Oversupply of Nurse Practitioners

15 hours ago, matthdrn said:

Unfortunately I have met NPs not fit for the role. They lack critical thinking skills needed to provide safe care along with the complete lack of knowledge of pharmacology and even disease state itself.  It seems like anyone willing to take out student loans or pay cash can get into these so called “online” programs. 

I have heard of this too, though not personally witnessed it, as my specialty is not typically offered in online schools. I don't think online schools are automatically awful, but for-profit, online school definitely raise my suspicions

This is why I went into a specialty.  I have lost count of how many FNPs friends cannot relocate and cannot find a job.  They are even working part-time in weight loss centers because they can't find full-time work.  

I just could not imagine doing prenatal care with only one semester of women's health.  I just can't fathom. 

On 2/21/2019 at 2:05 PM, DesertSky said:

I'm curious to see how the demand for AG-ACNP's compares to FNP's?  As previously mentioned, about 75% of new NP grads are completing their FNP. As a critical care nurse with years of clinical experience attending a reputable in-person brick and mortar program that finds my preceptors for me at level 1 trauma facilities, should I be concerned about being able to find a job after graduation?

 

It seems like there are way fewer nurses going the AG-ACNP route, so I'm hoping that makes a difference....

This is actually increasing.  There are many FNPs working in hospital settings taking care of acute care patients with some serious needs, but this is out-of-step with the primary care/family focus of FNP programs and educational training, as well as tested content on boards.  This leaves an FNP in a very vulnerable position if they are ever sued.  

I feel that FNPs are going to be pushed out of hospitals and working in urgent care settings and more, true, primary care clinics and hospitals will start to hire AG-ACNPs exclusively as their education and training is specific to that patient population and more expansive in terms of preparation to acute care environments. 

Edited Feb 23 by Jory

8 hours ago, Jory said:

This is actually increasing.  There are many FNPs working in hospital settings taking care of acute care patients with some serious needs, but this is out-of-step with the primary care/family focus of FNP programs and educational training, as well as tested content on boards.  This leaves an FNP in a very vulnerable position if they are ever sued.  

I feel that FNPs are going to be pushed out of hospitals and working in urgent care settings and more, true, primary care clinics and hospitals will start to hire AG-ACNPs exclusively as their education and training is specific to that patient population and more expansive in terms of preparation to acute care environments. 

I don't understand your post.  Primary care clinics are NOT going to hire more AG-ACNPs.  Why on earth would they do that?  Most senior citizens are healthy, although many suffer from chronic conditions.  That is why there are AG-PCNP programs, and I am a graduate of such a program who works in a primary care clinic.  I'd also like to note that I am also educated and trained to treat adolescents and adults of all ages, not just senior citizens.  

 

On 8/18/2018 at 9:51 PM, algae1492 said:

I do not stand anywhere near your experience, as I am a student in a FNP program. However, I will say the first day of clinical as a student RN I encountered a resident medication error. I cannot attest to anything else you've written. If you want to highlight who is making more serious and frequent errors, then it requires data to support the claim.

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I usually read only but not post anything because I'm basically here to gather more info about NP and see if this is going to be a route I want to go. However, for these three mistakes you've seen a new NP made(I hope it's not from the same person, for patients' sake), I kinda feel shocked. I'm a baby nurse, working at med-surg for 8 months, but I do know:

1, torsemide and furosemide both end with -semide, it has to be similar drugs with some very detailed differences(torsemide lasts longer and relatively lower dose and more gentle on kidneys than furosemide,I bilieve?)but very unlikely a patient would take both. How could an NP, regardless of new or experienced, make such mistake?

2, missing diagnosing a PE is possible for a new NP if this person has no RN experiences or there was no chest X-ray or some sorts of test. 

3, Aldoctone, another name sparinolactone(not sure of the spelling at this moment, don't pick on me for this), showed up in RN exam over and over again as comparing with furosemide, one is potassium sparing and the other is potassium wasting diuretics. Why this new NP made such an error when pt had high K+ level..is either the lab was missed when prescribing it or the person just didn't know it's a K sparing diuretics?

4, When you say glucophage, it somehow messes with me as glucogan.....but no, it's metformin....so yes, whenever pt's renal function is newly questioned or significantly dysfunction, we would question the dosage or even hild off metformin. For me, I'm more familiar with metformin. It took me a sec to realize glucophage is another name of metformin. But while I was in a huddle with MD, pharmacist, nurses, and a medical school student, there was one time this student questioned pt's metformin for the same reason, but the MD did not seem to be much concerned...for whatever reason unclear.

I don't know what to say about these mistakes made by new NPs...are these pretty common or very occasional? Do experienced NPs, PAs, MDs make simple mistakes as well? Should we be discouraged and question NP profession? One thing I do like NP over PA is that most of schools still require at least 2 years of experience as an RN while PA school require "direct patient care hours." Direct patient cares vary greatly while RN exlerience is pretty solid,IMO.

Hod on....I had to google what "locum" means...another word is "contract or traveller?" Just like traveller nurse. It takes a lot more to use a traveler than a permanent, in many jobs. In my area,SW NH, the local hospitals pay traveling nurse daily hotel rate for their housing(the traveler herself told me) when it only costs 10 days of hotel staying for one month rent. So it's only reasonable to hire a new grads for a permanent position than hiring an experienced locum/contractor/traveler. It is also reasonable for a new grad to take less pay than experienced provider...but I don't suppose these new grads will forever be new grads and take the same pay...with a couple of years experience, they'll have leverage to bargain for raise. I don't think a practice will keep replacing a provider with 5 years experience with new grads, but they certainly will replace a provider with 20 years experience with a new grads if the pay difference is more than 1/3 annually. The same with RN profession. Many RNs with decades of experience are replaced by new grads or less experienced RNs. Also, it is very unlikely for an ER/ICU/CCU NP with 20 years experience to be replaced by a new grad. But in primary/dermatology is very likely if they want to cut down the coat of the practice. The reason is simply. It's hardly to see a patient dies on site because an inexperienced NP misdiagnose a chronic condition or a skin cancer, but it is a very realistic issue in ER/ICU/CCU settings....now days, because of the online learning module, it makes working while schooling possible so that students don't have to take out tons of student loans. This could be another reason why a new NP would take way less pay...for the above mentioned $85000 pay as a new grad NP,I would take the job in that situation because it's still over 30000 more a year than my current RN job. I plan to go to a local NP school when I hit the 2 year mark oF working as an RN, use 4-5 years(usually how long a par time program takes) to finish but still work full time as an RN. By the time I graduate,I'll have 7 years of experience in nursing. I'm doing it part time: one for gaining more experience;2 for easing the financial burden. In our area, many of NP jobs still say"experience preferred" or even "new grads welcome." In uptown NY is the same, but in Mass, hiring standard for RNs and NPs are much higher than NH. It is almost impossible for a new grad RN,especially with an associate degree, to find a job in Mass...BSN required...is seen in most of hiring ads in Mass...but every single one of our class got at least one job offer before we even passed our NCLEX. So I'd say situations(such as specialties), geographics seem to play big roles in pay negotiation. 

I don't quite agree with the comparison of MD,PA,NP. PA, even with more intense training, does not necessarily do a better job than an NP,giving the current enrollment requirements for both schools. Clinical hours are limited no matter how close to MD training PAs are. Most of NP schools still require at least 2 years of RN experience. One can learn a lot within these 2 years if you are determined to be an NP who will take the patient care serious. PAs requires certain amount of direct patient care(the least 500 hours, some 1000, others 2000 hours) but "direct patient care" includes LNAs, CMAs, phlebotomy, radiology tech, PTA etc. We all know the differences between "what an RN can do" and what the aforemantioned direct patient caregivers can do." It's a huge difference. There is just no point to compare MD and NP, giving the extend of training for both positions. 

IMO,those poorly prepared new grad NP either would have to enhance their clinical skills with a reasonal pace, or they will be replaced by experienced NPs. All in all, to employers, NP service is just one of thousands commodities we buy every day. You get what you paid for. 

Starting a business depends on your state's autonomy, too.  Here, you can't start your own business to work independently, nor can you just pay a doctor to oversee your charts.  The doctor has to be the owner of record of the business and "invite you" to work for them.  Not surprisingly, our salaries are low on the average here. 

It's been happening in northern California for awhile.  I have even posted ads on this site for  NP jobs that are paying 100k when most RN in California are making 120k.+.  Oh and to have a chance at that 100k job you need 2 years experience, new grads need not apply.

Two many schools, too many NP's, and not enough jobs.  People in California aren't retiring early either.  I would not be surprised to see NP's making under 100k in the future at this rate.

15 hours ago, bryanleo9 said:

It's been happening in northern California for awhile.  I have even posted ads on this site for  NP jobs that are paying 100k when most RN in California are making 120k.+.  Oh and to have a chance at that 100k job you need 2 years experience, new grads need not apply.

Two many schools, too many NP's, and not enough jobs.  People in California aren't retiring early either.  I would not be surprised to see NP's making under 100k in the future at this rate.

I don't know what part of NoCal you are talking about.  I live and work in NoCal and made $125k per year as a new grad in a very low cost of living area (I rent a nice little house for $800 per month).  There is a huge demand for any and all sorts of providers in California in the inland areas.  The job market is saturated and competitive along the coast, but most of California is not on the coast.  I had 9 job offers as a new grad primary care NP in the beginning of 2018 and all of them paid extremely well in very affordable areas.

 

On 2/23/2019 at 4:35 AM, Jory said:

This is actually increasing.  There are many FNPs working in hospital settings taking care of acute care patients with some serious needs, but this is out-of-step with the primary care/family focus of FNP programs and educational training, as well as tested content on boards.  This leaves an FNP in a very vulnerable position if they are ever sued.  

I feel that FNPs are going to be pushed out of hospitals and working in urgent care settings and more, true, primary care clinics and hospitals will start to hire AG-ACNPs exclusively as their education and training is specific to that patient population and more expansive in terms of preparation to acute care environments. 

This just depends where you are at, in my area of TN all of the NPs that work in hospitals are FNPs, they received on the job training.Even the Np working for the ICU is a FNP who does central lines, intubations, etc because the hospital trained her. In the end the wording is so equivocal as to what NPs can do its really up to the hospital to decide what we can and cannot do. At the local VA, the hospitalist are also FNPs.

"99,722.88–121,208.40 a year."

 

For information regarding County jobs: • www.saccountyjobs.net

Pulled from a Sacramento, CA NP AD.  This is what I am talking about.  Again, most RN in the area make 120k plus.  

Virtual Family Nurse Practitioner

3.8 One Medical – Sacramento, CA

Glassdoor Estimated Salary: $76k-$100k