FNP grrl

hi medic- i suggest checking out the nurse practitioner forum here- there are several threads related to your question. also, a page or two back in this forum, there is a thread called "all np's please read this" which was active a few days ago- i think you might find it helpful as well. good luck w/ your future career.

you're welcome. and i know what you mean about those decisions!!!!!!!!!

1.) no, an emergency NP program isn't necessary to work ED. however, it is my opinion that any NP working in an ED setting should have some kind of emergency work experience as an RN or in EMS or the like- or be an experienced NP, comfortable w/ fast-paced, high-risk settings. i have never met anyone who graduated from an emergency NP program- i would have done that instead of FNP but it wasn't really an option for me. as it turns out, my ED nursing background combined w/ my urgent care/orthopedic NP jobs have been excellent preparation for working ED. Also, the FNP degree includes all ages which is helpful in most EDs. 2.) how many years of ER experience as an RN before working as an FNP in the ED? depends. i guess i'd say the more the better- but probably 2 minimum. urgent care settings & EMS background are also relevent, IMO. i'm sure there are some NPs out there who have done fine w/ less experience than that...i am biased toward more nursing experience being better. 3.) salaries really vary from locale to locale & job to job. RNs at the very top of their scale make more than NPs at the bottom of their scale. i'll make significantly more now as an NP in the ER than i did as an RN. i suggest you do some online research to check salaries in the areas you are considering working. 4.) i posted about this in another thread in this forum. briefly: NPs do the whole work-up/exam/H&P, order tests/meds, make medical dx, write Rx, and do more invasive and/or higher-risk procedures. all of this varies from state to state and job setting to job setting. 5.) the relationships between NPs & MDs depends- again, it varies state to state & setting to setting. i'm not sure if you mean the legal relationship (ie, licensure/supervising/etc) or if you are asking how collegial & respectful the relationships are. i'd be happy to answer if you clarify your question a bit. 6.)imo, PAs are not more marketable than NPs, though some disagree. it depends in part on what kind of work you are ultimately interested in. if you want to do a lot of surgical assisting, for example, you might be better off going the PA route (not that NPs can't do that too, but it seems that far more PAs end up in the OR). if you truly have emergency medicine as a goal, you can do it w/ either a PA or NP degree. my ER job is only NPs & MDs- no PAs. some ERs are the opposite. look at job listings in your area. and be prepared to advocate for & market yourself assertively after you graduate. 7.) drawbacks? do you mean NP vs RN? higher liability, expensive malpractice insurance (often paid by employer though), increased responsibility that isn't always fairly compensated, potential for negative work environment if MDs or staff aren't supportive of NPs, call (not in ER though!!!!). hope that helps- good luck!

thanks jen! i should also say that in my urgent care job, PAs & NPs work the same position. in my ER job, there are only docs & NPs. not sure why.

i'll be starting in the fast track of an ER as an FNP soon. i have worked as an RN for years in the ER. i also work as an FNP in an urgent care. the roles are very different. as an FNP, i have more in common with the docs in the ER & urgent care than i do the RNs. in urgent care, i work side-by-side w/ a doc. we each pick up charts & go in to see the next patient pretty much identically. i always consult w/ the MD any time the pt is very sick or very complicated or if i simply need some more in-depth medical information. i am not required to present patients to the docs...it is my judgment whether or not to consult with them. once i got past the beginning stage in the urgent care, i consulted less & less. there are whole shifts now when i don't really discuss any of my patients w/ them. we work as colleagues. the docs co-sign all the midlevels' charts in that setting (PAs & NPs). in my state, PAs must always be countersigned, while NPs don't have to be countersigned after an initial time period passes. i can write any RX that docs can in this state- ie, NPs here have full prescriptive authority, including narcs. this varies from state to state however. NPs and PAs get a full history, examine/work up a patient, write orders, interpret tests, write Rx and make medical diagnoses just like docs do. all of that is outside the RN scope of practice. i am not saying RNs don't order & interpret tests 'cause we all know they do!! i'm still an RN- i haven't forgotten. ER nurses are especially independent as we all also know. however, legally speaking, the RN cannot give medical orders or make a medical diagnosis. NPs and PAs also do more invasive procedures than RNs usually do. in my fast track/ urgent care setting, that means suturing, I&Ds, pelvics, reducing fractures & dislocations, digital blocks, etc. some NPs & PAs assist in surgery, put in chest tubes & central lines, intubate, etc. just depends on the setting. in the fast track job, i will be seeing patients (alone) that were triaged specifically to fast track- they are supposed to meet certain criteria to go to fast track in the first place- not a perfect system of course. all depends on who is triaging & how busy the rest of the ER is. the docs are nearby & i can consult whenever i need to. $$wise, i will be making quite a bit more as an NP that i did as an RN- plus productivity bonuses. of course, i never worked a lot of overtime as an RN either. and i never worked in a place where there was a severe RN shortage- so i am sure there are some travel/agency RNs in certain areas who will be making more per hour than i do. and ER pays better than, say, the health department. but overall NP salaries ARE higher than RN salaries. the thing that i love about NPs is that they practice medicine with a nursing framework.

i'm an FNP (less than 2 years) with 12 years of diverse ER nursing experience before i got my FNP. i have worked as an FNP in urgent care and for a hospital in orthopedic services doing mostly ER call (admitting /consulting on orthopedic trauma patients primarily, with some inpatient responsibiliies). as of last week, i was just offered a job to work with the ER docs' group in the fast track part of the ER--this is the same ER i worked at as a nurse for the past 7 years. the group consists of 20+ docs & one other FNP. i am very, very excited- this is truly a dream job for me. i feel very ready & very prepared to take on this job- all my ER background makes a huge difference. in fact, my ER background was a big part of the reason i was hired for my other two FNP jobs--and of course, both of those jobs were excellent preparation for moving into the ER. there is no special educational requirement, per se, for an FNP to work ER. in my opinion, however, ER, urgent care or EMS experience is a big, big plus. i am sure there are FNPs who have gone straight from school to ER without emergency experience & have done ok...but i would guess they are in a distinct minority. if there had been an emergency NP program available in my area when i was ready to go back to school, i would have done that instead of FNP simply because i knew that i only wanted to do emergency medicine. however, the opportunity to go to FNP school presented itself so that's what i did. (there is not a lot in the way of master's level educational opportunities in my area). now i am glad i have my FNP because it is very flexible & marketable, should i ever decide to do something else (which i cannot imagine at this point!) the FNP education itself didn't specifically train me for ER work--but i chose clinical rotations in both urgent care & ER which helped a lot. i should add one more thing: i am convinced that my ER experience made FNP school somewhat easier for me than for some of my peers from more narrowly-focused nursing backgrounds-- in the ER, we really do see one of everything. all that exposure made a big difference, especially in pharmacology & pathophysiology. edited to add that my relationship w/ the ER docs is fabulous- but of course i have known them for years. they LOVE their other NP & speak very highly of her.

julie- i appreciate the way you worded your above post. i had actually re-read my original post recently & i wasn't too happy w/ the way it came across. i think i presented my viewpoint-which is different from regret2004's- in a somewhat judgmental way- and i'd like to apologize for that. you are so right- considering all viewpoints, positive AND negative, is an intelligent & healthy way to approach a big decision like this. take care & best of luck to you.

impeccable response. thanks- i've been looking for a succinct comeback like that!!

Dave- You sound like an awesome NP...and I don't doubt that you'd be an awesome DO. I understand your desire not to turn your back on the NP profession....but the way I see it is that becoming a DO will not invalidate your NP background at all. Growing & developing & adding to your bag of tricks never erases what came before- know what I mean? It's all cumulative, and your NP background would inform your DO practice. Our profession needs strong advocacy from the medical side as much as it does from the nursing end of things...maybe even more. MDs and DOs who respect, support, promote & choose to work with NPs give the NP profession more clout- that's just reality. The more support we get from medicine, the better, IMO. I think the most important thing to do is go deep inside yourself and try to determine what your heart & gut are telling you about this. You already have some big potential problems out of the way --$$ isn't an issue, wondering whether or not you can actually handle the academics etc. isn't truly an issue (I'm sure you can), and it sounds like your spouse would be supportive- and you don't have kids, am I correct?- so really, you don't have major family issues either. And it sounds as if you have freedom to relocate. Your path to becoming a DO would be very challenging no doubt--but it seems you don't have a lot of barriers standing in your way or big hurdles to jump in order to accomplish this goal. I am not sure I understand your concerns about time- I thought you were quite young- did I get that wrong? are you really a crotchety old geezer?? Bottom line: I truly believe in living life to the fullest--and I really believe in making choices that will not cause you to live with regret down the line. So try to quiet your head for a while & picture your how your life would FEEL to you if you take path #1 (Continue as an NP) or path #2 (get your DO). I think your answer will make itself known. PS- why OB/GYN?

would you mind if i occasionally borrowed your dentures or hid your walker?

hi- i didn't answer this at first, b/c i haven't been in practice in the ER as an FNP for 1 year (yet)- let me tell you my background & you decide if i can help: -12 years ER nursing -1 semester FNP clinical in fast track of ER -1.5 years FNP/urgent care -1 year FNP/orthopedic call in ER w/ some inpatient rounding also -just got offered job in fast track of ER, starting in 2 months (yea!!!!!!) like you, my love is emergency medicine, and i am thrilled about my new ER job--it's in the same ER i worked last as an RN for 8 years- i am very excited. i'd be happy to chit-chat about NP practice in the ER.

well....i disagree w/ just about every bitter word regret2004 wrote- especially the anti-NP comments. as an NP, i am very respected by staff, patients, PAs, and MDs alike in my jobs. imo, any NP who isn't being respected is either 1.) in a lousy job or 2.) incompetent. while i am sorry regret2004 had such bad experiences...that post is not representative of the whole profession. not to say nursing is perfect....but please bear in mind that when someone takes such a strongly negative view of a profession that is well-loved by many of us, you can bet it was based on very unfortunate personal experience, not a balanced or objective outlook. i love nursing (ER nursing specifically) & i love being an NP. which does not mean i have loved every minute of it, but on balance- yes, i love it. i'd do it again. i'd recommend it to anyone who feels in their heart that it is the right career for them. i do NOT recommend it to someone who can't figure out anything better to do. have you considered making an appointment to see a career counselor? that might help you clarify your goals. i agree that you have to choose what is right for you regardless of what your sister or anyone else thinks. about being too emotional---there is a tightrope which must be successfully walked to stay in nursing long term without serious burn-out/bitterness. you must balance between compassion/empathy on the one hand and self-care/healthy detachment on the other. too much in either direction can send you off course. this balancing act is very hard...but it CAN be done. i have seen many nurses stay in the field for years & years without burn-out b/c they learned to do this well. keep this in mind...and you'll do ok. good luck, whatever you choose.

thanks for answering. i am still left wondering why you find it surprising gay men do 'hard work' like nursing? to me (and maybe i am misunderstanding), this sounds like you are making the assumption that gay men are typically weaker than straight men or not as capable of physical labor or are mostly hairdressers (or something like that). while some gay men might fit neatly into these kind of stereotypes, lots & lots & lots don't. lots of gay men are more 'he-man' than the average straight guy. and i know plenty of straight guys who have no interest in or ability to do hard physical labor. as for being surprised that women dominate nursing...i would suggest doing a bit of reading on the history of the nursing profession. when you look at the social/historical context of how nursing as a profession evolved, there is really nothing in the least bit surprising about how it came to be female-dominated. your comment about not being able to know something because you are not a woman seems evasive to me. i mean, i'm not a man, i'm not straight, i'm not elderly, i'm not from indonesia, i'm not a quaker, i'm not native american, i'm not a teacher--etc etc--but that doesn't mean i can't have any knowledge or understanding or empathy for what it might be like to be someone else. i'm not 'blaming' you- or anyone- about physical jobs being male-dominated. i don't have a problem with the fact that physical jobs are male-dominated; men are, overall, physically bigger & stronger than women. it makes sense. i guess i don't really understand equating logging (for example) with nursing in the 'physical jobs that straight men are more likely to do' line of thought. nursing is physically demanding, but it requires more physical stamina & endurance than it does raw strength or large size. women, who labor & birth babies, have never been strangers to endurance & stamina. it also requires a host of other skills that seem genderless to me. and there are lots of things about nursing that have long been linked w/ traditional 'female' roles (which is the historical context again). personally, i am delighted that more men are seeking nursing as a profession, just like i am delighted that women are doing things that used to be exclusively male, like firefighting and being a corporate CEO.

i agree w/ this. i would only add one caveat: with rare exception, i think when someone in an obvious position of professional power propositions someone much 'lower on the food chain' even one time (teacher-student is the best example...but so is CEO-secretary, senator-congressional page, doctor-patient etc etc), that also constitutes sexual harassment. if the two have the hots for each other, then i think they need to rearrange things so they are not in the professional relationship any more. (i am not talking about peers dating each other at work -though that can be problematic too).

HBS- i just wanted to say that your posts didn't offend me at all. i'm just sorry you got treated so badly. your experience reminds me so much of what women went through (& still do go through sometimes) when they first started to take a stand against sexual harassment; their complaints were minimized, invalidated, and met with hostility. they were told they had no "proof" (i mean come on! the only way to 'prove' it is to have little bitty video cameras hidden in your scrub pocket &/or tape the conversations on spy-size recorders hidden cleverly in your stethescope- please!!) it's all part of a 'blame/shame-the-victim' mentality we have imbedded in our culture when it comes to sexual crimes. this has been an eye-opener for me- though i realized that men were sometimes victims of SH, i have never heard a first-hand account like yours. actually it drives home the point that we can't let gender & sexual orientation determine how we perceive someone; in your case, it sounds like your male gender kept you from getting fair treatment. and that's just wrong. well i wish you the best HBS.