Regret leaving the bedside?

anchorRN, BSN, MSN, RN, APRN · Jul 14, 2016

I really dont feel like i'll miss the bedside, I'm currently in a more admin position in the Navy while we are in port, but when the ship gets underway I run the ward/ICU as the only RN on board. I HATE the admin portion, as a supervisor in the civilian world I hated it also. Making schedules for RNs, dealing with call-outs, drama, etc. no thanks. I am ready to move on to more autonomy.

Buyer beware, BSN · Jul 17, 2016

There are a lot more politics when it comes to being a provider than I would've thought. As a RN, you know your duties and do what you are assigned for 12 hours then go home. I had a bad experience with primary care for my first job. I was left alone in a practice as a new grad and was sold a dream which was not fulfilled. The office had been sold by my supervising MD to a "pain" clinic doc who only was out for the bottom line. Needless to say when the owning doc realized the practice wasn't a cash cow, he closed shop. My friend just lost her job this year in the same situation. She basically ran the practice for 2 years with little training as the doc said her preceptorship was enough and didn't give her any training time. She flourished but unfortunately the practice was a rural town with mostly Medicaid/medicare patients. She went to work one day and was told with the rest of the staff at the staff meeting that the office was closing!!! My current position is with the state. I treat HIV infected inmates and after about 6 months, the challenge was gone. Specializing in just a specific disease is very non-challenging after you learn the medication guidelines. My biggest challenge some days is just arguing with non-compliant inmates who refuse to take medications for various reason (usually manipulation to get what they want). I have posted in here about my issues with the job now that they want me to take over a new Hepatitis C clinic for no reimbursement. Unfortunately some people (administrators included) cannot get over the "nurse" in NP and think they can delegate new duties as if they are not making money off your care. At this point, I am not necessarily over NP...but I would love to return to the hospital settings. I am looking at jobs in the ER or even working as a hospitalist. I like working at an hourly wage and having the opportunity to make more money by picking up extra shifts. I really wish I had jumped aboard the new group which took over my hospital's ER. They paid $85/hr and only required 10 shifts per month to be full time. If Monday-Friday jobs interest you then go for it, but really negotiate your salary. Overtime is not paid to "exempt" employees and I know several NPs putting in 50+ hours per week. One NP who works in an outpatient practice said he was immediately reprimanded for leaving early one day after his clinic was over. He says he definitely puts in more than 40 hours per week but was told he needed to put in PTO time if he leaves early.

Your words give some of the best insight into the lemmings-like rush that many nurses, even brand new inexperienced nurses, feel is necessary to legitimize themselves by way of becoming a nurse practitioner. When I see thread after thread that read " I am a newly graduated BSN with 6 months experience looking to become a nurse practitioner" I often wonder what the driving impetus is behind this rapid dissaffection with the art and science of learning to take care of people in all ways and all settings by learning to become "just" a competent nurse.

I truly believe that whether you work in med/surg, ICU, or ED, you develop a unique set of skills in each area that can't be down-played and should be respected by all nurses across the board.

As for wanting to become a NP before you become a seasoned nurse, all I can say is that in just 6 months a lot of nurses I have seen still have difficulty finding the bathroom let alone taking care of the complex needs, both intra-psychic and medical, of your average patient. So to all those neophyte nurses who want to be NPs heed the words of the prior threads and consider becoming a PA instead. They don't care about that nursey stuff.

One more thing. I do wish every Joe Blow fly by night scam school in the world would quit the marketing and endless spewing out of endless legions of NPs. They clearly don't have Nursing's best interestd at heart, only their own bottom line. Do you hear me for-profit loan mills!!!

Enough alteady.

anchorRN, BSN, MSN, RN, APRN · Jul 17, 2016

Well I've been a nurse for 12 years lol I think I have a little more insight than a 6 month nurse haha. I work closely with a PA everyday and, being in WA state, he even recommended NP due to the autonomy that he doesn't have. I don't think I'll miss the bedside but I also know the grass isn't always greener. I appreciate all the advice though :)

DrCOVID, DNP · Jul 19, 2016

Although I am not an APRN yet, I am going to be at some point. I have seen and had good discussions with many NPs; many of my BSN classmates are NPs already and I run into them here at the hospital every now and then.There are pros and cons to both hospital bedside and clinic work, but I honestly think you have to find your balance wherever you go. It really has to do with personal taste. I know myself, and I am sure I will prefer more focus and one at a time as an NP than taking care of 6-7 at the same time on a standard floor. Also, as a male, I want more control and independence. I don't like being someone else's dog!

allnurses Guide · Jul 19, 2016

It's never just one thing at a time!

cards · Jul 19, 2016

I have only been an FNP for 6 months now but am specifically only working in the field of cardiology, and even more specifically, electrophysiology. All I can say is there were days as an RN i would absolutely dread going to work because nurses, a lot of the time just get abused with the amount of work we had to do. The laundry list of things needing to be completed continued to grow as did the expectation of ideal customer service. I remember being lectured to use specific words "excellent care, always" to get the patients to rate us well on surveys so we qualify for reimbursement - all that BS, plus patient care, plus everything else, and our shifts did not get longer to accomodate for this, and our pay certainly did not go up. It was a bunch of crap and I was just a number. Plus the politics and opportunities for advancement were grim. Still, I believe my unit was pretty well run, we had extra help from two nurses who did not take patients, I don't believe this is the norm. Even still, I do not miss it for a SINGLE SECOND. I love my 9-5, the increase in pay, the challenge that comes with the field of EP, the providers I work with are all awesome, I love being able to help patients in this way, to be able to make decisions for myself regarding the patients plan of care. There are a lot of other perks, like the ability to go to Dr. appts when I can, my employer doesn't striclty enforce PTO as long as we cover each other, they respect us as providers, give us CME time to help further our knowledge (did not get that as an RN...) My schedule is managable, I work alongside an MD every other day so we handle clinic together off the same patient template, I have 2.5 days a week where I have a very light schedule (0-5 patients/day) which I get as admin days, which I eventually will use that time to do inpatient work. If you get a job where your employer respects you and doesn't burn you out, where you can continue to challenge yourself, I think you would be very happy as an NP. I appreciate the mental challenge of the new job, and am no longer physically burnt out - I can focus on all other aspects of life aside from work!

cards · Jul 19, 2016

Your words give some of the best insight into the lemmings-like rush that many nurses, even brand new inexperienced nurses, feel is necessary to legitimize themselves by way of becoming a nurse practitioner. When I see thread after thread that read " I am a newly graduated BSN with 6 months experience looking to become a nurse practitioner" I often wonder what the driving impetus is behind this rapid disaffection with the art and science of learning to take care of people in all ways and all settings by learning to become "just" a competent nurse.
I truly believe that whether you work in med/surg, ICU, or ED, you develop a unique set of skills in each area that can't be down-played and should be respected by all nurses across the board.
As for wanting to become a NP before you become a seasoned nurse, all I can say is that in just 6 months a lot of nurses I have seen still have difficulty finding the bathroom let alone taking care of the complex needs, both intra-psychic and medical, of your average patient. So to all those neophyte nurses who want to be NPs heed the words of the prior threads and consider becoming a PA instead. They don't care about that nursey stuff.

Respectfully, DISAGREE. Future NPs - don't let any sour nurse deter you from your dreams whether you are 1 second out of school or 1 decade out of school. Yes obviously you lack certain skills that come with being a floor nurse (not really sure you will need those anyway being an outpatient NP) and yes you may also lack the understanding of hospital politics, dynamics of the healthcare system, how different providers interact and work with each other to care for a mutual patient, you may also have a very steep learning curve that may be more difficult to overcome compared to a seasoned nurse but that DOES NOT mean you cannot be a great NP. I would recommend at least completing a program part time so you gain valuable experience, but is it an absolute? Certainly not. With that said...

One more thing. I do wish every Joe Blow fly by night scam school in the world would quit the marketing and endless spewing out of endless legions of NPs. They clearly don't have Nursing's best interestd at heart, only their own bottom line. Do you hear me for-profit loan mills!!!
Enough already.

100% AGREE AGREE AGREE. This matters like a lot. And a great education can prepare any non-floor nurse to be a GREAT NP. Unfortunately, a lot of the programs these days are accepting and churning out average candidates - what a scary thought! The same thought applies with RN schools.

Buyer beware, BSN · Jul 20, 2016

You know every once in a while the intersection of outstanding intellects sends shivers down my spine.

I also want people to achieve their dreams but only in a prepared way that turns those dreams into pleasant realities.

Trauma Columnist · Jul 20, 2016

I've been an APN for 10 years now, was an RN for 14 years prior to that (just for background).

I've worked with some wonderful providers and some not so great providers with various credentials (NP, PA, MD).

Its more what YOU bring to the table then your credentials - if you are self-motivated, cont to engage in education (formal or informal), cont to strive to know more, then you will be a success. If however, you are happy to just go to school, obtain the needed credentials and figure that you are set in the world, then you will have issues.

As an APN, I am very autonomous, I rarely see physicians in my practice, no one cosigns my charts (outpt), I make my own pt care decisions. However, I did not have this much autonomy as a new grad - this came about as I gained experience and confidence in my abilities.

There is always a learning curve.

Jules A, MSN · Jul 28, 2016

However, I did not have this much autonomy as a new grad - this came about as I gained experience and confidence in my abilities.
There is always a learning curve.

Excellent point and hopefully insight the new grad NPs, especially those with no RN experience, will also have as they enter practice.

Goldenfox · Jul 29, 2016

...All I can say is there were days as an RN i would absolutely dread going to work because nurses, a lot of the time just get abused with the amount of work we had to do. The laundry list of things needing to be completed continued to grow as did the expectation of ideal customer service. I remember being lectured to use specific words "excellent care, always" to get the patients to rate us well on surveys so we qualify for reimbursement - all that BS, plus patient care, plus everything else, and our shifts did not get longer to accomodate for this, and our pay certainly did not go up. It was a bunch of crap and I was just a number. Plus the politics and opportunities for advancement were grim...
If you get a job where your employer respects you and doesn't burn you out, where you can continue to challenge yourself, I think you would be very happy as an NP. I appreciate the mental challenge of the new job, and am no longer physically burnt out - I can focus on all other aspects of life aside from work!

I could have written most of your post myself. I worked as an RN for many years and hated most of it. My patients received excellent care but I couldn't stand the politics and the BS. After a while I was doing charge most of the time, but I hated that too. Way too much drama. My escape from bedside nursing was years in the planning. And after I worked my last shift as a bedside RN I got down on my knees and said a special prayer of thanksgiving.

BUT...there is a saying that goes: 'be careful what you wish for'... My first years as an NP was a period of disenchanting disillusionment. Getting an NP job back then was nowhere as tough as it is now, but, for a short while, I worked with a physician in a primary care practice who was a slave driver. Even after we had seen the last patient for the day he expected me to stay there late every day reviewing charts and making callbacks. I was on call ALL the time. And he expected me to take home work and work on my weekends too. The practice itself was not a good environment to work in. All the people who were working in the front office were his family, and everybody was the boss. The pay wasn't all that great either, and he had lied to me about the benefits that I would be getting after my probation was up. Of course, I had to move on from that place. I gave a one month notice---in the interest of professionalism---and after that the whole family of them came out of a bag on me. But, I finished my time and left. After that I vowed never again to continue working in any place where abusive people are trying to take advantage of me.

In this profession you have to understand exactly what you're getting yourself into. Its not perfect, but I like it a whole lot better than bedside nursing. You just have to find the right opportunity for you. There are a LOT of very abusive physicians and hospital systems out there looking for NPs, but many of them don't treat or pay NPs fairly. We do all the same work that the physicians do but receive a fraction of the pay. And, because there are so many NP schools out there flooding the job market with new grads the pay will go even lower in years to come---especially in the major metro areas. I'm now in a position that I like but can do a whole lot better financially if I was running my own business and that is my goal for the coming year. There's no doctor or hospital anywhere out there who's going to pay me what I'm really worth. I wouldn't discourage anyone from becoming an NP just because of some of the negativity out there though. There are good opportunities if you're willing to go to them.