I know this is a topic that has been brought up many times on allnurses, but I am hoping this thread will give me additional insight. I am a 30-year-old male who has 10 years of Paramedic experience in a busy 911 system and 6 months of experience as an RN in a rural surgical ICU. I live in a rural area around San Antonio, Texas. I transitioned from paramedic to RN so that I could better provide for my family and still work in healthcare. I have found my RN experience enjoyable so far but have found myself contemplating the next step in my career. I entered nursing with the idea that I would work in the field to pay my dues and learn the nursing role; then transition to an advanced practice role such as NP, or CRNA.
Truth be told I had a preference for either working as an NP in the ED or Urgent Care setting, however after looking at the current saturation in the job market as well as the estimate that the job market will worsen over the next decade, I have become concerned with pursuing this route. I learned about the CRNA role more recently and I am investigating it currently, but it does have a big barrier of entry for me as I am the sole income earner for my family and do not live near a CRNA program (the huge debt burden scares me a lot.) I am hoping to gain wisdom and insight from people who currently work as advanced practice nurses and know better than I do searching through info on the internet.
If you are willing and able to answer I want to know if it is still worth pursuing an FNP, or AGACNP degree? Do you believe that this career is one that will sustain my family to retirement, or is the saturation heading to a point where I would be better off staying an RN, or pursuing CRNA? I want to make career moves now, so that I am the most prepared I can be for my career.
Specializes in Psychiatric and Mental Health NP (PMHNP).
2 hours ago, Tegridy said:
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.
I don't know if most RNs who become NPs do so for the wrong reasons, but I agree that many do. However, that is a very different perspective than there is going to be some huge crash in demand for NPs.
Interestingly, this may be an argument in favor of going straight for the NP w/o working as an RN first, which is what I did.
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.
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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."
"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."
"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. "
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:
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.
Jobs aren't hard to find. Good salaries are though especially when there is some new NP who will take 85k while your MD colleague doing the same job makes 285k. This hurts the professions immensely. I work inpatient and am already capped at my salary for the hospital system. If I quit or advocate for higher wages I can easily get replaced.
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.
Basically this, I am not sub 100k but I did do a residency and have worked alongside residents constantly. Sucks to see them graduate while we did the same work and their starting jobs are 150k more than mine. I get they did med school and should make more but it's demoralizing nonetheless to see that big of a gap when travel nurses out earn me at this point. CRNA seems to be the best bang for your buck for those young nurses out there.
Specializes in Former NP now Internal medicine PGY-3.
2 hours ago, Numenor said:
Basically this, I am not sub 100k but I did do a residency and have worked alongside residents constantly. Sucks to see them graduate while we did the same work and their starting jobs are 150k more than mine. I get they did med school and should make more but it's demoralizing nonetheless to see that big of a gap when travel nurses out earn me at this point. CRNA seems to be the best bang for your buck for those young nurses out there.
CRNA probably best bang for buck in healthcare, at least for direct clinical work.
Specializes in Former NP now Internal medicine PGY-3.
2 hours ago, Numenor said:
Jobs aren't hard to find. Good salaries are though especially when there is some new NP who will take 85k while your MD colleague doing the same job makes 285k. This hurts the professions immensely. I work inpatient and am already capped at my salary for the hospital system. If I quit or advocate for higher wages I can easily get replaced.
Travel nurses dwarf my salary at this point.
some of the travelers here out earning hospitalists and hospitalist in my area rake it in. It's insane. Id love to make 300k to page for stool softeners at 3 am LOL
Specializes in Psychiatric and Mental Health NP (PMHNP).
10 hours ago, Tegridy said:
some of the travelers here out earning hospitalists and hospitalist in my area rake it in. It's insane. Id love to make 300k to page for stool softeners at 3 am LOL
I think NP pay varies a lot by location and speciality. As a new grad NP, I worked in a rural area in California and made $125K my first year. After 1.5 years, I was being offered primary care jobs in the $130K to $140K range. I was also offered pain managment jobs in the $150K to $160K range. I ended up earning my PMHNP and after 1.5 years of mental health experience, just got a raise to $187K per year. As far as I am concerned, all those were well-paying jobs.
While some may feel there is a big gap between NP and MD pay, MDs also have much more time and expense involved in their education and training. Average medical school debt is $300K and it takes a minimum of 6 years to become a primary care MD. So I would say NP pay of $100K+ is fair, given it takes 2 years to become an FNP.
I think NP pay varies a lot by location and speciality. As a new grad NP, I worked in a rural area in California and made $125K my first year. After 1.5 years, I was being offered primary care jobs in the $130K to $140K range. I was also offered pain managment jobs in the $150K to $160K range. I ended up earning my PMHNP and after 1.5 years of mental health experience, just got a raise to $187K per year. As far as I am concerned, all those were well-paying jobs.
While some may feel there is a big gap between NP and MD pay, MDs also have much more time and expense involved in their education and training. Average medical school debt is $300K and it takes a minimum of 6 years to become a primary care MD. So I would say NP pay of $100K+ is fair, given it takes 2 years to become an FNP.
This is pretty limited thinking. 1. You are in CA. 2. PMHNP is niche and paid more because there is a severe lack of providers. You have to want to be in this area.
For 95% of other NPs, we are expected to fulfill the role of MD (at least at my job I take the same patient burden with little MD oversight) and I am paid barely more than a 10-year RN and not even close to a traveler's salary.
Keep in mind my job pays some of the highest salaries in the city...while my year residency might easily land me a job it doesn't command a higher salary
Make no mistake we are getting played. I recommend new nurses wanting to go into the APRN route to look at the CRNA role. They are compensated for how they perform and what they bring to the table.
I think NP pay varies a lot by location and speciality. As a new grad NP, I worked in a rural area in California and made $125K my first year. After 1.5 years, I was being offered primary care jobs in the $130K to $140K range. I was also offered pain managment jobs in the $150K to $160K range. I ended up earning my PMHNP and after 1.5 years of mental health experience, just got a raise to $187K per year. As far as I am concerned, all those were well-paying jobs.
While some may feel there is a big gap between NP and MD pay, MDs also have much more time and expense involved in their education and training. Average medical school debt is $300K and it takes a minimum of 6 years to become a primary care MD. So I would say NP pay of $100K+ is fair, given it takes 2 years to become an FNP.
I would like to point out that a nursing degree takes 4 years. Many nurses practice for many years before entering NP schooling which is another 2-3 years depending if you get masters or doctorates. Studies have shown shown similar patient outcomes. Longer doesn’t always mean better. APRNs should demand appropriate compensation for their experience, education and training.
Specializes in Former NP now Internal medicine PGY-3.
3 hours ago, FullGlass said:
I think NP pay varies a lot by location and speciality. As a new grad NP, I worked in a rural area in California and made $125K my first year. After 1.5 years, I was being offered primary care jobs in the $130K to $140K range. I was also offered pain managment jobs in the $150K to $160K range. I ended up earning my PMHNP and after 1.5 years of mental health experience, just got a raise to $187K per year. As far as I am concerned, all those were well-paying jobs.
While some may feel there is a big gap between NP and MD pay, MDs also have much more time and expense involved in their education and training. Average medical school debt is $300K and it takes a minimum of 6 years to become a primary care MD. So I would say NP pay of $100K+ is fair, given it takes 2 years to become an FNP.
I agree it is. high 100s is great money, low 100s is eh a level of pay reachable by many other less headache-ish careers. I guess comparing to PCP MD though I think most are offering us like close to 3 to start (I don't want to do primary anyway but if I had to…) and I think one of my buds signed for like 365 + 20k loan repay + 20k yearly bonus+ some light RVU bonus for psychiatry. not quite sure on schedule but it has like 8 weekend calls per year built in. 14 ppd. not bad. better than primary MD offers. Of course you have the headache of psych patients but then again what’s the diff most our primary patients have them also
Specializes in Former NP now Internal medicine PGY-3.
58 minutes ago, matthewandrew said:
I would like to point out that a nursing degree takes 4 years. Many nurses practice for many years before entering NP schooling which is another 2-3 years depending if you get masters or doctorates. Studies have shown shown similar patient outcomes. Longer doesn’t always mean better. APRNs should demand appropriate compensation for their experience, education and training.
But if you look at the metrics covered its the simplest of things to manage that yes you do not need an MD to manage and a 4th year med student could probably cover the metrics they studied. I doubt nursing experience helps much, at least it doesn’t the ones I know. Throw a 20 year seasoned nurse into a hospitalist role and their head will spin even though they spent the last 20 years “saving patients.”
Specializes in Psychiatric and Mental Health NP (PMHNP).
18 minutes ago, Tegridy said:
But if you look at the metrics covered its the simplest of things to manage that yes you do not need an MD to manage and a 4th year med student could probably cover the metrics they studied. I doubt nursing experience helps much, at least it doesn’t the ones I know. Throw a 20 year seasoned nurse into a hospitalist role and their head will spin even though they spent the last 20 years “saving patients.”
FullGlass, BSN, MSN, NP
2 Articles; 1,939 Posts
I don't know if most RNs who become NPs do so for the wrong reasons, but I agree that many do. However, that is a very different perspective than there is going to be some huge crash in demand for NPs.
Interestingly, this may be an argument in favor of going straight for the NP w/o working as an RN first, which is what I did.