My professor told us NPs have no future...

[anilechim]

Hi everyone,

I'm just starting out in nursing school. I'm in my first semester, and currently at the tail-end of A&P I. On Tuesday night, one of my classmates asked our professor, who spent the bulk of his career prior to teaching as a scientist for Schering-Plough Research Institute, what a Trump presidency could possibly mean for the future of healthcare professionals. My classmate went on further to ask our professor what he thought a job market in the future would look like for NP's. Before answering the question, our professor went on and on about how MDs and PAs will always be needed, but that he doesn't see a job market for NP's other than as nursing instructors. He was even pretty much shrugging his shoulders and rolling his eyes! This immediately raised a huge red flag for me. I was pretty horrified by how dismissive he was of this career path. He actually said, "yeah, that's an avenue a lot of nurses are taking these days, mainly because it's the only way to advance their careers."

Can he possibly be serious?! And furthermore, is there any truth to his assumption? I personally know two women who were nurses for 20+ years who recently went back to school to pursue DNPs and are currently working in their specialized fields alongside a group of doctors, and they're very happy and successful. I follow multiple nurses on Instagram who have large social media followings who are recent grads/current NP students and none of them have been relegated to teaching because there is "no job market for NPs."

My lab instructor is a highly respected doctor and I plan on discussing this with him tonight, since I'm sure he knows a lot more about this sort of thing than my lecture instructor seems to think he does.

I would love to "hear" your thoughts on this. Personally, I was horrified and quite offended.

[Skippingtowork]

Not all ACNP programs require any bedside experience. My alma mater's grad program, a state university, doesn't and I can name more. Only neonatal NP programs universally require relevant experience.

That is a problem.

600 hours of clinical experience isn't enough. Your typical PA has thousands. I don't say this to diss NPs but with the exception of CRNA and NNP, every other advanced degree in nursing varies wildly in requirements. Even other NPs and experienced nurses on this forum have attested to the lacking in NP education.

When you say "your typical PA has thousands" of clinical hours, I have a hard time adding that up. PAs are in school for 2-3 years. The first year is classroom, leaving the 2nd and possibly 3rd year for classroom and clinicals. I agree that I prefer how their program is designed, but one can get into the PA program with the academic prerequisites plus hands on patient care, ranging from experienced CNA, medical assistant all the way to former MD. Big variation. So a nurse with 1-2 years of full-time experience and the right motivation, should do well in NP program.

There are all sorts of medical professionals out there. No matter what school they go to, some are great, some are alright and some "not such a good idea."

[core0]

When you say "your typical PA has thousands" of clinical hours, I have a hard time adding that up. PAs are in school for 2-3 years. The first year is classroom, leaving the 2nd and possibly 3rd year for classroom and clinicals. I agree that I prefer how their program is designed, but one can get into the PA program with the academic prerequisites plus hands on patient care, ranging from experienced CNA, medical assistant all the way to former MD. Big variation. So a nurse with 1-2 years of full-time experience and the right motivation, should do well in NP program.

There are all sorts of medical professionals out there. No matter what school they go to, some are great, some are alright and some "not such a good idea."

The PA hours are pretty easy when you consider that its a full time job. The first year is didactic but most programs have some clinical component. Ours was 4 hours a week either doing H&Ps inpatient or following a PA in different clinics. Total around 200 hours. Our clinical year was 10 five week rotations. There were 8 required rotations and 2 optional. I still have my logs from 16 years ago. I averaged 84 hours per week on Surgery and 34 hours per week on psych. Overall average was 60 hours per week. Total hours was 3354. If you include first year around 3500 hours. This would be pretty typical 20 years ago. Now the hours are a little less but the programs average longer.

[Dodongo, APRN, NP]

I just want to point out there are quite a few ACNP programs that require ICU experience. The program I'm currently in had a 2 year minimum requirement. But I do agree about the rigor and uniformity of the PA educational process out stripping that of NPs by a considerable margin. I am supplementing my curriculum with courses in anatomy, physiology and histology through the medical program associated with my school because I think it's necessary for me to be a better provider. And my clinical semesters will be full time not one or two shifts a week. I have already spoken with my surgical preceptor (a physician) and I will be in the OR with him every time he is in the OR for the 10 week quarter. You can make NP education work but if you just sail through on the minimum requirements you are doing yourself a disservice.

[mrl3fnp]

Ahhhh both objective and scholarly...makes me so proud, lol. I simply posted what has actually happened in my area with regard to unprepared NPs not working out at two local facilities so I'm not sure where your confusion lies.

Apparently, the confusion lies on your end........because your experience at the two local facilities isn't reality. By the way.....if you prefer to use Grammarly then knock yourself out.......!

[Skippingtowork]

The PA hours are pretty easy when you consider that its a full time job. The first year is didactic but most programs have some clinical component. Ours was 4 hours a week either doing H&Ps inpatient or following a PA in different clinics. Total around 200 hours. Our clinical year was 10 five week rotations. There were 8 required rotations and 2 optional. I still have my logs from 16 years ago. I averaged 84 hours per week on Surgery and 34 hours per week on psych. Overall average was 60 hours per week. Total hours was 3354. If you include first year around 3500 hours. This would be pretty typical 20 years ago. Now the hours are a little less but the programs average longer.

I think that has changed. Even residency hours have been reduced from previous normals due to safety issues. I've been checking out quite a few PA programs and speaking to PAs who graduated more recently. A family member would like to be an NP, while another PA family member wants her to go the PA path because of the training with MDs and the hospital and procedure exposure.

[Dragonfly2014]

There is plenty of job market for NPs and it continues to grow. The projected job growth is similar to PAs. I disagree with your professor, his statements are biased and not grounded on any evidence, just personal opinion. You can view stats on the U.S. bureau of labor statistics.

[Nursferatu]

I will say from my recent interview experiences employers are more savvy about NP programs. I was flat out asked if I had ever set foot on the actual campus. I explained yes as my program was a hybrid. I am licensed in that state and completed some of my hours there. My employer said good thing you can show us all of that because we are not hiring NPs from strictly online programs. This is a large hospital system with a corner on the market in my area. That will affect many NP new grads in my area.

THIS! This is exactly the point! Anyone not doing due diligence in the program they are spending a fortune on, are doing themselves a disservice. Anyone who is willing to put their patients at risk so they can get a moderate bump in pay or prestige probably deserves the future lack of employment headed their way! This is why I believe the future of advance practice nursing is not in danger. It's not like 15 years ago when the practice and education wasn't as familiar. Yes, there are going to be schools/programs trying to take advantage of the market but people that really care about the profession and patient care will do the right thing and most likely reap the rewards.

[NurseLauraM]

I can only speak from my own experience, but I had a lot of success on the NP job market as a new grad (which was just earlier this year). In fact, I found it to be much easier to get an NP job than an RN job, although the DEA and credentialing took what felt like a lifetime... but that's another discussion . My classmates will attest to the same experience, as all had jobs within one year of graduating (and likely would have even sooner except that many took time off to travel, get more RN experience, etc). None of us can predict with certainty what the NP market will be like fifty years from now. However, from my perspective, things look pretty promising for the near future.

While I do believe NPs have a positive road ahead, I would also like to advise NP students against unrealistic job expectations. Although there is an NP shortage, it affects each geographical area and specialty area disproportionately. For example, in the area I went to school in, there were far more NP jobs for new grads in psych than in primary care. Apparently the need was quite dire because they were willing to hire FNPs with very little behavioral health experience. Alternatively, there was an abundance of primary care NP openings in other locations, particularly in rural settings. I was more apt to compromise on the latter than the former, so I took a primary care position in an underserved area. Go into the NP field optimistically, but don't expect a position in your #1 specialty within a 30 mile radius of where you currently reside.

Finally, the last thing I'll say is that I strongly agree with the posters who describe a lack of quality in some NP programs. I'd even take it a step further and say that no NP program independently prepares one to become a successful NP. NPs are expected to perform many of the same tasks as MDs, but with less standardized training and no residency. Thus, instead of relying on your NP program alone to prepare you, take personal responsibility of your education. Get as much RN experience as possible, be proactive in obtaining high-quality preceptorships, do extra clinical hours, and go above and beyond in your coursework.

[hopefulFNP2017]

Thanks NurseLauraM, some very good advice to an aspiring NP here. I am wondering what your life was before becoming an NP grad? Did you already have experience as a nurse or the healthcare arena? I have years of experience as an administrator in a medical school and have worked in clinical research/administration in hospitals, but I haven't had nurse-work prior to this and I'm acutely aware of the need to step it up and go through a period of being in the trenches if that's what will make things go...smoother on all fronts.

I think your advice about taking your education by the horns and being willing to put in extra to become a good nurse practitioner is very important. I don't want to become one of those new grads with an entitlement complex that people complain about, and want to build a good foundation in clinical education before I get out there seeing patients on my own. I think it makes sense; we need to take personal responsibility, get mentored, really get educated to become the kind of medical professional you could entrust yourself or your loved ones to take care of. My own standard is, if I walked into a urgent care clinic as a patient, could I trust an NP like myself?

[NurseLauraM]

Thanks NurseLauraM, some very good advice to an aspiring NP here. I am wondering what your life was before becoming an NP grad? Did you already have experience as a nurse or the healthcare arena? I have years of experience as an administrator in a medical school and have worked in clinical research/administration in hospitals, but I haven't had nurse-work prior to this and I'm acutely aware of the need to step it up and go through a period of being in the trenches if that's what will make things go...smoother on all fronts.

I think your advice about taking your education by the horns and being willing to put in extra to become a good nurse practitioner is very important. I don't want to become one of those new grads with an entitlement complex that people complain about, and want to build a good foundation in clinical education before I get out there seeing patients on my own. I think it makes sense; we need to take personal responsibility, get mentored, really get educated to become the kind of medical professional you could entrust yourself or your loved ones to take care of. My own standard is, if I walked into a urgent care clinic as a patient, could I trust an NP like myself?

Hi hopefulFNP2017, I'm glad you found my post helpful! I got my MSN pretty much immediately after completing my RN. I realize a lot of people are against rushing to get the MSN after the RN, but I think there are sometimes reasons it makes sense to sooner. Personally, I was on an athletic scholarship and had a year of eligibility left during which they would pay for school, so I had to go back right away in order to take advantage of that. Anyway, I digress.

During my NP program I worked as an RN about 20-30 hours a week for 2 years. This isn't much compared to what most NPs have as far as nursing experience, however it was the most I could do at the time and I feel that it benefited me quite a bit. I worked in an outpatient allergy/asthma practice. I might get some heat for saying this, but I don't feel it is necessary to work inpatient to be a successful NP (at least in primary care). That's not to say you don't gain valuable skills on the floor, but it is not the only route to becoming an NP. That being said, in realizing my relative lack of years of experience compared to other NPs, I feel it is my responsibility to go above and beyond as a new NP (meaning I spend a lot of time doing research, extra CMEs, additional training, etc. in my personal time). Many new NPs do this, however I have also encountered many who do not (the "if I'm not being paid for it I'm not doing it" type) and I personally think that is reckless behavior.

As far as healthcare experience in general, I actually worked as a receptionist in an outpatient pediatric practice during my undergrad. Because I wasn't in a clinical role I did not initially list this on my resume (stupid, I know). However, following some much appreciated advice I added it. And guess what? It was a major factor in one of my job offers! The interviewer actually told me, first thing when I sat down, that my receptionist experience stood out to her because she wanted someone who "understands the behind-the-scenes and doesn't take support staff for granted"... low and behold I was told by one of the NPs that the physician who had recently retired from that office was very rude to the administrative staff! I say this because I believe your clinical research/admin and administration experience could be very beneficial to you in future interviews for any number of reasons. Do not downplay it!

You mention not having any nursing experience. If you can, I would recommend working as an RN during your NP program. However, if you can't pull it (i.e. your course load is too high, job is too demanding) and you can afford to focus on your studies then put all of your energy into that. A lot of people dislike the idea of people getting MSNs with no RN experience. However, I believe that if you are willing to "work in the trenches" as you say, you can pull it off. Just be prepared that you may have to work a less-than-desirable NP job, or even work an RN job for a bit until you find/feel ready for an NP position. If you can, try to find an NP job with an extensive orientation/training period... I believe this is the most important thing for a new grad to focus on in the job search (especially with little RN experience). You will have a steeper learning curve and will have to work extra hard to prove yourself. However, if you have a strong work ethic and don't have unrealistic expectations - for example, believing you can get a perfect NP job immediately after graduating with no RN experience - you can be successful. By the way, it sounds like you absolutely have the right attitude! You seem hard-working and humble, and I think that will take you very far

[hopefulFNP2017]

Hi NurseLauraM, I just want to thank you again for your post--it's enormously helpful what you shared and very encouraging. I'm a bit exhausted from work at the moment so I can't write longer, but know that your response is appreciated.

[Goatie]

You need to report this professor to the dean of your school, because this is not true. There is a need for NP's, the VA System in particular is hiring a bunch now. I get unsolicited emails and calls all the time from headhunters coz I left my resume on-line. Once you get into the field as an NP, you will learn which job setting and population are best for you, but where I live (CA) there are plenty of jobs (specially psyc, medical spas (e.g. botox, lasers), need for bilingual NPs, and family practice. My specialty is geriatrics and I know I do NOT like snf's, so I'm picky about jobs I take.