Help... Peace corps, ABSN, d-e MSN, or MPH? which one first?

[awildsoul]

Greetings!

Thank you for clicking on my question. I am a recent college grad who has decided to return to school for nursing.

But... I don't know which program makes the most sense. Eventually, I want to become a nurse practitioner focusing on maternal child health in low-resource areas (either in the US or Africa). Which "specialty area" should I go into? Pediatrics? Primary Care/Family? Neonatal? I have some experience working in a rural hospital in Kenya, and I found myself volunteering in the NICU during all of my free-time. I loved it. Although I am considering midwifery, I want to be qualified to work with sick babies AND healthy mothers/babies.

Before determining that I want to be a nurse, I started the application process for the Peace Corps. This year they announced a Global Health Corps. Since I know what I want to do now, should I go back to school first, get some experience and then apply for the Global Health Corps? I just want to contribute in the most effective way.

Other factors...

Costs: Do I stay in-state in NY for school, or go to Johns Hopkins/UPenn/one of the best and take out 100,000 in loans (hoping that I will be able to pay them back by working in low-income communities and receiving loan reductions?) Doing the PC first would give me a better chance of getting scholarships. But, if I take out loans and do school first, I can then do the Global Health Corps PC and receive something like 30,000 a year in loan reduction).

Timing: I am 24. I want to be a mom and breast-feed for two years to each child, and have my first child around age 29... (preferably 3-4 children between 29-36). Am I crazy for trying to plan around this?

Sigh, I am sorry this is so long. I just don't know what to do... and I don't know anyone to talk to about this. If this is more appropriate in another forum, please let me know and I will delete and re-post. I want to hear from current NP's and PCV people who have experience figuring all this out. This is my first-time posting, and I am going to try to "Add Poll" so that if you don't have time to write out a response, you can just vote (although I will read every word of every response very carefully!)

Thank you SO, SO much.

In light and love,

Julia

[traumaRUs, MSN, APRN]

Being a nurse practitioner in the US doesnt equate to going to Africa. I think I would first do Peace Corps to even find out which direction you want to go in.

[babyNP., APRN]

Wow, you've got a lot on your plate that you'd like to do.

In order for you to be useful overseas, you'll need at least a year's experience because you'll need to be comfortable in your own field. There are various routes to doing this and the fastest would be what's called an entry-to-practice program where you receive your RN license and your Masters degree to become a Nurse Practitioner/Midwife. The shortest time to do this is about 2.5 years. You can do a Women's Health NP or become a Certified Nurse Midwife. If you want to become a Neonatal Nurse Practitioner (sick infants), you would need at least an additional year of school plus you would need two years of RN experience prior to starting (or before your clinicals) working in a Level III NICU in order to become board certified with the NCC (indeed, I would wager that all programs require this experience; I've done a thorough search on all the NNP programs a few years ago).

So...if you were to get into school this fall, it would be 3.5 years of school, 2 years of RN experience in the NICU, 1 year doing midwifery, 1 year of doing NICU. 7.5 years total at the barest minimum, which makes you age 32...this is not to only mention the fact that you may not be able to get a job into the NICU right away as it's a difficult market for nurses right now.

I think it would more worthwhile for you to choose one specialty and add another specialty in years later if you still want to pursue it. It's a lot of money and effort for two separate specialties because you probably won't be able to keep up your skills in both since it'll be very difficult, if not nearly impossible to work in both at the same time.

If you want to work overseas, becoming a midwife or women's health NP is much more useful and marketable because there is a great need working with low-risk women in pregnancy (high-risk pregnancy has a high mortality rate due to lack of resources). NNPs work with sick infants and generally low-income countries don't have the resources to take care of them. It doesn't matter if you have all the knowledge about them: if you don't have the equipment, you can't help them. It's about $5000 a day to stay in my NICU and there's no way that low-income countries could afford that kind of care to one patient.

You would be more effective gaining skills before working overseas, but I wouldn't dissuade someone from going out for the Peace Corps. My sister is doing it now in Morocco (youth development) and she loves it.

If you want to go to the big name schools and hope to get your loans paid off, realize that you'll have to work several years in low-income areas in the US. Again, NNPs wouldn't be able to do this (I've looked): only primary care specialties like women's health, midwifery, or family nurse practitioner.

Are you married? Is your spouse on board with your dreams? If you're not, it's hard to predict when you find your special person as anyone in the world will tell you. I liked to plan a lot too (to the extreme like you : ) but I can tell you that life takes you in many turns you never expected (totally cliche I know). If you want to do everything you listed, you probably wouldn't be able to have the children as young as you'd like.

As for what you should do? I would shadow a few NPs in various specialties around for a day and see if you like it. I was fortunate because I knew exactly what I wanted to do from the time I was a senior nursing student. I applied for jobs at the top NICUs 6 months before I graduated, have been working for a few years, and now am going to UPenn for my NNP. I have absolutely no regrets (moved across the country for the job and two years later am married to my DH) and I feel extraordinarily lucky knowing what I wanted to do and having so many mentors along the way.

Here is the google docs spreadsheet I did a few years back comparing all the schools that did NNP (it's a bit outdated). You can compare cost, etc, although it assumes you would already have your RN license.

https://docs.google.com/spreadsheet/ccc?key=0AixMmSLgCw6pdFpzc0xnOXBTRl85YUdYZ2RLM0t1dWc#gid=0

Best of luck: keep us updated on what you decide. There are plenty of resources around AN for you. I would also check out the "students" tab and click on the graduate school forum. Most of the students there are in your place.

[wellbeing12]

I am an older RN, with a BA Social Work, and BSN. I have lived & worked overseas:, one year in Cuba, one year in VietNam, two years in Panama, five years in Japan. Not all of this work was in Nursing. I've traveled to Somalia, Egypt, Turkey, China, Germany, and other countries, and have had an opportunity to see conditions in other areas of the world.

THe advice given above is comprehensive, and excellent. I can't add much to that, but here are my thoughts.

Instead of trying to encompass all of this now, break it down into smaller bits. The larger picture is too much to get into details at this time. It is fine to have an outline, to have goals, but you must make it manageable.

WRITE IT DOWN.

First of all, you need to become a RN.

What is your Major, what degree do you have?

If you are single, it is a plus if you are focused on and committed to pursing this path. Single = less distraction as you continue with this plan. If you are in a relationship, your partner must also be fully committed to supporting you.

An accelerated program to get a RN is probably 18 months.

While attending John Hopkins, which is a wonderful school, would be great, this school, and others may be prohibitively expensive. I believe George Washington University's MSN is $1600 PER CREDIT HOUR.

Please look at all the good State programs to make the education more affordable. Talk to recent - past 1-5 years -graduates of the schools, to try & determine which best suits your needs.

After receiving your RN license, you ABSOLUTELY need two years experience, and probably the best base would be in the Med-Surg field. This gives you a broad base from which you can expand. You NEED the basics, before going into a specialty area. Then, work for a year or so in Peds, NICU, Maternal-Child care, or something along the line of what you THINK you are interested in.

Please do this before going "full steam ahead". If you plunge into something you "think" you want to do, without having at least one year experience, you may find that you have gone into something - spent all the time, money, energy on - that is not what you really desired.

THEN, decide what path you want to pursue.

If you are then interested in Midwifery, please look at Frontier School of Nursing. I believe it is in KY. It is, if not the oldest, one of the oldest schools in the country for this.

But this is in the future. You can look at this, and all the other great schools in all the other fields.

Right now, you just need to focus and make your plans to get to the first rung of the ladder, which is obtaining your RN.

I don't know if this advice will be beneficial, but it's free.

[babyNP., APRN]

Are you alive out there, OP? Of course when I spend a long time writing out a post that has a lot of thoughtful information, I am doing it to help people out since I know that I've been on the other side. But a "thank you" would be appreciated...

[traumaRUs, MSN, APRN]

@babyrn - thanks

[HealthEnthusiast]

I also think the advice above is golden, but I wanted to add a few thoughts as a returned Peace Corps Volunteer (PCV) and current nursing school applicant.

I was a health extension volunteer in West Africa (before the creation of the Global Health Corps program). The kind of work PCVs do is worthwhile and challenging, but it's not for everyone. What kind of work did you do in Kenya, and for how long? If you would enjoy teaching classes, organizing activities such as summer camps and conferences, facilitating debates, or even weighing babies and demonstrating how to prepare homemade baby food, you may be a perfect fit for health education/extension work. Peace Corps volunteers are not allowed to administer direct care to patients, but often collaborate with local health care professionals on community projects and can frequently shadow them on the job.

If you want to provide direct health care or train others in health care delivery overseas, you will need to get your RN or other training first and later pursue the Global Health Corps (or similar program). Also, while the low income earned during Peace Corps service looks good on your FAFSA, simply being a returned PCV is not a guarantee for scholarships. A lot will still depend on other factors, such as essays and competitiveness of other applicants. Basically what I'm saying is only do PC first if you want to do small-scale community health development work. If you have your heart set on doing nursing or nurse training in a developing country, get those credentials first.

I don't know if that's helpful or not, but feel free to let me know if you have any specific questions. I would be happy to share my personal experiences or helpful links.

BTW- Apparently some schools offer a family nurse midwife option which earns you both CNM and FNP. It appears to be especially useful when working with under-served populations.

Good luck!

[awildsoul]

Yes!! I'm alive! I am still learning how to use Allnurses.com and I still can't PM people. I thought I would receive a notification when someone replied and I never received one... I was so bummed, I thought my question must have gotten overlooked, but I appreciate your comments more than I can say! I am reading through them all now, and will read through them again a few more times. Thank you, thank you, thank you. :)

[awildsoul]

Thank you all so, so much. I have a bachelor's of arts in Human Ecology and experience working abroad (summer trips) in various countries in Central America and Africa. I do understand that being a nurse in the US doesn't necessarily "equate to going to Africa," but I want to work in public health and with victims of war and political violence... and I'm going to make it happen. Even if it takes 7.5 years.

I am laughing at how it's taken me a whole month to find your answers! I've been checking the survey but must have had a link to only the survey and not the answers. Usually I am very tech savvy!

So.. what I'm understanding is... I should shadow a few nurse practitioners and narrow down my focus. In the time since I initially posted, I have narrowed it down to nurse-midwifery or family-nurse practice because those focus's would give me the most flexibility (at least initially, and I could always return later if I want to focus more on neonatal health).

Ahhh.. so, one step at a time!

1. Pre-Reqs (I am taking Microbiology, HA+ P 1, Statistics, and Chemistry right now) and will hopefully be able to take three more courses over the summer (HA+P2, Nutrition, and Development, and the GRE).

1.5(?) Peace Corps (still waiting to hear back...)

2. RN licensure (through ABSN) OR direct-entry master's (but only if I've really narrowed it down beforehand)

3. Experience!!!!!!

4. Doctors without Borders or Global Health Corps

Now, I am going to go back and read through your comments again. If I could, I would direct PM each of you who took so much time to share advice; I don't know many nurses or nurse practitioners and you all are the first who have been able to give me advice from your own experiences! I am "bookmarking" this now and having it send me an email weekly... which I hope will mean that I will see any more comments. Regardless, I will make sure to check.

[claritasd]

If you haven't made a decision yet, there's a Peace Corps Fellows program (scholarships and/or other benefits for returned Peace Corps volunteers) at the Johns Hopkins School of Nursing. http://www.peacecorps.gov/learn/whyvol/eduben/univandprog/14/

Also, I'm currently a PC volunteer, and I'm taking some of my prereq's online. Regardless of the order in which you do it, it's doable!

[timkru]

As mentioned by Claire above, the Peace Corps offers some significant benefits. Addtionally, there are also programs allowing an individual to obtain their masters degree (i.e. MPH) while serving in the Peace Corps.

If you'd like to perform patient care however, you'd be better off seeking a practice degree like that of a nurse midwife or nurse practitioner. While the role is not translatable in much of the developed world, there are many places in the developing world that you can practice according to your education. While an MPH is beneficial, once obtaining an advanced practice nurse degree, you may not find it necessary unless you'd like to have more publication clout or if you'd desire to work with the CDC, USAID, or other organization that does more community based health rather than patient care.

[Nickjack]

Hey! You sound somewhat similar to myself. Definitely do Peace Corps first. It's going to be 1000% different than just volunteering for a week, doing Peace Corps is actually a realistic way to see if health care in the developing world is right for you. My frist bachelors was in Public Health and then I went into Peace Corps. I was a health volunteer in Uganda, completed my 27 months and LOVED it. I couldn't wait to go get my nursing degree so I could return to the UG. Now I'm in a 12 month ABSN program and my plan is to work for a year or two (you really need the experience before you try to go at it alone) before returning. Also, I'd do PC first because you'll want to snag a job in a new grad program or a hospital once you graduate. Going abroad for two years without getting that hospital experience will make it harder to get an RN job when you come back. Hope that helps!