hospicenp

Wow. I sense so much hostility on this thread. Everyone's path is different, depending on where they started and what they want to do, what opportunities arise. Here's a synopsis of mine. I am an RN, first. Did 20+ years in critical care learning lots of ways that people die badly. Got interested in ethics and took a certificate course so I could teach. Decided to get my Masters and ended up on a CNS track. At the end of it there were no jobs. By that time I had realized that the opportunities for me were in hospice as an NP, so more school. As a hospice NP, I do the same things my MD colleagues do. I work in an inpatient unit, and I see patients, manage symptoms, write orders, do paracentesis, order infusions, wound care, and when the occasion arises I extubate vent patients. The important distinction is that while I DO everything the MDs do, I don't KNOW everything they know. I consult with my MD colleagues often. The best part is that after so many years of people dying badly under my care, now they die well, and I am in charge of that. I'm not calling the MD and begging for an order, I'm writing it.

The chances for DNP expansion are actually very good. You are just starting your career. Wait 2 years and see what's out there, you'll be amazed.

I never thought I would say this, because I have been a nurse forever and love being a nurse. But after being an NP and being in situations where I was unsure of a diagnosis or treatment course, I have wished I went to medical school. Not that I wish I were an MD, but that I had more knowledge, and believe me I study all the time. But there is a depth that I didn't get in NP school that I wish I had.

I would take the GRE, even if the school doesn't require it. Then, if your score is good, you can include it and it will show motivation, scholarship, etc now. Good luck.

Of your choices, North Carolina is the best. It's still restrictive, but you do have more autonomy than the other states. I lived in NC for 18 years (Winston-Salem and Greensboro) and found an interesting culture there. There are more universities per capita but a really high black illiteracy. The nursing community is very active at the national level for both NCNA/ANA and Sigma Theta Tau. There are lots of opportunities for arts and music. It can also be a socially closed society. I think you'd find a niche but you have to be patient. South Carolina never got over the Civil War and the good ole boy club is supreme. Alabama is even worse. Georgia is somewhat better at least in Atlanta but the rest of the state has the attitude that only MDs know anything. NPs are either female and therefore inferior or else male in a female role and therefore really inferior. JD Citizen, have I missed anything?

I forgot to say, no, you don't have to do a pediatrics rotation in a program for adult/gero NP.

NPs definitely do procedures. It depends on your practice. In my hospice practice, the most common thing I do is paracentesis. I also do a fair number of incision and drainage of abscesses. In other practices NPs do many other invasive procedures depending on the specialty. I am certified as an Adult NP, Gerontology NP (for the elderly), and Hospice NP. Only the first 2 are recognized for my license but I took the certification for Hospice ARNP as a matter of professional standing.

One of the worst states: Florida. Prescriptive authority does not include ANY scheduled drugs, which is a real hassle for me since I work in hospice. We have to file our MD protocol annually. We constantly fight the Florida Medical Association in the legislature, they introduce bills to limit us even further and would get away with it if we aren't vigilant. If it weren't for the particular group I work with, I wouldn't be here.

NPs diagnose and manage illnesses. Just like primary care MDs. That's what all that education is for.

Actually it was pediatrics. Google "Loretta Ford" for an accurate history of the NP profession. The point of the DNP is to elevate the NP as a profession, not individual schools or programs. There will always be competition between schools, that's human nature. But when NPs are talking to legislators they are seen as "less than" without an equivalent degree. That's what the pharmacists and physical therapists figured out, and changed their curriculum accordingly.

It all depends on what sort of job he wants and is able to get hired into. Remember, not everyone hires new NP grads. I work Mon-Fri, 8-5, except for about every 6th weekend I work 8-5 and then am off the following Mon and Fri as comp days. I also take call about every 4th or 5th week, Mon-Thurs, 5P-8A, phone calls only, and am then off on Friday of the same week for comp day. This is an inpatient hospice practice, I round on 14-16 patients per day plus meetings with families, social workers, and other team members so it's pretty busy. Not as hectic as an office seeing a patient every 10 minutes but still busy. There is no way I would try to have a second practice.

BTW, I've never like the cutesy scrubs either. How do nurses think they will be taken seriously when they dress like that?

I became a Nurse Practitioner so I could more fully realize the role of the nurse. We are meant to be fully functioning clinicians, not hiding behind MDs, following someone else's orders. That is not to say that I think I know the same things as an MD, I collaborate with them every day and ask advice. But it's advice, not orders, it's direction, not some legally binding dictate. I guess I'm really a rebel. I love taking full care of people, getting the history and working up the complaint, following up the prescription or solution I've recommended. In hospice I deal with uncontrolled pain, vomiting, constipation, dyspnea, and many other problems, from superior vena cava syndrome to bowel obstruction to active dying. It's very satisfying when what I did made a difference, and the patient is comfortable at last.

I haven't used it because of the money. I use LexiComp instead, which is also pricey (Just not as much) but downloads to my PDA and is great. Go to their website for more info. No I'm not in their employ, just a happy customer.

I have to make a couple of points in this discussion. First of all, NPs weren't "invented" to relieve the MD shortage, as one person mentioned. NPs were developed to extend the reach of the RN, in ways that nurses historically were able to do before MDs limited their practice. The fact that NPs *do* serve instead of MDs in many cases only proves that MDs weren't needed. The DNP is meant to put NPs on an equal basis with others in the health care field, such as PharmD's and Physical Therapists, who are making the clinical doctorate their degree requirement. The MD has always been a clinical doctorate but the way they lord it over people (including those with PhD's which is a higher degree) you'd think it was more than that. My Master's NP program was highly rigorous and a match for any clinical doctorate, and I have no intention of going back for more. But if I was starting the journey now I would do it, because it is the future, and you have to be ready for whatever happens. I'm going to retire in a couple of years, but if I weren't I'd be protecting my investment.