Ever Think Nursing Might Not Be Enough?

Nurses Career Support

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Hi All,

I graduate with my BSN in 5+ months and as much as I know my job is to make nursing diagnoses and not those of the medical variety, I find myself constantly focusing on the latter. It might just be due to the fact that the docs are rarely able to fully commit to a diagnosis when they chart their progress notes, so in my free time I dig through radiology summaries and whatever else I can find to fulfill my own curiosity about "what is really going on."

Or, maybe I'm just more geared toward being a doctor or a PA.

I applied to nursing school because I get a great feeling when I ease someone else's pain. I admit, it is more for me than it is them. But the natural by-product of my selfishness is my patients get excellent care. I go out of my way to not just do what is expected of me, but also to make my patient's time enjoyable. Nothing is better than when a patient says something like, "I didn't notice my pain all afternoon."

But looking toward the future, once my freshman idealism starts to dull a bit (and our instructors keep assuring us it will), what could likely sustain me is the challenge of differential diagnosis.

So my question...has anyone considered making the change, or do you know anyone who has actually gone from RN to MD or DO or PA...and what has the transition been like?

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Specializes in Critical Care.

The reality is nursing diagnoses, care plans are really a joke. I wish they would do away with them, whoever thought this would define and "professionalize" and upgrade nurses standing was just wasting our time.

The truth is we need to know and understand medicine, pharmacology, and pathophys, not nursing diagnoses. That said I too enjoy that side of nursing along with making a difference.

If you stay as a bedside nurse you will be the doctors eyes and ears while he's away, following instructions, updating on changes, and anticipating correct meds/orders. So it is a natural progression to want to advance from that to something more! The quickest and easiest way to advance is to be a family nurse practioner. You essentially are allowed to function as if you were a primary care doctor. It parallels PA's but because of nursing practice laws NP's have a little more indepence and prescribing privileges and can be solo practice depending on the individual state laws. Many work with or under a doctor by choice. Remember you are paid 50% or less of what a doctor is paid so I would think an indpt practice would not be cost effective as most internal med, family practice doctors are being bought out by the hospitals as their pay keeps dropping due to the insurance, medicare, medicaid cutbacks and the rising costs of overhead. So if they can't do it as an independent, how are you going to afford that?

If you are young, have the money or resources you could go back to medical school for a doctor. But I would get some nursing experience first and see if that is what you want to do. Also you need more science prereqs than most nursing programs and many require calculus to get in, then the MCAT. Medical school is very expensive and intense and probably figure on student loan debt $100,000+ and interest will be accruing during school for private loans and also for govt after 2012. It used to be deferred, but now all graduate school loans interest will capitilize sometime during or after 2012 to save the govt money. They also offer HEAL loans which if for some reason you are not able to pay off and default you will be barred from medicare and VA patients so be aware. You need time to pay off your student loans as they will be as large as a mortgage!

NP school would be cheaper but the pay is less and you can usually work during the program, not so with medical school. Some things to think about. WIll you be able to live very poorly and frugally during medical school and the residency afterwards? Unless you specialize in medical school your pay will be much less and your student loans will be an albatross on your neck!

It seems higher education is only meant for the rich these days or those with sugar daddies, inheritances, or scholarships!

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Specializes in Critical Care.

I know many nurses who have gone on for the NP and they seem happier than doing bedside nursing, though of course they have a new set of challenges. Yes some nurses do go on to become doctors. I know of a few, but I don't know them personally to know how they feel about it.

I thought of going to med school back in the day, and started taking the science and math prereqs, but in the end didn't pursue it. Sometimes I regret that, but I didn't want to be a workaholic as most doctors are. They work long hours and get very little sleep and have a lot of responsibility. I have deep respect for them and believe they deserve to be paid well for all they do!

I do believe that NP/PA school does train you to think more like a doctor than a nurse and is a good choice for those who want to advance, but can't afford the time and money to go to medical school.

The PA program follows more of a medical school curriculum, but is very competive and there are less PA programs available than NP programs. Also PA's do not have as much independence as NP, due to favorable laws for NP's as they were meant to be used in rural areas where there is a doctor shortage.

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Specializes in neurology, cardiology, ED.

Here's how I see it:

NP is 3+ years more of school for not that much more pay

MD is lots more school for maybe a lot more pay, but also more loans and way more malpractice!

PA is also3+ more years school, for also not that much more pay.

Morale of the story is finish RN school, work for a couple of years, then decide!

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

Care plans etc are a joke as 1st poster said.

When ur in charge of 100 patients, with 10 staff under you, you have no time at all to even look at ONE of those care plans. And ur too worried re (a) losing ur license if u do something wrong cos ur overworked, and (b) worried re getting sued even if u don't lose your license. And not one person will care if you DO end up going to court & being chucked out of the profession, trust me on this (I know people directly or indirectly it's happened to, all their nursing 'friends' subtly dropped them).

I am bored with nursing now. I've pretty much done all I wanted to do - which is not the same as saying I know everything; I don't. But it's all so the same, days are just full of old people on med/surg wards, who need meds, washing, dressings done, blah blah. Afternoons can be a bit more interesting, nights on surg wards are usually just full of obs, changing pumps & controlling people's pain. There isn't much challenge after a while.

Wish I was young again & could have chosen a different career perhaps. And I do still think we are the doctor's handmaiden; if you think for urself, or question anything to do with doctors, you get reprimanded and told just to do your job as a nurse - run after the doctor. It's all such a ridiculous sham, it quite makes me feel ashamed to be a RN actually.

Go for your dream. It's going to be tough & you will be so tired you won't be able to stand. Early mornings will be ur friend for the start of surg/med rounds & get used to eating on the run. But if you can do it, and can afford it, leave nursing - no RUN from nursing - and get out.

You will just become another handmaiden, despite what people say on here. We have no real autonomy and are still not seen as a profession, and I doubt we ever will be.

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Specializes in Infectious Disease, Neuro, Research.

** Personal opinion**

Yeah, NsgDxs are laughable. Frankly, as I've said before, if you're unable to develop differential diagnoses on your own, I would question being in direct care at all.

Having said that, in the Nsg service context, differentails will allow you to anticipate and suggest, not (generally)make independant interventions. If you work with good mentors, this will develop naturally, if not, it will add to your frustration, and cause you to seek out a specilization/facility where it is encouraged.

As noted, however, get some practice under your belt, before your express confidence in your "expertise".;)

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Specializes in ICU-CCRN, CVICU, SRNA.

you havent even worked yet to decide RN is not enough. Work in an open heart unit for a while before you decide that nursing doesnt require extensive knowldege of medicine.

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you havent even worked yet to decide RN is not enough. Work in an open heart unit for a while before you decide that nursing doesnt require extensive knowldege of medicine.

+++++1. good comment. try ICU youll probably love it.You havent worked a day as an RN yet so i feel like its too early to decided you want to change professions. Youll be surprised @ how much experienced CCRNs know.

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Every RN (I hope) tosses out all that nursing school crap ASAP. Delete, delete, delete all but the pathophys, A&P, and your micro edu.

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Specializes in NICU.

I suggest ICU (med, surg, neuro, trauma, peds, neonatal) for a while. There is a lot more patho-phys in these area. Remember too that nursing school is focused on the basics. If, after a couple of years, you still feel under-challenged, go for your NP. (Hint: if you chose neonatal, Neonatal NPs have a high level of autonomous function in the NICU - no office hours, no billing, just come for shifts and collect a wage/salary).

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I plan to burn my nursing school uniform and nursing dx book. I'll throw in my med-surg POS book as well. Well, maybe the books will get me some money from Amazon.

Get out of nursing after getting some health care hours, and apply to PA school.

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Specializes in Orthopedics.

I agree with what everyone else is saying. Work for a while. Let your "student brain" go and get on with the process of actually learning what it is to be a nurse, which is not taught in school. Let go of all that theory BS and forget about nursing dx/care plans, no one cares about those in the real world. In the hospital it's just another annoying piece of paper you have to initial as you're walking out the door because you didn't have time to be bothered with it when you are actually taking care of patients.

All that aside, other than being crazy busy all the time, being an MD is nothing like being an RN. As an RN you are the one looking at the patient and figuring out what he/she needs. Your job is to figure that out and then, figure out how to get the doc to do what you already know needs to be done. I love being a nurse and you couldn't pay me enough to do what docs do.

From what I have observed, the hospitalists have 80+ patients at a time, don't know the majority of them, and they spend their shifts answering pages, doing five minute assessments, writing orders and dictating practically in their sleep, and running to codes and such. They are mostly grumpy, unhappy overworked people, and I've only seen a handful who really seem to enjoy it. No thanks. but this is something youll be able to know for yourself soon enouh. Give yourself a year of bedside nursing and then see how you really feel about it.

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