KCEG

Thank you, Calinca! I'm still considering track options, trying to decide between FNP and Psych. I've got a strong interest in psych which led to a lot of undergrad hours, but right now I'm leaning towards FNP. I may end up dual-credentialing down the road if all goes well. My background is in respiratory therapy, but I transitioned to Industry several years ago and currently work as a sales representative for medical devices. Good luck to you!

Hello, Calinca. Good luck in your application. I'm sorry to hear you weren't accepted this cycle. I will be applying in 2013 to a few of the direct entry programs, as well. I'm getting ready to re-take Anatomy and Physiology, as well as Micro, since my previous grades no longer count. Vanderbilt is likely to be my first choice, and beginning next year, they will require A&P and Micro to be taken within the previous five years. I look forward to hearing from others as we navigate this process.

Thank you for the responses, Nomad, BlueDevil and Diva. I sincerely appreciate it. I'm not sure exactly where I want to practice geographically, which complicates things. I may practice in Texas, but I'm also willing to relocate to another part of the country depending on the options I find available at graduation. I know I will have much to learn even after completing school, but I am very intrigued by the states that allow independent practice. Thanks again for your willingness to answer my questions. Best Regards, KCEG

This is a very interesting topic to me personally. I am getting ready to apply to Vanderbilt's PreSpecialty FNP Program, and was told at their open house that they are working with the TN BON to clarify FNP and ACNP training and scope of practice. The Director of the ACNP program told me that in TN FNP's had no business practicing in the ED or working as a hospitalist, and she said that the BON is working to clarify the appropriate environments for Advanced Practice Nurses. I currently plan to return to Texas unless an attractive offer presents itself in an unrestricted state, and know several hospitals here where FNP's work in the Emergency Room, and as hospitalists, especially in facilities that are located outside metropolitan areas. Flexibility is high on my list of priorities when looking at Advanced Practice Opportunities after working in healthcare most of my career, and I'm not sure how concerned I should be with the information I've been hearing in relation to practice areas and restrictions. If a graduate is not academically trained in school to provide care to inpatients and ER's, is it possible to obtain this training after graduation by working in places that offer learning opportunities? How much of this is dictated by facilities and credentialing, as opposed to Boards of Nursing? Is it necessary to return for ACNP certification and be dual-credentialed to be "qualified" under the scenario that is being described? I apologize for all of the questions, but any insight that can be provided by currently practicing FNP's would be greatly appreciated. It seems there is significant confusion and difference of opinion from person to person and state to state on this issue. Thank you, KCEG

I recently went to Vanderbilt's Open House, and this situation was discussed early in the presentation. As elkpark said, the AACN can't mandate anything. There is a recommendation that NP's move toward doctoral education, but then again, there has been a recommendation that all RN's have a Baccalalaureate as their entry-level degree, as well, for quite some time. Long story short, they told they don't expect it to be an issue for quite some time, and the person who was speaking to us has a close working relationship with the Tennessee Board of Nursing. Each state is different, but they didn't see it being an issue anywhere in the U.S. If you enter into a Masters degree program before a mandate is put in place by the respective state Boards of Nursing (if a mandate is put in place), you will be grandfathered in and will be eligible for certification. Each state will work closely with programs to ensure that nobody is going to be left "holding the bag", as they told us. A DNP is a great choice, if time and finances permit, but if you don't want to get it up-front, you can always do a post-masters program. Best of luck with your decision. Kind Regards, KCEG

I don't know if anyone read my above post, but I learned today at Vanderbilt's Open House that FNP's who choose to work as a hospitalist in TN are working outside their scope of practice, which will be an issue if a situation arises in which that practitioner is involved in litigation. I wanted to correct my post from 1/29 where I said that a Family Nurse Practitioner could practice as a hospitalist. The FNP and ACNP Program Director's both spoke to the fact that NP's can find themselves operating outside their scope if they're not careful, which can result in unpleasant consequences from both a state BON and/or the legal system. FNP's are sometimes hired into hospitalist positions where I live, and I have first-hand knowledge of FNP's who function in this capacity, but they may face the possibility of being at odds with the BON in relation to their training and subsequent scope of practice . As always, it's imperative to know the laws and regulations of the state BON where you choose to practice. I'm just starting my voyage into the application cycle, and I'm trying to learn all I can about the pros and cons of each area of practice. Good luck to everyone on this same journey. Sincerely, KCEG

Hi Sam, it's nice to see your post. My brother-in-law is a PA, formerly a respiratory therapist, and he and I have been talking about the pros and cons of PA vs NP, as well. As a PA, he was very well trained in the sciences in the medical school model, which makes sense, since his training was done in a school of medicine. The main item that PA's push over NPs, from what I can see, is that they feel like they are better-trained out of the gate in medical science and patient assessment (which, undoubtably, they are). It appears that this doesn't translate into making a whole lot of difference when looking for work, however, or practicing clinically, from what he tells me. There's a lot of talk about ease of movement from one area of practice to another as a PA, but if you go the FNP route, you can work in pretty much any environment you want to, whether that be primary care in an office setting, the ER, as a hospitalist, or in a free-standing doc-in-a-box "urgent" care. If you decide to move from family practice to neonates, it is true that you will need additional education, but I don't think this is likely for most people. An added bonus of NP certification is that, in a lot of states, you can open your own practice if you choose to, referring more complex cases to a specialist, just as Family Practice Doc's do. There seems to be a contentious relationship between physicians and NP's in the national media, especially between accrediting bodies, but I think this stems primarily from MD's being threatened by NP's gaining increasing autonomy in clincal practice, making some physicians worry about competing with NP's. In day to day practice, this tension isn't usually present and doesn't seem to be an issue, at least in the part of Texas that I currently reside in. Good luck in your decision, and in your applications! Kind Regards, KCEG

Good luck, butterbye04! I hope you do well on the exam. I'm scheduling Transitions for Monday, Jan. 4th, if it's available. Regards, Eric

Maryland is, of course, one of the states my wife would like to return to after having worked there as a traveling respiratory therapist a couple of years ago. I believe they are a compact state, however, so perhaps we can visit for a traveling assignment or two after finishing our nursing degrees and gaining some experience. I'm glad we're in Texas! Thanks for all of the information you share on the forum, LunahRN. I wish I had done this years ago!

Hi Diana, I bought the textbooks for Transitions, as well, but I'm not sure if I will continue to buy them as I progress. I also ordered the StudyGroup 101 notes. Good luck on your exams! :nuke:

Congratulations, rttobern. I wish you well in getting your RCP salary matched. I recently talked with one of the local health systems in Dallas-Fort Worth about coming to work for them when I finish, and they said they might be able to offer me 50% credit time in service (i.e., 18 years RT = 9 years RN starting pay), but they would have to analyze it at the time. That would be a pretty sweet deal, as RN salaries here ratchet up much more quickly than RT salaries do. Good luck! Eric

Hi Meg, I'm an RT also, and I'm just starting the program. It's nice to see all of the other RT's who are going this route. I'm studying for Transitions as my first exam. I've looked at Excelsior for many years, and I'm excited to finally be enrolled. Good luck on your exams! Eric

Hi Pebbles, thanks for the post. I have just started to study for Transitions, and it will be my first Excelsior exam. Eric

Hello everyone, My wife and I recently enrolled in Excelsior after working as respiratory therapists for many years, and I contacted the CA Board of Nursing just to hear for myself what their requirement was. I was told that they considered applicants on a case by case basis, but when I asked politely what my chances were, I was told that if I worked more than 1000 hours as a licensed RN in another state, it would likely be a matter of paperwork to endorse into the State. I live in Texas, and I know several Excelsior graduates who have had no problems with finding positions and doing well. Good luck to all of you in your endeavors. Regards, Eric

Hello Mommy2three, Here is some info I just found from a link posted in another forum. It appears that the University of Wisconsin-Oshkosh has a program that may be of interest to you. It looks like you have a few campus sessions, but your clinical rotations are done in an area close to you. A potential stumbling block - Illinois has not granted them permission to do clinical rotations in their state, but you might contact the school to see if the list posted on their website is up-to-date, and if there is any room for negotiation or alternative arrangements. Best of luck! KCEG Contact Information Accelerated Online BSN Program Office University of Wisconsin Oshkosh Nursing/Education 306 800 Algoma Boulevard Oshkosh, WI 54901-8660 (920) 424-3096 [email protected] Sue Clark, Advisor/Recruiter Nursing Education 307 (920) 424-7215 [email protected] State Board of Nursing Approvals for Out-of-State Residents - Copied and pasted from website Approved: Alaska Arizona Colorado Georgia Idaho Indiana Iowa Kentucky Louisiana Maryland Massachusetts Michigan Minnesota Nebraska New Jersey New Mexico North Carolina North Dakota Oregon Pennsylvania South Dakota Utah Vermont Wisconsin Approval Denied: Arkansas California Illinois New York Ohio Oklahoma Texas Virginia Washington

Sorry to post under the Texas Tech Program, but wanted to reply to the earlier post quoted above. I just did a quick review of the Wisconsin-Oshkosh College of Nursing website, as it would be nice to enroll online and do clinicals close to home, and found out that several states have denied approval to the University of Wisconsin-Oshkosh for students to do clinical rotations in their home states. For those of us in Texas, this does not appear to be an option. Best of luck to everyone. List pasted below: Approved: Alaska Arizona Colorado Georgia Idaho Indiana Iowa Kentucky Louisiana Maryland Massachusetts Michigan Minnesota Nebraska New Jersey New Mexico North Carolina North Dakota Oregon Pennsylvania South Dakota Utah Vermont Wisconsin Approval Denied: Arkansas California Illinois New York Ohio Oklahoma Texas Virginia Washington Sincerely, KCEG

[ Hi Diane, Ah, the age-old debate, nursing or respiratory therapy. :) I am 34, as well, and I've been a Registered Respiratory Therapist for the past 14 years. I also have a BS degree in Health Information Management. I'm seriously considering nursing school, hence my presence on the allnurses forum. Educational programs are similar, as you can become an RN or RRT in two years, or 4, depending on if you want to get an Associates or Bachelors degree. Nursing will offer you many more opportunities, but the job descriptions make it difficult to compare the two professions. Respiratory Therapy varies greatly depending on what type of facility you work in, where you're located geographically, etc. I currently live in the midwest, and I was stunned when I first arrived at the variance in practice compared to what I was used to in the South. I went to school in southeast Kansas, but moved to Louisiana as soon as I graduated. Therapists in the South are responsible for intubations, arterial line insertions, etc., and are viewed as a type of physician extender who specializes in pulmonary issues. The doctors simply write RT consult and treat, and you call a pulmonologist with any problems. The place I work at now is much different, in that Anesthesia does all of the intubations, emergency or otherwise. We still have Respiratory Protocols, however, which means we are consulted whenever a physician writes orders. We are then responsible for evaluating the patient and ordering the appropriate interventions. Respiratory treatments and modalities are frequently overused by physicians, especially those who haven't specialized in diseases of the lung, stemming from a time in which hospitals were reimbursed for every procedure that was done, indicated or not. My job is very satisfying at the hospital I am at, but we are the only hospital in the city with protocols that allow us to dictate the therapeutic modality and frequency of care. Our hospital has won numerous awards for quality of care. Other departments I am familiar with in this city have to do what is ordered when it is ordered, which oftentimes results in large percentages of their workload being a waste of time, as far as helping your patient get better. For example, I am working a PRN shift at a cross-town hospital today, and of the 19 patients I am seeing, 6 have diagnoses and accompanying symtpms that support the care I am delivering. I do provide them with some companionship, but that is the extent to which I am helping them get better. I do, however, have time to peruse this board, which is nice. :) The main difference in respiratory vs nursing, as has been mentioned, is that a nurse usually works in one area and is totally responsible for the patient, while I am used to being responsible for only the pulmonary issues and complications. Nurses have much smaller patient loads, with much more care involved, and lots of paperwork, compared to what I am used to. Therapists are in demand, and I can move to almost any city in the country and have a job within a couple of days. I may work CCU one day, MICU the next, and NICU sometime next weeek. That aspect of being a therapist is something I like, as I know most of the nurses throughout the hospital, and I get a lot of variety in my patients. The nursing shortage, when compared to respiratory, is overwhelming. My hospital works 8-9 therapists a shift, days and nights, with one or two positions available at any given time, whereas nurses have probably 100 plus positions available within the hospital. Those numbers mean lots of flexibility for the nurses that are there, with clinical ladder programs that ratchet salaries up for new grads relatively quickly. It's been a difficult choice for me personally, as I really enjoy being a therapist. One of the deciding factors for me has been the fact that I like to work, and an agency nurse or travel nurse will make significantly more per hour than a therapist will. On a full-time basis, however, that isn't necessarily true. I will probably take a $5 or $6 per hour cut as a new RN unless I can negotiate a special exception. Good luck in your decision. If I was in your shoes, starting from ground zero, I would choose nursing without a second thought. :) Let me know if I can answer any respiratory-specific questions. Good luck in your studies! Sincerely, KCEG