Thinking about becoming a NP but also need career advice

db2xs · Nov 27, 2020

On 11/19/2020 at 12:12 PM, Grande_latte04 said:

I am a relatively new nurse. A little over a year of experience at this point. I am one of those people that needs direction/ needs to work towards a goal. That being said I think I want to become an NP. Not necessarily today or tomorrow, but I would like to start this in the next 5 years. The idea of commitment to a specialty right now is a bit terrifying. A little background: I have worked in long term care for 6 months- I actually loved LTC/rehab and memory care. I love bedside nursing/ I love the actual job of taking care of people. I left this job because my family needed to move across the country. Currently in California, and am working in primary care as a float nurse. I initially didn't love my job- but it has grown on me. I do adult primary care, pediatric primary care and would love to get into urgent care. I have spoken to my boss, and with the pandemic, there will be furloughs, and honestly, as the bread winner, the idea of losing income scares me. I found another job- super stable, better pay, better benefits working in mental health. I think I will like mental health- I enjoyed my nursing rotation in mental health and I have worked with psych patients in LTC.

But when I think about what I want to do, what I enjoy I just circle back I don't really know. I think about what is it that makes me excited/ what do I envision and how do I realistically get there (while also caring for a very young family) and I just get lost.

Here are just some thoughts I had (maybe they are idealist or ridiculous or dumb.. but this is why I am asking input from more experienced and wise nurses).

1) I enjoy working with children. I always have. I have at times imagined myself being a pediatric nurse. I have tried to get into pediatric hospitals to no end. Pediatric psych seems like something I could enjoy. I was once a teacher in a residential treatment facility for kids with behavior and emotional issues. I enjoyed it for the most part (company was pretty corrupt, but the population was enjoyable). I have thought about eventually PMHNP or possibly a PNP? I'm not necessarily asking the difference between the two, but maybe if someone has experiences with pediatrics in psych-mental health or is a PNP? And how those two might intersect?

2) My other thought(s) were to pursue a PMHNP and attempt to work in an emergency room? Does that happen? I don't even know? I have also had interest in becoming a SANE? Anyone w/ experience with that? Could I be a SANE nurse and pursue a PMHNP? Or could I become a PNP and do pediatric SANE (the idea that this has to exist is tragic and awful).

3) I am a bit of an adrenaline junkie. The idea of working in a more acute setting than a doctor's office is kind of where I'm at- I am excited to make a switch to a mental health facility- even with higher acuity. Maybe I would enjoy working in a crisis unit? Anyone with experience there?

4) I like the idea of being in charge/responsible for someone's care- be in mental or physical. I think I could be quite good at it with the right guidance/mentorship/opportunity.

5) My other thought is the money aspect. In my new position, I will be doing very well for myself- as an evening/NOC nurse I make >93k. As an NP I could possibly make another 35-40k a year... maybe an additional 50k. But to be entirely honest, the money is not that important to me. What is really more important is having some job flexibility- the ability to set my schedule or at least to have some control over my schedule. If that makes sense.

Sometimes I feel like I know exactly what I want to do- other times I feel like I need to be an RN and just get experience before I commit to something else. Maybe I should do travel nursing? or bungee jumping.. I just don't know.

Any life guidance any of you all might have would greatly be appreciated.

Additionally, I apologize for the manifesto.

No apologies needed and your post was hardly a manifesto.

I will give my two cents' worth first and foremost:

After reading your post, it sounds like what you might want to do is continue working as an RN and get more experience there. If you like adrenaline, variety, and hardcore hands-on work, I would suggest getting two or three per diem or part-time jobs that can satisfy all the different parts of you. Emergency, peds, or maybe even an outpatient psych job.

To address your specific points:

1) I am not a PMHNP but I don't see why you can't specialise in pediatric psychiatry/mental health. Kids definitely need mental health services.

2) There are plenty of mental health patients who are frequently flying through the ED, so I'm sure there would be no issue getting a job there if you wanted to go the PMHNP route.

3) I have no experience working in trauma or critical care but why not explore working in trauma? Is there a trauma unit near you? Refer to my previous comment about multiple gigs.

4) The idea of being "in charge" is just that--it's an idea. The RN is definitely in charge of patient care, just in a different way than an NP or MD. Depending on the setting, as an NP you may just be flitting in and out, writing orders and directing things but then you will leave and may not see the patient again for a week, a month--or maybe never again, depending on the setting. The thing I miss the most about being an RN is developing a solid relationship with my patients. You will spend more time with them as an RN than as an NP.

5) You list money as an important factor but then say money doesn't matter. What I understand is that flexibility is most important. If flexibility is truly what matters more, then stay an RN. As an NP you will more than likely have to work five 8-hr days, although there are some four 10-hr day positions out there.

I don't know where in your overall life's trajectory you are but unless you're over 60, I would say there's no rush to becoming an NP. If you're over 60, you have about 10 years left in your career and I suggest evaluating what it is you want to achieve in those 10 years and whether you have the gumption and energy to go back to school.

ArmaniX, MSN, APRN · Nov 28, 2020

You sound like someone who has absolutely no idea what they want. Which is fine. But, also not the ideal time to consider investing $$$ into a path you’re not certain you want to take.

I would get some good psych experience before committing to PMHNP; pediatric patients attempting suicide, abused, depressed does not seem enjoyable to me for a daily encounter so I’d be very sure before committing to this path.

I also am not a PMHNP but I do not believe they have a role in the ED. Patients coming through the ED are seen by an MD/FNP/AGACNP and triaged accordingly and sent to whichever service appropriate, possibly the psych unit.

Adrenaline junkie and psych unit.... again no experience but I feel the absolute absence of adrenaline inducing events would be the goal. Consider trauma/critical care/ED. Also consider a life full of adrenaline and high pressure events at work for 40+ hours each week... is this your idea of enjoyment when you’re aged?

The desire to be in charge is... a desire. The RN answers to the Provider. The NP answers to the MD/admin. Do you want the life/death decision and potential fallout/liability to fall on your shoulders as the NP or do you want to be the RN that can rely on their provider when things get tough? Adrenaline inducing events often include risky procedures/decisions and they have consequences.

I want to say money should not matter but we are all adults. I will say think clearly before letting a $ sign excite you.

You should have 100% certainty which path you want to take. You should research local job opportunities and what is available. California is not the easiest place to find a job as a new grad but location may give varying results. Good luck in path and just know that it is absolutely OK to remain a RN. Not everyone needs or should be a NP.