Suggestions... CNM, FNP.. dual specialty?

[Laceyrochelle26]

Hello everyone

I am looking for input for someone who has been there or has any experience or advice to offer.

I am wanting to return to graduate school to become a NP. I have been a RN for almost 9 years... I have always worked in some cardiology specialty (telemetry, pediatric ICU that specialized in cardiothorasic surgery... then in the ER and as a hospital rounding nurse for Cardiology practice). Obviously I really enjoy critical care/cardiology cases. However, I also really enjoy the natural birthing community (I love taking the pregnancy complaints that come into the ER as well). I have two very different interests.

I have a small child 18 months.. and we are planning to have more. I am really torn about where to go as far as specialty. I know this is obviously my decision I would just like to hear from people who may have had a similar background or decision?

I like the thought of having my own out of hospital midwifery practice and setting my schedule with my clients (other than their births obviously)..... but I worry about missing the hospital environment. I also worry if I will get bored working in a clinic only ..... the large metro hospital that heavily utilizes NPs and their experience is an hour away and I hate commuting so far. I recently transferred to a smaller local hospital for that very reason..which is great but NPs don't do a lot and mainly just work in the clinic.

I've also considered a dual degree but we don't live near any of the dual programs offered. I've also contemplated getting my NP in one field and later returning with a post masters?

I enjoy the ER and my cardiology rounding job... I am just getting burn out on long hours, always working late nights and weekends and missing out on things with my daughter. I understand you'll have some of that being a midwife as well but having 3 or 4 deliveries a month possibly overnight or inconvenient times seems more doable than 3 or more odd shifts on a weekly basis :-)

I would love to hear about your experiences in your specialities!

[Jules A, MSN]

Personally I would not be comfortable taking on a high risk specialty degree, like midwife, without a solid background in that field. In my experience our NP education is fairly underwhelming and I relied heavily on my experiences as a RN to sort through diagnostics and have a familiarity with medications.

Something I would encourage all NPs to do is attempt to make your own niche. If you enjoy working in your community hospital and they don't utilize NPs on cardiac units perhaps pitch it and get them to create a position for you. I have started as the first NP to work as an attending on 3 psych units and am blessed to have jobs I love and positions allowing me to utilize my full scope of practice. I have all the bells and whistles that most OP clinics don't offer and I work almost exclusively with physicians which I enjoy. The caveat in your case might be that Acute Care NP would likely be a better choice if you intend to work inpatient. Good luck!

[Laceyrochelle26]

I am wondering if I need to give up on the thought of getting to work locally.... our local hospital is critical access so it is small. I don't see much need for even a rounding nurse or a nurse practitioner to assist the hospital. I guess that could change though in the next two years and see how the hospital grows.

That is a good point to make your own niche. I had thought I could be known as the more "crunchy" provider that supports extended breastfeeding etc... I'm just not sure if I would even get to see many well child visits etc since most of the family doctors still do obstetrics and see their own deliveries.

I could easily get a job in Des Moines.. I still fill in as a rounding nurse in the hospital for the cardiology group and could get on with CV surgery or someone else there. I just don't really want to commute an hour (or more if I go to go to the west hospital) each day I work.. that is why I changed from working in their ER to our local ER.

[ghillbert, MSN, NP]

I'm an ACNP in cardiothoracic surgery, inpatient only. I wouldn't suggest it if you don't like long hours, weekends or holidays. I just had a baby several months ago and I do 4 x 10hr shifts but often get out late and it is rough with a baby.

[Laceyrochelle26]

That is how it is when I work triage/rounding with our cardiology group in patient... usually out late and very busy. The CV surgery used to have their own nurses too but a few years ago they changed and now only NP round for them.