Oversupply of Nurse Practitioners

[guest416560]

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.

[myoglobin, ASN, BSN, MSN]

49 minutes ago, ThePTNurseGuy said:

You’re honestly comparing apples and orange man. Discussing the number of schools for medical school and nursing is a night and day comparison. Different variables at play. If you’re telling me that Phoenix and Walden are going to out compete more reputable schools, with standards being raised and with accountability for clinical sites, we’ll just have to agree to disagree.

And you’re incorrect about half of nursing schools requiring GRE. That is not a factual statement. There might be a small minority but not a majority. The only consistent GRE requirement for nursing is their PhD programs.

I. I am comparing them in the sense that unlike most medical schools they (St George's) pays for spots. Darn near every practice in my state (Florida) are sufficiently money driven that they would jump at the chance to earn extra revenue even if Lucifer himself were writing the checks (not that Walden or any other school is).

2. I didn't say that half the schools (NP) require's GRE I said "many". I know that my second and third choices required GRE's which is one of the reasons I chose the school that I did (why do extra work). Some schools required GRE's for "borderline" students on a case by case basis.

3. In the final analysis I'm not sure how "non profit" / non profit schools really are. They benefit from millions in endowments, along with state, and federal tax revenue.. They tend to be bloated at the top with largess for faculty that is often vast. They are simply utilizing a different paradigm to maintain their market dominance. By way of analogy they are like the communist elite in the former Soviet Union who enjoyed preferred status. Of course they produce good results, but many of their "best" professors are more involved in research than actually teaching. Of course they produce excellent students, but they start with students with average SAT's in the mid to high 1500's who were at the very top of their classes. Again, if nurses emulate the education of MD's we will be just as expensive, less able to spend time with patients, and less inclined to approach patients holistically or to paraphrase Jesus "You are the salt of the earth: But if the salt loses its saltiness. how can it be made salty again? It is no longer good for anything, except to be thrown out and trampled underfoot". I don't want to emulate physicians I want to nurses practitioners to out compete, out work and outperform them in primary care, and to do so at a lower price to patients, insurance and the heath care system.

[Oldmahubbard]

As of 2019, with some 40 years of practice under our belts, we have saved the public not one nickel.

[myoglobin, ASN, BSN, MSN]

26 minutes ago, Oldmahubbard said:

As of 2019, with some 40 years of practice under our belts, we have saved the public not one nickel.

In most states NP's only get reimbursed at 85% of the physician rate so someone (in many cases insurance companies) and in other cases physicians (because they fraudulently bill at the MD rate under their own licenses) get the difference. I believe that NP's have had an impact on the rate of health care inflation (lowering it). Also, in IP states NP's are free to open "cash clinics" or set up whatever fee structure they wish so long as they can work within the insurance reimbursements. One area that NP's definitely can make a difference is by spending more time with patients, offering more convenient hours (evenings and weekends), and making home visits, things that are largely unheard of these days by physicians. Lower costs to educate (including time) and lower debt upon graduation (than MD's) helps to make this possible.

[Oldmahubbard]

99.9% of all NP visits have been billed at the MD rate, and some MD or administrator has pocketed virtually all of that money.

No we have not saved the public significant money. If you don't believe me, go to an NP provider, and look closely at your bill.

[myoglobin, ASN, BSN, MSN]

2 hours ago, Oldmahubbard said:

99.9% of all NP visits have been billed at the MD rate, and some MD or administrator has pocketed virtually all of that money.

No we have not saved the public significant money. If you don't believe me, go to an NP provider, and look closely at your bill.

How can such a situation commonly exist? I would think the insurance company would simply see "myoglobin NP" on the charting, but Dr. MD on the billing and then deny the bill (or process at a reduced NP rate). To say nothing of Medicare/Medicaid who would consider it fraud.

[JAMSN, MSN, RN, NP]

I was an RN for 8 years before NP. I am a new grad and start working as an NP in a couple months. I find that many NPs have never actually worked as nurses which is sad and scary, as many don't have any idea what nursing really is. I left bedside RN work because it's underpaid and nursing is miserable these days. Unsafe staffing ratios, abuse from patients and management, and patio satisfaction over safety and efficiency. Many RNs feel the same and are moving on to NP. I think the market is flooded because people are fleeing from the RN work role and we will have a severe RN shortage shortly ?

[myoglobin, ASN, BSN, MSN]

4 minutes ago, JAMSN said:

I was an RN for 8 years before NP. I am a new grad and start working as an NP in a couple months. I find that many NPs have never actually worked as nurses which is sad and scary, as many don't have any idea what nursing really is. I left bedside RN work because it's underpaid and nursing is miserable these days. Unsafe staffing ratios, abuse from patients and management, and patio satisfaction over safety and efficiency. Many RNs feel the same and are moving on to NP. I think the market is flooded because people are fleeing from the RN work role and we will have a severe RN shortage shortly ?

Yes, as I told my son "the best thing about nursing job security is that it is so miserable to be a bedside nurse, that there will always be demand until the AI robots are perfected and can take our places". RN's will be one of the last professions to turn the lights out (or hand over the stethoscope) to our future robotic overlords. Still, probably no later than 2060 or so even our jobs will be supplanted by truly capable self replicating, AI enabled robotics.

[LilPeanut, MSN, RN, NP]

On 6/17/2019 at 7:48 PM, FPMHNP2019 said:

Most of NP schools don't find preceptors for students. Thise very few schools that do are super expensive. Tuition ranges from 1500-1800$/credit...v.s. those that charge 400-800/credits but not place students.

Not true. There are major public universities that do it. I went to Ohio State, they found each and every preceptor I had.

On 6/19/2019 at 2:52 PM, ThePTNurseGuy said:

You’re honestly comparing apples and orange man. Discussing the number of schools for medical school and nursing is a night and day comparison. Different variables at play. If you’re telling me that Phoenix and Walden are going to out compete more reputable schools, with standards being raised and with accountability for clinical sites, we’ll just have to agree to disagree.

And you’re incorrect about half of nursing schools requiring GRE. That is not a factual statement. There might be a small minority but not a majority. The only consistent GRE requirement for nursing is their PhD programs.

Again, major public universities are going to require the GRE. I needed to take it at OSU. If you want to be accepted into graduate school by the university, you have to have taken the GRE and scored acceptably.

On 6/19/2019 at 4:04 PM, Oldmahubbard said:

As of 2019, with some 40 years of practice under our belts, we have saved the public not one nickel.

I will disagree with that. Studies show we do save money.

On 6/19/2019 at 3:18 PM, Oldmahubbard said:

This is where substantial work experience in the field makes such a big difference. If you are considering an NP program, you should have been working in that field as an RN. You should have developed something of a professional network. You should know some people who might precept you. Yes, it might fall through, but it is such a completely different scenario than a neophyte cold calling potential preceptors.

On 6/20/2019 at 11:50 AM, JAMSN said:

I was an RN for 8 years before NP. I am a new grad and start working as an NP in a couple months. I find that many NPs have never actually worked as nurses which is sad and scary, as many don't have any idea what nursing really is. I left bedside RN work because it's underpaid and nursing is miserable these days. Unsafe staffing ratios, abuse from patients and management, and patio satisfaction over safety and efficiency. Many RNs feel the same and are moving on to NP. I think the market is flooded because people are fleeing from the RN work role and we will have a severe RN shortage shortly ?

I put these two together because I disagree with it overall. I am a graduate entry graduate. When I started, I had no medical experience formally, just my personal medical experiences. I had a BA in Spanish and International studies with a minor in Political Science. I chose grad entry for two reasons: it was the fastest way to get my RN and be able to start working, seeing as I knew I could get into grad school, vs waiting to do a bachelor's or associates. Secondly, I wouldn't have to take any more chemistry LOL I took chem 101 undergrad and it nearly killed me. I can understand biochemical principles, but the stuff you do in chem classes? No thank you. I'm not making the drugs!

So, OSU's programs is structured so you go 1.5 years non-stop, double full time, at which point you can sit for your NCLEX. What happens next depends on your specialty. Critical care (like NNP) have to go work for a while to get some experience, and primary care can go straight through.

The biggest advantage that gives us is that our end point was always advanced practice. Even when I was taking the basic nursing classes, we were challenged to answer questions not only as we would if we were the RN, but if we were the clinician being called as well. I didn't have the role transition that cripples many NNPs because I had been preparing for that role since the beginning.

If I had gone either undergrad or associates, they would have likely required me to take more humanities classes as well. Come on people. I have had more humanities classes than anyone really should LOL. I've studied shakespeare in Spanish. I'm good with humanities. My reaction to papers for nursing school: "what? 2-3 pages? MAXIMUM? Are you serious?" Once I realized that papers for nursing school were really just about citing every idea you have and being concise as possible, it's super easy, it almost feels like cheating. I mean, I wrote 100 pages on the Lindbergh Kidnapping and how that related to the OJ Simpson trial when I was an undergrad. I wrote a similar length paper on the assumption of masculinity in gender indeterminate nouns, especially as it pertains to games, in spanish. Trust me, I can bullsh*t with the best.

That undergrad degree though means I can speak spanish with my patient families, understand where they are coming from culturally, understand the political issues that impact healthcare and how it drives care, and a host of multicultural things. The fact my kids were premature when I wasn't a nurse or provider, that at 23 weeks, I had to have the discussion, as a lay person, with my doctor that if my son came that night, they wouldn't intervene to save him. That while I was trying to get into nursing, and my now ex husband couldn't work and we could barely put food on the table, based on my retail worker's wages. The other experiences I had up to the point where I became a nurse are invaluable to me, because those allow me to see things from the patient's parent's point of view. Everything after becoming part of the health care system is affected by the knowledge we have.

But I understand why some families behave the way they do. I don't judge nearly as quickly as others. I remember on a visceral level what it was like to be a NICU mother. My kids survived and were ok, but I know what it's like to go home without a baby and how much I would hate it when people would tell me to sleep while I could, because "normal" mothers didn't get to sleep, and I wanted to be normal. I wanted my baby to be ok and everything to be normal. There's understanding of that on an intellectual level, and then there's living that.

Academically, I have always been commended on my level and depth of knowledge and pathophys and clinical care. Not once has chemistry above a chem 101 level been needed LOL

Graduate entry programs though can be incredibly successful, and can turn out clinicians that are arguably even more qualified than the average bear because they are coming into it at an older age where it isn't something they figure they just should do because that's how one advances - they come into it knowing themselves, knowing that this is what they want to do.

I also agree that people need to accept that they may need to move. Especially areas that have programs will quickly become saturated, you will have to move out of the area unless you are fulfilling a very specific niche. I went to school in Ohio. First NNP job in TX. Then worked in another place in Ohio. Now I'm in CA. Who knows if I will stay here. It has sucked with the moving, but you do what you have to do. And yes I had kids. There's a ton of hospitals that are dying from lack of NNPs.

[myoglobin, ASN, BSN, MSN]

51 minutes ago, LilPeanut said:

Not true. There are major public universities that do it. I went to Ohio State, they found each and every preceptor I had.

Again, major public universities are going to require the GRE. I needed to take it at OSU. If you want to be accepted into graduate school by the university, you have to have taken the GRE and scored acceptably.

I will disagree with that. Studies show we do save money.

I put these two together because I disagree with it overall. I am a graduate entry graduate. When I started, I had no medical experience formally, just my personal medical experiences. I had a BA in Spanish and International studies with a minor in Political Science. I chose grad entry for two reasons: it was the fastest way to get my RN and be able to start working, seeing as I knew I could get into grad school, vs waiting to do a bachelor's or associates. Secondly, I wouldn't have to take any more chemistry LOL I took chem 101 undergrad and it nearly killed me. I can understand biochemical principles, but the stuff you do in chem classes? No thank you. I'm not making the drugs!

So, OSU's programs is structured so you go 1.5 years non-stop, double full time, at which point you can sit for your NCLEX. What happens next depends on your specialty. Critical care (like NNP) have to go work for a while to get some experience, and primary care can go straight through.

The biggest advantage that gives us is that our end point was always advanced practice. Even when I was taking the basic nursing classes, we were challenged to answer questions not only as we would if we were the RN, but if we were the clinician being called as well. I didn't have the role transition that cripples many NNPs because I had been preparing for that role since the beginning.

If I had gone either undergrad or associates, they would have likely required me to take more humanities classes as well. Come on people. I have had more humanities classes than anyone really should LOL. I've studied shakespeare in Spanish. I'm good with humanities. My reaction to papers for nursing school: "what? 2-3 pages? MAXIMUM? Are you serious?" Once I realized that papers for nursing school were really just about citing every idea you have and being concise as possible, it's super easy, it almost feels like cheating. I mean, I wrote 100 pages on the Lindbergh Kidnapping and how that related to the OJ Simpson trial when I was an undergrad. I wrote a similar length paper on the assumption of masculinity in gender indeterminate nouns, especially as it pertains to games, in spanish. Trust me, I can bullsh*t with the best.

That undergrad degree though means I can speak spanish with my patient families, understand where they are coming from culturally, understand the political issues that impact healthcare and how it drives care, and a host of multicultural things. The fact my kids were premature when I wasn't a nurse or provider, that at 23 weeks, I had to have the discussion, as a lay person, with my doctor that if my son came that night, they wouldn't intervene to save him. That while I was trying to get into nursing, and my now ex husband couldn't work and we could barely put food on the table, based on my retail worker's wages. The other experiences I had up to the point where I became a nurse are invaluable to me, because those allow me to see things from the patient's parent's point of view. Everything after becoming part of the health care system is affected by the knowledge we have.

But I understand why some families behave the way they do. I don't judge nearly as quickly as others. I remember on a visceral level what it was like to be a NICU mother. My kids survived and were ok, but I know what it's like to go home without a baby and how much I would hate it when people would tell me to sleep while I could, because "normal" mothers didn't get to sleep, and I wanted to be normal. I wanted my baby to be ok and everything to be normal. There's understanding of that on an intellectual level, and then there's living that.

Academically, I have always been commended on my level and depth of knowledge and pathophys and clinical care. Not once has chemistry above a chem 101 level been needed LOL

Graduate entry programs though can be incredibly successful, and can turn out clinicians that are arguably even more qualified than the average bear because they are coming into it at an older age where it isn't something they figure they just should do because that's how one advances - they come into it knowing themselves, knowing that this is what they want to do.

I also agree that people need to accept that they may need to move. Especially areas that have programs will quickly become saturated, you will have to move out of the area unless you are fulfilling a very specific niche. I went to school in Ohio. First NNP job in TX. Then worked in another place in Ohio. Now I'm in CA. Who knows if I will stay here. It has sucked with the moving, but you do what you have to do. And yes I had kids. There's a ton of hospitals that are dying from lack of NNPs.

I don’t denigrate your path in any way, but you should’t disparage the path of those who take a different route either by choice or necessity. My school (The University is Southern Indiana a medium state school) doesn’t require the GRE. Also, if they are forced to find clinical sites they will most likely both charge more and cease offering distance education where it takes “boots ion the ground” in most cases to obtain such sites. This will mean that experienced, but working nurses with families will have dramatically reduced opportunities to further our education. I seek maximum opportunity for all and believe that the current system facilitates this (with room for improvement like advanced post grad CCRN like certification options).

[TheAngryMan]

2 hours ago, LilPeanut said:

Not true. There are major public universities that do it. I went to Ohio State, they found each and every preceptor I had.

Again, major public universities are going to require the GRE. I needed to take it at OSU. If you want to be accepted into graduate school by the university, you have to have taken the GRE and scored acceptably.

I will disagree with that. Studies show we do save money.

I put these two together because I disagree with it overall. I am a graduate entry graduate. When I started, I had no medical experience formally, just my personal medical experiences. I had a BA in Spanish and International studies with a minor in Political Science. I chose grad entry for two reasons: it was the fastest way to get my RN and be able to start working, seeing as I knew I could get into grad school, vs waiting to do a bachelor's or associates. Secondly, I wouldn't have to take any more chemistry LOL I took chem 101 undergrad and it nearly killed me. I can understand biochemical principles, but the stuff you do in chem classes? No thank you. I'm not making the drugs!

So, OSU's programs is structured so you go 1.5 years non-stop, double full time, at which point you can sit for your NCLEX. What happens next depends on your specialty. Critical care (like NNP) have to go work for a while to get some experience, and primary care can go straight through.

The biggest advantage that gives us is that our end point was always advanced practice. Even when I was taking the basic nursing classes, we were challenged to answer questions not only as we would if we were the RN, but if we were the clinician being called as well. I didn't have the role transition that cripples many NNPs because I had been preparing for that role since the beginning.

If I had gone either undergrad or associates, they would have likely required me to take more humanities classes as well. Come on people. I have had more humanities classes than anyone really should LOL. I've studied shakespeare in Spanish. I'm good with humanities. My reaction to papers for nursing school: "what? 2-3 pages? MAXIMUM? Are you serious?" Once I realized that papers for nursing school were really just about citing every idea you have and being concise as possible, it's super easy, it almost feels like cheating. I mean, I wrote 100 pages on the Lindbergh Kidnapping and how that related to the OJ Simpson trial when I was an undergrad. I wrote a similar length paper on the assumption of masculinity in gender indeterminate nouns, especially as it pertains to games, in spanish. Trust me, I can bullsh*t with the best.

That undergrad degree though means I can speak spanish with my patient families, understand where they are coming from culturally, understand the political issues that impact healthcare and how it drives care, and a host of multicultural things. The fact my kids were premature when I wasn't a nurse or provider, that at 23 weeks, I had to have the discussion, as a lay person, with my doctor that if my son came that night, they wouldn't intervene to save him. That while I was trying to get into nursing, and my now ex husband couldn't work and we could barely put food on the table, based on my retail worker's wages. The other experiences I had up to the point where I became a nurse are invaluable to me, because those allow me to see things from the patient's parent's point of view. Everything after becoming part of the health care system is affected by the knowledge we have.

But I understand why some families behave the way they do. I don't judge nearly as quickly as others. I remember on a visceral level what it was like to be a NICU mother. My kids survived and were ok, but I know what it's like to go home without a baby and how much I would hate it when people would tell me to sleep while I could, because "normal" mothers didn't get to sleep, and I wanted to be normal. I wanted my baby to be ok and everything to be normal. There's understanding of that on an intellectual level, and then there's living that.

Academically, I have always been commended on my level and depth of knowledge and pathophys and clinical care. Not once has chemistry above a chem 101 level been needed LOL

Graduate entry programs though can be incredibly successful, and can turn out clinicians that are arguably even more qualified than the average bear because they are coming into it at an older age where it isn't something they figure they just should do because that's how one advances - they come into it knowing themselves, knowing that this is what they want to do.

I also agree that people need to accept that they may need to move. Especially areas that have programs will quickly become saturated, you will have to move out of the area unless you are fulfilling a very specific niche. I went to school in Ohio. First NNP job in TX. Then worked in another place in Ohio. Now I'm in CA. Who knows if I will stay here. It has sucked with the moving, but you do what you have to do. And yes I had kids. There's a ton of hospitals that are dying from lack of NNPs.

I agree with 99% of your post... including the fact that reputable schools should require the GRE and provide clinicals. That seems pretty standard to me.

I am also on a similar path to you...that said, truly with all respect I would not admit that I was bad, or didn't even like chemistry. It strengthens the stereotype that Nurses and NP's "couldn't cut it as an MD or PA's".

Many of my classmates have B.S. degrees in Molecular Biology, Biochemistry, Neuroscience...etc. These are highly intelligent young people who could have easily chose PA, PT, Medical school....but they chose nursing, because they understand that nursing is becoming an increasing technical and scientifically rigorous profession. Even those who had a non science major as an undergrad degree show great enthusiasm for the scientific underpinnings of healthcare. To me the attitude of diminishing the basic science of healthcare is a huge detriment to the profession.

[myoglobin, ASN, BSN, MSN]

I never believe that it is wrong to be honest unless it is unnecessarily hurtful to people’s feelings. Some people are great at chemistry, while others excel at other academic areas. Of course we all need a basic understanding,

[LilPeanut, MSN, RN, NP]

4 hours ago, TheAngryMan said:

I agree with 99% of your post... including the fact that reputable schools should require the GRE and provide clinicals. That seems pretty standard to me.

I am also on a similar path to you...that said, truly with all respect I would not admit that I was bad, or didn't even like chemistry. It strengthens the stereotype that Nurses and NP's "couldn't cut it as an MD or PA's".

Many of my classmates have B.S. degrees in Molecular Biology, Biochemistry, Neuroscience...etc. These are highly intelligent young people who could have easily chose PA, PT, Medical school....but they chose nursing, because they understand that nursing is becoming an increasing technical and scientifically rigorous profession. Even those who had a non science major as an undergrad degree show great enthusiasm for the scientific underpinnings of healthcare. To me the attitude of diminishing the basic science of healthcare is a huge detriment to the profession.

You don't use inorganic chemistry in clinical practice. At all. That's part of the problem with medicine too - requiring classes that aren't actually needed for the knowledge and clinical work. If I wanted to research more into chemistry, I'd take chemistry classes.

Just like you do not use advanced geometry in clinical practice. Math in general had "scared" me away from pursuing a health sciences career. It's not that I can't pass those classes, but I'm miserable in them, they stress me out and if they aren't needed, then why do them?

I'm not great in calculus. I don't use calculus at all in my practice. You know what I'm great at? Basic algebra and word problems. You know what I use every single time I'm at work? Basic algebra and word problems.

I think doctoral education is largely a waste of time and money, as it currently stands. Working with residents in my unit, the vast majority of them had no business ever setting foot in my unit. They want to be radiologists or dermatologists. They don't need to manage a just born congenital diaphragmatic hernia, or a hypoplastic left heart, or even a 23+1 week infant. They don't have the interest and they aren't going to use it, so it's worse outcomes for everyone, because they can't spend the time to get good at it.

I am also great with biology. You know what you use a lot of in nursing/medicine? Biology. You need to be able to understand chemistry enough to understand biochemical principles and pharmacokinetics. Anything else is just peacock waving.

I am not worried what others think when I say I have no interest or desire to take more chemistry. They'll see my competence in the things I actually do, and shut their mouths.

I'd like to see them go into an OSH blind and find a baby with a pH of <6.8 and be able to save that baby. LOL I've done that, multiple times.

I also don't love stats, but I do understand it enough to be able to evaluate a study for its strength and know what p values I should be looking for. Let someone *** about that, we'll go toe to toe in clinical competence and see how it ends up.

4 hours ago, myoglobin said:

I never believe that it is wrong to be honest unless it is unnecessarily hurtful to people’s feelings. Some people are great at chemistry, while others excel at other academic areas. Of course we all need a basic understanding,

Indeed, and inorganic (and even organic) chemistry are not needed for 99.99% of NPs (or doctors).