I'm not new here, but my profile is. I'm posting for feedback - at the risk of criticism of course - from folks who are currently in the field as practitioners. I'd fish for feedback with colleagues in real life, but to be honest I'd rather not reveal my thoughts so honestly with those among whom I work. Take that for what you will. Also - as a premise for this post, based on my observations, it is assumed that, despite differences in education and philosophy of practice, PAs and NPs are essentially clinically equivalent.
I'm a former military combat medic. I got out, got a bs in biology, then went to work for a very large hospital network in health admin to feed my family while figuring out my next move. I considered medical school until deterred by the reality of spending the next 10-15 years of my life sacrificing time with my family. So I applied to and interviewed for pa school. What I learned during my time in that rat race was that the vast majority of my competition was actually well suited to sit for the mcat and apply for med school. The pa applicant pool is saturated with overqualified young professionals who made my combat medic experience and top-10% bio degree grades look inadequate.
Over a year later, I've changed my tune and am going into nursing, with the purpose of getting into an np program as soon as I can. I found a scholarship program that will pay my tuition and give me a living stipend so I can make my mortgage and feed my wife and kids. Here are the reasons I decided to on this path:
- First and foremost (given the anonymous nature of the internet I can say this, otherwise I would never mention it), this is the route of least resistance to becoming a provider. My local university's np program is part time over a 4-6 year period while working as an rn. The two big benefits here are 1) not sacrificing as much time with my young kids and 2) I don't have to move (no local pa program).
- I don't care about the money, I have relatively little school debt and it will all be forgiven anyways before it's paid off
- I don't care about clinical prestige. Working as an administrator who approves interhospital transfers has demystified the average physician, revealing that many lack a lot of common sense and/or are very narrow minded and can't understand very basic tenets of authorization and eligibility.
- As mentioned above, the pa applicant pool is saturated with young adults who are otherwise well suited to study and sit for the mcat. Were I to re-apply as a more competitive applicant, I would need more classes and more volunteering and application bullet points...at which point I may as well spend that time studying and sitting for the mcat. I interviewed at average/below average pa schools whose rates of acceptance were less than 6%. That's Harvard and Mayo med territory.
- A common theme on the pa forums is comparing the pa lobby to the nursing lobby, the latter of which is consistently deemed to have much more weight and heft. This to me bodes well for advanced practice nurses because the pa profession is essentially owned by the AMA, and why would physicians lobby to give the pa profession more autonomy, thereby replacing themselves in the clinic? Oversimplification but I state this to highlight the overall philosophy of comparing the two lobbies and potential futures with respect to autonomy.
- The largest hospital network in the country (the world?), the VA, is increasingly eschewing state restrictions for NPs and granting more autonomy of practice, albeit mostly for primary care and mental health. Pay still lags slightly behind PAs as can be seen in the private/public sector, but again I don't care about money (to a degree). The state I live in, for example, is restrictive regarding NPs prescribing controlled substances, but NPs at the local VA do not have this restriction.
- The longer I spend reading the opinions of and conversing with older PAs, the more grim the outlook is relative to NPs, and this is considering the aforementioned pay advantage. Though this could change in the future as non-physician practitioners are more heavily relied upon to fill the huge gaps in care with respect to the baby boomers, I would choose the profession with the better lobby at the moment which is nursing.
I completely understand the criticisms against my premise, and have no problem hearing out those who think that taking the path of least resistance is deplorable. I get it; but society has opened up and endorsed this pathway to practicing medicine and I plan on taking advantage of it. Feedback of those deep in the profession is greatly appreciated.
Edit for clarity: my bsn application is under review right now, I am not currently a nurse and hope to start during the fall '17 semester.
It's almost as if I wrote it myself. I feel the same way. Instead of killing myself, trying to compete with these people who can pull all-nighters 5 days a week and give up the next decade, I made a switch. I'll still be happy and I'll be helping patients, but I can progress my career at my own pace without committing my child to ramen noodles for the next 6 years (I was pre-dental).
Wow! I wish I could apply that much thought to literally ANYTHING in my life!
My only advise: Find love in care at every level. Find respect for all that find that same love. I say that because some of my least favorite RNs/CNAs to work with cannot wait to tell you how what they are doing is below them because of their ambitions. Try not to think of nursing as a stepping stone, but rather a practice to improve and become better at.
I was on a path like yours nearly 20 years ago. Same goals. Similar plan. Two weeks before starting an NP program with financial backing from my employer, I made a decision I have NEVER regretted. I decided to keep on being "just a nurse" -- an ER RN staff nurse -- and I hold my head high every day because I'm really good at what I do. Nurses who used to work beside me are now the PA's and NP's who blast through a two minute assessment before rushing back to their computers to put in a predicable panel of orders that I will carry out. Suturing (which you probably did as a combat medic) is the only thing they do that I actually envy. The vast majority of the hands-on, make-it-happen stuff in the ER falls to the staff nurses. Staying at a staff RN level does not mean you are failing in career advancement. It may mean that you keep getting better and better at the skills that will determine whether the patient lives or dies. Just throwing this out there, Non Sequitir. When you get into nursing, try the ER, and two decades from now you might just be passing on the same story.
I was on a path like yours nearly 20 years ago. Same goals. Similar plan. Two weeks before starting an NP program with financial backing from my employer, I made a decision I have NEVER regretted. I decided to keep on being "just a nurse" -- an ER RN staff nurse -- and I hold my head high every day because I'm really good at what I do. Nurses who used to work beside me are now the PA's and NP's who blast through a two minute assessment before rushing back to their computers to put in a predicable panel of orders that I will carry out. Suturing (which you probably did as a combat medic) is the only thing they do that I actually envy. The vast majority of the hands-on, make-it-happen stuff in the ER falls to the staff nurses. Staying at a staff RN level does not mean you are failing in career advancement. It may mean that you keep getting better and better at the skills that will determine whether the patient lives or dies. Just throwing this out there, Non Sequitir. When you get into nursing, try the ER, and two decades from now you might just be passing on the same story.
Totally agree. There are tons of nurses that only go into nursing ONLY because they want to be an NP, big mistake. I try to tell all of them it would be a mistake if you cant see yourself as a staff nurse and never doing an NP. Typically people that didn't really find job satisfaction as a staff nurse aren't any happier as an NP. Get your RN because you can see yourself retiring as a RN, and if you happen to find a niche you want to fulfill as an APRN down the road great and sometimes plans change. I returned to school to become a CRNA after originally planning NP because I enjoyed have more hands on patient interaction, but I LOVED my last job and it was very hard to leave.
Sounds like you have put a lot of thought into it, and I think its still a great plan! Depending on where you live you can still make pretty decent money as a RN. The quality of life in my opinion is aweseom. You can work as much or as little as you want. Most hospitals ahve the 3/day a week, 12 hr day thing which is really nice. You can have 4 days off a week with your family. But if you want to make some extra money its generally really easy to work overtime. So working 4 days a week isnt too bad. I sometimes will work 5/week to get some nice pay checks. And as you are working as a nurse there are so many specialties to go into and you might be able to better figure out what area really calls to you as far as becoming an NP. Its so versatile. We have NP's working in our ICU, cardiology clinics, some work with our CTS surgeons and assist in surgery and rounding, or you can go the CRNA route. I think you will be happy going this route. You said money wasnt your first motivator but you can still make a decent living as a nurse. And many hospitals will assist with your education tuition when you are employed. Who knows you you might even like being "just a nurse" :). I know I am. I have zero desire to advance my degree. Im happy with my 3, 12 hr days and ability to travel frequently, and you know do whatever!
Wow, you all are incredibly supportive. I thank all of you for your humorous and encouraging responses. If this board is reflection of the profession itself, then I really look forward to my pending admission decision with the local state U. Should hear something within the next two weeks.
You have to do what is best for you but I am a stubborn person, and I don't quit until I succeed, if it is something I really want. I take the roads less traveled. I make sure things are in order for me to make great sacrifices. I am in the process of going back to school to become an MD in psychiatry. My husband is supportive and shows it. I spend time with my family when I can. They will have to understand. The outcome is worth it for me. I want to look at my life years from now and be okay with the decisions I have made. I want to work for myself at some point. Nursing has its own set of sacrifices.
I here you. At a certain point for me, the ends do not justify the means. I've come from a background where the odds are stacked against me to quite a degree - first gen college student, born on a reservation to parents who currently qualify for welfare, served in Iraq as a medic in a unit who threatened to kill the person I replaced, was a very troubled youth, etc etc. Instead of quitting when I was initially rejected for military service I persisted. I persisted through college in the top 10% of my class, marriage at a time and place where about 65% of marriages end in divorce within 10 years, and continue to persist in the face of people who deny my heritage as a registered tribal member because my skin isn't dark enough. However, persisting through to med/pa school isn't worth it. I've got stuff going on in my life that I enjoy and am not willing to give up. I'm producing an album, building a microbrewery with my dad, I'm a cyclist 5 days a week, and most importantly I'm raising my two boys. I just can't give any of that up, especially the latter.
Oh goodie, someone else who wants to go into advanced practice nursing because the educational process is easier and less competitive than what the person actually wants to do ...
I honestly expected more feedback like this. The problem, in my opinion, is that the applicant pools are soooo saturated that med and pa schools can pick anyone they want, which naturally leads to a culture of application inflation like chasing bullet points and GPA instead of real hands on medical or life experience. For medical school, the residency bottleneck has helped create the physician shortage which was recently exacerbated by the ACA. That's their problem, and not something I am willing to wade into, especially considering MD salaries relative to their admin burdens are decreasing...what breaks this for me is the fact that in order to get to that underpaid place in life you have to sacrifice 10+ years. That's just not worth it. That's just not what I actually want to do. Society's solution to this problem has been the creation and expansion of non-physician practitioners...at this point, if you are over 30ish and have a family, then why wouldn't you pursue the NP/PA route?
Do what you love AND what works best for your family. You have to make sure that the amount of sacrifice you be your family will endure will be worth it. I was headed towards a similar path but in the end, the sacrifice and debt was just too much on my family and there were other things that will make me just as happy. So I made a change. I'm happy for you.
Non Sequitir, you would look much better with some soft curls, and lay off the neck exercises.
This is hideously offensive.
OP, thank you for your comprehensive comparison. It sounds like you have overcome some huge obstacles that live has thrown at you and yet, you persisted. Way to go and best of luck!
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I honestly expected more feedback like this. The problem, in my opinion, is that the applicant pools are soooo saturated that med and pa schools can pick anyone they want, which naturally leads to a culture of application inflation like chasing bullet points and GPA instead of real hands on medical or life experience. For medical school, the residency bottleneck has helped create the physician shortage which was recently exacerbated by the ACA. That's their problem, and not something I am willing to wade into, especially considering MD salaries relative to their admin burdens are decreasing...what breaks this for me is the fact that in order to get to that underpaid place in life you have to sacrifice 10+ years. That's just not worth it. That's just not what I actually want to do. Society's solution to this problem has been the creation and expansion of non-physician practitioners...at this point, if you are over 30ish and have a family, then why wouldn't you pursue the NP/PA route?
Not to speak for the poster you were responding to but the remark wasn't a criticism of those who decide on becoming an NP or PA instead of a physician but was really to bemoan the fact that the NP route is now perceived as the "easy" path to a provider role. As a practicing NP myself, it doesn't bode well for our profession to be regarded as the easy route.
But that's not really your fault either. As proud as I am of the beginnings of the NP profession and our achievements through the years, I am bothered by the lack of standards in how NP programs can be set up so that we now have programs springing up even in virtual classrooms with a handful of faculty that are housed in a corporate office somewhere while students are asked to find their own clinical placement. I am appalled at how programs get accredited and how candidate selection criteria in some programs are all over the place.
Your post is unfortunately, the kind of story these "opportunistic" NP programs want to hear. You will be a target of their aggressive marketing. My advise is that if you are someone committed to becoming a competent provider in the future, spend some time as a nurse at the bedside to figure out what specialty you are passionate about if you plan to start with a BSN first. The NP field is not a one size fits all. We have various tracks that prepare you as a specialist from the get go unlike the PA route which is more of a generalist training. Pick a reputable NP program and that may mean having to compete with other applicants who have stellar credentials in order to get in. That's OK, not everyone should be admitted.
Pick a reputable NP program and that may mean having to compete with other applicants who have stellar credentials in order to get in. That's OK, not everyone should be admitted.
I seriously wonder if there are any left as even the big names in my area are encouraging their undergraduate audience to remain in school straight through and discouraging RN experience in an effort to increase retention.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I seriously wonder if there are any left as even the big names in my area are encouraging their undergraduate audience to remain in school straight through and discouraging RN experience in an effort to increase retention.
My only contacts with NP students nowadays are via our affiliated university's AGACNP program. The ones that rotate with us have significant experience at the bedside, majority of which are in ICU's. The program stopped admitting direct entry candidates to the AGACNP track. I also know of RN's who didn't get accepted to the program despite being employed in the medical center.
I found your criticisms (maybe not that strong...down sides?) of the PA profession to be suprising. From what I heard, MDs prefer to work with PAs since they have similar educational background and training philosophies. Advance practice nursing has been quite nebulous in its educational standards and defining practice. In my market area, there are probably more opportunities for PAs than NPs for advance practice. I do not see them fading out at all.
I chose NP over PA because I saw more opportunities in organizational development. I could also teach, should I ever get burned out of clinical practice. To each their own.
callinshotz, LVN, RN
130 Posts
It's almost as if I wrote it myself. I feel the same way. Instead of killing myself, trying to compete with these people who can pull all-nighters 5 days a week and give up the next decade, I made a switch. I'll still be happy and I'll be helping patients, but I can progress my career at my own pace without committing my child to ramen noodles for the next 6 years (I was pre-dental).