I really need advice

allnurses Guide · Jan 23, 2018

After stalking this website for years I've finally decided to create an account and post.
I'm currently undergoing my BSN in upstate NY and have one year left until graduation. I've been President of my school's National Student Nurses Association chapter for 2 years, earned a few 4.0's but no lower than a 3.7 any semester (GPA is 3.85), participated in several leadership conferences and have been inducted into the nursing honors society. I feel my extracurricular involvement along with my decent GPA classifies me as a "well-rounded student."
I was just offered acceptance into my college's MSN/FNP or MSN/PMHNP upon graduation, meaning I would start right after my bsn. The program is 2 years and allows students to work part or full time during the semesters so I would plan on working part time as an RN to gain experience. From leadership positions on campus and excelling in my clinical rotations I feel confident in my ability to pick up on bedside nursing manner very quickly while working part time if I do choose to go straight through. I had a full scholarship for undergrad and would come out of grad school theoretically "only" owing
Welcome officially to AN, glad you created an account after all those years. As you have probably realized, you have hit on a hot button issue right now, with some passionate arguments on both sides. Remember to take every response both in context and with a grain of salt (including this one).
First, the facts. As much as the topic of RN experience in the NP role is discussed and debated there is no strong evidence (in terms of peer-reviewed published data) on either side. There are weaker published studies which so there is no difference in NP role socialization based on prior RN experience. In these studies (paraphrased) is that novice NP often cited prior experiences (be they life experiences or RN experience) as beneficial and those with RN experience tended to value their experience.
Second, opinion. To put things in context, from a practicing NP who has been involved in both didactic and clinical education of NP students (as well as medical students) for a number of years including a number of "5-year" students which are simialr to the program you have been accepted to.
Academics: Most of the schools that offer this type of program are higher quality and established programs. If you have done well academically at a quality school you should be able to handle the increased coursework and self-directed study, and the exams will be more difficult material but also more straightforward than NCLEX-style exams.
Life Experience: As we know from the (little) evidence we have, is prior life experience is important in the new role. One thing I can say rather objectively is that "5-year" students I have worked with in the past have had much greater variability in this than older students and that is a concern and it is palpable in the clinical setting. Only you (and your preceptors/faculty) will be able to figure out if this is something that will hold you back or not.
RN Experience: In short, from having worked with a lot of student NPs in both clincial and didactic settings is that some students need it and some don't. There is no blanket answer for this. There is some adamant opposition to the notion of NPs without prior RN experience but if you put that opposition in context, you'll find most of it comes from nurses that are not APRNs and/or are not involved in NP education. It is opinion without expertise. That being said, there are many practicing APRNs that highly value their prior RN experience.
Always keep in sharp relief that academic success does not always accurately predict clinical success; even the best students don't simply start working in their RN job as experts, it takes years of dedication and hard work.
I will post in response to the second part of you question a bit later.

allnurses Guide · Jan 23, 2018

I'm leaning towards FNP because I love the idea of assessing and treating patients across the spectrum whether it be inpatient or outpatient. While PMHNP has also interested me for a while, I don't like the idea of losing that stethoscope/touch & feel type of practice we're taught in nursing school.
I'd be 23 if I graduate with my FNP via this route and would have a little over 2 years of part-time RN experience. Will this make me marketable to employers? Will I even find a job with the way the new grad job market is portrayed on this website? I don't mind moving.

Deciding between FNP and PMHNP is a big choice, and while you can always post-masters later on, it is the foundation of your practice. From the advice of a number of practicing PMHNPs here on AN, prior RN experience in the psych specific role may be more valuable to you entering practice. Spend some time shadowing if you still have questions about what direction you want to go.

FNPs are a primary care trained specialty and while many FNPs do work int he inpatient setting (I have as well) there is increasing traction on employers hiring ACNPs for inpatient work, specialty in high acuity settings like the ICU. Consider this as well if you have a desire to work inpatient as you may be better severed by moving to an ACNP program even if it is not at your current school.

If you are willing to move where you need to, odds are you won't have any real difficulty finding a job. The market is some areas has tightened (and with that employers can be more picky about experience) but in other areas it is wide open, sometimes even with a short commute. Again, put posts in context re: the job market as many opinions are coming from people who aren't looking for NP jobs.

umbdude, MSN, APRN · Jan 23, 2018

I would just add that a 2-year high-quality NP program will not give you a lot of extra time to work as a RN, assuming that you continue to dedicate as much into school work as you did during undergrad.

Have you tried asking your school if you could "defer" matriculation for a year or two so you can gain some work/life experience? I would think that most schools would be open to that idea.

itswild · Jan 25, 2018

Thank you for this. I shadowed a FNP yesterday working at an urgent care for 8 hours and it was so cool to see him walk into the patients room, assess/treat them and then get them on their way. I have a shadow appointment with a cardiacFNP next week in a local hospital which I'm really looking forward to. PsychNP has been tougher to set up but I'll let you know how that goes!! :) Thanks again

itswild · Jan 25, 2018

Iwsoccjs,

Thank you for your input. By picking the hardest course load do you mean challenge myself now since I have the time and resources? I'm still leaning towards FNP because of the more hands on work they do but PMHNP really interests me as well because I've always been a huge mental health advocate, breaking the stigmas whenever possible. I'll be shadowing a PyschNP soon hopefully. Already have FNP shadowing under my belt.

Thanks again.

itswild · Jan 25, 2018

Thank you for your thought-out response BostonFNP,

I understand what you are saying, and I am looking for advice- which is exactly why I came onto here. I've always identified myself as a "quick learner" but I'm beginning to realize this won't necessarily be the case when I start working as an RN right before NP school. I'm weighing the pros and cons to each route with 1. being that I go right into NP school while working RN part time and 2. being that I take a year off and work full time RN before going back.

Opinions like the ones on this thread are exactly what I'm looking for because I believe everyones opinion to be valid in some way, shape or form.

Best,

itswild

itswild · Jan 25, 2018

Umbdude,

I have not asked my school this, but I'll keep that in mind when I decide which route I'm going to take. I see how important to some that 1-2 year experience is before starting school.