I'm an NP student - How did you choose your specialty?

Oldmahubbard · Mar 28, 2018

In my case, nursing was a second career, and I knew I didn't want to work in a hospital very long. Way too much stress. I managed it for almost a year, then jumped to home health.

For several years, it seemed like a dream job, although the pay was nothing great. I didn't mind working on weekends to make up the difference.

Almost immediately after becoming an RN, I began to notice unmet mental health needs, and apparently un-diagnosed psychiatric problems. Some with co-workers and supervisors.

The turning point was when I was assigned an elderly female in HH who lived alone. It didn't take long to realize she had an extensive set of rituals that occupied her entire day, in order to keep anxiety at bay. Some of the rituals included hand-washing, others involved counting and numbers.

There were many twists and turns in the road. Eventually I knew I had a calling, finished my BSN, and found a job in an assisted living facility where 70% of the residents had schizophrenia.

When I was replaced by an LPN, I found a job at a Community Mental health Clinic, where my knowledge expanded greatly over several years.

There were many obstacles, so many times I almost quit.

I went through some crazy crap.

If I hadn't had a deep and burning passion, a fire in the belly, to become a Psych NP, I would not have been successful.

I wonder how many people start Psych NP programs and never finish.

How did I choose my speciality?

I went through a soul shaking experience over a period of many years, that's how. It nearly killed me.

But that is what makes me any good.

My opinion only.

babyNP., APRN · Mar 28, 2018

Almost immediately after becoming an RN, I began to notice unmet mental health needs, and apparently un-diagnosed psychiatric problems. Some with co-workers and supervisors.

I don't literally LOL at most things I read on the internet, but this one I did. Thanks for that and thanks for helping out what is a very hard population that I can't imagine...

Oldmahubbard · Mar 28, 2018

I don't literally LOL at most things I read on the internet, but this one I did. Thanks for that and thanks for helping out what is a very hard population that I can't imagine...

Yep, a ton of crazy nurses out there and many become supervisors. Sad.

Godsgirl73, MSN, NP · Mar 28, 2018

Like many of the other posters, I'm going to address the accelerated NP program first. As a former NP, there was a significant difference between the students I preceptored who had actually worked as nurses for any length of time, as opposed to those who were direct entry BSN-MN-NP. Those who had at least 5 years of nursing experience prior to doing their NP typically did quite well in their NP programs. Those who went straight through the BSN-MN-NP stream didn't pass their preceptorships in most cases. Unfortunately, my own experience and that of numerous NP colleagues suggests that direct BSN-to-NP is not generally successful, regardless of whether or not one is a mature student. Sure, age and prior career experience can definitely bring something extra to the table. But at the end of the day, if a nurse hasn't solidified his or her basic nursing skills, which I would argue is typically the case for most new nurses, then they certainly aren't ready to perform ADVANCED assessment skills, nor are they ready to provide accurate diagnoses and treatment plans.

I don't believe any of the nurses who have responded to the original question are eating their young. It seems they are being honest about what kind of advanced skill level and critical thinking is required from a NP.

Now, to answer your original question, I, too, found what will soon be my specialty after many years of nursing and life experience. In all of my previous nursing and NP positions, I can honestly say there was a calling to do the kind of work I did. I truly believe you will know when the time is right. Trust your instincts.

Godsgirl73, MSN, NP · Mar 28, 2018

"A novice NP is a novice NP, regardless of their prior experience"

No. I would argue that's simply not true in most cases. There is a significant difference between the "novice" NP who has more than a year or two of previous work experience in emergency, L&D, outpost hospitals, public health, etc, versus the "novice" NP who has never done any clinical practice outside of a practicum. The former is an established RN, who has a wealth of knowledge and experience to rely on in order to accurately assess, diagnose, and treat/manage the patient's problem. The latter is a new grad, who has mostly book-learning to offer with limited experience to back it up. Don't tell me there's no difference between the two, because I assure you, there is.

I've been both the "novice" outpost nurse, who worked the equivalent of a NP position, almost immediately after graduating with my BSN, and the very experienced NP. I look back at my early days of outpost nursing and shudder to think of all I didn't know. Some nights and weekends, I was the only medical person available in the community I lived in. I'm sure it was only the grace of God that kept my patients safe in some cases.

Oldmahubbard · Mar 28, 2018

No. I would argue that's simply not true in most cases. There is a significant difference between the "novice" NP who has more than a year or two of previous work experience in emergency, L&D, outpost hospitals, public health, etc, versus the "novice" NP who has never done any clinical practice outside of a practicum. The former is an established RN, who has a wealth of knowledge and experience to rely on in order to accurately assess, diagnose, and treat/manage the patient's problem. The latter is a new grad, who has mostly book-learning to offer with limited experience to back it up. Don't tell me there's no difference between the two, because I assure you, there is.
I've been both the "novice" outpost nurse, who worked the equivalent of a NP position, almost immediately after graduating with my BSN, and the very experienced NP. I look back at my early days of outpost nursing and shudder to think of all I didn't know. Some nights and weekends, I was the only medical person available in the community I lived in. I'm sure it was only the grace of God that kept my patients safe in some cases.

Thank you

The_Salty_Cat · Mar 29, 2018

This proves the point of many members on here and bedside nurses I work with. New grad nurses (BSN) that aren't even out of orientation and applying to NP schools. I am lumping in the Direct Entry MSN students also into this group. You need a base of nursing knowledge and experience to be a competent NP. Your nursing school will not teach you everything that you need to know to be a good provider. NP programs should require a minimum of 5 yrs nursing experience before applying. That way you actually have a good base of knowledge and experience to have an informed decision on their route to take in NP school. It is a scary thought that patients go to the doctor's office for a problem and they are treated by a fresh New Grad NP that has zero nursing experience prior to being an NP.
{Getting off my soapbox}

Wow!!!! Jeez, you are so rude! Cut her some slack.

You're quite strong in your opinion that NPs must have YEARS of RN experience. Are you a practicing nurse practitioner? Have you had experiences with direct entry NPs that made you feel this way?

And yes, I am a direct entry MSN/DNP student. The training in the NP program is far different than the training in the RN program. As a patient, I've also been seen by newly graduated NPs and they took excellent care of me, far better than my previous physician actually! The scope of practice between RN and NP is very different. Having 5 years of RN experience will not help you become an excellent NP provider. Rather, the NP training is more important than the RN experience.

Some preceptors I know told me that sometimes they had a hard time to precept people with lots and lots of RN experience because they couldn't move from the RN frame of mind into the provider frame of mind, which is crucial in succeeding during clinicals.

I think that there is an unfortunate culture in nursing that implies the requirement of "putting your time in." Nurses are really one of the only professions that does so. PTs and PAs don't require each other to work in the profession prior to continuing on in their professions.

Leader25, ASN, BSN, RN · Mar 29, 2018

"however I want to have a job that won't constantly burn me out. I'd like to have a job that I smile at and am busy at, but am not so mentally exhausted that I can't socialize or do anything but sleep when I get home from a shift. I think that might be why labor and delivery seems so appealing to me... it's usually happy. It also could be the fact that I love kids and I love babies."

Nurses,even long term senior nurses are very very protective of their patient's health,mental and physical .That is why were have mental exhaustion,burnout,so little time to "socialize" and are witness to many of life's ironies and natures cruelties...especially in Labor and Delivery,Nicu. Wish you the best of luck.

Bumex, DNP, NP · Mar 29, 2018

Wow!!!! Jeez, you are so rude! Cut her some slack.
You're quite strong in your opinion that NPs must have YEARS of RN experience. Are you a practicing nurse practitioner? Have you had experiences with direct entry NPs that made you feel this way?
And yes, I am a direct entry MSN/DNP student. The training in the NP program is far different than the training in the RN program. As a patient, I've also been seen by newly graduated NPs and they took excellent care of me, far better than my previous physician actually! The scope of practice between RN and NP is very different. Having 5 years of RN experience will not help you become an excellent NP provider. Rather, the NP training is more important than the RN experience.
Some preceptors I know told me that sometimes they had a hard time to precept people with lots and lots of RN experience because they couldn't move from the RN frame of mind into the provider frame of mind, which is crucial in succeeding during clinicals.
I think that there is an unfortunate culture in nursing that implies the requirement of "putting your time in." Nurses are really one of the only professions that does so. PTs and PAs don't require each other to work in the profession prior to continuing on in their professions.

Do you have proof that 5 years experience as a RN does not link to better outcomes? Can you prove those new grad NPs that took care of you were inexperienced RNs? Also, PTs and PAs don't have a RN equivalent- therefore that point is null. You're argument logic is miserably flawed. You seem to have strong opinions and you're a student with minimal functional understanding of healthcare.

I have had experiences with direct entry students whom were arrogant and had no idea what they didn't know. I don't think every direct entry student is bad- but many individuals should foster and sharpen their skills before delving into advanced practice. I agree that there are many experienced RNs that are NP students who have a hard time breaking away from the RN philosophy, however, these are no better than the inexperienced RNs that are direct entry NP students whom are poor functioning. Again, a moot point from you, unless you've got proof.

SpankedInPittsburgh, DNP, RN · Mar 29, 2018

Do you have proof that 5 years experience as a RN does not link to better outcomes? Can you prove those new grad NPs that took care of you were inexperienced RNs? Also, PTs and PAs don't have a RN equivalent- therefore that point is null. You're argument logic is miserably flawed. You seem to have strong opinions and you're a student with minimal functional understanding of healthcare.
I have had experiences with direct entry students whom were arrogant and had no idea what they didn't know. I don't think every direct entry student is bad- but many individuals should foster and sharpen their skills before delving into advanced practice. I agree that there are many experienced RNs that are NP students who have a hard time breaking away from the RN philosophy, however, these are no better than the inexperienced RNs that are direct entry NP students whom are poor functioning. Again, a moot point from you, unless you've got proof.

Do you have proof that 5 years of RN experience makes for a better NP besides your opinion? I hardly think its fair to ask the other side of a debate to cite studies when you are not prepared to do so yourself. If there is such a study that quantifies the value of this experience with patient satisfaction, wellness, readmission rates or outcomes I'd love to see it.

Have Nurse, ADN, RN · Mar 29, 2018

Though I appreciate you taking the time out of your day to respond to my post, I wish you had shared why you love your job in the NICU, as your signature states, rather than telling me why I am an invalid candidate for the career I am working toward. These programs would not exist if they were so radically unsafe.
As a direct entry student (thanks for lumping me in there) and an adult learner, I've been shocked over and over again at how brutal nurses are on students and new nurses. For being one of the most compassionate groups of people out there, it's amazing how nurses truly eat their young. Rather than tearing me down, give me the advice or help I'm asking for, because I could very well be your colleague one day.

I am not a NP. But, for what it's worth, I would like to weigh in here and offer why I decided to go into Med/Surg/Ortho/Neuro for 18 years before switching to Home Health:

Seeing how the human anatomy worked, seeing surgeries and how it changed peoples lives, the quick pace of getting a Pre-Op ready and then caring for them upon their return, educating both the patient and family when appropriate, comforting them when they were struggling so hard and seeing them blossom, appealed to me.

You might see what intriques you the most and aim that way. Some people know what they want to do right out of the gate. You sound like one of those and I cannot fault you for that.

But, there is wisdom in getting a general firm foundation in nursing before you branch out. Really, it's a gold mine of opportunity that will enrich you.

Best to you!!

Bumex, DNP, NP · Mar 29, 2018

Do you have proof that 5 years of RN experience makes for a better NP besides your opinion? I hardly think its fair to ask the other side of a debate to cite studies when you are not prepared to do so yourself. If there is such a study that quantifies the value of this experience with patient satisfaction, wellness, readmission rates or outcomes I'd love to see it.

No kidding, your criticism on my post is the exact point I was making to the post I quoted. I'm merely conveying to this student that they were being oxymoronic. Critiquing someone's opinion with no facts is exactly the problem. We all have our opinions, but we all know that every individual is different. I would be interested in a study on this. Honestly, if there were several studies with results tending to find no significant difference I would be more open to it. If stduies even showed that non RN experienced NPs were better, I would be in support of it. Thinking like a true scientist would mean exploring new avenues, and trying to find what works the best. However, until this arguement actually has facts, I have my opinion.

The original question the OP asked was about finding your specialty. Most individuals think that experience helps guide you, I am one of those people. Does that need to be the answer for everyone? No, it does not.