To remain as an RN w MSN or to proceed to be an FNP

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  1. to accept RN full time offer or proceed FNP program

    • 2
      accept RN full time perm job 2 hrs from home and relocate
    • 10
      decline RN job offer and proceed FNP program

12 members have participated

I have finished my first semester of FNP program and passed my classes. However i got a perm fulltime job offer as an RN about 2 hours from where i live. I am having second thoughts if i should pursue my FNP. I have read a lot about pharm, patho, and assessment but hard to remember them and apply to a real pt. Will be doing first clinicals this spring. Im not sure if i should pursue FNP or not. Im not comfortable diagnosing and prescribing meds at this level. Is this a normal feeling? How do you know if FNP is for you? Any advise is highly appreciated.

So how do we overcome this feeling of not knowing what to do as an NP? Ive been reading but tend to forget what i just read. How do we apply what we've learned to diagnose and treat patients with multiple problems with multiple comorbid conditions and multiple meds?

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Specializes in allergy and asthma, urgent care.
So how do we overcome this feeling of not knowing what to do as an NP? Ive been reading but tend to forget what i just read. How do we apply what we've learned to diagnose and treat patients with multiple problems with multiple comorbid conditions and multiple meds?

This comes with experience and practice. No one comes out of NP school ready to take on complex patients based on what's in your head. You look up stuff, you confer with colleagues. You see the same thing a few times and then you remember off the top of your head what to do. The key to success is not memorizing tests, drugs, and dosages. It's recognizing that something is normal or not, then using your critical thinking skills to further determine what needs to be done. You utilize resources-people, guidelines, references, etc. I looked up EVERYTHING when I first started as a NP, even when I was pretty sure I knew what I was looking at and what to do. I still look up lots of things and I ask a lot of questions. I never want to be complacent and think I know it all, cause I never will.

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Specializes in Cardiac, Home Health, Primary Care.

I also try to keep in mind that there have been thousands who have done this before me. Hundreds (if not thousands) who graduated from my program and are successful. Thousands who have passed the certification exam who are successful. Sure there are a few in there who probably aren't doing so great but the odds say "yeah. I can be good too."

And in the APEA CD's for review Amelie takes the time to address new NP's for a brief minute. She says something along these lines:

When you become a practicing NP you may feel like you are so new and have so much to learn. Your patients will view you as a very learned health care provider....so much so that they pay to see you.

That is in NO WAY a direct quote but when I heard it I couldn't help but think "wow....I'm gonna have people pay to get my opinion??"

I'm not sure when I'll get over this feeling. I do know that I enjoy the detective work. I enjoy helping people. There are parts of the job I'm dreading but at least as NP I call the shots instead of following orders... ;)

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Specializes in Cardiac, Home Health, Primary Care.

Oh and I'm not necessarily trying to sway you. But you wouldn't have gone through the admission process to get into your program if you didn't really wanna do it.

I just want you to know you aren't alone in your feelings. I came on this forum and loved reading the hesitancy of my fellow NP students. Reminded me I wasn't alone.

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What apps do u use to help u? R there apps out there to help u with differential dx, dermatology, primary care NP protocols, meds? Are all your meds to prescribe and standardized procedures written in a protocol u collaborated w an MD? Or do u have to look up at guidelines to prescribe meds without a written protocol?

How do u choose which guideline to use?

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What good references do u use to know what lab orders you will order for a particular diagnosis?

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Specializes in Cardiac, Home Health, Primary Care.

We had to buy LexiComp so I use that, I had an ICD9 database, medscape....

LexiComp has 5 minute consult which is pretty to the point about common issues.

I have also started a "clinical notebook" with Evernote so I can view and edit on my phone or on my computer. You can easily search your "notes" with the search function (like looking for COPD). I am only about 1/3 of the way done but little by little I will make it.

And in some instances it's hard to know "what is right" because different bodies of information may conflict. Example: cancers screening. USPTF says no self breast exam and no mammo until 50. American cancer society says yes to SBE and mammo at 40. Which is right?? Who knows.

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Specializes in Cardiac, Home Health, Primary Care.

5 minute clinical consult is an actual text also. I looked at one and it seemed pretty nice. It shows differentials, common labs, treatment, etc.

There are probably other texts also that do similar things.

As far as prescribing my state board has a form we fill out with the MD regarding what we will be prescribing under their "oversight". The examples they have online include everything you can think of and they can be tailored depending on specialty. But the MD doesn't necessarily give you a protocol as an NP. I can follow a protocol the MD gave me as an RN. As an NP you should have the freedom to make your own decisions and write your own orders. Not just "follow protocols".

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Specializes in Cardiac, Home Health, Primary Care.

And after posting this about the 5 minute clinical consult I decided to just go ahead and order it as the text had much more than the LexiComp app does. And at $85 on Amazon it really wasn't THAT horribly expensive. It might be something for you to look into as it does already have almost everything you need to know in a short, concise format.

You could also get an older version (they have a new one every year) for cheaper just to see if you like it.

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Specializes in Adult Internal Medicine.
What good references do u use to know what lab orders you will order for a particular diagnosis?

If you are going into primary care but the Butarro text it's well worth it.

Sent from my iPhone.

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How is your employment search as a new grad NP? Is it hard or easy to find employment as a new grad NP? which setting did u land a job? are there new grad NP residency programs you know about? which ones are they? for those who have been NPs for awhile, did u participate in a new grad NP residency program? where do we find those programs?

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Specializes in Cardiac, Home Health, Primary Care.
How is your employment search as a new grad NP? Is it hard or easy to find employment as a new grad NP? which setting did u land a job? are there new grad NP residency programs you know about? which ones are they? for those who have been NPs for awhile, did u participate in a new grad NP residency program? where do we find those programs?

My job search is kind of limited...but partly because I made it that way. I live about an hour from the largest city in my state...of course they have several large hospitals. Thing is I HATE that drive so would rather wait it out and find something closer to home (or in the opposite direction). Given these limitations I have applied for 3 positions and am actively interviewing for one (they have several docs who weren't able to meet me on the same day. Meeting the last 2 tomorrow). I'm about 95% sure I will be offered this job as its within the system I work with now.

In my area there aren't NP residency programs that I know of but that's not saying much (as I explained above). I have stressed to the clinic I'm interviewing for about my nervousness about being a new grad. They have all (the manager and all of the doctors) that they understand and will give me time to build up my confidence. They hired their first PA last year as a new grad so they have at least dealt with the issue recently. The one thing that still makes me nervous is 2 days per week I'd be in a separate clinic as the sole provider. The doctor there only finished his med training about 3 years ago so he assures me he will be available with any question. The staff in the clinic have all been there for several years and knows the patients well also which helps.

The job I'm interviewing for is primary care. Split between a clinic with 5 docs where I will take overflow and walk ins and the more rural clinic where I'd be the primary provider for the day.

As far as how hard or easy it is to find jobs it really depends on your area. There aren't TONS of options for me but, again, I've limited myself so I can't blame anybody but myself for that.

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