twozer0

I work in outpatient/inpatient Urology and sometimes see pre/post ops (generally the docs keep the major surgery folks). Recently I have switched to 100% outpatient. I did work PACU for several years before becoming an NP so I have some surgical experience prior to my NP. This made rounding on post ops pretty simple since I knew mostly what to expect and what general criteria we had for meeting discharge. I have, on occasion, gone into the OR to place a difficult foley via cystoscope. While I could train to get RNFA, being an additional hand during surgery wouldn't offer much (for me personally) to my current practice. We do all your major urological surgery except cystectomy including robotics. To answer your question, you don't really need OR experience to work in a surgical specialty (unless they physically want you assisting). Most of the time they want you to have an understanding of handling inpatients in the post op setting and how to prep patients for surgery. Bonus points if you have RNFA if they want that.

Before becoming an NP I worked a ton of PACU call and odd hours (getting called in at 2am or never leaving due to surgery). Money is great but so is leaving the office at 4pm every day and being able to coach my sons baseball team or watch my daughter at her Gymnastics. My salary meets my needs and I've considered picking up a few shifts but ultimately it won't really make much of an impact in my life. We all have reasons, find which one is more important for you. Can't fault anyone for wanting to hustle.

You need a urinalysis with Microscopy. Consider referral to Urology if its >3rbc/hpf if not correlating with menstrual cycle.

I take call and it is "included in my salary". When I negotiated my contract I had asked about call pay and I was told that it was built into my salary and that they don't pay separately for call. Thankfully I don't get called a lot (I'm in a specialty) and I also do not have to go anywhere. Now with that being said, If there were a need for me to come in to the hospital, I would definitely ask for call pay. This is time away from your family, etc. I did PACU nursing before becoming an NP and I was there all the time but I got paid accordingly. Don't let them cheap out! If I were you I would ask some other NP's/PA's/Docs that do call if they get paid and ask them how they structured it. You are likely to get wildly different answers here.

I felt my education my fairly good (I attended a very well known B&M program) but I had a lot of nursing experience to make up for some of the shortfalls. I'm not knocking direct entry applicants but I will say the barrier to entry for PA, MD, DO is a lot higher. For example, if you wanted to become a PA after being a nurse, you are likely required to take a few extra classes in order to meet entry requirements. Also, you have the MCAT for medical school. These are useful tools as they can weed out some of the candidates who likely will not perform well (some but not all). Nursing has none of these, just sign up and go. This is held over our head. Ultimately, its up to the individual to become competent at the job but often the choice to go to NP school is made for the wrong reasons. I commented in the past on this forum about someone who was looking into NP school but was unhappy for a myriad of reasons. A lot of prospective candidates don't even realize what goes down. If you don't like nursing due to the work/workload chances are you will not like being and NP as the workload just becomes more cumbersome. My personal opinion and advice for people thinking of entering advanced practice is to really think it out. Write down pros and cons. DO SOME SHADOWING. See if this really is the life you want to lead or if your current situation maybe just needs a transfer in dept or organization. It took me several years to decide that this was the right path. Its not that I defiantly oppose direct entry, its just that I feel we have a unique opportunity that the others don't to learn some of the game before playing ball. Use that to your advantage and plan accordingly.

Sometimes you need that second opinion.

Sure the job is different but again many of the issues that you described in your initial post exist as an NP. For example, you mention hating administration and being a sandwich boy. The same people that you disliked as an RN are the same people as an NP. You might not have as many encounters with them or a new set of admins to deal with. I wish I could deliver a sandwich instead of answering a box of triages. Giving someone a sandwich sounds like a vacation compared to that. As the old saying goes, the grass isn't always greener on the other side. I only say this for your reasons of not liking what you did as an RN.

If you hated being an RN for those reasons, you will hate being an APRN for much of the same. Similar issues exist for the APRN but in a capacity that now has you in charge (and responsible). I would think about this one long and hard before you pull the trigger.

My two cents. I do not know your situation but IF I were in your shoes, I wouldn't bother. I would probably do something that I've always wanted to do (unless being an NP is that!). If you don't need the income from working full time or even part time, go do something fun. Travel, do double flights of beers, jump out of a plane, etc. I mean I am not you, nor do I know your situation but I can think of a million things I would rather do than work! Best of luck deciding!

We have several FNP's working inpatient with the hospitalists. I also see them working for other specialty groups and rounding on patients in the hospital. Community hospital setting, non academic center.

The argument was not about the quality of NP's, the argument was about the job market and oversaturation. Sure there will be jobs, but you'll have hundreds lining up for the availability. If you think for a second that a business wouldn't pit you against each other, you are sadly mistaken. It's not about quality, its about the bottom line. It always has been. This happens in EVERY industry. Why do you think Unions exist? In regards to your comment about medical school. Medical school is not the dictator of the supply of physicians en route to practice, residency is. There are more applicants to match than available and some never get matched. Residency is what dictates who enters practice, which is primarily backed by CMS. There are some private slots created by grants, private funds, or university center funding but the majority are CMS. This means there are a finite amount of docs entering the workforce every year based on residency. Its not the medical schools limiting the supply, its the residency. So I'm not sure where you are getting your information from.

You're looking at the competition from the wrong side. We don't want there to be a ton of competition between practitioners, we want competition between employers. This is basic economics here, when supply is greater than demand, the price goes down (and so does your bottom line). Nobody is discouraging anyone here, were talking numbers, and they don't lie. Sure these are projected for job creation but even with a margin of error of 10%, were still way over. If its your soul desire to become an NP, become an NP, nobody is stopping anyone. We're merely looking at the numbers and saying, yeah, not looking great. Also, you cannot compare NP education to medical school, pretty sure this is obvious here. The screening for medical school is harsh and is so for a reason.

The growth of NP's is beyond sustainability much how Law was (and sorta still is). As Jules pointed out 23,000 new NP's hitting the market per year but with only 64,200 jobs projected by 2026. I don't think many of us want to be negative but those numbers don't jive well for the upward mobility of Nurse Practitioners. My biggest fear is that wages will fall (in very high competitive areas, like Florida) or stay stagnant due to virtually no competition in the marketplace. It's great that we have such a positive outlook but almost nowhere do these articles talk about students in the wings. That 64k will be filled mighty quick (3 years) and I fear it wont be long until we start seeing the impact of this. Of course I remain hopeful but like DJmatte mentions below, if you aren't in the game now or very shortly its going to be a difficult situation for those future prospects. Edit: One other thing to think about is PA's and the impact on them and our job supply as well.

As an FNP I work for a specialist group. I see patients in the ICU (and the hospital for that matter) on a consult basis only for our specialty. I do not manage these patients as I am only seeing them for the reason we were consulted. As an FNP I would never want to manage a patient like that as our training just doesn't support that type of care. FNP training was based a lot around health prevention and maintenance something that the inpatient setting does very little of (not saying they don't its just not as prevalent as an outpatient setting).

Any NP job could be 3 days a week pending employer needs or how you negotiate your contract.

Weird. Typically staff that do not bill for service do not get a bonus (based on my experiences, of course could be different at other places). I never got a bonus of any kind as a staff nurse nor would I expect the provider staff to pay me for one. So yes it seems odd.

You will have more upward mobility by going back to school. Not to mention its a free ride (do they require you give them X amount of service after?). Do an opportunity cost for yourself to see if it is worth it to you. Just google the term and it will show you how. Only you can decide whats best.

I wanted to be a CRNA but instead went to NP school. I worked in PACU for several years before and during NP school. One of my best friends is a CRNA. I was encouraged by all of the MD's and CRNA's to do school but I didn't. In the end I chose NP school for the fact I wanted more patient interaction and I didn't want to work those call hours (I mean I did several years of them in the PACU, ain't nobody got time for that!). As a father I wanted to be able to do things with my children where being stuck in the OR on a call weekend or having to stay to run an OR room after scheduled hours just wasn't what I wanted. The pay is great but more money wouldn't necessarily equate into more job satisfaction or happiness. Pre children CRNA was like a flashing neon sign, post children it wasn't that lucrative to me. Just my experience with it all.

It would be hard to judge making that much of a career change that it would be worth it without actually doing it. My two cents would be to forgo the NP school not because I don't think you should do it but because I don't know how much life improvement you would get from doing so (or even if you feel you would want to do it as a career). You sound like you are doing pretty well in your current career field, and don't hate it that much. My question to you is if you want to feel something rewarding are there other avenues than spending the 5+ years in school to become and NP, plus cost, plus time lost doing schoolwork, plus the stress of going to school, etc.? Perhaps volunteering or being involved in your community? I started my BSN program 5 months before my first child was born and started NP school 5 months after my second. It was a journey, I'm glad that I'm done with it but I've also been a nurse and working in a related field for 10 years. For example, I don't think I would leave a job that I'm making steady money in, has flexibility and is tolerable (not my dream job) to enter a career field I'm not even certain I would enjoy or have any experience in. It's totally possible to do it and if you feel the juice is worth the squeeze by all means, take that red pill! Just be vigilant about what you would be losing to what you would gain. The grass isn't always greener. :)

Here is a really well written article about one of the elephants in the room. Cost. https://www.forbes.com/sites/realspin/2017/10/24/focus-on-health-coverage-misses-the-point/#7692ec5d7b9b

Just call me by my first name. We're all grown ups here right?!

There are options for loan repayment like the nurse corps but I cannot offer much information about them. Have you done any research on bedside nursing? Its a good starting point before wanting to make the jump and responsibility to practitioner. Nursing would be more hands on and less office type setting (if you do hospital). Its were most of use decided to take the next step. Have you looked into the military for health care careers?

I want to start out by saying this is a big career move and I want to point out some of the little things that often go overlooked. I assume you have no nursing degree or healthcare background as you state marketing and educational research? Now I am not trying to dissuade you from choosing NP as a career path but only mention the thought process I would go through if I were in your shoes. 1. Is this the right decision for me? This is a big change. I know big changes can happen but when thinking of this keep in mind the practicality and the proposed benefits of what this type of change would bring. Think of the cost and time it would take to get you to where you think you want to be. Is it worth that to you? Do an opportunity cost with this. Perhaps there is something related to your field that is better suited to your talents? By no means am I discouraging you, just offering some practical questions. If you do decide to go past this, think of the following. 2. How long will this degree take? With no health background the road to NP would be 5-6 years of full time school if you go straight through (which I don't recommend as you should get at minimum a few years of experience as a nurse). Given your circumstance (if it is true) it would be much easier to take classes for PA and enter into a PA program that it would be to run the nursing gamut. 3. Cost. Do you still owe loans on your current degree? If so, how long have paid on them and when do you feel you will likely pay them off? Going the full way to NP I would assume on the cheap end would cost upwards of 60k (and this is a conservative figure). Add that to your current loan pile if you still have them. 4. Can you afford school? As in, will you be able to go to school full time and still make ends meet? What are your outlying debts such as a mortgage, car payment, etc.? They still need paid even if you are in school so is there a means to pay for them while you go? I would advise against taking out loans of live off of as the amount you are likely to borrow will not typically equal out to your starting salary. A lot of these things are often overshadowed by the end result of which we learn to find out that the journey is just as important as the goal. Best of luck on whatever you decide.

Myself I do not have a problem with individuals wanting to become a practitioner. My issue is with the decision to become a practitioner for many isn't based on actually wanting to be a practitioner but rather because they aren't happy in with their current work as a bedside nurse. A lot of NP's and prospective students I personally know have stated that they chose to be an NP/student solely due to the schedule they would have. They are tired of working late hours or not being home on the weekends. While this is an appealing prospect, it should not be your first motivator to be a practitioner (in my opinion). It's not even a guarantee that a job like that will fall into place. For example, Urgent care typically has weekend and evening hours. The decision to become an NP should involve more than just a proposed lifestyle. It should not be an easy decision! CRNA is another high profile advanced nursing practice job that get allure from the high dollar salary that attracts many but limits its ranks due to a rigorous program. Many don't make it to school and several will drop out along the way. It was my first choice actually before NP school but after working several years in the PACU I decided that it just wasn't for me. I made an informed decision that wasn't driven by money but rather what was required of the job. This should be the primary motivator for NP. What does the job entail? Many entering the program don't understand the enhanced liability that encompasses being a practitioner or that you might be the sole provider for a patient. Some are just not cut out for this role. What I'm getting at is many are not making an informed decision to enter the profession, many have not networked well enough if at all, many have little nursing experience (if any), and many are unprepared for what the job entails. While we will have many great practitioners in the future, with the bar being set low we will also have many bad practitioners entering the field. I'm not saying that medicine or any of the other professions have their bad apples, its just they do a better job of mitigating them at the gate. If the profession is to be taken seriously as a whole their needs to be a high standard of quality.

The NP bar is low when compared to our nursing and allied counterparts. Empirical evidence in my neck of the woods reveals a staggering amount of bedside nurses with