Oversupply of Nurse Practitioners

Specialties NP

Published

I recently received a published form from the State of Florida showing that ARNPs increased 22% over the past two years. RNs only increased by 7.4% If you are a new grad wondering why you can't find a position here is your answer. Our NP mills have pumped out too many graduates for the demand of society. I don't have the data to back it up but if this is happening in Florida I would assume it is happening around the nation.

I'm licensed in Florida but moved to California years ago because I could see the tsunami of new graduates slowly starting to erode the wages of established NPs. It's now happening here in California and I have been directly affected. I can count at least another dozen of my NP colleagues around the nation who are complaining of wage deflation happening because new grads will accept a position at almost any wage. Starting wages are below those for RNs in some cases.

For those of you thinking of becoming a NP think and long and hard before you commit your money and your time. The job is enjoyable but the return on investment is declining year after the year with the flooding of the markets. Maybe one day the leaders of our nursing schools will open a book on economics and understand the relationship between supply and demand rather than stuff another useless nursing theory down our throats.

Specializes in Family Nurse Practitioner.
BostonFNP said:
Remember if you take the boards as an NP you are on the clock for your practice hours if you want to be able to re-certify in five years.

No worries as with all things nursing the actual hours in practice requirement is embarrassing low as evidenced by the lack of real world skill in many of the full time NP faculty I have encountered. If my math is correct 1,000 hours over 5 years...not even 4 hours a week? Would you want a provider with only 4 hours diagnosing and prescribing experience a week caring for your family member?

But wait there is credit for poster presentations and also publishing which can be obtained by professors simply overseeing DNP projects as part of their job requirements. Cronyism at its finest.

https://www.nursingworld.org/~4abfd7/globalassets/certification/renewals/RenewalRequirements

3 Votes
Jules A said:
No worries as with all things nursing the actual hours in practice requirement is embarrassing low as evidenced by the lack of real world skill in many of the full time NP faculty I have encountered. If my math is correct 1,000 hours over 5 years...not even 4 hours a week? Would you want a provider with only 4 hours diagnosing and prescribing experience a week caring for your family member?

But wait there is credit for poster presentations and also publishing which can be obtained by professors simply overseeing DNP projects as part of their job requirements. Cronyism at its finest.

https://www.nursingworld.org/~4abfd7/globalassets/certification/renewals/RenewalRequirements

Oh my goodness! Were you all not aware that the ANCC has now (since 2016) made practice hours optional for renewal?? You don't have to have any practice hours at all. It's right there in the link you posted, Jules. We are all required to complete 75 hours of continuing education, inc. 25 hours of pharm hours, and one of the eight optional renewal categories, one of which is 1000 hours of clinical practice. You can do 75 hours of continuing ED and 1000 practice hours, or you can have no clinical hours at all and do additional education hours, precepting hours, presentations, etc.

I saw this back in 2016, and was so shocked that I called the ANCC to confirm I wasn't somehow reading it wrong. The ANCC person I talked to on the telephone confirmed that, yes, I was correct, they have eliminated any requirement of practice hours for renewal. I believe this was done for people like academics who are teaching full-time and not practicing, so they can maintain their certification (which is a requirement of many nursing programs. When I taught, I just maintained a part-time clinical practice outside my full-time teaching job, but lots of faculty members don't want to do that).

So, hey! Kick back, take it easy, no worries! It's all good!

How low does nursing lower the requirements and standards until they just become entirely meaningless? (Although I will admit that, the older and more fed up with nursing I get, the less I care ...)

2 Votes
Specializes in Family Nurse Practitioner.
elkpark said:
Oh my goodness! Were you all not aware that the ANCC has now (since 2016) made practice hours optional for renewal?? You don't have to have any practice hours at all. It's right there in the link you posted, Jules. We are all required to complete 75 hours of continuing education, inc. 25 hours of pharm hours, and one of the eight optional renewal categories, one of which is 1000 hours of clinical practice. You can do 75 hours of continuing ED and 1000 practice hours, or you can have no clinical hours at all and do additional education hours, precepting hours, presentations, etc.

I saw this back in 2016, and was so shocked that I called the ANCC to confirm I wasn't somehow reading it wrong. The ANCC person I talked to on the telephone confirmed that, yes, I was correct, they have eliminated any requirement of practice hours for renewal. I believe this was done for people like academics who are teaching full-time and not practicing, so they can maintain their certification (which is a requirement of many nursing programs. When I taught, I just maintained a part-time clinical practice outside my full-time teaching job, but lots of faculty members don't want to do that).

So, hey! Kick back, take it easy, no worries! It's all good!

How low does nursing lower the requirements and standards until they just become entirely meaningless? (Although I will admit that, the older and more fed up with nursing I get, the less I care ...)

I JUST CAN'T...say anything close to what I feel and remain even slightly within the TOS.

2 Votes
Specializes in Nursing Professional Development.
Catherineann said:
I'm in my last month of my post-masters FNP program and am feeling quite discouraged about my decision. I came to the realization that there are too many of us when I was trying to find preceptors for my rotations and had to make literally hundreds of phone calls to find someone who didn't already have an NP student. There are 10 FNP students in my small community hospital alone and some of them have only been nurses for a short period of time. I've been offered a specialty job that pays significantly less than my job as an ICU nurse. When I told them what I currently make as an ICU nurse with 14 years of bedside care experience, they were shocked. In addition, the benefits are far better at my current job. I'm feeling quite deflated.

Thank you for sharing this story. I know a lot of nursing students and newer nurses who need to read it. I wish you the best of luck in building a career that works well for you.

1 Votes
Specializes in Psychiatric and Mental Health NP (PMHNP).

To the OP: You do not prove there is an oversupply of NPs. You just state that the supply has increased. So what? If my glass is half full, and I increase the contents by 22%, I still don't have a full glass. There is still an acute shortage and maldistribution of primary care providers and the vast majority of NPs work in primary care. EVERYONE in my graduating class of Dec 2017 had at least one job offer prior to graduation, and this is in a supposedly oversaturated market according to the self-proclaimed experts on this forum.

I have yet to see one shred of evidence from all the Eeyores on this forum that proves, or even strongly supports, that there is an oversupply of NPs or that compensation is decreasing for NPs. Yes, there may be regional variation, but it is on the prospective NP to do their research on job opportunities and pay in their desired location. My NP school was very accurate in describing the job market and NP pay in their region. It doesn't take a genius to ferret out job opportunities and compensation in specific locations. Someone who can't figure out how to do that probably isn't smart enough to be an NP. There are crappy NP schools out there, unfortunately, but if people want to go to those schools, it is a free country. Going to a good school is an advantage for a new grad NP, and anyone who denies that is fooling themselves. That is true of any profession. Who do you think will have an easier time finding their first job - a new Harvard MBA or someone who went to an MBA diploma mill? Someone who is willing to relocate or someone who has decided they can't move? I don't know about the rest of you, but if I decided I wanted to be an actress, I'd move to LA or NYC. If I wanted a career in high finance, I'd move to NYC. If I wanted a career with the federal government, I'd move to DC. When I worked in high tech, I lived and worked in major tech centers like Silicon Valley, DC, L.A.

I have provided evidence that there is still high demand for primary care providers, and that includes NPs. In addition, as more states provide NPs with full practice authority, the demand for primary care NPs will continue to increase. Primary care is becoming less and less attractive to MDs due the high cost of medical school and higher compensation in specialties.

RNs can make excellent money and many RNs truly want to be RNs their whole career. We need good RNs. Anyone who is an experienced RN, then goes to school and looks for their first job as an NP is going to take an initial pay cut. People who can't afford that shouldn't go to NP school. In addition, one should become an NP because that is the job they want to perform, not just to make more money. There have been many posts on this forum by former RNs who just didn't like being an NP, regardless of pay.

I'm sick of all the negativity here because it scared the crap out of me when I was a student. After reading the falsehoods that certain people love to post here for some weird idiosyncratic psychological needs, I was terrified that I wouldn't be able to get a job as a new grad NP, much less a good job. Well, I got 9 excellent job offers. I love my job, the clinic management and patients are happy with me, and I am quite satisfied with my pay. I also live in a beautiful area. We have clinics in our system that can't find any NPs, PAs, or MDs, even when they are in beautiful, desirable, low cost of living areas that are very close to good-sized cities and we are paying top dollar! We have recently recruited some NPs from "oversaturated" markets and they are very happy they made the move.

When evaluating compensation, one must consider the local cost of living. $175,000K in the Bay Area is actually crappy pay given the high cost of living there. Someone making $80K a year in an affordable area is way better off.

People CAN move. You're not moving to a 3rd world country, for goodness' sake. The economy is good. A house can be sold. The kids will adjust to a new school. The spouse can find a new job. I'm an Army brat and attended 12 schools in 12 years. I loved it!

For those are interested, look for my other posts on how to get a good job as a new grad NP.

And, yet again, here is some actual evidence:

According to the Medical Group Management Association (MGMA), primary care compensation has been increasing substantially, based on data from over 136,000 providers in over 5,800 organizations. "Nurse practitioners saw the largest increase over this period [past 5 years] with almost 30% growth in total compensation. Physician assistants saw the second-largest median rise in total compensation with a 25% increase." This is from an article about primary care MD compensation:

"Compensation Data Underscores Primary Care Doc Shortage," Health Leaders Media, May 21, 2018,

Compensation Data Underscores Primary Care Doc Shortage | HealthLeaders Media

In a 2017 report, recruiting firm Merritt Hawkins reported that NPs and PAs were 3rd on their most requested recruiting assignments (after doctors), up from number 5 in the previous year. Page 9 of this report shows average pay for NP recruiting assignments since 2012, and it has been steadily increasing, from an average of 105, 000 in 2012 to $123,000 in 2017. You can find that report on this page:

Thought Leadership

2017 Survey of Physician and Advanced Practitioner Recruiting Incentives

Thought Leadership

And finally, the hubris of many on this forum astonishes me. I have great respect for my RN and NP instructors, many of whom are national and international leaders in their fields. All of my clinical NP professors had at least 20 years practice experience prior to becoming NP professors and they all continued to practice at least 8 hours per week; many worked more. I will always appreciate their excellent instruction and kindness to me.

The only reason I even bother to post here anymore is that I don't want current students to be freaked out like I was. There are plenty of good NP jobs out there!

Find a good job is a skill that must be learned and practiced. There is plenty of information available on how to find a job. My school also put a lot of effort into teaching us how to find our first NP job.

19 Votes

the number of NPs/PAs have increased but its in part because we need more. Now in some places we are saturated but once i travel out to rural areas they are desperate to have us. The problem is many of these places people dont want to work. I also noticed to be competitive in places like Florida you need to learn say Spanish and French or Arabic. we stay competitive we can get the jobs and justify the cost.

2 Votes
Specializes in Psychiatric and Mental Health NP (PMHNP).

Most of California has a primary care and mental health care provider shortage. I know, since I live in California. If you only want to live and work in the coastal areas, yes, those areas have a more competitive job market, except in inner cities. ALL of inland California has an RN and NP shortage. I see no actual evidence that California NP pay is decreasing. Given that as a new grad NP, I had 9 job offers after a 3 month job search, I find it ridiculous to claim that there are too many NPs.

With regard to Florida, that state has a severe primary care MD shortage that is only expected to get worse. Unfortunately, Florida also has a lot of restrictions on NP practice. NPs can and should ease the primary care MD shortage, but can't due to greedy and backward MDs and their lobby.

The Advanced Practice Nurse Solution - Florida Association of Nurse Practitioners

4 Votes

The only studies I need to see are the classifieds on Indeed for NPs. That combined with what my seasoned, more than 5 years experience as a NP colleagues tell me in regards to pay.

Here is a job I was just sent. It keeps getting worse

$25 to $45 an hour in Pacific Palisades California. Probably one of the most expensive place to live in So Cal.

1 Votes

In my first NP job search , circa 2004, I was explicitly told that there was an NP glut. On one job interview, I was told that many recent grads did not have the basic skills to do the job, in this case, pap smears.

The salary I was offered on my first job, was no more than what a modestly experienced RN would make.

It seems the word has been out that we are not "good to go" after school, and we have a long road to prove ourselves.

1 Votes
Oldmahubbard said:
In my first NP job search , circa 2004, I was explicitly told that there was an NP glut. On one job interview, I was told that many recent grads did not have the basic skills to do the job, in this case, pap smears.

The salary I was offered on my first job, was no more than what a modestly experienced RN would make.

It seems the word has been out that we are not "good to go" after school, and we have a long road to prove ourselves.

I think this depends on the program. Some programs make sure you are ready while others seem to just be diploma mills. I know what school you attend can matter as a new grad when it comes to applying for jobs.

1 Votes
FNP2B1 said:
The only studies I need to see are the classifieds on Indeed for NPs. That combined with what my seasoned, more than 5 years experience as a NP colleagues tell me in regards to pay.

Here is a job I was just sent. It keeps getting worse

$25 to $45 an hour in Pacific Palisades California. Probably one of the most expensive place to live in So Cal.

For the record though, that job is an RN position (even though they note they'll accept a nurse practitioner). Truth is though in that job you aren't acting as a NP. You're only doing infusions. Albeit for that area even as an RN the pay is too low. I'm betting they're only anticipating applicants expecting to use it to supplement their income vs someone expecting to live off that job.

I don't trust jobs posted on indeed. It's been my experience that it's a cesspool of head hunters, travel assignments, and people just looking to fill bodies in slots. Which may accurately gauge where this profession is heading. There are few if any career oriented options.

1 Votes
Specializes in Primary care.

I want to feel optimistic about future of our profession. I think problems start at the beginning. Education of NPs is (Both MSN and DNP) lagging way behind PA schools. I still don't understand the fact that how can some schools including really reputable ones requiring NP students to arrange for their clinical placements after charging them thousands of dollars in tuition. NP schools are not as selective as PA schools, a lot of them don't require GRE or any other examination. RN experience at some cases reduced or not even required. Online programs are not helping either. It should be more standardized approach to NP education. Unfortunately, it became a financially lucrative option for colleges and universities. in the meantime new grads are stuck with student loans and low paying new grad positions.

Quality of the NP programs vary, yes but I think clinical hours should be be increased.Pediatrics, gerontology, women's health rotations should be more robust and supported by the NP programs should not fall on student's shoulders. I think that would increase our negotiation power.

6 Votes
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