Having difficulty determining my next step

djmatte, ADN, MSN, RN, NP · Sep 5, 2018

At one year in your chosen profession, I'd hardly consider it a career. I would take that thought and continue improving your skills and understanding of that profession before committing to new roles within it. Especially with so many thoughts about where you *could* go, more time under your belt will make it clear where you *should* go.

PICCRN79 · Sep 5, 2018

Wow. Reading your post I almost felt as though you had gotten into my brain and put all of my thoughts on paper. Like you, I am currently in a BSN program. Unlike you, I know with certainty that I do not want to be an NP. I have been a nurse for many years. I have not worked floor nursing, but in vascular access within the hospital. Once I complete my BSN, I am going to pursue opportunities as a clinical device educator. I also want to go right on and get my masters. I know that I want to be involved with education, performance improvement and support learning for nurses. Like you, I also like to solve problems. For these reasons, my top two choices are the CNS and nurse education. As you mentioned, sadly the CNS seems to be a role that is being forgotten. CNS's have so much value to the hospital. There are CNS's in my hospital and I am planning to move to Hawaii and I do see some CNS jobs there as well.

Unlike you, I cannot see myself teaching at a university. I do not want to teach nursing and it seems like MSN prepared nurse educators will be taking pay cuts from working in the hospital.

I think I am fairly set on the CNS, but it is a little nerve wracking to be taking on education and debt on an APRN that seems to be being phased out....

Good luck! I look forward to hearing what you decide.

Xlorgguss · Sep 5, 2018

At one year in your chosen profession, I'd hardly consider it a career. I would take that thought and continue improving your skills and understanding of that profession before committing to new roles within it. Especially with so many thoughts about where you *could* go, more time under your belt will make it clear where you *should* go.

I do agree that with more time the answer will become more apparent. I am finishing my BSN and I just started by third of four semesters so I will graduate in the Spring. Perhaps its the nature of nursing these days, but as a profession we are constantly asked where we are off to next in our career. Now whether that is a good thing or bad thing is debatable. The reality is that I am in my late 20's. I have plenty of time to continue to develop as a nurse as I finish my BSN and further as I continue the 2-3 years as I advance through Graduate school. I don't think there is any harm with being aware of what aspects I like in nursing and continue to foster those. Perhaps I'm passionate about supporting new nurses because I was (and to some degree still am) a new nurse. We read every day how nurses are burnt out and frustrated in their careers. I would love to be able to support nurses transition into their roles and continue to support them in practice. I personally went through a new grad residency program that I found very helpful, but those programs are limited and very competitive. In my class that I attended today we talked about how 20-30% of nurses who enter practice leave completely within a year. I love the nursing profession and I would love to be an agent of change and support for the profession. I'm just not sure the exact route that it will take to get me there.

Xlorgguss · Sep 5, 2018

Wow. Reading your post I almost felt as though you had gotten into my brain and put all of my thoughts on paper. Like you, I am currently in a BSN program. Unlike you, I know with certainty that I do not want to be an NP. I have been a nurse for many years. I have not worked floor nursing, but in vascular access within the hospital. Once I complete my BSN, I am going to pursue opportunities as a clinical device educator. I also want to go right on and get my masters. I know that I want to be involved with education, performance improvement and support learning for nurses. Like you, I also like to solve problems. For these reasons, my top two choices are the CNS and nurse education. As you mentioned, sadly the CNS seems to be a role that is being forgotten. CNS's have so much value to the hospital. There are CNS's in my hospital and I am planning to move to Hawaii and I do see some CNS jobs there as well.
Unlike you, I cannot see myself teaching at a university. I do not want to teach nursing and it seems like MSN prepared nurse educators will be taking pay cuts from working in the hospital.
I think I am fairly set on the CNS, but it is a little nerve wracking to be taking on education and debt on an APRN that seems to be being phased out....
Good luck! I look forward to hearing what you decide.

Oh that's awesome! It is unfortunate that the role of CNS has all but vanished. I really don't know where our CNS's go honestly. Many of my instructors from nursing schools were CNS's and many of them (at least three) were going on to pursue their NP. I think I would enjoy being an NP sure, but the primary role as an NP is not to educate nursing staff- its a provider role. Our favorite APP's at work are the ones who we go to with questions and they explain and teach us in the few extra minutes that they have. So much emphasis is being placed in being Evidence Based Practice, and I do think that most nurses are inquisitive and have plenty of questions. However there often isn't time to devote to answering clinical questions or it can be very overwhelming for nurses seeking to answer their "why" questions. Its often much easier to just "do what is ordered" instead of actually sitting down to figure out if what we are actually doing is helping, hurting, or useless. The role of nursing has changed so much over its history and continues to evolve. I'm just looking for the role that will best prepare me to continue my passions.

llg, PhD, RN · Sep 5, 2018

I also think that you should give yourself a little more time in the staff nurse role without trying to force yourself into making a hasty decision you might regret later. But don't just "wait around" for another year or two. Use that time to explore some of those possible career paths by getting involved in projects that will give you experience with the types of work that you would be doing in some of those roles.

For example ... if you think you might like staff education, get some experience working on educational projects for your current job. Precept. Join your unit's education committee. Or work on some quality improvement project that would include some educational component. etc. As you get involved in various committees and projects at work, you will get a chance to experience some of the things that people in advanced roles experience -- and you can see whether or not you like that type of work or not.

As you get more experience doing nursing things beyond the basic things that 1st year new grads get to do, you'll have a clearer vision of what type of work will fit you the best. You'll also get to meet people in various roles other than bedside staff nurse and talking with them about their daily lives might help you get a sense of their jobs.

At 1 year, you have barely scratched the surface of the staff nurse role. Get more experience and start experiencing the more advanced aspects. Then you will be more ready to decide. Until then, all you have is imaginings -- not real knowledge of those possible career paths.

Xlorgguss · Sep 6, 2018

I also think that you should give yourself a little more time in the staff nurse role without trying to force yourself into making a hasty decision you might regret later. But don't just "wait around" for another year or two. Use that time to explore some of those possible career paths by getting involved in projects that will give you experience with the types of work that you would be doing in some of those roles.
For example ... if you think you might like staff education, get some experience working on educational projects for your current job. Precept. Join your unit's education committee. Or work on some quality improvement project that would include some educational component. etc. As you get involved in various committees and projects at work, you will get a chance to experience some of the things that people in advanced roles experience -- and you can see whether or not you like that type of work or not.
As you get more experience doing nursing things beyond the basic things that 1st year new grads get to do, you'll have a clearer vision of what type of work will fit you the best. You'll also get to meet people in various roles other than bedside staff nurse and talking with them about their daily lives might help you get a sense of their jobs.
At 1 year, you have barely scratched the surface of the staff nurse role. Get more experience and start experiencing the more advanced aspects. Then you will be more ready to decide. Until then, all you have is imaginings -- not real knowledge of those possible career paths.

I have definitely started to branch out farther than my immediate role as a bedside nurse. I am a preceptor, have joined a committee, and have been working with our educator or revamping our orientation process and am working on starting an online education drive to make resources readily available. I am also likely going to be tapped in the next few months to orient to charge responsibilities. One issue that I have found is that many of our staff do not follow current protocols either because there isn't an updated one or it is extremely difficult for us to find it. Now this is obviously a bigger problem than just our floor as it is voiced as a concern on nearly every other floor. I know that I enjoy teaching, enjoy being a problem fixer, and constantly evaluating what we do well and what should be adjusted. By no means am I trying to rush into anything, I am trying to do the exact opposite. I am trying to identify which degree will allow me to pursue those passions. My gut tells me nursing education, however those roles are sometimes not defined well varying on unit to unit. As I previously stated I love the idea of being a CNS, but that role has all but disappeared in my area. There is a program, but there is literally only a seven credit difference between the CNS degree and an NP. Undoubtedly going the NP route is much more flexible in the sense that I could always go the provider route. And by no means am I looking to have an answer here and now, I am just trying to be mindful of all of the options that I have in front of me, and be open to other options that I have not considered. Perhaps a EdD?

Dodongo, APRN, NP · Sep 6, 2018

Don't become a NP unless you want to be a medical provider. You won't be dealing with the bedside nurses except during rounds. You're job isn't to teach bedside nurses or support them. You'll be seeing patients, writing notes, placing orders, doing advanced procedures. You should go be a nurse leader or educator.

Xlorgguss · Sep 6, 2018

Don't become a NP unless you want to be a medical provider. You won't be dealing with the bedside nurses except during rounds. You're job isn't to teach bedside nurses or support them. You'll be seeing patients, writing notes, placing orders, doing advanced procedures. You should go be a nurse leader or educator.

While I completely agree about not going the NP route unless you want to specifically be a provider, the program that offers the CNS role has nearly the exact same education as the NP role with the exception of 3 1 credit courses and 100 hours of clinical. It begs the question, if you are going for all of that, why not just go the NP route just for the security and just as an "in case". When I spoke with one of my instructors she recommended going the FNP route. I'm really just torn between the different roles. Being a provider might be something I'd like to do, but at this point I'm unsure.

Dodongo, APRN, NP · Sep 6, 2018

While I completely agree about not going the NP route unless you want to specifically be a provider, the program that offers the CNS role has nearly the exact same education as the NP role with the exception of 3 1 credit courses and 100 hours of clinical. It begs the question, if you are going for all of that, why not just go the NP route just for the security and just as an "in case". When I spoke with one of my instructors she recommended going the FNP route. I'm really just torn between the different roles. Being a provider might be something I'd like to do, but at this point I'm unsure.

I guess I just dont get it. If you don't know what you want to do, why are you rushing to go to grad school. Being an NP isn't just some job you do when you don't know what else to do. It's far too much responsibility for that.

djmatte, ADN, MSN, RN, NP · Sep 7, 2018

While I completely agree about not going the NP route unless you want to specifically be a provider, the program that offers the CNS role has nearly the exact same education as the NP role with the exception of 3 1 credit courses and 100 hours of clinical. It begs the question, if you are going for all of that, why not just go the NP route just for the security and just as an "in case". When I spoke with one of my instructors she recommended going the FNP route. I'm really just torn between the different roles. Being a provider might be something I'd like to do, but at this point I'm unsure.

While the educations may appear similar, the roles and functions are vastly different. Many people sadly look at fnp as some catch all safety net, but in reality it has a very specific function of providing primary care as a provider across the lifespan. Yes we're not limited to specific areas such as adult or pediatric only, but we still are limited in the scope of the type of services we provide. Cns on the other hand has a more nursing practice focus. They are often used as efforts in hospital settings to organize patient care and education to nurses about best practices in specific care settings. Where an ACNP, fnp, or an fnp writes orders as a provider in a range of settings, a cns is there to help coordinate the most appropriate method of carrying out those orders. But while you're torn on where you would like to go, relax and let the career play itself out. You may find nursing education lacking enough that you want to go that route. Or you may like the idea of being a local expert as a cns. Or toy may find a passion with ob and decide midwifery is your jam. Sky's the limit in this profession and there are lots of options to choose from as you move forward.

PICCRN79 · Sep 7, 2018

Great responses to this from these seasoned nurses. As I read through your posts, perhaps you should really consider the CNS as I am. The CNS is just so versatile. You can be a CNS and work as an educator, but educators are not CNS's. Having been a nurse now for 15 years, I am certain of what I am looking for. CNS's can get prescriptive authority in many states. This is a head-scratcher for me, as I have no plans of doing any patient care related work and the CNS's in the facility I work in are used in a performance improvement manner, not in direct patient care.