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Do you want to become an NP?

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Tips to consider if you are considering becoming an NP.

Specializes in Internal Medicine. Has 14 years experience.

Do you want to become an NP?

Lately is seems like there are a lot of posts complaining about NP saturation, low NP wages, and NP regret, particularly among new NP grads or NP students (but there are lots of salty veterans too). I want to post some advice for anyone considering NP school, current students, and really any NP upset at the current climate.

1) Do your research before going to school

Figure out things like how many schools are in your area? How many graduates are they producing? What is a new grads job outlook like in your area? What are new grads making in the area? What are experienced NP's making in the area? What school has the best reputation? How much does each school cost?

Depending on where you live, the outlook of becoming a new NP can be a road to riches or a position battle for a job that will pay you less than you were making as an RN.

If you find yourself in a competitive market for new grads, you seriously need to ask yourself if relocating is something you would entertain, or if you are comfortable taking a lower wage to start.

2) Location, location, location

A lot of folks talking about saturation are in populated areas like the Midwest, SoCal, NorCal, and Washington (DC or state). Supply and demand. The more an area is pumping out new grads or more people move there, the lower employers can push down wages.

There will be people willing to take less to get their feet wet (Are you willing to be one of them?). This is common sense and it blows my mind when I read these posts with people thinking getting their NP was going to be a fast track to easy money, and halfway through school they realized what they had done. School is expensive and if you didn't do your research, shame on you.

This is not just true for NP's either and goes for all APRN's. Compare CRNA starting pay in the midwest to Texas or other rural areas and it will be in some cases a difference of over $100k. A close friend just turned down a job in Chicago when he finished up at TCU because a position here in West Texas was nearly double the salary.

3) The salary you start at is not where it will end

When I started I was making $90k a year with productivity bonuses (which was a little better than my RN pay and more work-life balance), a year and half later, I increased to $110k with a different company, also with incentive bonuses. The year following, a hospitalist group in our neighbor city in New Mexico raised my base to 170k (with hefty bonus incentives). In a short time I have almost doubled my pay.

It's important to remember this when offered your first position, and remember my advice about learning what experienced NP's are making in your market. Which leads me to...

4) Experience pays

See the above. I would have never landed the more lucrative positions as a new grad, but like being a new RN, after about a year or so of experience, your value goes up a lot.

5) Choose your school wisely

Especially if you're in a saturated area. Employers in high volume areas typically like grads from schools they trust, and there are lots of stories about online degree mills being shunned in certain areas.

That said, if you are willing to relocate to the moon (or similarly off the beaten path), employers often could care less and are looking for a warm body to help out.

Prioritize things like local recognition and cost when choosing a school (especially if you are going to stay in the area). I chose a well regarded public university in my area that I paid less than $17k for the entire degree, sharing clinical sites with students from prestigious schools like Georgetown. I got to graduate debt free and had several offers before graduating.

6) If you have experience and have to relocate, you might take a pay cut

It's mindblowing to me when I see NP's making $200k a year here complaining about being offered less money when searching for jobs elsewhere. Obviously NP's generate far more income than we are worth, but folks making near $200k are making nearly double the national average in NP income, and are the NP 1%.

Remember, NP saturation is probably happening, but even with that, the average salary for NP's as a whole continues to rise.

I will make $200k a year this year when it's all added up, and have looked into positions in Austin and Honolulu (two saturated markets) due to my wife's work. The Austin job offered me about $150k, Honolulu for the same position I currently have was $140k. I wasn't at all upset or surprised by these offers being lower than my current salary because in the end, they're still much higher than the national average (and high for the area too). It all requires perspective.

7) Money also isn't everything

Sure it helps, but most NP jobs, especially in primary care, come with much better hours and quality of life when compared to bedside nursing.

Consider that when your first NP job offer is in the same territory of you RN job. My first NP job was only a few grand more than my RN job, but had much better hours, had every weekend off, similar amount of PTO, required no overtime(which I had to do in my RN job to make the amount I was getting), and I actually had free time to spend with my family at the end of every workday versus being a zombie working nightshift.

In the end, is the NP market saturated? Yes and no, and that's because it depends on where you live and whether or not you have experience. Take a look at any job website, and you'll realize that once you have gotten your feet wet, the number of positions open to you probably doubles or triples.

If you do your research, you will make an informed decision and can avoid being one of the posters here crying about how bad it is.

FNP-C, AGACNP-BC. Been an APRN since 2014 and currently work as a hospitalist in an independent practice state. Went back and got my AGACNP when I realized my job required skills and knowledge more tailored to that role.

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8 Comment(s)

MikeFNPC, MSN

Specializes in FNP.

Hey Nick, great comments and would like to know where your address will be in Honolulu, lol. My company has sent me there for CME in the past. You offer lots to think about and I agree with your comments. So far, I've precepted several students. As I write this, I'm discussing some of what you have to say with my current student. Several of my students have expressed fear as they anticipate working as an NP. To add, I'd like to offer; don't be afraid to reach out to this forum, join a local professional NP organization, or ask questions about any job offers BEFORE signing any contracts.

My experience as an NP has been amazing. Going back to school and working as a provider was the best decision of my professional career. Everyday it's fulfilling to me personally as well as financially. I truly hope that anyone who has doubts, as probably every NP student has had, finds encouragement from practicing NP's.

Edited by MikeFNPC
spelling

Great post. I have known some NPs who have made it work out for them financially, and some who have not. Some of that is due to random factors, ie luck.

I would agree money isn't everything, and having weekends and holidays off is still appreciated, even after all these years.

One issue I have observed is that people who go to NP school full-time and borrow most of their living expenses, along with tuition for 2 years, have difficulty ever making up that difference.

I think most people are better off going part-time if possible, and working full time as an RN in a closely related field, purposefully, to get more experience.

My employment as an RN in psych was invaluable. In no way did my NP program prepare me, I prepared myself, which I have said before.

I have enjoyed my career. If you are doing it mostly for the money, good chance you will be disappointed.

Prospective students have a lot of research to do.

Yeah,

You gotta do your homework prior to investing a giant pile of cash into becoming an NP. In my cohort it was worth it for some folks and not for others. We have two giant providers in the Pittsburgh market that set the wage scale for new NPs. More than a few of my classmates are actually making less money in the short term if you take out the giant student loan payment they make every month then they were as nurses. This isn't the case for me. My employer paid for my studies and is guaranteed me a job upon graduation. Basically I initiated my NP studies because I would get a 1/3rd bump in base pay and my pension. In short it was a business decision. If I had to pay many thousands of dollars with no certain return at my age I never would have done it honestly.

If new grad NPs are willing to relocate to areas of need (hee-haw land or underserved urban markets with high costs of living) then they can make some major $$$ but most don't want to do that. I've said this before being a nurse is what I do not who I am. If it doesn't make sense financially then don't do it. It's the same as any other job in any other field.

Polly Peptide, BSN, RN

Specializes in Hospice, Med/Surg. Has 2 years experience.

Your "attitude of gratitude" strikes me as a bit off.

Normally I appreciate it, but as it relates to this article and your advice, I find it disconcerting. More specifically, you compare your role as an NP, and the pay and hours, to your role as an RN. Thus, you appear to be "grateful" for a perhaps less than expected bump in pay, because your hours aren't as painful as they were when you were a bedside nurse.

I say all of this because NPs fill the same roles as PAs. And PAs do not have this issue with role comparison. They aren't "grateful" for more regular hours with a slight change in pay. They aren't comparing their new position with a former position. Sure, some of them may have been EMTs or something similar on a full-time basis. But others might just have been CNAs for 6 weeks in order to get their HCE. In general, they don't have a former role they might fall back on. A PA is a PA. An NP is almost always a former RN (except for the fast-trackers).

While I promote RN experience prior to becoming an NP in general, I do think we are shooting ourselves in the foot by being so "grateful" for a pay increase and better conditions that we don't negotiate for what we deserve. This is reflected in our overall lower pay as compared to PAs (though I think there are other factors at play). I'm sure that PAs are complaining that NPs are bringing their pay down now, too, not to mention the overall market saturation issue.

I am making a career change into nursing. I come from the business side of healthcare. No matter your job, you have to have some business savvy. You have to go into an interview knowing your value in the market, and it is NOT based upon your former pay. YES, employers would like to base it upon your current or former pay, but the reality is, it is based upon what the market will bear for your NEW role and the value you bring to it..and THAT is based upon what your competition is getting paid AND what they are willing to accept, as well as how much competition is out there.

Combine those things and try to make yourself standout from the rest - then you can be grateful once you know you didn't leave anything on the table.

Riburn3, BSN, MSN, APRN, NP

Specializes in Internal Medicine. Has 14 years experience.

True, but a PA takes a wide range of salaries as well, sometimes lower than NPs to start, and a lot of times their comparison is terrible or nothing. Most NPs were making an RNs salary before jumping into NP school, which is why you see comparisons. Many PAs were in something unrelated to healthcare, and often making much less. Very different comparisons.

djmatte, ADN, MSN, RN, NP

Has 7 years experience.

Riburn3 said:
True, but a PA takes a wide range of salaries as well, sometimes lower than NPs to start, and a lot of times their comparison is terrible or nothing. Most NPs were making an RNs salary before jumping into NP school, which is why you see comparisons. Many PAs were in something unrelated to healthcare, and often making much less. Very different comparisons.

Also it's logical to make the comparison as nurse practitioners are first and foremost a registered nurse... No matter how much some want to run away from that title. They represent the highest level of practice a nurse can achieve in terms as a profession and to suggest we not look at ourselves in terms of nurses defeats the whole foundation of empowering experienced registered nurses to help fulfill healthcare gaps which is literally the whole point of the NP profession.

AJJKRN

Specializes in Medical-Surgical/Float Pool/Stepdown. Has 6+ years experience.

Well said and Damn Skippy!

AJJKRN

Specializes in Medical-Surgical/Float Pool/Stepdown. Has 6+ years experience.

AJJKRN said:
Well said and Damn Skippy!

For whatever reason, when I posted my response to djmatte very spot on response above, the quote did not insert...and I clearly was not paying enough attention...