time2go

I graduated with the AGNP in Primary Care in 2019 and passed the boards. I think all NP programs leave a lot to be desired. From what I read, everyone has imposter syndrome initially, having to depend on online information of some kind. It's a shame residency programs remain uncommon. Those would be great. At any rate, being accredited, being all online except for the one visit, and reasonable tuition with a really good veteran discount at the time were the deciding factors for me and I'm satisfied with the experience.

This is old but I'll respond because the independent practice in CA is not nearly what I or any other NPs I know expected. There are now 2 types of NPs: 103s which work somewhere there are MDs or DOs working (like a medical practice, hospital, clinic) and can work without specific standardized procedures. You must register and get approved as a 103 and practice that way for THREE YEARS, regardless of how long you have been an NP, then apply for 104 which is independent with your own practice and not needing a collaborative physician. You absolutely need a collaborative physician until you apply to CA BRN and get approved as a 104. You have to get sigs from doc verifying that you have the appropriate working experience in order to get approved! It's all on the CA BRN website. Read it and weep! ????

You don't need a hospice NP as preceptor. Whatever your NP designation is going to be is who needs to precept. For example, if you're heading toward Adult/Geriatric Primary Care, you need a primary care preceptor. Hospice NP is not a licensed designation, it's a specialty after all your licensing stuff is done. You need experience once you are an NP if you want to be certified by HPNA. There are NPs who work hospice who are not certified in the specialty. Many will just find per diem work doing face-to-face visits required by CMS prior to the RN recertifying a patient from benefit period 3-infinity, however long the patient stays on service. The other part of hospice as an NP other than the regulatory requirements is symptom palliation. There is always an MD/DO available to run things by if you are uncertain since an NP cannot be Medical Director in hospice based on CMS rules. Symptom control knowledge is a needed skill in hospice but there are usually less than 20 meds you should be familiar with in that regard in order to take care of the majority of symptoms you'll run into in hospice. I was a certified hospice RN prior to being an NP and, if you want to be involved in the nuts and bolts of hospice work, the RN role is much more involved with patients than the NP. If your main goal is to be involved daily with patients as an NP, you may want to look into being on staff at a hospital in the palliative department.

I'm in that position now. I agreed to it but I'm getting tired of it. I'm ACHPN NP and I agreed to do admissions (RN job) in a pinch. Well, since hospices do indeed tend to run lean, I do way more admissions than I had anticipated. Doing F2Fs does get pretty routine too so not sure which is better/worse. If I had it to do over, I likely would not have agreed to the hospice admissions.

I could never find a definitive recommendation for pre-test study and review. Seems like experience is the only thing that absolutely will help but you know how that goes. Like with the NCLEX, what you learn in school is different from what you learn in practice.

I took it twice, passed the second time and there were not many similarities between the two. Seems they concentrate on hospital palliative things more than hospice. I remember when I took the CHPN a few years ago, it was heavy on hospice. Not so on the ACHPN in my experience. I honestly could not begin to suggest a study source but Palliativelove, your experience probably has you more prepared than I. I've always done home hospice.

Old thread but I took the test today for the second time and passed. Both times I took the test, the questions were so different. I would be interested to hear if anyone used a test prep they thought was useful. I think the test is so broad, there's no way to really select a useful study aid. For MAYBE 10% of the questions, I was relatively sure of my answers but there seemed to be a lot of wiggle room between 2 out of 4 answers throughout the whole test. Any thoughts from anyone who has passed the ACHPN exam?

The bottom line as I see it is an NPs willingness to take a job where he or she is expected to function as the MD or DO, knowing there will be a pay disparity. So many "midlevels" (I know, many hate that term) want to show what they know and be completely independent. They jump at the chance to take on loads of responsibility. That's on you if you take that path. No one can argue that the education difference between physician and NP is huge. Eventually, a good NP can be a better PCP than an average or crappy physician but that is totally up to the individual, as is the choice of function. I choose to do what I am strong in and enjoy having someone else to refer to when something is out of my wheelhouse. Nurse practitioners and PAs, by virtue of education are indeed midlevel providers. I'm all for independent practice but within my comfort zone. If we take the midlevel educational route, we should be happy with the midlevel function and remuneration. We can still advocate for ourselves without holding ourselves out as something we are not.

Started pre-reqs at 53! Finished AGNP at 64. Take that! Never say you're too old to change something unless you're already dead.

Agreed. I was a CHPN, hospice RN before I finished my NP. Now I'm a hospice NP. Knowing the role of the hospice NP was a comfort to me because I knew that if I got through the education and credentialing process, I could absolutely do the job! I agree also with the previous poster that you likely know more than you realize. Don't minimize your knowledge by comparing to someone else's. I never wanted to work in a hospital and never have. I still know how to do my job. If you're motivated to learn, you'll be fine.

I have the same concerns about this book. There are, indeed, tons of typos but I'm going with the actual content, along with other things, because, well, can't hurt!

1. I'm a hospice nurse and my employer kept me on as an AGNP. We only do adults who are mostly in the geriatric age range so it's perfect. 2. I have many opportunities that looked interesting but then the opportunity came up to stay where I am so that's what I did. I was in discussions with another NP who does home visits, another hospice company, and a primary care practice. 3. Less actual physical work and higher pay, which is what I was looking for. 4. Just decide whether you want to work with kids. So many primary care offices see mostly adults anyway. Many clinics will likely be off your list but I guess it depends on your location as to whether you'll be impacted in your job search. I never really wanted to work in a clinic. I've been charge nurse in that arena and the providers are usually too rushed. If the choices as FNP are greater, are any of those additional choices places you would like to work? There's your personal answer.

Clinicals were a whirlwind. There were papers and assignments and clinicals and charting on the patients you see in clinicals.

Just graduated from Spring Arbor AGNP. The clinical portion is by far the most problematic. You have your clinicals which require the practice hours in addition to online assignments/modules plus you will likely have another class so that makes basically 3 things to keep track of during the last part of the program. The clinical documentation in Typhon is a true pain and if you get behind, you will be sorry! You are supposed to chart on every patient you see in clinicals and that was not made clear at the beginning for our cohort. The coursework is not bad but the time management piece of the puzzle during clinicals can really trip you up. I had to stop working for a couple months then do part time at the end. Whomever asked about the range on completion time: AGNP has 500 clinical hours and you can get the program done in 2.5 yrs. FNP has 750 and unless you double up on clinical hours at some point, you're most likely looking at 3 years. If you aren't working and can get through the clinical hours faster, that's the only thing that's variable time wise. I have only gone here for my Master's so have nothing to compare it to since I went to an on campus state school for my BSN but all-in-all I think it's a good program. If I could go somewhere else for free, I would be tempted to get something to compare it to but that ain't gonna happen! I think any online program has a lot of self-teaching and if you can't do that, don't do online. There's a ton of reading and the classes go fast. The instructors are responsive but, let's face it, getting an answer to your questions within 48 hours in a 7 week class sometimes doesn't help.

I wanted to quit nursing school nearly every semester. I'm now finishing my AGNP and I've wanted to quit that too. Before you quit, learn about all the jobs you can do that are not in the hospital. Hospital nursing is not for everyone but nursing is such a broad animal, there may be something you find that you love. I never worked in a hospital. People will say you have to for a year or two to get your skills and assessments, blah, blah, blah. I hated the hospital and went directly into hospice. LOVE IT. I plan to keep doing it as an NP and throw in a little primary care. You are wise to be sure before you quit.

This thread has been around a long time and I'm happy to see it got continued recently. I was a claims adjuster, real estate agent, dog groomer, etc., etc. prior to starting my nursing school journey at the age of 53 with pre-reqs at a community college, getting through regular and organic chemistry, statistics (not a math person AT ALL), and more algebra THAN I EVER WOULD HAVE THOUGHT (!) Next, I moved from California to South Dakota in 2010 for nursing school since California schools were crazy crowded and I wanted to finally just get'er done. Went to SDSU in Rapid City for my BSN and came back to California for my first nursing job at the age of 58. I'm now in the last year of my Adult/Geriatric NP program at soon-to-be 63 and continue to be a hospice nurse. When you talk about age-ism in nursing, I have to think it may be in hospitals but I have never encountered it in my field. I got my CHPN (Certified Hospice and Palliative Nurse) in 2016 and have always been able to find jobs. As an NP, I expect the same. If you have the right attitude and skills and you gravitate toward something you're good at, you will be fine. Going back to the initial posts from 2010, I MUST take exception to telling anyone in their 50s or 60s to lean toward LVN or CNA. Those jobs are for the younger! They are usually more physical than RN work and honestly, learning what you need to learn to be an RN is way more do-able past a certain age than turning and lifting and bathing patients. I won't even talk about the wage difference. If you're going to bust your hump in your 60s and it's going to be your last big career change, make it worth your while monetarily.

Started prerequisites at age 53, graduated with BSN at 58, currently working hospice with CHPN, just started my AGNP at age 61 so I can do face to face, monthly facility visits and palliative care until I'm 75 or so. No, you're not too old. I'm in southern California and was faced with the lottery/waiting list dilemma so I moved to Rapid City SD to go through the SDSU BSN program. Retrospectively, it was a great decision. I highly recommend relocating for school if you're in the same boat.

As a CHPN, I would go with what heron stated, "Start an inpatient care home that can contract with hospice agencies to provide respite care without having to provide all the services required by CMS, because the contracting hospice already does that?" Some exceptions, though: Having an RCFE (this includes board & care homes and assisted living facilities) that markets to hospice agencies, you would have the least restrictions. However, RCFEs are private pay so insurance wouldn't cover your board and care fee. The patient or family would have to pay that (usually anywhere from $2000 to $5000 per month) and the hospice agency would be billing Medicare or whatever other insurance is involved for their hospice care. An alternative would be to open a SNF because only a SNF can provide respite but that's a pretty large undertaking. The stay in a SNF can be paid by medicaid but not in an RCFE. In my state at least, in order to provide hospice respite that is covered by insurance, you need 24 hr RN coverage and to be licensed appropriately. My research indicates you, as an RN, can't just open a senior living home and call yourself a SNF and be able to do respite. I would do it if that were the case! Easy peasy.

I had a similar issue when I got my CA license by endorsement. It took me 4 months to finally get my license and I was already in the state working as an MA until my license came through. Turns out they had my middle name wrong. Someone along the way had decided my middle name should be different. Anyway when I called the consumer line instead of the BRN line, I finally got hold of someone who helped me and I had my license the next day. I'm afraid your only choice is to keep calling until you get someone who will actually check and see what's going on...unless you want to drive to Sacramento. California is so bad about licensing time frames. I had my name on the BRN website in South Dakota the morning after I took the NCLEX! I realize there's a huge difference in population numbers, but really, 4 months?!

Can you just call and ask or maybe go through the information they have sent you thus far for the answer? Maybe check the website and see if it mentions whether you need a CA nursing license when you start the residency? Sometimes you're not actually doing anything that requires a license early on so you may or may not need your license at the beginning. Since California is not a compact state, I don't think there's any type of grace period.

Hey there fellow folks of a certain age: Felt the need to chime in again after a long while: I graduated a BSN program at South Dakota State University when I was 58. If anyone is being discouraged by waiting lists or tuition for BSN vs. ADN, I recommend you check them out. I had a great experience there with the majority of the faculty and classmates too! The West River program is the one I attended in Rapid City. It was challenging but I held my own. The hardest part at this age for me was the fact that so much is based on memorization. I don't memorize like I used to but once I can connect new information to life experience, it stays with me. Once you get past the rote memorization and into the application of information to scenarios, it makes a lot more sense. "Thinking like a nurse" is the main thing to keep in mind. Once you make that transition, things fall into place better. I'm now on my second job 2 years later, the first being charge nurse at a clinic. I am currently a hospice nurse (which was my goal all along) and I'm loving it. Demanding but good. I still wonder if I should work in acute care for a certain time to get the breadth of experience to be had there but it isn't a huge stumbling block. I'm tickled to death that I finally decided to see this through and I encourage anyone who wants to to do the same. It's not too late until you're dead.

Laudamia: I was posting on here earlier this year and it took me a ridiculous amount of time to get my license. Nothing on breeze ever indicated anything was being done on my application. Each time I called, I was told "there's no reason you shouldn't have your license by now". Finally, after many weeks, someone checked to see what the scoop was and the next day I had my license. I now have two entries on the CA BON website. One with the wrong middle name which is labeled "former name" and one with the correct middle name. What it boils down to is that someone who was entering information made an assumption, based on an initial, that my middle name was something it has never been so everything was under that name until someone bothered to investigate based on my SSN. I have to assume that office is crazy busy and things do not work like clockwork. Don't expect logical or reasonable explanations for delays. Mistakes on the part of whoever inputs the information take weeks to detect. Sad but true. I almost fainted when I finally got my license; it does happen eventually but trying to make logical assumptions about the timeline are futile.

I'm from southern California and I started nursing school in 2010. There were waiting lists up the wazoo then too in California. I graduated with my BSN last December from SDSU--South Dakota State University (West River) in Rapid City. There is no waiting list on the west end of the state although the main campus in Brookings gets full. Anyone from California would rather live in RC anyway as the weather, while still South Dakota weather, is not as bad as the eastern half of the state. Lots of people from Washington and California go to SoDak State for nursing. Good luck. I know it's a chore to find the right school.

I'm 59 and approaching a year since I got my BSN. My final senior project was to do something that embodied my nursing school journey. I wrote a poem that my classmates seemed to identify with and enjoy so here it is in hopes that it will help you clarify your thoughts and feelings on going to nursing school at "a certain age". It really does express my satisfaction at having completed this challenge. So here we go I said again; it’s time to get this done. “You’ve tried before”, I told myself. Is this old plan “the one”? The nursey thing’s been in my head for over 20 years. I chose a different path back then. It’s time for new frontiers. The husband’s trained; the kids are grown. I have the time for study. There aren’t that many years to go Before my brain gets muddy. The brain cells they’re a shrinkin’, the back is gettin’ stiff, And on the porch at 95, I’ll sit and think “What if?” What if I’d gone to nursing school way back in 2010? What if I’d tried and made it through? I’d wonder now, “what then?” Could life have been more challenging? Could work have been more fun? Could I sit here now amazed and proud of all that I had done? Well, now no need to wonder ‘cause I did it, yes it’s true. It kicked my butt and made me scream and yet I made it through. I hardly can believe it; it’s been a rutted road. With twists and turns and bounces- and student loans now owed. This dream has cost me plenty; both money and years spent. I’ve stopped and started, moved four times— Suffered APA torment. And now I have a BSN; a tribute to my pain. I’m hoping it will serve me well (and I can find a vein). I’ll cath and teach, inject and soothe and all that nursey stuff. I’ll help you live or help you die; I’ll be soft or tough. Depending on the circumstance and what’s required right then; I’ll be there when you lose the fight; applaud you when you win. Florence is our model, a supernurse indeed. Though shackled by her gender, she strove to fill a need. A need for education, investigation, sight. The sight to look beyond the now and help turn on the light. We learn new things and change the old; get better as we go. We prove our worth and gain respect; find out what we don’t know. And now that I’ve gone through this trial and written out this verse; I’ll always be what I’ve become. I’ll live and die a nurse. -HVanderhyde BSN,RN

RHIT to RN: If you want it badly enough, you can find the stamina. I started my pre-reqs at 53 and graduated with my BSN at 58. I must say it was hard but not necessarily because of my age per se as much as due to my dislike of having to do things I don't enjoy. Once you reach a certain age, most folks, myself included, have gotten their lives to a point where lots of the extraneous stuff has been cast aside and you feel like you have more control over your life.You do not have that control in nursing school. Writing research papers and doing group projects was not my fave but here I am: a nurse; and words can't express how glad I am I did it. I am so proud to be an RN I could spontaneously combust!