I need help making some decisions.

SteveNNP, MSN, NP · Mar 1, 2008

From a current MSN/NNP student, I would recommend just waiting out BSN school and start to work as an RN before deciding you already hate the RN role. The "real world" of nursing is a far cry from the ivory tower the nursing schools teach....

I also got kind of bored with nursing while in school, but once I graduated, the level of autonomy and responsibility I had/have as an RN quickly became enough to handle. I chose to further my education so I could have an expanded role in my NICU field, not because I was dissatisfied as an RN. I will sorely miss my RN role once I finish my NNP.

As an RN in the acute care setting, you DO interpret and act on abnormal labs, and suggest tests/treatments/procedures to the medical staff. Once you get away from having 1-2 nonacute pts in school, and find yourself responsible for 1-8 critically ill pts, you'll feel like you are doing more, and making more of a difference.

I know I haven't answered most of your questions, but I just wanted to butt in and offer my :twocents:

yellow finch, BSN, RN · Mar 2, 2008

Like Steve, I would recommend waiting out and working as an RN before making any decisions. It's hard to really know what you want to do without experiencing work at the bedside. And nursing school is nowhere near the real thing. There's waaaayyy more to the bedside than the limited things you're allowed to do as a student.

It sounds like the ICU would be a good place for you. You typically have more "challenging" experiences there in that the patients have far more interventions and you spend more time with them getting to know them better. The Dr's tend to collaborate more with you, which means you'll have ample opportunity to ask questions and use your critical thinking skills that can sometimes go to the wayside out on the floor. Plus, ICU is a nice pathway to ACNP.

I say this with close to 2 years on the floor and 1 in the ICU. You learn something from every position you hold. I found myself bored on the floor and apathetic about my job until hitting the ICU and truly enjoy what I do now. My days can be horribly busy but I walk away feeling rewarded. On the other hand, I tend to only interact with select groups of docs (Neuro, Pulmonary, sometimes Cardio) while out on the floor there was a whole lot more in the way of diversity (Internal Med, GI, CV, Pulm, Psych, Ortho, etc.) in specialty groups.

All in all, you can learn and absorb so much no matter what area you choose to enter. And you might find your niche while you're at it. Don't be in too much of a hurry to move on. At least that's my opinion (whatever it's worth).

Best of luck!

jjjoy, LPN · Mar 2, 2008

They consider it “critical thinking” to not give insulin to someone with a BS of 40. Point is I NEED to use my brain more.

I hear ya! Nursing school is SOOOO caught up in the importance of "critical thinking" that they sometimes seem to ascribe everything to it (or the lack of it). And how about those inane nursing diagnoses where you must work backwards from the medical diagnosis to the symptoms to the NANDA approved terminology in order to justify the most basic of tasks such as providing education, comfort, and hygiene care? Sigh!

I don't have any advice for you myself as I ended up avoiding clinical nursing positions since they seemed to be either crazy juggling acts (that in no way reflected nursing as we were taught in school) or seemed to demand more knowledge and and experience than I felt I was able to provide (I'm not a 'fake it til you make it' person especially when it comes to people's well-being).

Whatever you decide to do, keep us updated! I'd be curious to see how how this plays out for you.

FuturoEnfermera · Mar 2, 2008

thank you all so much! i really do want to stick with it and find something i really like about it. i'm just feeling like the more exposure i have to nursing, the more i feel like i'm not going to be satisfied. i broke down to my clinical instructor and she's offered to have me shadow her in the icu where she works. like i said, she's awesome. it worries me too that everything about my program is so great but i still don't like it. make any sense? my clinicals so far have been on a rehab floor, which is, i assume, the least acute and "mindless" as it gets. the patients are pretty much well and learning how to readjust to living after accidents, strokes, etc.

maybe it's also because i'm so early in but it drives me crazy that every answer is "call the doctor" and it seems there is nothing that we'll ever be able to do ourselves. i precepted in rehab last week (worked with a nurse and 3 patients), which was my second clinical week ever and i felt like i could have done it all myself. before i left at 11am i did all the acuckecks, vitals, i&o caths, showers, and charting myself. i had to watch my nurse do meds since i wasn't checked off on that in lab until yesterday. i can't image how bored i'll be when i have my 1 patient next week. i know they start us slow on purpose but jeez. granted i did have to check with my nurse on a few things but the amount of stuff to do in the time available was totally doable. maybe being a single mom of two under 4 makes it easier for me to multitask without stress. =)

i'm happy to hear that somewhere down the road i'll be able to make some decisions and do something that will seem more meaningful! patience is not my virtue.

jjjoy, LPN · Mar 2, 2008

Ah, nursing school clinicals... they make it look so easy!! Why, oh, why?! Even if the actual work isn't that tough, the reality in most places is that they just pile on the amount of work so that there's no humanly possible way to get it all done. And nurses are responsible for so much more than just the "nursing"... that is they have a lot of paperwork, chasing down people & devices & information, taking down new orders, keeping up on new lab results (easy with just one patient, but not easy when you're juggling 8 acute patients or 15 not so acute patients).

And "call the doctor"... just try pulling that all that often as a nurse! You're expected to avoid calling the doctor whenever possible and when you do, you're expected to anticipate their orders - even make suggestions... which is fine and all after you've been working a good long time and it's a condition with which you have plenty of experience... Sigh! And expect that at least 1/3 of the time, the MD will bark at you for calling them over something they consider minor, even though you legally HAVE to call them for some things (eg order for a laxative).

Definitely do the ICU observation. It's a lot more in depth and the nurses are much more involved in the medical care of their 2 patients, not having all their time taken up with getting meds out, prepping patients for tests, checking for new orders, notifying MDs of changes in status, calling to pharmacy for missing meds, making sure pt X gets the right meal tray, doing discharges and admits on several different patients, etc.

Nacki, MSN, NP · Mar 2, 2008

Definitely do the ICU observation. It's a lot more in depth and the nurses are much more involved in the medical care of their 2 patients, not having all their time taken up with getting meds out, prepping patients for tests, checking for new orders, notifying MDs of changes in status, calling to pharmacy for missing meds, making sure pt X gets the right meal tray, doing discharges and admits on several different patients, etc.

I'm an ICU nurse and do all of the above and more. You still have to do "medial" things that will take up your time. Its just a tad bit more manageable with only 2 pts.

caliotter3 · Mar 2, 2008

I also agree that you should get some experience in nursing before you decide on your next step. BTW, one of the best doctors I have ever observed was an RN before she became a doctor. When I found this out about her, I connected her caring attitude and extra efforts to her experience as an RN.

jjjoy, LPN · Mar 2, 2008

I'm an ICU nurse and do all of the above and more. You still have to do "medial" things that will take up your time. Its just a tad bit more manageable with only 2 pts.

I didn't mean it to come across that ICU nurses didn't do those things. I just meant that the ICU nurse usually has a more in depth understanding of and involvement in the medical issues of the patients, what with tritrating powerful drugs and needing to be right on top of the patients' immediate condition.

On a med-surg floor, there are times that the nurse barely has a chance to think much on the patient's disease process beyond - are they breathing okay? Bleeding? Urinating? Mental status changes? In pain? Are their labs WNL? Any new orders? Tests to prep for?

As an ICU nurse yourself, though, you certainly have a more accurate perspective than I do! So please do share any insight on the realities!

Dixiecup · Mar 4, 2008

Once you actually become an NP, you will be able to do all those things you are longing to do now. But you have to get through the nursing part of it to get there!

I live in Missouri, and the NP's here are almost interchangable with the doctors. I imagine some places are not like that but here, they are utilized to the full extent.

PackMule · Mar 12, 2008

What my nursing really taught me is to learn and trust my intuitive skills as I gained more experience which made the application of my advanced practice skills, once I got them (assessment and diagnosis) more meaningful. You can take a cook-book, flow chart approach and look at some quidelines to diagnose and treat medical problems, but the intuitive nature of this art you gain working in nursing can't be learned in graduate school. Nursing school is purely laying a foundation. In the real world nursing is so much more.

Good Luck in your decision making and enjoy the process as opposed to looking at the end product.

Jas0nRN · Mar 24, 2008

I agree that an ICU would probably be bset for you. Med-surg your often too busy to even look at results duringthe day shift. ICU will not only allow you to make more decisions but be able to see what those decisions were based on. regardless of what you decide to do a few years as a nurse will enable you to learn some of those labs, lung sounds, and assessment skills that will be the foundation for being a provider. Nothing worse than a med-student who is more worried about trying to figure out what to call a breath sound instead of figuring out what the diagnosis is.

I went straight back to NP school upon getting my BSn and have found full time work and full time school to be overwhelming and so am cutting back. With two small kids being an ICU nurse might enable you to do this in more manageable chunks. A few of my fellow students have dropped out b/c tehy felt like they were missing too much of their kids childhood. Its a hard decision.

If you do speak Spanish I can't tell you how badly I want you to be an Np or MD. So few speak spanish well enough to really get through to people. So many people claim to be fluent when their barely at a third graders comprehension. I myself am conversational. It makes a world of diference and can really save someones life. If you are learning spanish keep up with it. Ed, L&D, any outpt clinic see the most Spanish speakers.

JasonRN