FamNP123

I'm turning 30 this fall. I currently am a family nurse practitioner, have been working as one for the past 7 months. About 2/3 way through my NP Program I realized I really wish I had pursued medical school, but kept with my program and even did a one year "residency" to help me feel better prepared. If I was single I would in a heartbeat. The problem is my husband is a second year med student and we want to start having kids in the next year or two. I just don't see how time, financial (we would live off his residency salary, plus a housing small stipend from the military) or location wise I would be able to manage it, especially since wherever we go for residency won't be near any family to help raise our children. I have a strong desire to be a mom, but I also have this huge itch to go to medical school and it's getting stronger as I work as an NP. There are parts of being an NP that I love but the more I practice the more I realize how immensely there is to know & be trained in. Plus, overall my job is pretty crappy. I get paid 84k currently to do the job of a physician (I do have a physician I can go to with any questions), and the liability of a physician. If I were to pursue med school I'd have to quit this job for prerequisites and MCAT prep because I put in around 50+ hours a week and have not much spare time. I'd likely go back to working as a nurse. My husband is in military so I could use his GI bill to pay for 3 years of my schooling, which he has brought up himself. He's very supportive. The only way it could realistically work is if I got into school near wherever he gets into residency, which would make it even that much more difficult to pursue. I don't see us doing long distance for 3+ years. my very rough draft fairytale plan is to finish my one year contract with this job, go back to bedside or find a fluff NP job and start doing prerequisites, and then try to get into a school near where my husband gets into residency. Or do I just suck it up and be an NP and maybe pursue when kids are a lot older? Any tips are appreciated.

I am looking for guidance/advice on my new job. I am a newer grad family NP, graduated 9/2021 and then did a year long primary care residency at the VA that concluded 7/2023. I had to move after the residency so I took a job in family med. small, private clinic owned by an MD with two other midlevels. I kind of was pressed for time getting a job due to relocation, but the clinic seemed very tight knit and laid back, and I really like the owner of the clinic. However, the job has many negatives. I got no orientation, was seeing 11 patients the first day (they were all fairly easy though, sports physicians and well child's), and within 2 weeks was seeing full schedule of 22/day. Three months in and I'm still very anxious, overwhelmed and filled with self doubt daily. I feel I don't have mental energy for anything but the gym occasionally after work. I am very conflicted on staying here. I do like some aspects about the job, and I do enjoy most of my patients. But part of me thinks I'm just not cut out for it... I'm constantly worrying I'm making the wrong decision plus trying to keep up on charting, labs, messages, inbox, prior auths. I can go to the MD with any questions but I'm always so busy I can't always find the time to. I feel I don't have time to tend to my hobbies. The PTO is only three weeks and I have to use most of it just to see my family as I'm 13 hours from them. My husband is in med school and I feel like I can't fully be there for him. We want to have kids but I can't imagine being pregnant and having a baby with all this stress. I'm afraid if I go to bedside I'd ruin being able to go somewhere else. I also have no time to interview either. I also REALLY miss working three days/week. I feel the weekends are barely enough for me to recoup and refresh. I know this is long winded but I'm looking for any advice or insight. Part of me says just make it a year and then leave, and it will open up other doors. But some days, I don't think I can do it. The market here is kinda tight for NPs, I'm in a small big city.

Yes I understand that is the way many people are able to do it, yet many people are full time students full time nurses. I just don't see how you can learn the material while working 36-40 hours a week. Maybe during the fluff classes where learning that content is less pertinent to becoming a provider (which is about a year of classes in many NP programs). Just my viewpoint... I am sure some students can make it work just fine.

I'm in Spring Arbor's program now. The program is OK. The professors are a lot more interactive in the classes than I have heard compared to other online programs. Some classes offered great lectures that made it feel more like in person program. They really drill in things we need to know and hold us accountable for knowing certain material. The grading is easy and I honestly wish the exams were proctored with less busy work. The clinical faculty is very difficult and does not help much with clinical placement or with issues that come up. They do provide a list of clinical sites/preceptors that are affiliated with the school, but it is up to the students to contact the sites/preceptors and find a placement. The benefits of Spring Arbor versus Walden (I don't know much about Walden, other than it's for-profit), is that although the program is online, it is a brick-and-mortar non-profit school here in Michigan. I would highly recommend either 1) finding an in-person school or at least a school that helps with clinical placement and/or 2) a school that is more rigorous that will push you to better learn the material and be tested on it. As others have said, I think being a competent NP depends on the student as much (if not more) than it does the school. Good luck!

Not sure if online stuff is your thing, but I highly recommend investing in an online medical education program. The two I love are Osmosis and OnlineMedEd. They have helped me tremendously in my last semester of NP school. If you look great by videos, I highly recommend! For book wise, I bought the Leik review book to go over through my classes. I don't study it extensively but will read through whatever topics we are covering in class. It also comes with an access code for an app with questions that I do. It not only helps you learn the material but also preparing for boards without doing an extensive review just yet. Good luck!

I don't have advice, but do you mind asking me your timeline of when you finished school, applied, etc.? I am interested in residencies but not sure when to apply or start one. I also am not sure who to use for LOR as my program is about 95% online (other than clinicals obviously), making it difficult to find professors. Good luck! And sorry I don't have advice.

This post is half venting, half wanting advice. I go to a non-profit online NP Program (not sure if I should say the name). I've been SO frustrated with the clinical faculty. Not the professors, but mostly the heads of the MSN clinical faculty (who help with all of the clinical sides of things). To sum it up, I've been pushed back in my clinical hours the past year for many reasons: 8 weeks of stay at home orders last year not allowing us to go to clinical, the staff taking 4-5 weeks (or more) to process and approve paperwork, having difficulty finding preceptors (partly due to COVID), preceptors taking too long to do my evaluations, being out for 3 weeks for surgery I had to have, and now I just finished an extension for semester 2 clinical and am 5 weeks behind, waiting to start semester 3. My school charged us for going over last semester $430 (this is the first time they have done this, which I find absolutely asinine as they know a lot of our clinicals got messed with due to lockdowns). I finished my semester 2 hours 3 weeks ago and was first waiting on my preceptor for do my eval, now I can't start my OBGYN hours until the school manually registers me, which they said takes a lot of work (which I find ridiculous, it's just a simple registration we normally do ourselves). I have called and emailed them telling them how I am already behind and really need to start ASAP so I can finish on time in late July (I still have pediatrics to do after OBGYN). I feel stupid as I told my OBGYN preceptor I should be set to start about 3 weeks ago. I am just fed up with them taking advantage of us being out from covid last year, not being able to find preceptors, and them taking forever to approve our paperwork. My mom (yes, she gives me advice) thinks I need to call the school and complain and do something about it so they don't charge me again and so they can realize what they are doing to students. My classmate emailed the dean of nursing about similar complaints and he never responded. Am I being petty? Should I just suck it up, accept that I am behind and pay the money that they're going to charge me again for going over? (I know I am going to be behind again this semester, I can't afford to do more than 2-3 days of clinical a week).

Thank you so much for your explanation and guidance. Your response highlights why medicine seems more intricate and thorough due to the extensive education and training you explained. I feel I am not getting that with the program I chose. As you mentioned not being able to work, I see so many NP students working full time as an RN and full time school. I do not understand how this is even allowed. I am part time in work and in school and am still cramming in all of the material we are presented in our 7 week courses while trying to do clinical. Working not only takes away potential study days, but it adds to mental and physical stress/demand that can be positively given toward learning and training. I truly believe getting into medical school would be the most exhausting and largest barrier for me. Once in, I do not doubt my ability to learn the material (which it will help coming from NP), study it, and apply myself through a whole program. As I stated above, I know people who had great grades, MCAT scores, letters of recommendation, etc. that had a very difficult time getting in. I believe getting an acceptance letter is more out of one's control than it is excelling in medical school and finishing all the way through residency. That's just how I see it, though. I could be completely wrong, because I have not (obviously) gone through medical school. I know it is extremely tough. Thank you again for your conversation. Good luck in your psychiatry career. It's nice to get perspective from the physician side.

I appreciate your insight. That is the debate I am currently struggling with: to either just bust my butt in the NP field and optimize my own current knowledge and training and accept my decision/path or pursue medical school (and that adds another question of when). I know the latter would be more difficult. I honestly believe (and I feel you would agree) that just getting into medical school would be the most difficult. A PCT (patient care technician) at my hospital told me he applied to 30-40 medical schools with a 3.8 GPA, with I believe a 510 MCAT, and said he interviewed well in the group interviews, and still did not get in to any. That would be my biggest fear, honestly. I guess I would still have a career to fall back on, however. So, I think now I am just devoting all my energy and time to studying in NP school, doing extra and trying to fill in any gaps I can. Thanks for your responses.

I went into nursing because 1) I want to help make a difference in people’s lives, 2) I am interested in health and improving health outcomes 3) I am interested in anatomy, physiology, & pathophysiology & 4) I enjoy caring for others and I enjoy the business of nursing that allows you to still be there for patients. I pursed an advanced practice nursing degree to learn more about the human sciences & to have a bigger impact on patients and be able to follow patients & build a rapport with them. With all due respect, I think in my post I did point out that I do want to hold myself accountable. Hence why I am supplementing covering a lot of material and extra studying resources that my school doesn’t cover. I’m not asking for an easy way out. If I was I would be happy my program is not rigorous or doesn’t cover the minuscule details. I know I made a decision to prematurely pursue NP. That doesn’t mean I won’t make it or I can’t make up for my few years of nursing experience if I bust my butt. I don’t believe that more years of nursing automatically makes a better NP. I was saying that we definitely take as many “fluff” classes as we do classes that apply to direct patient decisions and outcomes. I believe that’s a problem. I’d rather have a gross anatomy class than a leadership class, or a longer pathophysiology course rather than (yet another) nursing theory course. So, yes, I am disappointed in my decision.

Wow, amazing! I can’t wait to read it. Thank you for the encouragement and resource ?

Hello all, I am set to be done with NP school this July (that is if I finish all my clinical hours by then). I would like more clinical hours and training as I do not feel my program was very rigorous and I want to be as prepared as possible entering into an NP position. I know that many jobs have great trainings for new NPs, but I know with the job market condition, I may only be able to apply to positions that to not offer that (thrown into seeing too many patients too soon, or having no direct oversight). I am looking at doing a year residency or fellowship. I live in Michigan, where there are not any offered other than a psych and hospice/palliative care at U of M, which I am not interested in either. Most are out of state, which require an RN and NP license in that state. Is it difficult to get RN and NP licenses in different states, and would it be worth it just to do a residency/fellowship for one year? I would likely not live/practice in that state after as my family is here in Michigan, but would be willing to move away for one year for this experience. There is alos many options for post-masters certs. However, I am less inclined as I am not sure what the quality and practicality of this would be in terms of further clinical experience, education and skills (ie is it worth is other than extra letters to my name or just a way for schools to receive more money?). I don't know the quality of these, but I know they do help NPs broaden their scope, but I would want one that further prepares me in primary care. Plus these would not get me practicing and making income sooner, and would add to my school payments. Any input would be great. The other option would be to hold out until I can find a job that would give me a formal training as a new grad and understands my limitations as a new grad NP. I am not sure how difficult these are to find. Thankfully I can still work as a nurse and would have income during this time, but I know waiting too long is not ideal in terms of retaining clinical and educational knowledge gained in school (although I would study and review while applying). I know some new NPs get the great opportunity to essentially complete an informal residency with a physician or NP after graduation either through connections or pure luck. Not sure how I could make this possible or seek this out.

Yes, I know that many NPs are great. But I do believe the medical school style sets you up for the best outcomes in terms of knowledge and experience prior to seeing patients independently. PA school even offers a more in depth, medical-style based curriculum. I know NPs are supposed to have a different scope and offer a unique style, but I often see NPs doing exactly what physicians do in the clinical role, especially in primary care. I also do have quite a bit of self doubt in my ability to be a great and competent NP. This is due to 1) I have only been an RN for 3 years. 2) My program is online and not difficult. So, it's not that these insecurities reflect the NP profession per se, more so my personal situation and poor choice to leap into NP school without really considering much or gaining more RN experience (although many argue you don't need RN experience to be a competent NP, which I do think is not completely true, it depends on the individual highly).

My program is completely online. The classes are fast-paced, 7 weeks each. 7 weeks is fine for fluff classes (pop health, health politics, theory, ethics, etc.), but not for the foundational classes (pharm, patho, primary care). These need to be extended to give students more ability to dive deeper into material. Our tests are not proctored. I didn't cheat for any, but it is 100% possible to cheat on every test. This scares me. If I could go back in time, I would have either 1) gone to med school, or 2) done more research to find either a hybrid or in person NP Program that is more rigorous. At the time, I chose online as I live somewhat rural and wanted to live with my parents and still be able to work. I'm seeing now how that doesn't set you up for the best education to be a provider. So now I am in 2 years too deep and not sure what to do (just accept my decision, do my best to be a great and competent provider, or pursue medical school). I do love nursing, and I know that NP scope SHOULD be different that physician, yet it seems NPs are being pushed to be more independent even with physician oversight (seeing too complex of patients, not having a CP actually there at the office, taking on too many patients, not receiving formal training). Family is 100% a large issue in this. If I were single, I would absolutely pursue medical school after NP school or shortly after (1-2 years). I am engaged and would like to have children, making medical school much more tough. Also, my fiance wants to do MD/DO versus PA and is applying to both next year, which would make it even more difficult. May have to just wait until he is done with the actual medical school portion if I still wish to pursue medical school.

Yes, I have been realizing that hospital NPs have a much more collaborative role with physicians. I think this is because hospital oversight for patients is more strict, and physicians often need to sign-off on every note that an APP writes (at least at my hospital). The role of APP at my hospital involves the NP/PA rounding on the patient, putting in new orders for gaps of care or if RNs need simple orders, yet the physician kind of decides the ultimate route regarding consults, new medications, and discharge decisions. Whereas outpatient NPs are pretty much overseeing a lot of patient's overall care, and may ask the CP a question when needed in more complicated cases of patients they ultimately see over (at least that's what my preceptor does). Sadly, FNPs do not have much of an option in my state to be in the hospital. I also would not feel prepared at all to round in a hospital. I do not feel confident in my education as it is, especially doing hospital work. My FNP program is almost fully geared toward outpatient option. My only option if I did not go to med school would be to get a post-masters ACNP certification. Yet after being weary about my current education, I'm worried that would just be extra letters after my name and not be actual rigorous education and clinical experience. The other option is the Primary Care NP fellowship. I have seen there are quite a few, and I may look into them. There are few in my state, which would require moving for a year, which I would be willing to do, but worried it may be messy trying to get RN and NP license in a different state.

Yeah, I hope people didn't take my post as shade toward the NP community. If anything I'm putting shade on myself for jumping so soon into school after only a short time as a nurse, and toward the lack of NP school standardization and how easy some programs are compared to most PA schools and med school. And just because a program isn't as rigorous, doesn't mean it won't graduate great NPs, and vice versus. I kinda wish they would have turned me away and said I needed more nursing experience. At the time I was just ecstatic to get in. A pros and cons list is a great idea and I can't believe I didn't think of that. Thank you for your encouragement and reply!

Yeah, I will just have to give it my all through the rest of my NP education and starting the NP profession and see how it goes and how I fit into the role. I agree that in terms of medical science and raw material, MD offers a much more challenging, rigorous coursework and clinical education. Thank you for your insight!

Sorry, I didn't realize you posted this as well. But yeah, you hit the nail on the head with that first paragraph. My fiance was studying for the MCAT today. I picked up one of the organic chem books (I took organic 1 and 2 in undergrad, don't remember a lot), and the thought of having to relearn all that kind of got me down & feeling it was unrealistic for me to purse med school. And then another 300-500 hours to study for the MCAT. It really is a question of "would all that be worth it already being 26 years old?" And that's not even the actual schooling to become a doctor. If I was 22 or 23, I'd say more likely. I guess the difference between a resident and a new NP is I think the thought of being a new NP is more terrifying to me because residents aren't autonomous. They make medical decisions but as first years they are making minor ones and always work with a senior/higher residents. I know NPs in many states aren't *technically* autonomous and work under MDs, but that supervision is rather loose and you are making a lot of decisions and managing patients on your own with much less formal clinical hours and less in depth physiology, patho, and pharm education. I just pray for a good training and finding a good NP/MD that will help me transition. It's kind of just me doubting my abilities to be a competent provider given my watered down education. It doesn't help that I've only had 3 years RN experience. I am doing everything I can to amend that and learn on my own like you said we should be doing anyway, and that won't ever stop because of my fear of being inadequate. I appreciate your input! You definitely reiterated lot of what I've been thinking.

Yeah, I am kind of doing just an internal debate and struggle. There are so many factors that go into what tugs me one way or the other. Like you said, I have to give NP profession a chance, and my abilities to be a competent provider a chance. Right now I am just putting as much as I can into my education to get the most out of it. I can't just do the bare minimum, start as an NP, and then say it wasn't for me (even though I doubt I'd pass the boards doing the bare minimum). The money of an NP does not bother me, that's probably last on the list of why I would choose MD over NP. But for job saturation and availability, NP definitely worries me as I know schools are pumping out NPs like crazy. And I also do have this guilt for leaving the bedside when RNs are so needed. But a perk of NP is you don't really have to leave the bedside. with med school, you'd have to. See how my mind goes crazy about this decision....

I also have a lot of your same thoughts when debating the issue. I've spent the last 8 years since from undergrad to now being in some form of formal education. I'd love to just be in my career and invest in hobbies, traveling, and family like you said. Doing another 8-10 years of school kind of makes me sick, but also not doing what I am really passionate about because I'm scared, not motivated enough, or whatever else makes me sick. But I also know I absolutely am equipping myself by getting my APRN to fulfill that passion, which is why I started NP school in the first place. It'll just take a lot of self sufficiency, continuing learning and education to fill in those gaps. I will admit that ever since getting into the online forums comparing NP, PA, and MD education, I have had this struggle and doubted NP education being able to prepare myself for practice. A big fear of mine is being incompetent and putting patients at risk, but I also will do everything I can to overcome that (isn't that what we are always doing as nurses?). Part of this comes with my short 3 year RN experience. And also just being in a new career. I don't doubt this is what new residents and new attendings feel as well. I guess med school is a way to just ensure I will be as qualified as I can feel and to take that doubt away as much as I can. But then again, a lengthy education and a title doesn't always mean you'll be the most competent to care for a patient. And whether or not people want to believe the BS that nursing background, education, and experience doesn't help to become an APRN, I believe it absolutely does.

Yeah, I have to take into account every aspect. With my fiance applying to med schools next year, we would have literally zero income until one of us starts residency. I agree that it is probably one of the most challenging careers in terms of rigorous application and education, but it is very rewarding. Hence my struggle. Not that nursing and APRN is not rewarding, it's just a different depth of education, expertise and pay off compared to MD. Hopefully I can find a good mentor and provider to work under when I am new. I know a lot of physicians appreciate the collaborative aspect that NPs offer, so seeking that will be the goal. Thank you for your reply and insight. Any sort of feedback I can get on this is great.

Before becoming an RN, I was debating MD vs. PA vs. RN and eventually get my masters degree. I decided to go the RN route because at the time, nursing seemed like it had a lot of opportunities and it is a highly respected and flexible field. 8 or so months after working as an RN, I jumped the gun and joined on an online NP Program for FNP. Just two years later, I am realizing what a mistake that was. The first year I was so busy with fluff assignments and truly just doing my best while also gaining nursing experience (I have worked full time through most of the program, just went down to part time a few months ago). I did not realize the lack of depth I was receiving and what they weren't teaching me. The past few months, I have realized how insufficient NP education is (not sure how it took me this long to wake up, I guess just not having time to think about it because I was still busting my butt with the readings). Nonetheless, this has put me into a mental spiral if this is what I even want to do now. I've taken it upon myself to basically do the bare minimum for the fluff work and spend extra time on patho, pharm, sciences, etc. and do med school style questions (using Osmosis, Human Dx, anki flash cards). I'm a pretty good self-learner and I know my limitations and what I am weak on. But I feel like I am just in too deep and there's too much to learn out there. I'm around 8 months from graduating, starting OB and peds clinical next semester and at this point I'd feel it idiotic not to just finish. But how ridiculous would it be to go to med school after I graduate? I am burning to really, really, learn the details on medicine in a proper fashion. Ideally, I'd love to find a great doc to work with who will know my limitations, be willing to teach me and utilize me as his/her extender of care, but I know that isn't always promised and I don't want to end up working without physician supervision and see cases I was never taught in NP school. But I also am like, why the hell didn't I realize this a year ago and just quit the program then? I think I was just so excited to become a provider. I'm 26 years old. I know if I did do med school I'd be in a hell of a lot of debt and pretty poor for awhile, and I do want to have a family with my fiance, so that would definitely take the back burner. I also know it will be extremely difficult from the application process to residency. He also is applying to med schools now. Any advice or anything would be appreciated. I already know what I did was a mistake, so no need for lectures.