unplannedRN

Maryville has a good reputation, and a very decent rating in those national reports. I considered them as my 2nd or 3rd choice. Graceland University is very respectable, too. Frontier is very mother/child oriented; it's emphasized in the curriculum, it seems. Some schools, especially in the South, seem to (unintentionally?) favor regional students, vs. those thousands of miles away. They'll take just as much of your money, though, so beware of them. It's a good thing if you can choose a school within your region, though--it gives name recognition when you're job hunting, and that can help when you encounter out-dated notions of "degree mills online". The schools near you may also have local resources to help you with such things as finding preceptorships (unofficially, just word of mouth referrals, but these can be a Godsend). You can also drive, if you like, instead of fly, to required seminars, and may even have relatives you can stay with....things like that add up. Some fancier big-name schools may not live up to their superior reputation (and therefore be worth the extra cost), as whatever made the brick-and-mortar school top-notch may not be translating at all to their online format, or vice-versa. I have worked with 2 students from instant-recognition schools (1 brick 'n mortar, and one online) whom I would not allow to touch a family member! In other schools, the online version is much BETTER than their conventional program, and attracts a more determined student; this can elevate a "whose that? never heard of 'em!" place to a great option...There would be lower tuition, too. Graduation rates, certification pass rates, and so on, can help you compare. You'd have to do your homework before choosing--which is just what you are doing :-)

Illinois is one of those. However, it turns out that if you have been licensed in another state AND have 2 full years of clinical nursing practice, the you meet the requirement in IL. The logic is that now you DO have the required clinical hours for a license that you didn't have in your online program. There is also an appeal process.

I can't find this reference in the thread. Surely, though, this is something that might understandably cost someone his/her license, starting with practicing medicine and dispensing medication, both without a license, and for abuse of another person.

Oh, and, a footnote, in case anyone is tempted to say, "just a reprimand?" That nurse spent money for legal representation at the BON hearing, but could not have afforded an appeal. Her attorney told her afterward, too, that, "If your case is held before a class of nursing students..."--and hers was--"...they throw the book at you, to make a lasting memory for the students about cutting corners...and you're lucky they didn't do worse, for that reason", after initially telling her the charges were so ridiculous and lacking in evidence, and her actual real offense of pre-pouring medications so common and relatively minor she'd likely be "in and out of there in 10 minutes!" She lost her job (making legal funds further out of reach, no doubt), and was turned down by others. She would have had trouble joining the military, adopting a child, working for the actual government, for a VA hospital or clinic, or an agency such as the BON, and (ironically) any inspection organization for facilities. The higher-up the position, or the more important the need for "relationships" with other agencies in a job role, the more weight any disciplinary history would have, too, of course...so there might be no problem working as a staff nurse, but as a manager or representative? Well. She might be denied entrance to a higher school of nursing, too. She would always be of limited value as a "whistle-blower" witness, because it could seem she had a vendetta against employers or providers, if she complained or provided evidence in another case. Regardless, forever after she is required to let every employer know who cares to ask. If she were to apply for licensure by an endorsement to another state, it would take time, money, and embarrassment to gather the necessary extra information. Sometimes this would including multiple letters of reference from supervisors and other professionals who "know her history" attesting to her "rehabilitation". There could always be a question in employers' minds, too, of whether the Board suspected (but lacked proof of) more than what was she was finally reprimanded for. Why? The Board has the discretion to decide the correct action based on circumstances surrounding the basic facts, and yet apparently decided to set a firm example with her case. (I say this because others "only" reprimanded, per the disciplinary records on state BON sites, have done some pretty shocking things to "only" be reprimanded!) For that reason, some will wonder, understandably, what else she REALLY did to be judged harshly, and presume there just must not have been quite enough evidence. In responding to probing questions, if there are any, there's another a lose/lose risk: If she went into too much detail about the retaliation aspect of what happened, instead of focusing on the lesson she learned, or if she mentioned that the nursing home was substandard, etc.,and she had foolishly tried to effect changes, she might leave a worse impression. Not only will she be seen as lacking in adequate remorse for what she did undeniably do--pre-pour medications--and lacking in improved judgement, but some employers would be scared to hire a potential whistle-blower. So even a seemingly small "tarnish" on a nurse's license is no small thing, and it is all too easy to set someone up for one. That's pretty ironic when you know that some employers will let a criminal or addict go quietly (and unreported) to protect themselves. It is easy to say "Do everything right, and you'll have nothing to worry about." True, except that not only are people human enough to make relatively minor procedural slips (especially smaller than pre-pouring medications) even when usually quite conscientious, but when errors are made, it's often the "why?" that determines whether a nurse was negligent or careless, vs. simply making a mistake. Isn't it? I'm not sure of the solution, but maybe a healthy skepticism about complaints to the BON in some situations is called for. Spending much time setting examples for students of what happens when you violate procedure might be important. But for other, much more serious types of cases (mentioned in the media), oversight and control is inadequate due to lack of time, resources, personnel, and probably due to legal limits to investigation and tracking. Perhaps more of these scarce resources might be used for tracking those nurses, and investigating those major offenses.

However, I do personally know of a case where a nurse who (perhaps foolishly) commented on some questionable practice by a nursing home where she went via a staffing agency--and had her license tarnished forever in retaliation. She was "caught" the next day and reported to the BON for doing something almost universally done in those days--such as pre-pouring meds prior to an evening med pass. Meanwhile, every other nurse there was doing the same, but someone just "happened to notice it" in her case and make an issue of it, while everyone else scuttled away with their own med carts and "pre-poured" meds. (This was in the days when bubble packs were used in ECFs, vs. individually-labeled blister-wrapped pills, so pre-pouring meant actually popping them out of a big weekly bubble card into the med cup.) She didn't have her license revoked, of course, but she did suffer a BON hearing, a formal reprimand for the breach of regulations in pre-pouring ("setting up" meds in advance) and the nursing home got away with punishing her for expressing concern about poor care! Thus she is ow the one with the "history, and even though the nursing home still has a crummy record, no one there had their licenses sullied in any way. I have also talked at length with a pharmacist at a hospital where I worked, who had perosnally seen a peer fired for reporting missing drugs; they were being diverted by a nurse relapsing into addiction, but the hospital was angry he documented it and reported it properly, vs. sneaking under the table to help the hospital just let her go quietly and hide the whole event. In this case, a pharmacist lost his job, the public and BON didn't hear about a dangerous nurse, and his advice to me to keep quiet when I found something questionable in the narcotics wastage record was pretty compelling. (That dilemma resolved itself, I was very relieved to see.) "Reporting you to the Board" is a fairly common threat from the very people and agencies who need reporting themselves, and it is used as retaliation against a potential whistle-blower. It's not hard to catch most nurses taking shortcuts to cope with lack of resources. They should not take them, it's true; neither should the Board ignore such mistakes because the reporting person or facility might have ulterior motives. But the "report you to the Board" threat and punitive action should be more openly discussed and acknowledged as one too-effective way of keeping nurses quiet about substandard care--especially outsiders such as traveling nurses, student nurses, etc.

It's been 3 years, so hopefully this is past history for 47lpn. If not, it would be sad, because the nation needs nurses and people deserve second chances. I personally believe there should be a process through which nurses who have kept themselves out of any kind of trouble for many years, and who can demonstrate rehabilitation, and whose offense never involved danger to others or mistreatment of a patient, can be guaranteed a second chance, with limitations based on patient and employer protection. Here's some things I have learned about sharing bad news (even just a disability that isn't visible--never mind the ADA!) during a job search: It's best to wait until you meet for your interview before discussing details, but NEVER leave anything off your application when the application expressly requests that information. If you do omit information regarding criminal or disciplinary history, you are lying, and that is much worse than having a mistake in your past. In addition, if you lie even once, and are reported or word gets around, you'll ruin your chances entirely and depending on the circumstances, can be subject to further disciplinary action! Second, move to another area, not another state, and only if you want to escape the small-town gossip aspect of it. Your record goes with you, and relocation can seem like an attempt to hide your history, which, again, is worse than having one in the first place! If you move to another state, you will be suspected of moving to escape further problems, even when you can show you've moved for another reason. Many employers let nurses go rather than report them, to avoid adverse publicity and/or lawsuits from patients or the fired employee. The nurse in such cases moves on to do more harm elsewhere. When you move without a very recent and good nursing work history and an unrelated reason for doing so, they always wonder; if you have an actual conviction history it will increase the level of suspicion. Your best bet is to try a bigger city in the same state, or stay put. Answer briefly and factually on applications, but only if asked. At the first interview when you are asked, or when you sign releases for background checks, again give a brief factual account, emphasizing how you've changed and want to earn their trust. Don't get defensive or emotional. If you're not asked, and the background check hasn't been started yet, share this first with the nurse who interviews you for the actual position. It's better sharing this face-to-face, with obvious regret but not wallowing in shame or pleading for forgiveness. Don't put another person in the position of having to hire you to show he/she "forgives" you, nor sound desperate enough that they will feel guilty for not hiring you. People resent this, and they will avoid the whole uncomfortable situation by sincerely reassuring you about "second chances" , truly wish you well, but...breathe a sigh of relief when you go. Keep it frank and regretful but don't dwell on it unless they do; let alone wallow or beg. You made a very big mistake and one you deeply regret; you know you have to earn their trust (i.e. know that this is not a free "do-over"); you're willing to go the extra mile to do so; you have put it behind you and moved on; you are a professional and determined to show it; you understand their concerns. They will either give you a chance or not, but in any case, this is your HISTORY, not who you are now, and they are considering whether to risk hiring someone with your skills AND that history, not judging you as a person or your worth as a nurse to your patients. Some of them may have disciplinary histories themselves or a family member who is struggling with an addiction And, of course, there are nurses who made mistakes and never got caught, while also cleaning up their act. And any hiring manager who is secretly addicted or has any such issue he/she is hiding will steer a wide path around you, lest you draw attention to their own problem! Again, this is your HISTORY, not who you are now. Remember that. Keep your head high, but be humble. Someone will hire you; it just takes time. Daycare for the minimally-dependent elderly (where there are no narcotics), outpatient psych, school nursing for teens, giving flu shots, auditing records, home health admissions (at facilities, not their homes), dialysis, and other work where there are no prescription pads or stored narcotics, and where you do not give out medicines, or do so only in the presence of another nurse, and where there is little chance for diversion of a patient's meds: any of these might indeed be your best bet. Those are just guesses, but dialysis is a good bet because coworkers are in sight of each other at all times, and there are no narcotics to divert. Good luck to all of you who are trying to bounce back from a big mistake. Keep your dignity and don't give up. You may find that what you end up doing is much more to your liking than what you were aiming for. (Which makes me wonder, 47lpn: what was that other job you loved, and were laid off from? Maybe that's the right job for you!)

I should clarify (re primary care) by "education" I meant patient (not nursing student) education, a much more important function of "real nursing" than dispensing antibiotics for a sore throat, although that is important, too. It's just that it is no more invasion of "exclusively medical doctor territory" to provide basic medical diagnostics and treatment that it was for the first nurses who inserted an NG tube back in the 60s. Much of what made such care primary care activities as diagnosing anemia or strep throat or diabetes "medicine" is now done by other departments and software anyway. (How do you know you have anemia? The automated blood cell counter says so!) Ironically, the hands-on provider such as a the APN who can't prescribe tests as quickly and easily gains diagnostic skill and intuition by having to examine, listen, and think more deeply before automatically ordering a bunch of tests, and so may be a better and more cost-effective diagnostician than someone who has been trained to run the gamut, mainly for liability reasons. But nurses who will do these basic formerly-medical services can still be more nurses than doctors, equally qualified, but in a different field, that just overlaps enough to allow them to do so conveniently as part of a larger, more holistic service. (How did that kind of anemia happen, and what can you do about it? "Let me explain...") Much of primary care nursing is medical holistic health assessment, education and coaching for patients and their families. In the meantime, much PCP care is becoming, for workload and liability reasons, triage to specialists' care, or to their own "mid-level practitioner's" care--and my PCP, for one, is very frustrated by this! Doctors already have "junior MDs"--partners with the equivalent of a medical school degree (with first-year internship) behind them, but who are unable ever to advance through their own residencies to independence. They're called PAs, and having chosen to stop at that level in medicine, they are the ones to rightfully maintain the role of "doctor's right hand", with all the privileges and limitations thereof.

It is true that nurses commonly function at a level other disciplines do only with higher degrees. In other words, a Critical Care ASN, let alone a BSN, both do work that a Bachelor's-degreed person in another field wouldn't be allowed to touch. This means that while doing their actual jobs, often they rub elbows at the higher levels of practice/education/research with other disciplines carrying higher credentials, and despite their knowledge level, therefore have lower status in a degree-besotted medical community. What isn't acknowledged is how much of the post-graduation experiential learning takes place in nursing and other medical fields, and therefore how much is learned after the initial credential....this is just not true of dentistry, PT or other fields where the experience matters, but does not triple the knowledge level in just a few years. The only parallels are in disciplines which have similarly wide areas of clinical focus, such as medicine itself and, perhaps, a paramedic working in the city. You have to “see it all and do it all”, with a very wide scope. The difference in doctors and nurse or PA training is that the doctors do those 10,000 hours before graduation, and the nurses and PAs do them on the job, earning about what the medical student does in his/her stipend, though the nurse gets paid by an employer. (Well, actually, the PA who is not a hospitalist will not be gaining those “see it all” hours in primary care; those you see in the acute care environment. But that’s another topic.) Please understand, I am not comparing nursing and medicine as being the same discipline; on the contrary, I feel strongly that they are very different disciplines except in hospitalist work, where the philosophy and perspective are different, but the body of knowledge and experience demanded is quite similar. In most of AP Nursing, it is a different type of practice altogether, with only a bit more overlap than, say, a chiropractor has with medicine. Market forces cause most APNs to assume demi-doctor roles too often, and put too little emphasis on holistic care, patient educations, etc. Anyway: What is also often ignored is the fact that the average MSN program is considerably longer than a Master's degree in many other fields, and often requires the nurse to have 2 years of post-licensure practice before even applying to an NP program. Thus you have a BSN + 2 years of additional paid on-the-job training (4000 hours), plus 2.5 average years of post-grad education, plus the minimum 500-600 supervised hours. So the graduate has the undergrad clinical hours, plus 4000 basic RN practice hours, plus 550-700 supervised APN hours, or close to 6000 in all. Of course, some have many more years of nursing practice in several different areas, such as dialysis, or oncology....each representing quite a residency. Even though those do not include the APN perspective, the amount of useable experience about the workings and behavior of sick bodies and minds and families under stress is huge—and irreplaceable. (In contrast, other primary-care disciplines such as medicine LEAVE that intensity after graduation, not go there for the start of, let alone the rest of, their careers. Which may be why some can honestly say, “I’ve forgotten more than you’ll ever know.” Precisely.) Furthermore, what makes the internship/residency so valuable, whether paid or not, is that it DOES take place after the basic framework of knowledge is present upon which to build. New experiences strengthen and add to what has already been learned, and make it easier to comprehend future novel experiences. That exponential growth type of learning happens faster every year, and that is why entering a graduate program with a few years of nursing experience makes for much more learning in the same 600 hours than for the students who don't have it. (An one legitimate reason why experienced nurses rightfully scorn highly-educated nurses who don’t recognize that, or whom have never worked in acute care.) But the bottom line is you have: BSN + 2 yrs experience, + 2.5-3 years for the MSN=8.5-9 years for the APRN, plus—what? another 2 or more years for the DNP? What this means is that the MSN was ALREADY devoting the time and the money to be considered well-educated practitioners...but without the "scholarly" and research additional focus, and training or didactic /formal additional clinical training. This left them handicapped and disrespected....but having spent as much time, effort and funds on their “just a Masters" degrees as doctorates have in many other disciplines. Now, how does that resemble the Associate-degreed nurse doing critical care, back in the days when "mandatory BSN" was coming? Yep—the problem is not primarily that nurses are under-educated....it’s a very sexist problem: The nurses educations are mislabeled, under-RATED, and under-RECOGNIZED. Consider how little education a medical doctor has in research and evaluation of EB medicine. Far less than does a student of psychology, for example. Do we look down on them because they are not dually-degreed PhD/MDs? No, they learn that in practitioner-update seminars after they enter practice—but we instantly cower in shame and hurry to make amends, if we as APNs are scorned because we also lack that focus in our degree plan. So the “old school” APN is lacking in well-roundedness when it comes to understanding EBP? The MSN programs need to dump some (not add on even more with the DNP) of the extensive repetition of 4th-year- BSN courses about public policy, health care legislation, administration, reimbursement...and make the DNP a clinical degree—albeit one with lots of ability to evaluate and add to the fund of EBP knowledge. What’s so hard about that? Are we training lobbyists, administrators, researchers-- or clinicians? Aren’t those other roles why we have the other MSNs and PhDs? Yes, make the MSN the door to “clinical leader”, and the fork in the road t research, clinical practice, administrator, or policy activist—the doctoral roles. Grandfather the previously-educated ones not just out of necessity and fairness or even generosity, but because they learned on the job what will be spoonfed to incoming generations, as is often the case in a rapidly-developing field. (Honor pioneers, don’t scorn them as old-school! Duh: They are why the role exists!) That’s not what is happening, though. What do we do? Instead of reworking/renaming and improving what we have, we hurry to stuff it with even more (now officially doctoral-level) “filler” courses—about 3 year’s worth, actually-- that don’t add clinical knowledge or much discernment for EBP development, but do add “education units” and money and time to the “new APN” DNP degree. Those filler courses—looking like just what they are-- also make us look foolish and lacking in self-respect, when the intent is just the opposite. They make us look stupid, in that when we feel under-educated for a role we already play, our solution is to dash out and add useless NON-clinical filler, and hit our pioneering and hopeful APRNs over the head with the new “standards” and accompanying costs. No, nursing should long ago have made the basic APRN entry degree a DNP, but before they padded the MSN with so much time and money! Now, in order to simply recognize the expertise the APRN has, and credential nurses accordingly, we won’t just correct the APRN educational programs to include the necessary extra foci of research, etc. Nor will the 1 or 2-year pre-grad school practice recommendation be incorporated instead as part of the formal degree plan, as it perhaps should be. Instead, a correction will mean adding even more time and money. No 8-year doctorate for nursing! It’s 9-10 years or bust for us—Never mind we’ll never be able to pay off the loans, given what APNs make in most places. The DNP should not pile on top of the existing MSN practitioner programs; it really SHOULD replace them for clinical practice areas. The "grandfathering" that is needed is simple recognition that current APNs with MSNs already have the DNP, minus (in some but certainly not all cases) some catch-up knowledge in the areas of research, EBP evaluations, etc. It should not add more bloat and administrative/philosophical/nursing theoretical “filler” to an already bloated Master’s program, and worst of all, offer very little increased CLINICAL expertise! No wonder other professions sometimes make fun of nursing’s scramble to attain equality; it’s too obvious, and it shows poor self-image. Ironically, this is just what the “new consensus model” is supposed to fix. We’re visibly “trying too hard” instead of demanding recognition for what we already are asked to do—and do quite competently, thank you!—as we always have at the ASN, BSN, and MSN—and yes, LPN-- levels. To be fair, we must say that many an LPN knows more on some medical and psychiatric topics than does many a practitioner of other disciplines with BS and MD degrees. I know; I’ve worked with them! What is needed during the transition is a post-APN DNP "bridge", not a 5-year DNP for BSNs, nor a 2-3 year DNP on top of the 6-7 (including those 2 RN practice years) already demanded! You just won't get nurses to spend 12-plus years and 140 k on educations earning 80-90k, doing whatever the AMA wants to allow them to do (i.e.; the high-volume, low-knowledge, boring but bread-and-butter essential “leftovers” in medical care), while skimming off 75% of their earnings, and complaining that NPs are shamefully under-educated MD-wannabees! We need an eight-year (top to bottom) Advanced-Practice doctoral program.... and stronger education for the public about what is medicine and what isn't. (You younger nurses may not know that in the 1950's only doctors drew blood, started IVs, inserted tubes in any orifice, etc. Now, of course, LPNs do those things, and technicians, too. Likewise, its a ridiculous red herring to refer to primary care by APRNs as medicine-only territory, or to claim that RNs who do advanced nursing, AND can provide those very basic services along with the more important work of education etc, (i.e. nursing!) are trying to be demi-doctors. ) It's an insult to the intelligence of the public and the practitioner. Adding the DNP on as just extra money and hours or "term papers due" (whether as a 2nd post-grad degree, or a straight-shot from the BSN) instead of reworking the current programs to a more reasonable time frame and cost, is a mistake. Instead of boosting the APRN up to a higher level of prestige and recognition more in line with what he/she actually does, it's reaching down from the Ivory Tower to yank her up by the collar, "Get your act together! Can't you see that little old MSN is demeaning us real nursing scholars?!"

I have to add that NPs should really take a firm line on this, once they decide what type and pattern of compensation seems fair. I have read posts on MD discussion boards where they complain that NPs make a little less, but have no call and no OT, and much lower liability, so what in the heck did they go to MD school for. (Etc.) I'm not kidding. And maybe that was the way it used to be, almost, back when NPs needed a co-signature for a Tylenol and an MD almost in eyesight at all times. They really weren't ABLE to take call or do much alone. (...as for the "little less money"...well.) Those days are long gone, of course. But as APNs become more and more a big and recognized presence in healthcare, that protection from work overload is changing. I've seen NPs making 5am rounds in ICU in hospitals where they don't have hospitalists and the attendings should be there instead. They've told me this is common, and that they are expected to pull a full day back in the office, too. As MDs get squeezed harder and harder and rely on NPs more and more, they will naturally be inclined to download as much of the drudgery as possible, without downloading extra money, and real autonomy--not just as 1:1 " just between you and me in our clinic" arrangements, but making it official, by offering APNs support in the legislature, etc. This must be prevented. MDs and other providers should be collaborating on how to manage the workload and use healthcare funds wisely, etc....not abusing one another. Please, practicing NPs--learn your rights and stick up for them, for yourselves and for those coming behind you. This I know from long experience: It is ever so much harder to take back your power and rights after you've given them away, than it is to get them in the first place. So if you let anything slip by now, be prepared to fight much harder and longer to restore the balance later. As an older nurse, I've been a fighter for respect and recognition for nurses for a long time, so some of the freedoms you have now are due to nurses like me. And yet, ironically, if I get to be an NP, I'll be benefiting from the work of those in front of me at that level--like you!

I'm just a prospective NP student, but happened across this. I think that unless you are a salaried employee or co-owner of the business (clinic or whatever), or an independent contractor, then you are by definition a non-exempt hourly employee. In that case, USDL law says you HAVE to be compensated in money, or 1:1 extra time off work for taking call--unless you don't get any calls. If you do, and you've already worked 40 hours for the week, or will have by the end of the pay period, then you are in OT and must be paid accordingly. (Typically, holidays pay more, but I don't know if that part is the law--don't think so.) Just being available is a gray area with which I'm less familiar. (When I've had call as a nurse, we got a flat-but-low rate for being available, then the full OT rate for any actual hours worked, in 15-minute increments. We kept careful records.) Salaried employees can be paid, but it's negotiable, not the law, that they earn money for after-hours work.

To really understand, it might help to ask, ""How is a door hinge similar to an elbow?" or one of those plumbing "ball joints" have in common with similar joints in the body, like the shoulder? Or rocks in a stone wall that has no mortar similar to wrist and ankle/foot bones? Why is padding needed between weight bearing ones, vs just lube? What would be the reason any joint might have ligaments restricting its movement too far where it is, instead of letting it go (wobble) any way it wants? Asking the "whys" and looking at joints from animals, diagrams, and most importantly, non-living similar mechanics, should make it 10 times easier to remember how these joints work at exam time, too. Remember a lot of these inventions were made after someone saw the miraculous arrangements of the animal body, human and otherwise. Good luck!

Hello, I need a fast program for all kinds of practical reasons, and no matter how rigorous the program, I will study even more, voluntarily...I LIKE to actually learn and be challenged, so I hate busywork. I'm looking for a tough but minimal-busywork online NP program--FNP or PMHNP I work FT and commute 8 hours a week, too--no chance I could drop to under 32 hours and would have to switch to another job anyway, before I could do that; no option where I work. I won't be able to attend live Skype meetings at any old time. Background: I'm also about 15 years older than most "finally-getting-back to school" candidates, so I have to be very cautious about piling up massive debt. I just finished an online full-time online RN-BSN while working FT; already had a BA from a brick-n-mortar school. That BSN came from a very writing-intense school, and it seemed to me that the writing load actually took away from learning time. I spent hours and hours simply looking for references to back up what I sometimes already knew, and more time writing what I did learn, than having time to learn more. It's fine demonstrating what you've learned, but I found myself having to cut short the learning part to get the "next big paper" (or project) done--since there was no set maximum, nor final "that's the end of the course" aspect, just the actual work submission that was required to demonstrate skill and pass the course. In many cases I really was interested in the material, and would have preferred to learn it and more, pass the exams, and get to an optional seminar and my clinical experiences. I am looking for a school that is FAST, but rigorous, one which demands the student know a LOT and be willing to study very hard....but not in busywork, chit-chat online that is really just about opinions, and no more "busywork" than absolutely must be. (I have yet to learn a single iota in those scholarly critical-thinking "peer discussions"; it's either the blind leading the blind, or just opinions about the lecture.) Why all the busywork, away? MDs and PAs don't have the same philosophy or approach as NPs, I know, but they manage to learn a lot about health care, without writing a massive term paper every 2-4 weeks, on the "business and philosophy of medicine", or long chats with their peers on classroom lectures--yes? The mad rush to offer DNP programs first has a lot of schools offering a nearly worthless rehash of the same business/ finance/ theory/philosophy/research MSN courses, just longer and heavier versions for the DNP, and with more demanding papers. Where is the patient in all of that? I've only seen a few that actually add clinical knowledge or research opportunities, even in the research modules for EBP. I care about nursing policy, the future of nursing, etc. all those leadership topics, of course, but they bore me most of the time...I want to learn health and biology and psychology, public health, and how to apply them and help with research. I spend hundreds of hours every year reading PubMed research journals already, so I don't need a kick in the pants to think critically, synthesize, and take them all with a grain of salt. Can anyone advise me on which schools work you hard, demand a lot, but spend every spare minute (beyond the absolutely-necessary "nursing core courses") in the science and practice of holistic nursing? I would be grateful to hear any information. Of course, cost information would be helpful. I have heard Georgetown (which I could never afford) and a few others (which??) is like this, but that most online schools are still very much in the churning-out-papers and video chat mode--especially those where independent study is prized, or they've had only educator/IT/Nurse Leader MSN programs until recently, like Walden. That seems to me like having you pay more money to sit in front of your PC, instead of in a classroom. What freedom you gain, or save in commute time, or gain in scheduling flexibility, are lost again because of the long, long hours tied to one single chair--yours, at home! As for you lucky ones who can take time off for school! Wow....I can't imagine being able to just attend college--I've worked FT every inch of the way, from CNA to now!

But they do require nursing experience, or should....at least a year's worth. I do Disease Managfement and they like at least 5 years of good med-surg...most have over 15 years. But I agree; seeking something less demanding is a good idea. Working in a call center can be very demanding on other ways...sitting for 8-10 hours is bad for health, adds to poor coordination and muscle weakness/pain, and is mentally grueling toward the end of a long shift. Blurred vision is a problem, too, when eyes are tired. Working nights would be VERY VERY BAD for anyone with an immune system disease; shift rotation would be bad, too. If you don't plan to live the night shift on your days off, too, then you are doing shift rotation. I speak from experience and plenty of study.

It is the strangest feeling to remember my first year as an LPN like yesterday, and yet be one of these "mature" nurses you're discussing that can remember (just barely, though) when community hopsitals still used urine testing to calculate how much sliding scale insulin to give, and papwer requisitions for labs, and huge metal oxygen tanks , becuase they didn't have wall O2. We gave real backrubs and drawsheet changes and "peri care/Foly care" and dentures scrubs to everyone every night, and made the underweight ones special Ensure + ice cream or fruit milkshakes in the unit's kitchen. This was all in a tiny old "City Hospital" the year before I took my first LPN training at the "new medical center" in town--all of--gasp! 400-plus beds! High tech beds and o2 and suction in the wall and computers in the nurse's station--oh, my! (though not for charting). I even knew a retired nurse (who worked as a ward secretary in acute care) who could remember when nurse stood to attention when doctor entered a unit (then called a ward), and gave up her seat. They also carried the (heavy metal) chart stack for the doctor, accompanying him/her to the bedside on rounds and handing him each patient's chart. Ostensibly it was to leave his hands free for reading and writing and examining, but often he would glance in it, hand it back to the nurse and give a verbal she would have to memorize until they got back to the station with the stack, where she would write it herself for him to co-sign. I feel ancient as a nurse when I read and remember some of "way back in the 80s comments". But when I go to the hospital the pumps are what we used 10 years ago, and I can still do everything, so I don't feel out dated. Sometimes the nurse caring for me or a family member is so green and overwhelmed she does not know how to do something right, and I see much danger in that. Recently a friend had agonizing back surgery abd was agitated with pain. Finally the nurse agreed to ask for a manual bolus of something beyond what the PCA included. While she was gone I checked the PCA settings and usage history, and saw that the pump was programmed for basal rate and patient-driven bolus and locked, but had never been released to run, and the syringe was still full. In other words, 15 hours and 2 shifts of nurses had not seen that my friend was completely unmedicated, and THAT's why she was agitated and delirious! Ironically, that had happened to me just 5 years before her, so PCAs must be tricky for junior nurses. And it was clear that even the charge nurses were green and young on that floor. When I reported it, I did so gently, but it took the team leader getting the much older unit manager to come in to confirm I was right. I didn't chart yet in bedside computers--whch were just arriving as I left bedside nursing, though now my entire day is spent at a pc. Learning new skills is fster than gfaining years of experience, so an experienced nurse who is up to date might make the best mentor here in the staes, and an older one who remebers the old ways would cope better with a 3rd-world environment where you have to go with your gut, live with uncertainty and without technology, and find ways to invent on the spot when you have to, all the while knowing what is safe to risk trying and what not. But I do have to grit my teeth when a younger nurse (and a few the same age as me, but newer in nursing) destroy an "easy" and previously healthy vein because they have poor IV skills/inexperience and they don't want any tips from me....they're used to technology doing a lot of what we learned to do well before technology made it easier, and so consequently they have trouble thinking outside that ease-n-conveneice box. I think we still make better thirld-world nurses because we had to function on instinct and observation more, and accomplish a lot wthout something preinvented to handle that very problem. When I ask a younger nurse to feel for a veinn, and use knowedge of anatomy to determine where it goes and where the valves are, they look blank, and impatient, and just poke again, almost randomly. They don't yet have tips and tricks for tricky cases, and most are not as inclined to think it through and try a different way, nor listen to experience. I try not to be a "let me show you how" butt-in...So one by one my good veins are being painfully and needlessly ruined with lumps of scar tissue when I have IV treatments. Very frustrating. But I was a good nurse form the start, and though I had a lot to learn I had some fresh ideas...if young nurses don't presume they're as competent as experienced nurses form day one, they stand to add a lot to the profession as each new cohort does. So I always hope to work where I can be one of the good, kind , respectful--and respected in return--"mature" nurses.

Dear "WannaBe", Funny you should ask: Those were EXACTLY my concerns before entering WGUs ASN-MSN program with a BA in Psychology. I had wanted to be a clinical psychologist since HS, and I am middle-aged. I checked into distance-learning psych programs and saw that only 2 are APA-accredited, and they are very expensive! I would not have time to pay off the loans and still retire before age 85. So...the Masters in Nursing. I did get advanced placement for my science, math, and social science courses, but was required to repeat some things I felt should be covered. I had hoped to get the MSN, and start using it as a Certified Diabetes Educator, then work on a PMHNP, with the idea of going into bariatrics/disease prevention/public health environment. I would so love to work with the Indian Health Service! But not as a "regular" nurse--I've done my time on the floors FT. I have decided, though, I will probably leave for the direct route to MHNP when I complete the BSN this summer, as the WGU format is solid education but makes me (an experienced "independent learner") wacko. Not only that, but if this whole DNP-for-Advanced-Practice-Nursing thing does happen in 2015, then I want to be "grandfathered in" at the Masters level, so I will have a working license, and do the DNP afterward PT, for personal achievement. I don't have the time at my age to be taking 4 more years--understanding I have an ASN-plus and a BA and a semester yet to go for the BSN--to begin practice as an APN. I do feel this is the way the profession is going; if nursing continues to grow in a nursing direction, though overlapping with medicine somewhat in practice, as we always have--common sense requires it. Nursing IS a doctoral profession at its highest level, and has been for a long time. The money and the educators have just not been there. Four extra years, though, is too much for a working nurse, and they will NOT get working nurses to go 6 extra years PT, nor 4 FT beyond a BSN, and to pay 60 or more extra thousands of dollars...to become health practitioners earning 25% or less of what MDs make--some who have just a couple of more years of training! (I know, I know--they can have residencies lasting many years--but how many psychiatrists and FPM doctors actually do? I have written elsewhere and feel passionately that NPs are NOT "demi-doctors", "assistant" or "junior" doctors (as a Physician Assistant actually is); we're a whole other discipline. But when you decide on the financial feasibility and worth of a career--and it does matter--then you must look at the ratio of years in training + debt: future income...) ...Particularly if your whole 40-year career is not ahead of you! Particularly if you must stop school, start paying back your loans for 1-2 years of required nursing experience, then go back to school. If you start to live as a working nurse, rather than on a poor student's income, you will amass personal debt that will not allow you to leave work to go back to school FT unless your spouse foots the bill, either. (And yet nurses starting green with an NP really aren't as good for at least a few years...nor are green MDs; that's why nursing grad schools are trying to slip in what amounts to a "pre-residency" in general nursing, a lot like the intern is getting, after the didactic part of his/her training.) Many of these grad nursing schools require a year or 2 of nursing experience for entry, so it must be considered part of the training--just like an MD's intern year, no? And so if you look at that, you must conclude that to be a working APN with a DNP, you need to have 4 years of college-BSN, plus 1-2 years FT experience (in critical care for CRNA programs), then 4 years of graduate school, then at least 540 hours of post-DNP residency. Can we add? Yes, we can: TEN years, people. TEN. Oops--with the 540 hours, it's actually TEN and a FT quarter-year. A quarter you will have to stop work to get, or squeeze in around your regular job--so it costs income, too. Many MDs have 8 years or training plus a residency of about 3 years. Few have more than that unless they're going for advanced surgery/specialty, or something in acute care, and long before they go into independent practice they are senior residents making good money (relative to nurses, not physicians in private practice), and have had a license for YEARS that allows for paying off some student loans through moonlighting. NPs, meanwhile, have no such license or capability while still officially in residency, and they are more tightly restricted to their area of practice. For example, I have seen neurology residents working in psychiatric emergency rooms as fully-paid MDs doing psychiatric work-ups I could frankly have done better. Neurology is not psychiatry, though psychiatrists would do better to have more pure psychology and neurology training--but that's another topic! I don't want to have my cherished dreams of (corny or not) "making a difference" and finally using more of my mind just crash and burn. I don't want to find myself cynically screaming: "Show me the MONEY!!!" after a few years in expensive school, while working FT, with no end in sight. I sure wouldn't want to start practice (especially in mid-life) owing 40-60% of what an MD does in student loans, with 25-30% of the earning capacity of a Family Practice or GP physician. So I am 99% sure I'm making the switch, going the FNP route if that's what's affordable, and getting the PMHNP post-Master's if that's more feasible (start dates, program hours, PT options, cost per CH, etc.) though if I were as young as I suspect you might be, then I might go the straight DNP as I hoped to do.