maldoniaNP

I'm a dual WHNP/ANP and I wouldn't have it any other way. I would have felt practically unhireable as a WHNP alone, particularly as a new grad. Totally worth it for one more semester. Good luck!

Agree with OPs... licensure tends to follow certification. AACN doesn't issue APN certification, and since none of the major certification boards (besides the CRNA group, which endorses a 2025 deadline instead of a 2015 deadline) have issued statements supporting any DNP requirement deadline at all, 2015 looks pretty unrealistic.

I completely sympathize - I didn't make it to 4 weeks on PEP when I was asked to start it after a needlestick about 4 yrs ago. I think I made it to somewhere around 2-3 wks...but the s/e were just too much to take, and I, too, kept looking at the stats cited by Esme12 in terms of incidence of seroconversion amongst exposed HCWs. (It helped my decision that my patient was on ARVs and had a very low viral load at the time of the stick.) I can't really remember whether the s/e got better - or if so, how much - over time, but I know I reached a point where I was just done. That being said, I really wished at the time, and for awhile afterwards, that I'd stuck it out, since each of the following HIV f/u tests were pretty unnerving, and obviously I can't imagine what I would have done if I'd later seroconverted, knowing I hadn't completed the regimen. Good luck...I hope this gets easier for you soon.

I'm a few years out now, but starting out as a new grad in a nonprofit community practice I was offered just under $70K. A couple years later, a new job offer in private IM practice was about $79K. My impression is that primary care practices offer salaries on the lower end of the spectrum you listed, and for the higher end I would guess you'd be working a) in a specialty practice, or b) in an urgent care clinic with a ton of volume. Just a guess, though. Good luck!

Hm, it's hard for me to judge as I haven't been through a PA program, but while there's certainly a level of intensity to most PA programs, the NP programs I've been familiar with (either as a student or a preceptor) have been no walk in the park. And whatever's happening in that one year of classroom teaching, the PA students who come to a rotation with us after their didactic work is complete are generally not any further along in their understanding of the fundamentals of diagnostics/pathophys/pharm/etc than the NP students. The students that have stood out have been those that bring previous experience and knowledge to their programs, regardless of whether they're PA or NP students. To be clear, I don't in any way want to be interpreted as PA-bashing here, as I have a ton of respect for both PAs and PA programs, and I really value the collegial relationships I have with many PAs. I just think that making sweeping generalizations about one educational approach being objectively better or worse than another is problematic.

Ideally PEP is started within 1-2 hrs of exposure, and at least within 24-36hrs. I'm not sure how effective it would be 1 wk after exposure, if at all; at this point it's probably more worthwhile to track down the pt's results than to worry about - likely unnecessarily - exposing yourself to the drug toxicity of ARVs (as spoken by someone who was on a 3-drug regimen for a month after a stick from a known HIV/HCV+ pt).

Um, I'm not sure that one actually DOES "have to agree" that a PA program is superior to an NP program. One may have a preference for one model of education over another, but that doesn't make one inherently and/or objectively "superior" to another. I've actually had the opportuntity to precept both PA and NP students. PA students come to their intensive 5 week rotation with a year of intensive classroom teaching about EVERYTHING, and then aren't in classes at all for the second year of their program. NP students are (in a good program, at least) learning in the classroom alongside relevant clinical rotations throughout the entire 2+ year program. They're different models but each has been proven to provide an appropriate foundation for each role. I've had mediocre and awesome students from both PA and NP programs. (And, not for nothing, but I'm not exactly sure how many people you thought were going to agree with you that PA programs are superior to NP programs on a Nurse Practitioner discussion board...)

I'm in a "hybrid" online/in-class DNP program right now - I've taken two classes so far and am officially starting (with my cohort) in the fall. Each course meets in person twice per semester; most of the students in the program are from all over the country, so they fly in twice each semester for a weekend for the in-person classes. I've thought it's been a really nice approach to adult learning. I work full time (as do most of the other students in the program) so even if I could make it to traditional, on-campus program physically, since I'm local to the program, I wouldn't be able to make it work logistically with work, kids, etc. At the same time, I think online-only would be tough for me, since I value forming relationships and having dialogues with classmates and professors. I've been taking one class at a time and will be taking two this coming semester. We'll see how 2 classes goes, but 1 class was very, very do-able. Good luck! :)

I had a previous employer where they decided to accept online CMEs, but in that case it was primarily because our total CME stipend was so limited, the only way to use up the CME time off allowance and come in under this stipend limit was to spend a day doing online CMEs (I actually submitted the "syllabus" I'd come up with to my supervisor, which made us all feel better about it, since it did seem a little strange). It sounds as though someone else you work with was allowed to do this in the past, so since there's a precedent for it (even if it was an exception) you might be able to convince them to make an exception for you as well.

But how could one go about preparing a single DNP licensing exam, when advanced practice training is already so specialized? Further, the DNP isn't limited to only APN students - nurses whose area of practice is, say, management/ hospital administration are enrolling in these programs as well. What single exam could possibly test for competence adequately in each area of specialization, without requiring each DNP student to have knowledge in areas completely unrelated to their specialty? We already have certification exams to test for competency in our respective areas of specialization. If the goal of creating a "DNP Exam" for all DNP graduates that resembles the COMLEX or USMLE is only to make the DNP look more like a medical degree (which, of course, it's not)...well, I'm just not convinced that's enough of a reason. Just my $0.02. :)

I think I'd want to think a bit more about what it is I want to do with this degree. The CNL and NP roles are very different - one prepares you for working as a nurse leader in a more traditional nursing role; the other prepares you for advanced practice - diagnosing, prescribing, etc. That said, a 2-year program that trains you as a nurse and awards an MSN - that sounds pretty reasonable, esp. if you're not completely sure what it is you want to do within nursing. There's nothing to keep you from then entering a post-masters NP program later on if you determine that's really what you want to do. And I totally agree - $160K sounds like too much money to spend on a degree, particularly if you're not completely sure that degree will allow you to do what you want to do. (How terrible would it be to spend all that money only to discover you actually want to work in a completely different nursing role?)

dancingnurse13: I can only speak to my experience at Yale, but I really haven't had much trouble finding positions, either as an RN or, upon graduating, as an NP. I don't know that the school as an entity did anything directly to "get" me my jobs, but the connections I made through my clinical rotations did: my first RN job was on a floor where I'd had a med/surg rotation, and I was alerted to what ended up becoming my first NP job through a connection one of my preceptors had to another NP in the area I was moving to. I work now in primary care (and had always intended to), but found the time I spent working in the hospital as an RN invaluable, both personally and professionally. I can't imagine having felt prepared to graduate without it. I can't compare my experience to PAs, though, since I've only lived what I've lived. :) Good luck!

I attend about 1-2 conferences per year and complete online CMEs - mostly through Medscape, though there are a ton of free CME/CEU websites out there. I don't know that there's much of a mechanism for evaluating a clinician's practice in an ongoing way via continuing education courses...most of them don't even include an evaluation method at the end, and those that do are pretty limited. I suppose I end up relying mostly on peer/patient feedback and patient outcomes as ongoing evidence of personal areas of competency vs need for further work.

I don't know if this is possible, considering some of the things you've referenced regarding how well-run (or not) this place is, but I think I'd be more concerned with making sure they put systems in place to ensure you can do your job well, at least moreso than looking for increased pay... Does this hospital have an EMR that allows you to logon remotely from the site you're in that day to check on labs/imaging/etc from the other locations? I've worked in settings previously where the providers worked in different facilities each day of the week, but it worked b/c we were all able to logon to our EMR - used for all our patients - from wherever we were. There was also some time built into our days to do this - maybe you can ask that they consider this? I think a key question you'd want to ask yourself, though, is: if this is a place where you're feeling like the structure is enough of a mess to lead you to consider increasing your malpractice insurance, is this a place you really want to be working? Is it maybe time to consider looking for a new position altogether? I spent about 3 months working in an office where I lacked enough confidence in the practice's ability to support my work - and ensure that we together provided safe care - that I decided to purchase independent malpractice insurance. Something I probably should have done a long time ago, but for me it was an "a-ha" moment, and soon afterwards I decided it was time for me to go.

I'm starting the second year of a masters entry program right now, and I also had a BS in Biology before coming into the program. I looked at the Hopkins program too, but after talking to a few people decided it sounded like not having the BSN (if you have a BS in another science) wouldn't be a big deal. I could be wrong - though I hope I'm not, since I'm already a third of the way into this program!