Specialize as an NP ??? Which one??

[momofm1998]

Need some expert advise from all you employed, certified, and specialized NPs. If you could speak to new grads, what advice would you give them about getting enhanced skills/experience/certs in areas of our scope? I am seeing that every ad for NPs is asking for special certs, skills, education. Not many for just an average NP. I know midlevels have to bring something to the table to benefit the employer and earn their salary. What skills/specialization have you found are valuable to have, almost assures employability, and seems to have a future to it???

My experience as an NP has consisted of retail health, VA disability exams, sports physicals and some primary care. I have a CRNI certification in infusion therapy from my RN work. Kept it, was too hard to get. I am planning to relocate and need some advice please. Tons of experience as an RN-ICU, dialysis, management, infusion therapy, acute care, ER, home health, cardiac, floor nursing, travel nursing..

I dont know how to suture, read x-rays, or do joint injections. Dont know how to do Botox or fillers. Couldn't really manage HTN or diabetes without lots of help from a more experienced provider. I'm just a NP with the limited skills you see above. I do have excellent diagnostic(gut feeling) skills, assessment skills, and communication skills. Love my patients!

I completed the level one AADE course for diabetic educators before realizing I would need years of working with DM before I could even consider taking the AADE exam. I completed the 24-hour Buprenorphine (Suboxone) Waiver training and then found my state will not allow midlevels to Rx this treatment. I have completed the DOT/CMV course to sit for the FMCSA CME exam and am studying for that now.

As you can see, I have been searching for something that would make me more employable. The state I live in could literally ask for a "33 year old blonde, green eyed, 126 #, childless, NP with her DNP, with a certification in "whatever plus additional certifications as a first assist, living 3.5 miles from the facility in a brownstone with a tin roof" and 45 NPs would apply. That is how saturated this area is with midlevels. One reason for my relocation.

I have thought about Botox training, not necessarily for wrinkles but migraines, CP in peds for spasticity treatment, incontinence treatment. I have thought about going further with my infusion certification for infusion clinics, teaching IV skills (I taught peripheral IV skills as an RN). I have considered learning how to suture, read x-rays and pursue Urgent Care. I even thought about going for my DNP and opening my own small clinic offering very limited services (that would entail more schooling, more student loans)

My needs are to be able to work part-time (disabled child)and still make enough to supplement the household. My thinking is if I develop my skills in an area of need, I could be more "hirable" and be able to work part time.

Any input would be greatly appreciated. My ideal job?? If I were skilled in procedures, teaching new grad NPs, at a reasonable price, all those skills, from glucometer to EKG reading to suturing like a pro, they are going to need out there. But gotta have an income til then..

Thank you for any and all suggestions.

[FullGlass, BSN, MSN, NP]

Honestly, you should consider relocating to an area with a better job market for NPs. Check out my other posts for information on this.

My number one piece of advice to new grad NPs: BE FLEXIBLE ON LOCATION.

[PollywogNP, ADN, BSN, MSN, LPN, NP]

Are you FNP?

[momofm1998]

I'm just an NP with the limited skills you see above

[Oldmahubbard]

I am in Psych, but I don't understand why you can't manage HTN and DM without help.

The market where you are is terrible. Scary terrible.

[djmatte, ADN, MSN, RN, NP]

5 hours ago, momofm1998 said:

I'm just an NP with the limited skills you see above

What kind of NP are you? There isn't "just an NP". You should already have some specialized training be it adult-geri, family medicine, women's health, etc. That's where you start in promoting your"skills". Some of the things you mentioned are bread and butter things we do on primary care including sports physicals and other assessments you noted. And the thought that you couldn't manage diabetes or hypertension is concerning when they both are very commonly treated in a range of primary np specialties and are somewhat certification baseline diseases. At the very least you seem to be underselling yourself from the start and grabbing a hodge podge of certifications with no clear direction of whether they will be useful.

Perspective: when I got my FNP and my first job, I tried heavily on two areas of experience. The family medicine component that Frontier Nursing University ingrained from their long history of taking care of the whole lifespan and how my nursing career in pain management translated into how I was to benefit my employer. I was able to articulate my favorite populations and why. What my thoughts were on things like the opiate crisis and a desire to improve patient care through utilizing a broad range of therapies. I received no specialized training to do this outside my fnp and have only honed/expanded my abilities in these areas and others since.

[Oldmahubbard]

My Psych NP career started in forensics, where many of the patients are liars.

I did that for quite a few years, and one of the physicians there apparently thought I could expand into LTC. And that is how I got the job.

In LTC, the patients are very seldom liars, they just can't tell you what is wrong.

It is surprising how some of the soft skills transfer.

But if I were a PMHNP that couldn't manage major mental illness without help, nobody would want to hire me.

I think you might need more primary care experience.

[traumaRUs, MSN, APRN]

I got hired into a large nephrology practice and beat out 5 other applicants, two with nephrology experience. I capitalized:

1. My ability to think on my feet and handle emergencies by myself.

2. Assessment skills - being able to tell sick from not sick.

3. Flexibility and willingness to learn and add in enthusiasm.

Agree with others though that if your area is saturated you may need to move.

[verene, MSN]

What specialization did you train in during your program? There isn't "just an NP" role - everything is specialized - primary care, acute care, psychiatric, gero, etc. Which board exam did you take and which role are you certified in?

In finding a position you can be confident in - look to the skills you were trained in during school, and to your work experience as an RN. What populations have you enjoyed working with? What are skills or populations you'd like to develop greater capacity for?

If there are no jobs at all in your area - consider moving, but also consider how you are presenting to perspective employers - if you don't know what you want to do, and don't know how to organize your current experience and skills into a cohesive narrative of why they should hire you - this could also be part of the issue in finding a job.

[momofm1998]

I completely agree with the two posters stating I need more primary care experience if that is the area of my choice to pursue.. I am an FNP. Got s decent education at a respected brick and mortar school . But in agreement with so many on All Nurses, schools teach too too too much fluff and Not enough of the real world stuff.. my first job out of school was retail health and that taught me a lot about common problems but nada about managing diabetes, HTN, arthritis and so many chronic diseases we see in PC. Transferred to this state and Next job was at a Rural federally funded clinic in a saturated area and primarily doing insurance assessments, sports physicals, very little primary care. My experience with the primary care patients I did see over a couple years frustrated me because of my lack of ability to truly help...Very complex patients, non compliant, and me with little oversight. Then the requests for Rxing “pain” medicine started so I left.

I just feel stupid! All this experience and nothing specific I can list on a resume. The primary docs expect and rightly so, an NP with my 9 years experience to hit the floor running. I can’t do that.

I want to get trained in something and be really good at it. As an RN, I was the go-to for infusion therapy. I love skin care and derm because of all the atopic dermatitis and other skin problems I have seen that I knew needed more than a pill or lotion. I truly enjoy my primary patients and getting a good history and discovering the real etiology of presenting problem.

And yes, yes, yes to the suggestions to relocate. Actually planning that now. As I look over my original question, I see that it is one I have to answer myself. If I could tell any new NP or RN grad one thing, it would be to identify an area you love, learn it inside and backwards, join the association, get certified in it, and become an expert in that field. Just generalizing is worthless in the job market today. Know a little about a lot and master of known is equal to not employable!

Thank you for all your wise comments..it is gratifying to have this board as a counsel when we hit roadblocks..

[Oldmahubbard]

Stupid you absolutely are not.

I couldn't manage major mental illness if my only experience was handing out buspar.

Retail health, sports assessments, etc, is not real experience.

You will have to knuckle down with the books, and know the primary care algorithms.

Of course, you can do it.

[djmatte, ADN, MSN, RN, NP]

2 hours ago, momofm1998 said:

Just generalizing is worthless in the job market today. Know a little about a lot and master of known is equal to not employable!

I'm wondering what is this hang up regarding specializing vs as you call generalizing? Internal medicine or family medicine docs don't believe for a second they are somehow lacking because they don't have further specializations. Why should you?! You are a family nurse practitioner. You specialize in treating patients across the lifespan from chronic conditions to acute issues. You have and demonstrated skills to examine a patient and make medical decisions (even in something as mundane as a sports physical). You won't do everything that can encompass your profession all the time and some things few to never. But you will likely see a good portion of it through out your career. And as always with the practice of medicine, you knowledge and ability to treat is always expanding.

I have colleagues that manage diabetes more efficiently than I do, but I manage other chronic illnesses quite well and still stufy the guidelines when things I know I can improve crop up. The more I read and the more often I see certain things, the better I get at it. For instance, 1 year ago I'd never had a patient with h pylori. Now after at least 5 since then I can identify the symptoms most commonly present in my area, the workup required, and the medication regimen without thought. Yet I received no further specialty focus outside of CME conferences.

Knowing the areas you are lacking is important, but shouldn't define you as a clinician. You can spend your spare time expanding your own identified shortcomings and still present yourself in a positive light as an experienced FNP that's not just obtained certification, but also demonstrated some ability to learn new material. The problem I find lies in your attitude and your over presumption of what you perceive as a lack of skills. If this is how you project your image here, God help how your interviews or resume look.