Hello, any advice would be greatly appreciated because I'm very lost right now.
Long story short: I did a career change with a big brand name accelerated family nurse practitioner program (aka get the FNP with no nursing experience). I excelled in school, was very worried about my limited clinical experience (before and during) and the quality of my clinicals, but was reassured I'd be fine. Graduate and got a job as an FNP at a FQHC and things were not fine. It was sadly a disaster from all three fronts -- it was a hard clinic with sick patients, I am not the beat at learning on the fly under pressure and other things about me that could improve, and I honestly believe my training was absurdly and dangerously insufficient for the scope of practice I am now licensed to do-- I'd seen nearly none of it before (I could have cried when I got a patient with the flu or an asthma exacerbation because it was finally something i knew what I was doing and I was capable of handling those cases fine). One month in, I quit before I was fired. I will have great character references from my employers, but a bad review of my clinical skills.
I would still love to be an FNP, and I'm so willing to work hard, but I don't know where to go from here. Its been 8 months since I graduated now (took time off for family matters I'd neglected in school and then waiting for licensing because I also moved) and my first job ended in a disaster after a month. My confidence is shot and I am afraid employers will not be willing to take a chance on me (I am applying, but it's only been a couple weeks). I feel trapped because I've already done my training--- but I don't feel trained for my role.
1. What FNP jobs could I apply for that have a more limited scope or more extensive training? I've applied to all the retail health jobs I can find, but no luck yet. Is there a market that is desperate to hire people in retail health? I'm willing to move! (Fellowship/residency programs are sadly not an immediate answer -- they mostly have deadlines that are a year away now and they are very competitive--I was rejected from two before I ever applied to any jobs)
2. What else should I apply for? Should I apply to RN jobs? Which ones? Should I try to get a post-masters in psych to try to find a more limited scope? How do I avoid torching my health care career?
3. Any advice at all is appreciated!
P.S. Please don't turn the focus of the discussion to whether nursing programs without RN experience should exist or not. If I had the opportunity, I would not attend my program again, but dwelling on that doesn't help me move forward (and for the record, I also have classmates who are happy with their choice and I'm sure they will be great NPs)
1. NP residency/fellowship - hopefully they can prepare you for practice as your school obviously failed.
2. A job that understands you are not nearly proficient enough to practice without close supervision for a year or two.
3. Not everyone is meant to be a NP. I'm sorry you gave money to a school that taught you nursing nonsense rather than clinical medicine, but maybe you should go be a bedside nurse.
I am just getting so tired of seeing and hearing about of these new grad NPs who are not even remotely close to being adequately trained to practice medicine. our profession is heading down an unfortunate path and I think it bodes poorly for all of us.
I wanted to thank everyone so much for their kind words and their advice. You all really were so helpful to me and I appreciate it. I'm popping back in to give my plan, in case someone else comes after me looking for hope. I've been accepted into an RN inpatient new grad residency program. It was a very hard to decision to step away from the FNP role, especially when I saw others from my program doing it. But I told myself that my job was only to evaluate myself and what I was doing and what I wanted and go from there. One of the moments that stuck out for me was one of the first days as an FNP when I had a patient with acute abdominal pain. I was going to be the only person to assess that patient and as I made up my list of differentials I realized that not only had I not seen any of these diagnoses evaluated or treated in real life (excluding gastroenteritis), but I hadn't SEEN a single one of them in real life. None. There are NPs that can work with this reality and make it through to a being a great provider-- I'm not one of them. I need to know what I know and be able to look my patients in the eye and believe myself when I say that I'm confident I can take care of them. My current goal is to work as an RN for a year or two, hopefully while getting some FNP experience through part time volunteer work or working in some place like a minute clinic-- and then apply to a residency and hope for the best. If I end up staying in the RN role and never making the transition to NP, that's a great career too. My best advice to others is that if you're looking at your NP program and you're going, but I don't think I'm going to be prepared at the end with that level of knowledge and time seeing patients! Trust yourself. Just because it's enough for someone else, doesn't mean that it's going to be enough for you.
This sounds like an excellent opportunity for you right now. So happy for you. You sound like you are working through this situation really well and with a clear head. Good job taking charge of this!
My current goal is to work as an RN for a year or two, hopefully while getting some FNP experience through part time volunteer work or working in some place like a minute clinic-- and then apply to a residency and hope for the best.
I some ways I'd advise against swapping back and going to work as an RN for a few years. I do think the retail health pathway is a good one for you based on what you've said.
I think you'll be happy you did this. 12 years ago, I was working as an academic at a Big Ten university while taking all the nursing school prerequisites. I got straight A's in those and was accepted into multiple programs for non-nurses to become NP's. I decided not to go that route and instead enrolled in an Accelerated BSN program at my state's public university medical campus. I worked as a nurse for six years and completed NP school (part-time) during the last three of those years. I knew that I would never be able to practice with confidence if I had gone through one of those non-nursing NP programs.
One thing to keep in mind is that you might never feel like you learned enough during your year or two of nursing. Good nurses learn continuously throughout their careers. But you'll get enough information under your belt to gain more clinical confidence, and then you can keep learning on the job as an NP.
While I applaud you for making a decision that you feel is right for you, I disagree that having RN experience is needed to perform ardvanced level nursing practice in PRIMARY care. Two completely different scopes of practice. Now if you had said you wanted to work inpatient, or even certain specialties, that is a different story.
For any new grad in this position, please consider a few things before taking on a new job:
1. Residency program: there are a few that will accept new grads as for out as 2 years after graduating, and is a great place to build up your skills and confidence once you graduate. Why this isn't a requirement at our schools is beyond me. Medical school requires this, even those entering family medicine get residency training. It's a smart move to go for any new grad who has concerns about their skills or has concerns their job will not support them through a ramp up period.
2. This leads me to point two. Ask about their experience working with new grads, including if they offer a ramp up period. Ask about their expectations for when they would like to see a new grad be up to speed in seeing a full patient load. I, too, did a DE FNP program, and am about to graduate with a job offer lined up. These were questions I asked. You will need support. Don't just take any job that comes your way. Ensure this is a job that will support and nurture your skills.
3. Which brings me to my final point; interview back! Ask questions, do your research. Consult with alumni, preceptors , etc. The more you know, the more confident you will feel.
If an RN is truly what you want to be, that's great. But for anyone in the same predicament, know that it will require extra diligence on your part to ensure you feel competent in providing advanced practice care in primary care settings. While there are benefits to having RN experience for working in certain settings (ER, acute care, etc), you will likely run into the same problem if you decide you want to go back into primary care. Seek out opportunities that will build your confidence in providing advance level care. Have a mentor.
Dodongo, APRN, NP
793 Posts
3 options:
1. NP residency/fellowship - hopefully they can prepare you for practice as your school obviously failed.
2. A job that understands you are not nearly proficient enough to practice without close supervision for a year or two.
3. Not everyone is meant to be a NP. I'm sorry you gave money to a school that taught you nursing nonsense rather than clinical medicine, but maybe you should go be a bedside nurse.
I am just getting so tired of seeing and hearing about of these new grad NPs who are not even remotely close to being adequately trained to practice medicine. our profession is heading down an unfortunate path and I think it bodes poorly for all of us.