable places tend to start at.