FNP2019

Deep breath. You’re preparing yourself well for this role. They’ve hired you because you have great credentials. And they know you’re a new grad. Take comfort in the fact that its a teaching hospital- they should be very used to questions. Asking thoughtful questions is part of the learning process. And I have a feeling that a lot of it will come easier to you than you expect (tho doing this in a provider role will be new). FWIW- I remember feeling exactly how you feel. I’m nearly at year three of practice- 1.5 years urgent care, 6 month ED fellowship as training into my current role. Some days I still tell my patients “huh, you brought me a bit of a mystery. Let me think on this” and then consult uptodate, Google, and my colleagues.

As an FNP working in the ED (studying for ENP right now), I wouldn’t entirely discount the experience that primary care provides. After all, many acute issues are exacerbations of chronic issues, and you’ll find one does a whole lot more chronic care management than expected. Many times a shift I get to practice my “how ARE you taking your blood pressure at home?” and “are you REALLY REALLY taking those meds as prescribed?” interviewing and education skills. And peds! You’ll definitely need to know pediatric primary care… because they’re almost all primary care cases (in my experience, sick kids are blessedly few and far between). Wishing you the best in your journey!

100% agree with Numenor. NP is an entirely different role, with its own downsides. The hours may not be better (especially if you count admin time that’s often off the clock or call). If you want more money, spending 6 figures on a new degree isn’t a good way to do it. And honestly, RNs making overtime routinely make more than their NP colleagues. I’d say you’re extremely lucky to have a job you love, especially in the current state of healthcare now.

I second everything favthing says. I did all three- PLUS some. All were useful. I’d recommend buying a used copy of a course from one of the online groups in facebook. That way you can try more than one format and see what works for you. I found the Barkley audio helped give me something to listen to en route to clinicals, even tho I’m not a great visual learner. Hollier was in person, great for the intense focused review days so I had to get through the material. Fitzgerald I did the full online course. I also did Qbank questions- great for practice! And looked at the Leik book for areas I felt weak in. I was anxious to be well prepared for practice, even tho I went to a great program and passed AANP FNP boards w flying colors. Remember- you’re studying for more than a test, so learn as much as you can!

While the pay may vary from state to state / rural vs urban environments and may be lucrative.... do NOT go back to school for the money. Nuh-uh. Do it because you REALLY want to be a nurse practitioner. It's a very different role. I went from being a RN (easiest job ever) to NP (holy moly: the paperwork! The stress! Missing dinner while waiting for urgent results!) in a primary care setting. I love my job now- its stimulating, fun, challenging. I even sometimes feel like I made the world a little better for someone. But 100% would not do it for the paltry $12/hr raise if my heart wasn’t in it. Not worth the stress, lost wages during the 2 years of school, and $100,000 in tuition.

@adventure_rn I second this 100%. @kerleigh722 Don’t hesitate to take the time you need to research your career path. If there are specialties you are interested in, it will be easier to get into as an RN. So the work you put in now will most definitely make your life easier later on as an NP (not to mention saving you the stress of a job you hate later on).

Hi Kerleigh, Just a few thoughts from a recent FNP grad- if you’re interested in inpatient care, most FNP programs will NOT prepare you for it. Many do not allow any in-hospital clinicals- for me to do an ED rotation it was a real fight (and even then I only got 50 hours approved). If you have extensive experience in the speciality of interest, you might have a shot, but just know that it will be your RN experience that you’ll be leaning on, as your FNP education won’t address mgmt of hospitalized patients. My recommendation: Look closely at your experience- where does it position you in regards to your goals? Start looking at job boards- what is available in your area and what qualifications are needed? Start networking NOW! It is likely a contact that will hook you up with your first job- and they are a valuable source of insight into the profession in your area. Best of luck!

Shameful situation. Do what you gotta do. Truthfully, its not just an APRN problem. Seems a lot of healthcare providers step into psych without training. We’ve got an obgyn-turned-mental health counselor in our area prescribing psych meds under his MD license. How he still holds that license is beyond me, because his Rxs are totally inappropriate. Opioids for migraine?

Hi Oldmahubbard- I’ve followed your posts for a while and really respect your opinion and experience. It seems things have largely changed since you were a student! Here was my experience: BSN- I graduated with my bachelors (non-nursing in 2006) and did an RN diploma program (12 month program which eventually became a BSN- many pre-reqs required). We had extensive clinicals 2-3 full days a week for 48+ weeks working alongside a nurse WITH a clinical instructor for 4-8 students. I was well prepared to enter my new grad orientation in a pediatric trauma center ED. FNP- I recently completed my MSN with Georgetown. I had NO shadowing. Everything was direct patient care with a preceptor, with a focus on building up my skills in accordance with where we were in the program. First semester of clinical was all well-person visits (HPI, physical assessment), second was episodic (acute visits, with problem-focus treatment plans), third was chronic care (addressing all of the previous, plus mgmt of chronic conditions), all leading to fully managing a 10-13 patient case load. I start a new job next month. I may be nervous (because who wouldn’t be?!) but I KNOW I am well prepared to provide outpatient care. So, as to your point re: training. For both RNs and APRNs, there is variability in programs. But choosing a good program can lead to adequate clinical experience. Yes, it is not cheap to do- but neither are med errors. I’d argue that the problem is diploma mills producing “graduates” and employers unable to provide sufficient support from experienced staff to help the transition. FNPs working in the ICU is not a problem with FNP training- it is a problem with going OUTSIDE the scope of training.

Hi Future Provider, I totally get what you're saying. I think that recent grad vs not-so-recent grads have very different experiences MSN programs (regardless of the school). Having graduated 10 years ago with my BSN, I can say... yep- the material is pretty much new to me! Though I have used it extensively in practical application, it is an altogether different thing to be tested on it. And I see many of my extremely talented and experienced classmates facing the same dilemma. So don't be hard on yourself if you find yourself (now a few years out of school, I assume?) having a harder time than some of your classmates who went back sooner. To both you and the OP, best of luck in figuring out which program you want to do. Truth is, it is 100% dependent on your own work ethic. Bust your butt in school and you'll be fine when you graduate.

Even if the two are the same cost, the question is: what job do you want to do? If you want to try out nursing, the ASBN is a terrific option. It'll give you the chance to really learn about being a nurse. You can also make good money as a nurse- often comparable (or more) than an NP- because you get hourly wages with shift differentials, overtime, etc vs salary. I am a strong believer that one should get nursing experience before becoming an NP- after working with direct-entry NPs, I gotta tell you, their lack of experience in nursing shows in an awkward way (making them difficult to work with), even if they are technically good at medication management and some of the other "advanced provider" tasks. Good luck!

Rock your look whatever you go with, but certainly don't straighten it unless you want to! Certain jobs may require that you pull your hair back (or you might just realize that it is better to keep your hair away from patients who will tug at it if it is in reach- like kiddos!). Just practice styles that can work on a daily basis that aren't too much work, but still look neat, and you are good to go.

Seriously? Classes at Georgetown EASY? I have to question whether your friend really did the GU program (I have heard people say GW was easy- and people almost always mix those two up). Also, Georgetown has a strict policy of not placing students with the same preceptor (I've only heard of it done by student request, but who knows, maybe it happened once or twice). I am in the FNP program right now and it is the absolutely most rigorous program I have ever done! (I daresay I am no dummy- I'm actually very good at school, with two bachelors degrees and a Masters from a top-tier Southern Ivy). To OP- Georgetown has been excellent. I'm finishing up my second semester. Professors are overall quite good- very knowledgeable in their topic. On campus intensive was EXCELLENT. My only gripe would be clinical placement- it is especially hard in cities... but that is pretty much true everywhere, even Brick and Mortar programs. Best bet is to go wherever you want (Georgetown, Simmons, probably doesn't matter) and network like crazy to secure connections at different sites. Advantage to that is you miss out on the crappy placements because you can vet the sites ahead of time for providers you like, distance from home, places you want to work, etc.

Hi Meredith, I come from a similar background as you (MPH international health and development) and spent the last 8 years working in global health programs in DC before going back to school for my FNP and a complete career re-route. Please do careful research into jobs available once you're done. I have and there are VERY few opportunities, as advanced practice nursing is not recognized internationally. If you've got colleagues at the CDC, start connecting with them to find out if they accept nurse practitioners. You might find yourself up against MDs, who ARE internationally recognized, and passed over. You can certainly go the project management route, but keep in mind 1) your clinical skills may not get used AT ALL. (this is what drove me from the field and you'll be frustrated as you see your fellow clinicians, especially international colleagues, go from being valuable members of the healthcare system to managers pushing paperwork); 2) you certainly don't need a clinical degree (and the $80,000+ in debt you'll go into for it); and 3) funding is drying up in international development at an astonishing rate. Especially for HQ-based staff, as they are moving most operations out to the field where qualified locals can (and should!) be doing the jobs that used to be done by us expats. My recommendation: Network, network, network. Find the people who have jobs you want and talk to them. Find out who else is doing them. TL;DR: What specialty do I recommend? Probably NONE of them. Best of luck!

Sounds like a great plan! If you've got the languages, you are halfway there! :-) In the meantime, I encourage you to look into options that might expose you to health in the community- maybe working as an HIV counselor or as a translator in a clinic. Feeling comfortable with the medical environment and lingo will be a definite boost when you start school.