Considering becoming an APRN

[RNmedic92]

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.

 Thank you in advance for your time!

[FullGlass, BSN, MSN, NP]

1 hour 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. 

So does a medical degree.

BSN RN = 4 years undergrad

FNP = 2 years grad

Total = 6 years

Internship = 0

Residency = 0

 

Medical Doctor - assume primary care

4 years undergrad

3-4 years med school

1 year internship

1-2 year residency

Total = 10-12 years

In addition, the medical education is MUCH harder and it is also a lot harder to get into med school.  On average, doctors are smarter than RNs or NPs.

No one here is saying what they think NPs should make.  What they make in California? 

I'd also like to point out that primary care MDs do not make huge sums of money compared to specialists, which is why so few medical students are choosing primary care.  The average salary for a primary care MD in California is $216K, not much more than I make!

https://www.ziprecruiter.com/Salaries/What-Is-the-Average-Primary-Care-Physician-Salary-by-State

Personally, and this is just my opinion, I think we are moving towards almost all primary care being provided by NPs and PAs, simply b/c not enough med students can afford primary care as a career choice.  And if indeed NPs are getting fairly similar results, that makes sense.  I do see a need for MDs to serve as mentors and "subject matter experts," but our current health delivery model does not easily lend itself to that.

I also think we should have NP residencies.  I sure wish I had one.

As for RN experience, that does not matter for the NP.  There is no evidence that RN experience makes a better NP, a topic that has been beaten to death here.

[FullGlass, BSN, MSN, NP]

14 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

Don't traveling NPs also make very good money?  NPs can also travel.

[Tegridy]

15 hours ago, FullGlass said:

Don't traveling NPs also make very good money?  NPs can also travel.

They probably can I just haven't searched for it. Right now the need is for RNs but im sure this bloat in travel salary won't last. 

[Guest1144461]

On 11/23/2021 at 5:27 PM, FullGlass said:

Don't traveling NPs also make very good money?  NPs can also travel.

 

On 11/24/2021 at 8:41 AM, Tegridy said:

They probably can I just haven't searched for it. Right now the need is for RNs but im sure this bloat in travel salary won't last. 

Spoiler alert: they don't and most of the locums job descriptions throw NPs into jobs they aren't prepared for in most cases (solo nocturnal and admitting cross-coverage).

I have done the solo thing and it isn't easy unless you have some amazing training/experience.

[Tegridy]

17 hours ago, Numenor said:

 

Spoiler alert: they don't and most of the locums job descriptions throw NPs into jobs they aren't prepared for in most cases (solo nocturnal and admitting cross-coverage).

I have done the solo thing and it isn't easy unless you have some amazing training/experience.

Probably cross coverage at some hospital without specialist back up and a tired ED doc as the attending for the floor and the ED. Basically just transferring stuff out then. eww

[FullGlass, BSN, MSN, NP]

8 hours ago, Tegridy said:

Probably cross coverage at some hospital without specialist back up and a tired ED doc as the attending for the floor and the ED. Basically just transferring stuff out then. eww

 

On 11/25/2021 at 12:37 PM, Numenor said:

 

Spoiler alert: they don't and most of the locums job descriptions throw NPs into jobs they aren't prepared for in most cases (solo nocturnal and admitting cross-coverage).

 

I was thinking about this some more.  Another reason that MDs make more $ is that they do practice good quality control and NPs do not, in terms of who enters the profession.

Medical school is very hard to get into, meaning that only the smartest get in.  Unfortunately, there are too many shoddy NP schools now that will let in anyone w/a pulse, especially the for-profit schools.  Honestly, I have met so many NPs that make me ashamed to be an NP.  Frankly, just reading some comments and questions on this forum by NPs and aspiring NPs makes me cringe.

The medical profession does now allow tons of new med schools b/c of the strict accredititation requirements and cost.  There are no "online" med schools.  

If NPs want to make more money, then they need to make the NP degree one that is earned with rigor by the "best and brigtest."

 

[matthewandrew, NP]

20 minutes ago, FullGlass said:

 

I was thinking about this some more.  Another reason that MDs make more $ is that they do practice good quality control and NPs do not, in terms of who enters the profession.

Medical school is very hard to get into, meaning that only the smartest get in.  Unfortunately, there are too many shoddy NP schools now that will let in anyone w/a pulse, especially the for-profit schools.  Honestly, I have met so many NPs that make me ashamed to be an NP.  Frankly, just reading some comments and questions on this forum by NPs and aspiring NPs makes me cringe.

The medical profession does now allow tons of new med schools b/c of the strict accredititation requirements and cost.  There are no "online" med schools.  

If NPs want to make more money, then they need to make the NP degree one that is earned with rigor by the "best and brigtest."

 

Very true. I think there should be a minimum 1 year of experience as an RN requirement. I think online schools shouldn’t be allowed. 

[Tegridy]

1 hour ago, FullGlass said:

 

I was thinking about this some more.  Another reason that MDs make more $ is that they do practice good quality control and NPs do not, in terms of who enters the profession.

Medical school is very hard to get into, meaning that only the smartest get in.  Unfortunately, there are too many shoddy NP schools now that will let in anyone w/a pulse, especially the for-profit schools.  Honestly, I have met so many NPs that make me ashamed to be an NP.  Frankly, just reading some comments and questions on this forum by NPs and aspiring NPs makes me cringe.

The medical profession does now allow tons of new med schools b/c of the strict accredititation requirements and cost.  There are no "online" med schools.  

If NPs want to make more money, then they need to make the NP degree one that is earned with rigor by the "best and brigtest."

 

I agree that would be ideal. At most they should instill the idea that everyone has their limitations and gaps in knowledge. Seems like a lot of the NPs come out thinking they know everything. Some med students do also but that's quickly beat out of them in residency. But the NPs do not have residency so they jump right into practice and its a mess.

I wouldn't expect all nPs to be able to do everything a physician can (some do and some do even better than some MDs obviously) but at least give them enough info to know they don't know everything. Personally I feel less knowledgeable the more I read and learn even though the opposite is likely true. 

 

I think its nuts NPs can come out and practice without some sort of residency. But I also think an NP with lets say 5 years experience should be able to have some sort of fast tract to physician-hood if they want. At least for primary care specialties... Maybe make them do 2 years of med school then 2-3 years of FM or IM residency instead of the full thing... At least give them a couple years off. 

 

But the whole medical system is a mess so...

[Tegridy]

1 hour ago, matthewandrew said:

Very true. I think there should be a minimum 1 year of experience as an RN requirement. I think online schools shouldn’t be allowed. 

1 year residency because being a hospital RN doesn't have anything to do with outpatient medicine.

[FullGlass, BSN, MSN, NP]

3 hours ago, Tegridy said:

But I also think an NP with lets say 5 years experience should be able to have some sort of fast tract to physician-hood if they want. At least for primary care specialties... Maybe make them do 2 years of med school then 2-3 years of FM or IM residency instead of the full thing... At least give them a couple years off. 

 

But the whole medical system is a mess so...

I totally agree on a fast track for NPs to become MDs.  It would also be a great way to get more primary care MDs.

In Europe,  becoming an MD is faster than here.  MDs can do 3 years undergrad, then 3 years of med school.  

 

[Guest1144461]

7 hours ago, Tegridy said:

I agree that would be ideal. At most they should instill the idea that everyone has their limitations and gaps in knowledge. Seems like a lot of the NPs come out thinking they know everything. Some med students do also but that's quickly beat out of them in residency. But the NPs do not have residency so they jump right into practice and its a mess.

I wouldn't expect all nPs to be able to do everything a physician can (some do and some do even better than some MDs obviously) but at least give them enough info to know they don't know everything. Personally I feel less knowledgeable the more I read and learn even though the opposite is likely true. 

 

I think its nuts NPs can come out and practice without some sort of residency. But I also think an NP with lets say 5 years experience should be able to have some sort of fast tract to physician-hood if they want. At least for primary care specialties... Maybe make them do 2 years of med school then 2-3 years of FM or IM residency instead of the full thing... At least give them a couple years off. 

 

But the whole medical system is a mess so...

I was an ICU nurse for years and frankly, I don't think it means much. Either you are going to be a competent provider or you aren't. The best NPs I have met were previous engineers (or similar) who PROBABLY could have gone to med school if they were at a previous life stage but for brevity's sake they didn't.

I don't think I could have functioned without a residency and I don't my attendings would have any confidence in me either. It really did forge me as a provider 10x more than NP school. It was fun being in the trenches with the residents haha.

I don't know, you basically are skipping all of step 1 with NP education. They does count somewhat, maybe less so as time goes on...

[Tegridy]

8 hours ago, FullGlass said:

I totally agree on a fast track for NPs to become MDs.  It would also be a great way to get more primary care MDs.

In Europe,  becoming an MD is faster than here.  MDs can do 3 years undergrad, then 3 years of med school.  

 

Its quicker in most places. IMGs can graduate much younger than we can most of the time. The American medical school system is sort of a bad deal for Americans (cost and time). But that's a whole other topic.