I recently received a published form from the State of Florida showing that ARNPs increased 22% over the past two years. RNs only increased by 7.4% If you are a new grad wondering why you can't find a position here is your answer. Our NP mills have pumped out too many graduates for the demand of society. I don't have the data to back it up but if this is happening in Florida I would assume it is happening around the nation.
I'm licensed in Florida but moved to California years ago because I could see the tsunami of new graduates slowly starting to erode the wages of established NPs. It's now happening here in California and I have been directly affected. I can count at least another dozen of my NP colleagues around the nation who are complaining of wage deflation happening because new grads will accept a position at almost any wage. Starting wages are below those for RNs in some cases.
For those of you thinking of becoming a NP think and long and hard before you commit your money and your time. The job is enjoyable but the return on investment is declining year after the year with the flooding of the markets. Maybe one day the leaders of our nursing schools will open a book on economics and understand the relationship between supply and demand rather than stuff another useless nursing theory down our throats.
There is for sure a definite increase in Nurse practitioners in California who find it hard to get a job as a new grad, I know that in San Diego some have been waiting up to a year for employment. Those who get it quicker usually know someone.
In this climate, I would not become an NP unless I got into a school with name recognition. It gives you an edge not only because of reputation, but because those programs are more likely to set you up with clinicals instead of making you find your own. You make contacts that way, and you benefit from the alumni network. I would also bet that the education is better, but I'm not sure about that.
Going to a for-profit where you take your classes online, find (or don't) your own clinicals, etc., seems like fool's errand. So much money with so much risk of poor return.
Sorry, I would edit my post above to include this but don't see an edit button
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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.
The majority of my real education came from bedside. The hospital is also where MDs receive their real, experiential education. I worked in different ICUs for about 8 years, including a general med-surg and a cardiothoracic. You get to see procedures done and participate, you have to interpret labs and diagnostic reports, and you have to know about medications. You end up learning whether you want to or not. What I learned in NP school was building on that base. I guess that there are some brilliant students who can be competent in the NP role with only a year or so of med-surg or tele experience, but that certainly was not me.
I will say though that, in my experience, MDs and NPs work at about the same level at some point. My MD colleagues tend to work up a patient to the same point I would and refer on at the same point as well. I sometimes run into a MD who chooses to manage complex conditions on his or her own, but that can go either way--they're doing it either because they're very smart, or they're overestimating their abilities.
Law is experiencing something very similar to advanced practice nursing right now. There is very poor regulation of law schools by the ABA, and tons of for-profits have opened. It flooded the job market, depressed wages, and made findings jobs difficult to impossible. The days of attorneys having a guaranteed six figure income are long gone--their pay can be below that of an RN now.
Aren't they all for profit in the end, look at the chancellors' salaries. LOL But I know what you are saying. Our "non" profit large state public university has a hybrid online-live (mostly online) program for NPs and they still have to find their own clinicals. Now granted, the name recognition of the school--IF looking for placement in the same state--makes it easier for them but they still have to find a site that will take them, go through interviews, etc. They are not GUARANTEED placement any or everywhere and every term.
Speaking of low standards, I about fell out of my chair the other day. There was a girl in my RN clinicals and class that was dumb as a brick. She had failed A&P at least once and yes, I know this because I saw her repeat it. Our professors made admissions and concessions for certain students, she was one of them, long story another time.
I walk into my NP meeting a few weeks ago and look who is there. I guess she must have been smarter than she put on because she must have passed the boards (right?? can folks cheat the boards too???) but seven save us, I fear for her patients. She even said more stupid things during the meeting. Ai-ya-yaaiii! Hers was an online program that was definitely for profit.
I was one of those new grads who oversaturated the NP market and took my first job at a busy cardiology group making $105k/yr. Sounds great, right? Not so much. Yes, some employers want to hire new grads because they don't have to pay them much. In Arizona, the majority of NP positions either require AT LEAST 1 year practicing autonomously as an NP or start right from the beginning and say SORRY, NO NEW GRADS! I made good money at my first job but I had to get out of there. I didn't get oriented/trained on how to a) be a provider or b) be a provider in cardiology (actually, electrophysiology). Nothing. I followed a doctor around for a couple of days and they expected me to be on my own, seeing patients (appts were 10 minutes each. And 90% of the day they had them quadruple booked!), interrogating/programming pacemakers, etc. That's right 10-minute appointments with FOUR patients booked per slot. I understand double booking throughout the day to compensate for the no-shows, but this was a horribly unsafe environment.
You guys should never go off what these websites estimate your pay because they are mostly completely wrong. You have to be patient and not accept these low paying positions and when they do offer you a low ball offer just telling them the offer is under valued for the risk. I don’t know about the job market in primary because I’m acute care but as a new grad I got multiple offers in the 120s. You have to come in these positions well prepared don’t just settle for “I’m a new grad and I need to be taught the basics”. Do the research and learn! It’s not supposed to be easy! You have your own self to blame going into a NP program with little nursing experience.
There are some proactive solutions to the issue of actual and potential oversupply. These include:
a. Actively, spending on political action and public advocacy campaigns in the states that do not currently have independent practice. Just imagine how much more demand (for NP's) independent practice would create in states like New York, New Jersey, California, Texas, Florida or Illinois we can (and are just read about states like Virginia) and are increasing NP "market".
b. In those states that do allow NP independent practice actively market ourselves as alternative to physicians in the role of primary care. Indeed, by embracing complementary and alternative medicine to the extent that it is supported by evidenced based practice, we can offer an attractive alternative to allopathic physicians who may be more reticent to adopt these modalities. This includes evidence supported dietary interventions such as caloric restriction with adequate nutrition, DASH, and ketogenic diets in appropriate populations. In addition, by adopting approaches such as weekend and evening hours (especially in areas such as psychiatry where this is rare) we can also increase market share. Also, utilizing our lower cost scenarios to provide "more time with the patient". Thus in psychiatry for example whereas many physician practices only provide 15 minute medical management appointments PMHNP's should aspire to 30 minutes (or more) in their private practices. They can also acquire relatively rare (and in demand) knowledge and certification in areas like EMDR, and DBT, and trauma based CBT therapy (or failing that hire or develop relationships with these therapists). Most areas are severely limited in these therapy modalities and by making them available to "our" patient populations we can truly offer a valuable service to the public.
c. Actively, pursue regulations such as the "California ratio and overtime laws" that make bedside nursing more manageable and attractive. This will lesson the "flight to NP" among bedside nurses.
d. Be aware that any trend towards lower salaries will also affect MD's (at least primary care MD's) and drive them into specialties or into retirement as well.
Ya'll need to leave the west coast. NP jobs vary greatly based upon region, as well as need in certain specialties...just like RN jobs. Other areas may not pay as well, but the cost of living is also more affordable so it ends up being no skin off your back. Seriously....huge country. I would just suggest steering clear of FL...the docs there are not aiding in passing NP friendly laws, so the pay and work sucks.
Florida was the last state to give NP's the ability to prescribe controlled medicines. The only thing that makes this state reasonable at all is the vast demand created by so many old, sick people combined with massive influx from PR. Thus, massive demand creates opportunity despite oversupply and restricted practice.
Florida was the last state to give NP's the ability to prescribe controlled medicines. The only thing that makes this state reasonable at all is the vast demand created by so many old, sick people combined with massive influx from PR. Thus, massive demand creates opportunity despite oversupply and restricted practice.
Everytime my wife says she wants to Florida, I remind her it would be career suicide for me. It's one of the few states I would only move to of it granted full practice authority. Passed that no thanks. I'll tolerate practicing in Flint Michigan over anyplace in Florida.
irvine123
56 Posts
There is for sure a definite increase in Nurse practitioners in California who find it hard to get a job as a new grad, I know that in San Diego some have been waiting up to a year for employment. Those who get it quicker usually know someone.