Just some questions for you NP's ;-)

Purple_Scrubs, BSN, RN · Oct 15, 2009

I just wanted to bump this up, I would like to see the answers as well :)

Super Nurse JoshuA · Oct 15, 2009

I would also like to see some NP's answer the OP's questions.

Editorial Team / Admin · Oct 15, 2009

Hello,

I am trying to figure out what route my life needs to take. I am having a difficult time deciding on whether to apply for a MSN in clinical leadership, or a NP program.

Hello,

You probably need to shadow an NP to get a better idea of what to expect. Try an FNP (since you talked about that specialty below).

Two questions you need to ask yourself: "Do I want to provide healthcare for my patients" (NP) or "Do I want to educate nurses in the clinical area; evaluating and teaching them to hone their skills" (CNL).

I want to do both, really. I love being charge nurse, and if I did the MSN/CL program, I could become an assistant manager at my old job. Actually, I could probably become an actualy manager (vs. assistant), but I love working on the floor, I love helping my patients, I love helping their family, and I love helping new nurses become more comfortable with their skills. These are the rolls that the asst manager takes on at this hospital, he/she is not in a office. I'm not sure how much it pays, though. My old manager and I are facebook friends and she is encouraging me to go thru with it b/c she thinks I would be excellent at it. But on the flip side, I want to go through a NP program...

No reason you could not do both. But, if you are not really wanting to be a HCP, pursuing NP might not be what you want.

- When you reflect back on your life as a floor nurse, vs. NP, are you more at ease and content with your life now? Do you have any regrets? I know being a NP is streessful, but how is the stress different than being a floor nurse?

Not sure "at ease" is how I would describe things. I'm certain I have no regrets and am content as NP. I never enjoyed bedside nursing per se. Yes, it is stressful, but nursing is stressful. As NP, you are responsible for dx, tx of the patient. That can be on one end, the most rewarding thing in the world and on the other end, the most frightening responsibility you could know.

- I am SCARED to DEATH of writing a prescription. I won't be able to remember everything from the pharmacolgy section, so I'm scared I will write something that is contraindicated for the patient!

That's quite common to be anxious about having that responsibility. You will have to have a very good background in Pharmacology during your NP program and stay up-to-date post grad.

- If I get into family practice, man, it sounds like a killer for someone who has never worked with pediatrics or maternity. I don't know anything about kids and to be honest, I am scared to death of them! for those of you who never worked with kids, how prepared did you feel after becoming a NP to work with them in family practice?

That's the part of my practice that I like the very least; pediatrics.

Many FNPs work in environments where they do not take care of peds. It will be area-dependent if you can find jobs like that.

- did you work on cadaviers in the program? Do you suture people, insert central lines, etc or is that not in the scope for most states?

No, no cadavers.

Yes, suture, central line placement.

- How many hours did you work when you went through the program? Most schools do offer the part-time option, but I would rather go full-time because I'm scared that I will forget everything if I go part, and then bomb the boards, or worse, not be a comptetent NP.

I worked full-time pursuing my first NP.

I did not work with the post-grad certificate.

-How common is it for you to calculate drug dosages? I'm so scared of that!
Thanks ladies and gents!!!

Very common. That's a huge part of my practice.

Again, you need to shadow a "real-life" NP. Not sure what specialty you are really interested in? And, you might consider CNS (if your state recognizes this). traumaRUs (another admin on the site) is a CNS and will be able to help you with that specialty.

I am an Educator as well. I love teaching. So, I was able to combine my first love (OB-GYN NP) with Education and have never regretted it.

Good luck.

Advanced Practice Columnist / Guide · Oct 16, 2009

Hello,
I am trying to figure out what route my life needs to take. I am having a difficult time deciding on whether to apply for a MSN in clinical leadership, or a NP program. I want to do both, really. I love being charge nurse, and if I did the MSN/CL program, I could become an assistant manager at my old job. Actually, I could probably become an actualy manager (vs. assistant), but I love working on the floor, I love helping my patients, I love helping their family, and I love helping new nurses become more comfortable with their skills. These are the rolls that the asst manager takes on at this hospital, he/she is not in a office. I'm not sure how much it pays, though. My old manager and I are facebook friends and she is encouraging me to go thru with it b/c she thinks I would be excellent at it. But on the flip side, I want to go through a NP program...

This is just my overly cautious point of view but I'd stay away from the CNL programs. It's not an advanced practice role and would not prepare you as a manager or an educator. It's touted as a generalist nurse role. I don't know if it has widespread acceptance yet and the previous buzz about the programs and the role taking off with hospitals begging for CNL's seems to have fizzled. The economy might have put an early death to this "new role"...but again, that's just my opinion.

- When you reflect back on your life as a floor nurse, vs. NP, are you more at ease and content with your life now? Do you have any regrets? I know being a NP is streessful, but how is the stress different than being a floor nurse?

Not to copy sirI's response but I wouldn't call it "more at ease" either. I still get palpitations every now and then when a patient highly suspicious for sepsis rolls in the ICU with a MAP of 40 or a post-CABG patient dumps 400 ml of bright blood from the mediastinal tubes in a hot second. However, I wouldn't exchange a day of being an NP to return to working at the bedside as an RN. I love the challenge and the ability to do more.

I still have lots of interaction with bedside RN's and I do like that about my role. Once in a while, I would jump in and attach a Swan-Ganz to the monitor cables when a post-op patient comes in and the nurses do not mind me doing that. The RN's also let me touch the IV pumps and change rates as long as I tell them what I am doing - they would have slapped the resident's hand really hard if they did that!

- I am SCARED to DEATH of writing a prescription. I won't be able to remember everything from the pharmacolgy section, so I'm scared I will write something that is contraindicated for the patient!

I work in an acute care setting. I have a Pharmacist, Uptodate, and Micromedex to refer to. Even physicians don't remember exact dosages.

- If I get into family practice, man, it sounds like a killer for someone who has never worked with pediatrics or maternity. I don't know anything about kids and to be honest, I am scared to death of them! for those of you who never worked with kids, how prepared did you feel after becoming a NP to work with them in family practice?

exactly the reason why I did an Adult Acute Care NP program. Sick kids freak me out.

- did you work on cadaviers in the program? Do you suture people, insert central lines, etc or is that not in the scope for most states?

Advanced Pathophysiology is all lecture with no lab component in my program. In my job, I insert central lines and secure them with sutures. In the hospital setting, this is more of a credentialing and priviledging issue rather than a state scope of practice matter.

- How many hours did you work when you went through the program? Most schools do offer the part-time option, but I would rather go full-time because I'm scared that I will forget everything if I go part, and then bomb the boards, or worse, not be a comptetent NP.

1st year, I worked full time. 2nd year, I worked part-time but picked up shifts as much as I can. I went to school with a full time courseload and was done in exactly 2 years. The boards were not that bad if you prepare for it.

-How common is it for you to calculate drug dosages? I'm so scared of that!

I do quite frequently but again, the Pharmacist is always a big help in this matter. The hospital system I work for has enough protocols and formulary guides that it's almost too easy to write med orders. Vasoactive drugs given as IV drips are always standardized.

allnurses Guide · Oct 18, 2009

I can't speak to the CNL role or liking NP better than RN, as I have not worked as a bedside RN, but I can give you the perspective of a new clinic-based FNP.

I see only adults, although I wish I could see kids too. In my area, at least, there are not too many "true" family practices where you see both adults and kids. I don't think it would be horribly difficult to find a position as an FNP where you only see adults.

I think prescribing in the out patient setting is a whole different ballgame than in a hospital. We only deal with PO and topical meds, so calculating dosages is not an issue. The Tarascon pharmacopeaia and Sanford guide are my best buddies. I have them on my Palm so I can quickly check any dosages or other info I need. The area pharmacists are also great about calling if something I wrote doesn't look right. They are also a great resource if I have questions.

We never dealt with cadavers in school, nor learned how to perform invasive procedures. I took a separate course on my own to learn how to suture, but I don't do it in my current practice. I do I&Ds, wound debridement, removal of foreign bodies if easily accessible, wart removal, suture removal. I learned how to do IUD placement in one of my clinical settings, but i don't do it now. I do a lot of patient education, which I really like.

I went to school full time and worked about 14-20 hours per week during the program. That was about all I could manage and still keep up with my schoolwork. Classes and clinicals took up at least 35 hours of my week.

I agree with the others, in that it would be a good idea to shadow an NP, maybe in both a hospital and clinic/office setting. That might give you a better idea of which path would make you happier-NP or CNL.

Good luck!

sandnnw, BSN, MSN, EMT-B, APRN · Oct 18, 2009

NP...don't look back.

raindrop · Oct 19, 2009

Thank you, thank you, thank you!!

I know what direction to take, thanks to all of your responses. I am all about the FUTURE, and come to find out, NPGilly was absolutely correct when she stated that Clinical Nurse Leaders are becoming a thing of the past. I spoke with one from my old job over the weekend, and she is no longer a CNL as of last month. The hospital didn't think it was a cost-effective or needed role anymore, so all CNL are now floor nurses. That would really stink to get a MSN in anything, in hopes to get out of bedside nursing, and then end up back to square 1. No thanks!

So here is what stinks about becoming a NP - I need more chemistry. Nobody hates Chemistry like I do. I could probably handle a semester of it, but based upon my research thus far, it looks like I will need another year. Oh, and I have to take the GRE. My interest was piqued with the CNL option because 1)my uni offered this program ,2) I would not have to take the GRE if I graduated with a high GPA in all my core BSN courses.

So another year of Chem and the GRE. Yuck. I The only portion that I *think* I will do poorly on during the GRE test is Math.

NurseKitten, MSN, RN · Oct 19, 2009

Find a chemistry tutor who has a biochem or pharmacy background. It will make the "dry" chemistry more relevant to what you're doing. I hated gen chem, but LOVED LOVED LOVED organic and biochem - it made a difference when I actually understood why ephedrine crosses the blood-brain and epinephrine doesn't!

I second what the others said: Go shadow a few ARNP's, and see what their practice is like. :)

sandnnw, BSN, MSN, EMT-B, APRN · Oct 19, 2009

Now that I have a few minutes...

- When you reflect back on your life as a floor nurse, vs. NP, are you more at ease and content with your life now? Do you have any regrets? I know being a NP is streessful, but how is the stress different than being a floor nurse? Much more at ease...life was hard as a floor nurse, esp on a surgical/transplant floor. The stress of an NP is different. Time management, trying to get your patients to understand what they read/see on TV is not always right for them. You learn independence is refreshing, inspiring and opens up a whole new world. Regrets? NO, I wish I had chosen broader clinical sites/preceptors.

- I am SCARED to DEATH of writing a prescription. I won't be able to remember everything from the pharmacolgy section, so I'm scared I will write something that is contraindicated for the patient! Don't worry, that's why you are a student. You'll have a great PathoPharm class and discuss all kinds of drugs, protocols, etc. Again, don't get too worked up about this, it comes w/practice and experience.

- If I get into family practice, man, it sounds like a killer for someone who has never worked with pediatrics or maternity. I don't know anything about kids and to be honest, I am scared to death of them! for those of you who never worked with kids, how prepared did you feel after becoming a NP to work with them in family practice? Again, that's why you'll have a peds/maternal health rotation. Chose one with plenty of hours. Unless you work in a urgent care/walk-in clinic, you won't see a ton of kids. Most of what my peers see in our clinic is cuts, scrapes, fractures and viral illnesses. You'll see much more in your rotation. Having your FNP does NOT mean you have to work with kids.

- did you work on cadaviers in the program? Do you suture people, insert central lines, etc or is that not in the scope for most states? No cadaviers, we used Sims. Our program used on-line Sims that were very realistic and sometimes very hard to ferret out what was going on. I loved them, very challenging, thought provoking, which is what's supposed to happen in graduate school.

- How many hours did you work when you went through the program? Most schools do offer the part-time option, but I would rather go full-time because I'm scared that I will forget everything if I go part, and then bomb the boards, or worse, not be a comptetent NP. Again, don't worry. I started trying to work 36, then dropped to 28 the next semester. The clinical hours are difficult to fit into a full-time job, people do it, but I think it robs them of a positive graduate experience. Work is distracting, but necessary if you have a mortgage

-How common is it for you to calculate drug dosages? I'm so scared of that! I'm scared of the dark too. Blah, it will be second hand by the time you graduate.

In summary, "NP, don't look back..."

jlcole45 · Oct 20, 2009

For the GRE it is well worth the money to sign up for one of the prep classes like offered at Kaplan or the like. It increased my score over a 100 points.

Advanced Practice Columnist / Guide · Oct 20, 2009

I know what direction to take, thanks to all of your responses. I am all about the FUTURE, and come to find out, NPGilly was absolutely correct when she stated that Clinical Nurse Leaders are becoming a thing of the past. I spoke with one from my old job over the weekend, and she is no longer a CNL as of last month. The hospital didn't think it was a cost-effective or needed role anymore, so all CNL are now floor nurses. That would really stink to get a MSN in anything, in hopes to get out of bedside nursing, and then end up back to square 1. No thanks!

I actually wouldn't even call the CNL as a "thing of the past" because the role never really broke ground. It's relatively new and while a few instututions welcomed the idea at first, many are now realizing that in this crappy economy, redundant roles such as the CNL can be eliminated and the previously held duties of the CNL can easily be combined with other older roles such as charge nurses, case managers, and clinical coordinators who are not required to have a Master's degree or even a Bachelor's for that matter in some institutions. APN's, on the other hand, have a revenue-generating ability and hospitals have a tendency to put more value on that.

The CNS role although not as popular as NP, is still very much alive in many places around here where I live. The state does not provide title protection for the role but hospitals here continue to see the value of a Master's prepared specialist nurse despite this era of cost-cutting and lay-offs. There is usually one CNS in each patient care unit or clinical service line in our hospitals here. The CNS pretty much serves as the "go-to person" for the nursing staff when they have questions about a new equipment, clinical nursing protocols, patients with unusual diagnoses, etc. They also coordinate nursing staff educational needs as far as unit-specific competencies and skills, nursing specialty certifications, and staff credentialing for nursing procedures. Our hospital's nursing research arm produces a significant amount of nursing-based studies that are typically headed by one of the CNS on staff who serves as primary investigator. You may want to look into CNS role and its traditional functions prior to making your final decision.

So here is what stinks about becoming a NP - I need more chemistry. Nobody hates Chemistry like I do. I could probably handle a semester of it, but based upon my research thus far, it looks like I will need another year. Oh, and I have to take the GRE. My interest was piqued with the CNL option because 1)my uni offered this program ,2) I would not have to take the GRE if I graduated with a high GPA in all my core BSN courses. So another year of Chem and the GRE. Yuck. I The only portion that I *think* I will do poorly on during the GRE test is Math.

Typically, your BSN diploma is your ticket to a Master's degree in nursing directed at NP training (and an RN license, of course). I am surprised you still have to take a year's worth of Chemistry to get in the specific program you researched. I finished my undegrad degree in nursing in 1991 and registerd for my MSN in 2002 and was not required to repeat any courses I had taken previoulsy. I did have to take the GRE. However, many institutions including the one I attended no longer require the GRE now. Perhaps, a little bit more research on your part will reveal that there are other programs that wouldn't have the same degree of restrictions in their admission policies as the one you are currently looking at. Keep your school options open.