NP: Age limit?

[romantic]

Hello all Advanced Practice Nurses,

What is the age limit to apply to NP program in your opinion? When do you think is late to do so? Is 50 late? 55? What is the rate of success in this field for the nurses older than 50?

Thank you!

romanti

[myoglobin, ASN, BSN, MSN]

I would simply assert that there are many aspects of competence. One clinician may be more likely to "slip" and make an error (regardless of age), while at the same time adding an effective intervention that improves morbidity/mortality or "catching" a condition that the the less "slip prone" clinician may have been able to accomplish. We are all a complex interactions of many variables. One MD's "slipped self" may outperform another MD or NP at the very height of their career. Also, some people are much more likely to "slip" in certain situations such as when they are under pressure or with certain personality types (again at any age). There of course needs to be a "minimum" level of competence that must be met and that should be the standard not whether or not someone is "slipping" verses their old self. It is a standard defined by law rather than chronological age.

Also, I've found that sometimes medical management involves trade off's that to someone not involved in the case might appear to be an error. For example I sometimes treat highly resistant OCD/ADHD clients who need to be treated both with high doses of sertonergic agents such as Zoloft and with ADHD drugs (such as Adderall XR). There is an intrinsic "risk" to this that could even result in their death(s) from things like serotonin syndrome. At the same time not effectively treating the conditions could also lead to poor outcomes including deaths (for example those with untreated ADHD are more likely to be involved in automobile accidents or make errors at work and those with uncontrolled OCD are more likely to commit suicide). I attempt to apprise clients of the "risk to benefit ratio" but in truth this is only a "best guess" with uncertain outcomes. Also, in line with the "To Err is Human" report most serious errors involve a "systems failure" rather than a personal one. Time pressures to see patients that are to demanding and software/communication systems that are completely inadequate. It is a complex issue that goes far beyond someone's age.

[romantic, BSN, RN]

On 8/14/2020 at 6:20 AM, gettingbsn2msn said:

I finished NP school at 52. It was somewhat difficult to find a first job but I attribute that to over saturation and not age. Many MD's work into their 80's but at a less capacity. That is my hope. I just do not know what I would do in my retirement years. I do not play golf or tennis.

On a side note my son finished his BSN 2 years ago. At his graduation I met two people in his graduating class that were going on to become NP's. Both were in their 50's.

I believe one has to weigh the cost. If you are borrowing 100k do do this I would say "no." If you can find a lower cost school I would go ahead. I moved across the country to save 80k plus I went to a brick and mortar school that set up my clinical rotations.

Thanks a lot for this information! I am glad to hear that.

My plan is to work as long as possible. I did found one school that is not extremely expensive, and I am not planning on taking a loan. Not in my age :).

Moving somewhere else to make the education cheaper is a good idea, but I am not that adventures, plus I still have a husband that I have to think about ?

Start playing golf. It is not too late ?

[romantic, BSN, RN]

On 8/14/2020 at 9:34 AM, umbdude said:

I was 41 when I got my RN and 44 for NP. I too plan to work into my 70s (but probably no more than 16 hrs/week), assuming I'm still alive and cognitively intact.

Darling, You are in the best age: fresh brain and enough of life experience will bring

prolific years.

[MICU_2015_FNP, MSN, APRN]

On 7/15/2020 at 7:36 PM, FullGlass said:

Thank you! No, you are not too old. Nursing is also my 2nd career. I started ABSN at age 53, went straight through to MSN NP, graduating at age 56. Got 9 job offers, all in the six figures. After about 1.5 years of NP experience, got job offers from $135K to $165K.

As others have comments, life experience and looking a little older can be a big asset for a provider.

With regard to cost of education, older individuals typically have more financial resources, so can pay more cash and require less loans. They may also be able to utilize a home equity line of credit, which is a lower interest rate than student loans. Your employer may also pay for part of your education.

There are also a lot of scholarships available. The HRSA Nurse Corps Scholarship is a full ride scholarship that even includes a living stipend, in return for working in an underserved area for 2-4 years. Many states have the equivalent program for state residents. Underserved does not mean just rural areas - it includes inner city areas, as well as smaller cities and towns. There are also scholarships offered by private entities such as J&J, various NP associations, etc. Most schools also have scholarships available for their students.

Good luck!

Do you mind sharing where you work? or what job offers you received??

I haven't seen NP job offers above $112k!

[myoglobin, ASN, BSN, MSN]

I work 1099 from home as a Washington state PMHNP and earned 17K this month seeing clients three days per week.  

[MICU_2015_FNP, MSN, APRN]

18 minutes ago, myoglobin said:

I work 1099 from home as a Washington state PMHNP and earned 17K this month seeing clients three days per week.  

Wow. That is a great field. I'm in primary care. We have no money... ? LOL

Thanks for sharing!

[myoglobin, ASN, BSN, MSN]

Well, Washington State, Oregon and other states like Nevada and Arizona have Independent practice. There is no reason that you couldn't see clients (either in person or tele) and make similar or better income than me.  I will wager that most of the companies that are paying in the low "100's" for primary care are taking in just as much "gross" income from insurance (or private pay rates) as my company, it is just that they are paying their employees less.  For example I took my son for a primary care visit to a local emergency care clinic here in Orlando Florida (he had a worrisome peri-anal wound and was reticent to let me do the necessary wound care). The cost was $200.00 for about a 15 minute visit. There was a three hour wait to be seen (and about 50 people waiting).  It is not unreasonable to conclude that "the clinic" was collecting $500.00 plus per hour for services rendered ($200.00 times 4 is $800.00, but I am allowing for some longer appointments and some reimbursements from insurance companies that were less than what we paid for cash).  However, I doubt that the PA who saw my son earns over $120K per year (and probably works 50 hours plus per week).  Now if "you" had such a clinic (say in Nevada I really like the 24 hour aspect of say Vegas integrated with the IP status of the state) why couldn't you earn say $100-200 per hour and still pay your staff a living wage?  Also consider that my significant other has worked for years seeing only Medicaid clients from home (as a PMHNP) and she earns $85.00 per hour and her company bills her clinic about $125.00 per hour for her services.  They indicate that she is still their most profitable "producer" since she doesn't get benefits and doesn't get admin time (and this is in Arizona where Medicaid reimbursement is rather poor).  

In many cases people (read MD's and corporations) are earning great money from primary care, it's just not being passed on to the workers.  

[FullGlass, BSN, MSN, NP]

3 hours ago, MICU_2015_FNP said:

Do you mind sharing where you work? or what job offers you received??

I haven't seen NP job offers above $112k!

I'm in California, and although we are not an Independent Practice state, California has the highest pay for NPs.

Right out of school I got job offers ranging from $110K to $125K per year.  After a little than one year of NP experience, I got offers from $140K to $160K per year in primary care and specialty care.

I decided to pursue my PMHNP and am working on that now.  However, I work part-time for a mental health clinic making $72 per hour with full benefits.  Many psych clinics in California are hiring non-PMHNPs because we have such a shortage of mental health providers.

I was willing to work in "less desireable" locations (that is purely subjective, of course).  My first job was in a very remote rural area, but it was also beautiful and great for people who like outdoor activities.  I made $125K per year and rented a nice little 2BR 2BA house for $750 a month then it went up to $800 a month.

The entire Central Valley (San Joaquin Valley) is desperate for providers, from Bakersfield in the south up to Redding in the north, and is quite affordable.

The 2 fastest growing cities in California now are Sacramento and Bakersfield.

Right now is not a great job market, due to COVID, unfortunately.  Many outpatient facilities have had to cut back services and hours, and doctors, NPs, and PAs have been laid off.  

 

[FiremedicMike, BSN, RN, EMT-P]

On 9/11/2020 at 6:44 PM, myoglobin said:

I work 1099 from home as a Washington state PMHNP and earned 17K this month seeing clients three days per week.  

Can you give me a mental picture of what these appointments look like?  I have an interest in going down the PMHNP route, but I would rather be focused on a mix of counseling and med management for my own patient panel (specifically focused on public safety personnel), rather than inpatient acute psych.. 

[myoglobin, ASN, BSN, MSN]

4 hours ago, FiremedicMike said:

Can you give me a mental picture of what these appointments look like?  I have an interest in going down the PMHNP route, but I would rather be focused on a mix of counseling and med management for my own patient panel (specifically focused on public safety personnel), rather than inpatient acute psych.. 

I see almost anyone from age six and up.  Although, I do "supportive" and evidence based lifestyle therapy since I practice in Washington where there exist a plethora of highly trained therapists in modalities ranging from CBT-T, EMDR to DBT I stick mostly to medication management and CAM approaches. It would be foolish for me to believe that I could ever offer as much (in terms of therapy) as those who devoted their entire educational endeavor to therapy, and then more education to specific therapeutic modalities. Having said that I always cover the basics of CBT(I) for those with sleep issues and offer a variety of resources to virtually all clients ranging from The Carlat Report podcast to Dr. David Puder's excellent podcast (both of which I listen to on Apple).  My appointment lengths are 30 minutes for medication management, and 90 minutes for initials.  If I could get the company to give me a fourth day I would probably start doing one hour medication management appointments and two hour initials for those more complex patients that would most benefit from a greater amount of time.

[WestCoastSunRN, MSN, CNS]

44 minutes ago, myoglobin said:

I see almost anyone from age six and up.  Although, I do "supportive" and evidence based lifestyle therapy since I practice in Washington where there exist a plethora of highly trained therapists in modalities ranging from CBT-T, EMDR to DBT I stick mostly to medication management and CAM approaches. It would be foolish for me to believe that I could ever offer as much (in terms of therapy) as those who devoted their entire educational endeavor to therapy, and then more education to specific therapeutic modalities. Having said that I always cover the basics of CBT(I) for those with sleep issues and offer a variety of resources to virtually all clients ranging from The Carlat Report podcast to Dr. David Puder's excellent podcast (both of which I listen to on Apple).  My appointment lengths are 30 minutes for medication management, and 90 minutes for initials.  If I could get the company to give me a fourth day I would probably start doing one hour medication management appointments and two hour initials for those more complex patients that would most benefit from a greater amount of time.

Hi!  Very cool that you are doing Telehealth in Washington from Florida!  (That's what I understood?)

If I got that right, you are licensed in WA - and that is how you are allowed to do the telehealth visits?  I ask, because since COVID many previous over-state-lines restrictions have been lifted to make telehealth more accessible.  Has any of that impacted your practice, or do you see how it might (ie., allow you start seeing patients in other states?)

[myoglobin, ASN, BSN, MSN]

I am licensed in Washington, Arizona, Colorado, and Florida (which is not independent practice). However, I currently only see clients via telehealth in Washington. I also only pay for my DEA license in Washington meaning I can only prescribe controlled substances in Washington. I may add other states (pay for the DEA) if I decide to go "cash only" and see clients on my own in the future.