NPs...Would you do it again?

I have been a nurse practitioner for a year now. Have always wanted to be one since high school, and now that I'm working in a family practice - I probably wish I would have went to pharmacy or dental school. I was accepted into CRNA school - kind of wishing I would have went with it, but didn't think I could handle the professional stress at that time, so backed out.

Currently looking to get into a federal position and get into the public health service - my goal is to retire now! :)

I'm curious what has you so dissatisfied with family practice, as I'm looking at either family nurse practitioner or CRNA school.

How truly autonomous are you in your practice? (I think this may vary by state?)

I am not very autonomous in my current position. I work inpatient and the hospital I work at is just really starting to see the benefits of NPs, which means we are in new territory and have to prove ourselves. Repeatedly.

Do you feel well respected? (I've seen some pretty nasty internet talk regarding NPs on various forums, and was wondering if this actually carried over into the real world...)

I feel well respected as a person in my current job. I feel well respected by my patients and coworkers. I do not feel a great deal of respect from some of the physicians I work alongside - which seems to vary greatly by specialty.

and the most important question I have...

Do you feel NP school provided you with a thorough enough knowledge base (or in other words...did you feel comfortable practicing as a relatively new grad NP)?

I think I felt pretty well prepared to get started. Comfortable...no. I think those who feel really comfortable right out of school are fooling themselves or think better of themselves than they should. It's scary to be responsible for making all the decisions we make on a daily basis - and I think that fear when one first gets started translates into appropriate caution after one is experienced. I've been a NP for only about a year-and-a-half. The first six months or so I was scared daily. The past year I've become comfortable, more confident, and much less frightened.

Was I well prepared by my NP program for entry-level NP practice? Yes, I was. And I learned HOW to learn, how to find information I needed, what resources are good, when I'm getting out of an area I should be in so I need to ask for help from others, etc.

Looking back, do any of you wish you had became a physician instead? (please no flaming...just an honest question...I'm aware that most NPs probably had no desire to become a physician)

Sorry for the long post...I guess what I'm really getting to is, would you become an NP again if you had a "do-over"?

Never had any desire to be a physician and would not have gone that route. A physician I worked with in the past encouraged me to apply to medical school rather than NP programs and I laughed. I have a husband I love and whom I was not willing to ignore for years in order to pursue physician training. And I love people and feel very strongly that lots of medical schools and residency programs educate the caring right out of students.

Nursing education is very different to medical education, so I would advise you to look very closely at both types of education to determine where you best fit and will be satisfied.

I'm just trying to weigh my options to see if I am following the right path.

I hope you don't mind me answering, I'm about 4 months away from being an NP:)

How truly autonomous are you in your practice? (I think this may vary by state?)

What I have seen from the various areas I've done clinical in is the amount of autonomy varies greatly. I have seen the range from a very autonomous practice to a role that was really nothing more than an executive secretary with a license. However, the NPs were all happy in their jobs. Not everyone wants the responsibility and stress a lot of autonomy creates. If that is something you need to be happy in your job, then you just have to find a position that provides you with that.

Do you feel well respected?

The NP with very little autonomy was well liked by the physicians she worked with, but I did not feel like they gave her much credit for her knowledge. On the other hand, she didn't seem to want it, so... I also had another experience where the NPs were not at all respected by the RNs. I was so surprised by this, since everywhere else I have been the RNs were very appreciative and respectful to the NPs. Where I am now, the NPs are highly respected by everyone in the unit, including the physicians. They are treated as an equal member of the medical staff. If an NP disagrees with a treatment decision of the MD, they will speak up and argue their opinion. They physicians always carefully consider their opinion and I've seen them change what they planned on doing because of the NP's input. Which means, it too runs the gambit. You just need to find a job that fits what you are looking for.

Do you feel NP school provided you with a thorough enough knowledge base (or in other words...did you feel comfortable practicing as a relatively new grad NP)?

We'll see how things go once I start working, but I am feeling like I am ready to graduate and start my practice. For everything I know, there are still 10+ things I don't know, but I know enough to find my specialty area and start learning what I need to know to be a competent NP. I don't feel like there is a whole lot more that school can teach me. I just need the clinical experience time.

Looking back, do any of you wish you had became a physician instead?

I considered med school. In fact I considered it before nursing school. I don't think I was really convinced that NP school was right for me until I did clinical hours with a physician. Their perspective is SO different from our perspective, and we're good at things that they aren't. I think having a medical team comprised of MDs and NPs makes the group stronger overall. The nursing perspective is what fits my personality and view of the world. I am where I need to be. I often wish I had the more formal educational background that the MDs have, but I know that as long as I keep working to learn as much as I can throughout my degree, there's no reason I can't eventually get to the level of knowledge that I want to have. And I think, if you want to be highly respected by the physicians you work with, then you have to go above and beyond what is required by our certifications or the basics of our job and really learn everything you can about the area you work in. If you can demonstrate that you do know what you are doing and work hard to be the best you can be at your job, you will be respected.

Just curious...what programs did you all attend. I'm interested in np school.

How truly autonomous are you in your practice? (I think this may vary by state?)

Completely. I have my own practice in a consortium in an independent practice state that recognizes NPs as fully equal to physician providers in every way.

Do you feel well respected? (I've seen some pretty nasty internet talk regarding NPs on various forums, and was wondering if this actually carried over into the real world...)

Yes. I occasionally get grief from a patient, but have never gotten any from professional colleagues. If patients don't want to see me because I am a NP, I'm ok with that. I know they are out there, but I have a full panel so I don't spend much time worrying about people for whom I bear no responsibility and with whom I have no relationship. It comes up about once or twice a year. Since I see about 125 patients a week, that is a pretty small number. A few weeks ago a patient was upset that they had to make the same co-payment to see me that they would any physician provider. They felt the rate should be discounted. They gave the same song and dance to the receptionist who told them if they were paying for years of education on a prorated basis, an appointment with me would cost more, since I hold more degrees than any of the others, lol. I don't waste time arguing with people or pleading with them to respect the NP role. Maybe that patient has a valid point (with regard to medical education because I do believe residency is a wonderful advantage to physicians; it is certainly a debatable topic). However, I don't set the rates, so I don't waste time discussing it. My goal is to stay on time, and I don't want to waste precious minutes debating the finer points of complicated third party payment systems with patients. They need to write to Blue Cross (or whoever), the insurance commissioner or their congressional representative. From physician and PA peers I have enjoyed nothing but collegial and respectful communication and relationships.

and the most important question I have...

Do you feel NP school provided you with a thorough enough knowledge base (or in other words...did you feel comfortable practicing as a relatively new grad NP)?

I felt safe, if not always sure. My rule of thumb has always been, "If I do not figure this out right now, will the patient be harmed?" If the answer is yes I get input from the more experienced NP in the office or one of the physicians. If the answer is no, I do my level best to handle it myself, even if I am sometimes wrong. Ex.-Could that weird finger rash be fungal? They aren't going to die if triamcinolone doesn't do the trick, lol. (Cue obnoxious med student to come in and tell me about how that rash could be fatal, lol).

Looking back, do any of you wish you had became a physician instead? (please no flaming...just an honest question...I'm aware that most NPs probably had no desire to become a physician)

No, but I wish we had a post graduate residency of one year. I have never felt at a disadvantage because I didn't get a human cadaver to dissect in gross anatomy, and I felt my didactic education was more than sufficient. The thing I envy physicians for is their residency, and I wish we had something akin to that opportunity. I don't feel it needs to be a paid residency; I'd gladly have done it for free and paid tuition for the experience. As it is I took the opportunities that were presented to me, and one of those was a 6 month post graduate fellowship in family practice. I learned more there than in the 18 months preceding, for sure. All in all, I had 2,400 hours of clinic time as a NP student before I went to work (and 18 years of critical care experience). That is a fraction of what MDs/DOs get, but about 4x what many of my classmates were able to do, so I was truly lucky. I did another 1,100 hours in endocrinology and cardiology practices as a DNP student. You take what you can get, but it isn't comparable and it is the biggest drawback to being a NP, in my opinion. However, I spread my NP(DNP) education out over 6 years because I wanted to do all of those hours, and I wanted more than the bare minimum. I had that option because my partner makes mad bank, lol. Even so, no, I would not have gone to med school and traditional FP residency under the current paradigm in medicine. I'd have had to give up too much, and the bottom line is that while I'm neither as stupid or as lazy as the occasional med student that pops in here likes to accuse NPs of being, I am selfish. I own that. I would never have made the sacrifices that medical students must for their education. The route I took suited this family the best, and we are all pleased with the course and outcome.

I sincerely hope you will be able to say the same one day. Good luck to you.

I love what I do completely. What I do now is what some might call scut monkey work. H&P for cardiac procedures. Nothing high speed but I make a difference in my patients life. I used to be hung up on autonomy, not so much anymore. In WA, an independent practice state, in the hospital you are the same as a PA. I came to the profession late in life so no way would I be an MD. I'm too old to allow doogie houser to berate me in private or public. It would not end well for either of us. I wish I was an RN for longer, doing this with 10 yrs under my belt might make me more confident, maybe. I second the year, maybe two, of residency would be fantastic. Best of luck

Thank you everyone for all of the responses! I think this has somewhat helped me to solidify what I already knew. I think I will continue to follow my NP dream after a few years of experience...we'll see :) I'm set to graduate from a nursing program later this year and I love the nursing perspective on patients. I also do not want to sacrifice family life to med school and residency, as some of you had also mentioned. Thanks again!