becoming an NP only to return to RN role?

Advanced Practice Columnist / Guide · Jun 1, 2009

I think the anecdotal accounts of such phenomena are common. However, I have not found actual published data of the number of NP's working at an RN-level position. Each state has the exact number of NP certificants within their jurisdiction but surveys from AANP or Advance, I feel, does not reveal the real statistics as NP participation in such surveys may not be as global as it should be.

I also do know of NP program graduates who still work in an RN role. In the past, the ones I knew stayed in their RN position due to difficulty finding NP jobs. Recently, I have met a few others with other reasons for why they never practiced as NP's. One person I know decided to stay as an Agency RN for better pay and employment options, another one who stayed as an ICU RN to beef up an application to CRNA school (which the person eventually did get admitted to), and a few others who are teaching in nursing programs both at the Associate's and Bachelor's degree level.

core0 · Jun 2, 2009

Can anyone else chime in on how common (or not) this phenomenon is? I have personally known 2 nurse practitioners who were long time RNs that elected to continue work primarily as RN and ultimately decided they will pretty much stop working as NPs. They had part time NP jobs so it's not like they never worked as NPs or were unclear about the pros/cons of each role.
I should add that although neither RN or NP route is the road to riches, the woefully depressed salaries for NPs in my state may play a part? Both said they earned better wages and had easier workloads as RNs than as FNP. One is highly recommending I seek out work as a RN in a specialty. These are people I know and respect so I take their advice to heart and frankly am feeling a little anxious and confused by this.
Has anyone else encountered this phenomenon? Certainly this wasn't something they talked about in NP school, I feel like it's almost taboo to bring up!

Anecdotally its pretty common. A lot of times students don't realize the different burden that is placed on the provider. I'm not saying this is harder than bedside nursing, just hard in a different way. Overall the number of NPs not working in the role is around 40% which included 30% not working in the role and another 10% have left nursing. Take a look at table 13 here:

http://bhpr.hrsa.gov/healthworkforce/rnsurvey04/appendixa.htm#11

From here:

http://bhpr.hrsa.gov/healthworkforce/rnsurvey04/

David Carpenter, PA-C

Advanced Practice Columnist / Guide · Jun 2, 2009

Interesting data. I forgot about the 2004 National Sample Survey of Registered Nurses which I do remember participating in. However, I disagree that the percentage of NP's working in the role is only 40%. If you take a close look at the table, you'll find that of the 141,209 NP's, 81,433 have the position title where they are employed and this is 57% of the estimated total number of NP's. 42,425 of the estimated total number of NP's do not have the position title but work in a field of nursing (30%), and 17,352 neither have the position title nor work in the field of nursing (12.3%). 57% + 30% + 12.3% = 100%.

Interestingly, the percentage of NP's with the position title where they work are higher for those with national certification and/or State BON recognition (approx 67%).

core0 · Jun 3, 2009

Interesting data. I forgot about the 2004 National Sample Survey of Registered Nurses which I do remember participating in. However, I disagree that the percentage of NP's working in the role is only 40%. If you take a close look at the table, you'll find that of the 141,209 NP's, 81,433 have the position title where they are employed and this is 57% of the estimated total number of NP's. 42,425 of the estimated total number of NP's do not have the position title but work in a field of nursing (30%), and 17,352 neither have the position title nor work in the field of nursing (12.3%). 57% + 30% + 12.3% = 100%.
Interestingly, the percentage of NP's with the position title where they work are higher for those with national certification and/or State BON recognition (approx 67%).

I think thats cause more than effect. NPs that are working in the role are more likely to have certification because of either credentialing or licensure. The question that I have is why is the number of NPs in the role less than the number of NPs within the role and state BON recognition?

The more interesting part is the percentages of cert, AS and BSN RNs that stay in the field. Thats actually the data set that I was working with.

David Carpenter, PA-C

jer_sd · Jun 3, 2009

NP education does make a stronger RN, or at least my advanced practice education did make me a better nurse.

As a NP we have the ability to work under two seperate but related occupations or job roles. We maintain RN licensure and the ability to function in that role, yet we also have advanced practice licensure as well.

There are frustrations with NP practice. Especially in dependant practice states, you may want to practice a specific way however your supervising physican may restrict your practice in ways you dont care for. If there are limited job optinos in your area you may be stuck providing care you dont care for.

If a NP works as a RN there are benifits, less responsibility, good pay, varied scheduales. However there are frustrations having the training and experience being a health care provider steping back to a RN role can be a hard pill to take.

I have considered steping ack to a RN role full time, more flexable scheduale able to call in sick with less guilt, the salary is close as a RN for 12 years compared to a NP for 6. However I enjoy the provider role and that has won out over convienience for me so far at the stage I am in. I still work per diem as a RN but my full time employment is as a NP

Jeremy