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What was your first AGACNP job?

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kdawnz is a MSN, NP and specializes in AG-ACNP-BC.

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Numenor has 8 years experience as a MSN, NP and specializes in Internal Medicine.

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21 minutes ago, kdawnz said:

Of course I agree... being an RN in general doesn't necessarily prepare you to be an NP. I know many many RN's who would be abysmal providers no matter how much time they spent the role. It's just a personality type, but I do feel that if you have the personality type and the experience you are less likely to be deemed utterly worthless as a new provider.  

The reality is that at this moment there are not sufficient internship/fellowship programs for all ACNP's to go through. It's not feasible or possible for us all to do with the lack of programs. So what do you recommend living in this current time? Are we all screwed? I would say not... I did most of my clinical in an ICU that relied heavily on their ACNP's, and nearly all were hired as new grads. Most already worked on the unit or in the facility, but were fresh out of school. They do most all procedures and manage around 8 ICU patients at any given time and seem to do just fine (several were about 8 months in when I started). In fact some of the weakest team members were the ones that had prior experience in a different setting. 

My frustration is the huge influx of NP's that seems to have happened in the last year. Jobs that had 7 applicants 15 months ago now have 30 in my area. Maybe just lots of these online programs saturating the market? I don't know. Everyone seems suprised. When I started school this was not the situation at all... so no, I didn't really sign up for a scenario where moving across the country and working 80 hours a week for $60,000/yr was the plan or expectation for myself and my family. Since my RN time is meaningless I guess I should have just gone to school 6 years ago instead of wasting my time becoming a leader and "mastering" the role before going on. Figuring out how to navigate this and contemplating working in a setting/specialty (clinic) that I am entirely unfamiliar with feels a bit odd since the learning curve there will be much steeper than the learning curve inpatient where I have spent my entire career and done all of my training.

I am looking at basic math here. The average residency program for MDs is 10-12k hours (plus the thousands as med students...), the average NP program is 600. RN experience in no way accounts for that gap, it just simply doesn't. You will see this when you are the one calling shots and there isn't an MD to fall back on for the real decision making like when you were an RN. You don't know what you don't know, that is the hardest part of the job. 

I came into the NP world thinking we were prepared, the residency program showed me that as a whole NPs are NOT prepared to function independently and certainly not right out of school.

They aren't managing 8 patients independently I can guarantee you that and procedure are just procedures. I have done paras, thoras and CVC/art lines etc etc. Anyone can be trained to do these. There is no NP straight of school or in most settings managing an ICU patient solo. They round, write the notes, call consults and put in orders. The management at the end of the day is dictated by the attending. Lets not fool anyone here. 

You don't want to move? See this is the problem with the NP world. Everyone wants a well paying job in their city without any flexibility or sacrifice. MDs literally move multiple times for their career without batting an eye and make pennies for years, but a one year gig to professionally boost their career far above their peers is too much for NPs. I am speaking generally here but this is what I have seen on this board. Look, this is the reason why the NP market is getting saturated and crap online schools are king. Convenience over all. 

FWIW I belonged to an ACNP facebook group for board prep. I was horrified at the dozens of questions asked knowing these NP students were literally at graduation. It was straight terrifying.

Edited by Numenor

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Tegridy specializes in Former NP now Internal medicine PGY-1.

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7 hours ago, kdawnz said:

I would say you are oversimplifying a tad as well... not all work places are built alike nor is RN experience. New grads such as myself certainly need a lot of support and I understand that is hard to come by depending on the setting and location, but even interns just out of med school come in and are expected to hit the ground running though they seem to be woefully unprepared. I routinely have 4th year medical students walk in to an ICU room and ask what the tube in their mouth is and what's that big machine next to the bed. 3 months later they are on call for a 15 bed ICU by themselves at night with an attending at home 10 miles away. It's hard and it's a steep learning curve, but it seems to be what medicine demands. Do I have more to offer right at this moment than the average intern I've worked with and probably even an R2? Yes, I would say that I do. I have familiarity, instinct, and a decade spent hand holding said interns and residents followed by 2.5 years of education and time actually doing the job. I worked in a somewhat unique setting that was insanely under covered with 1 attending running an OR 40+ hours a week in addition to the 15 bed ICU, so an awful lot was expected of nurses. However, I don't think this is necessarily unique to those of us that worked long enough as an RN to have really started to grasp the medicine and gotten well past the point of just checking off the task list. That being said, school and clinical was very humbling and I worked my butt off to try and fill the gaping holes in my knowledge. I did get a lot out of school and was given a lot of autonomy in clinical, but maybe this is somewhat unique? 

I am wondering what you recommend for a new ACNP graduate? It sounds like you don't believe starting in a hospital is feasible. Hospitalist internships are not a thing anywhere near me.. I've looked in the 20 states that surround me. I have found several CT surgery NP internships but as I ultimately do not want to live in a metropolitan area that has this service specializing doesn't seem wise. Should every ACNP in the country head back east and try to get in to one of the highly competitive hospital internships there? It doesn't seem terribly reasonable or feasible for a nation of ACNP's to do 
 

7 hours ago, kdawnz said:

Of course I agree... being an RN in general doesn't necessarily prepare you to be an NP. I know many many RN's who would be abysmal providers no matter how much time they spent the role. It's just a personality type, but I do feel that if you have the personality type and the experience you are less likely to be deemed utterly worthless as a new provider.  

The reality is that at this moment there are not sufficient internship/fellowship programs for all ACNP's to go through. It's not feasible or possible for us all to do with the lack of programs. So what do you recommend living in this current time? Are we all screwed? I would say not... I did most of my clinical in an ICU that relied heavily on their ACNP's, and nearly all were hired as new grads. Most already worked on the unit or in the facility, but were fresh out of school. They do most all procedures and manage around 8 ICU patients at any given time and seem to do just fine (several were about 8 months in when I started). In fact some of the weakest team members were the ones that had prior experience in a different setting. 

My frustration is the huge influx of NP's that seems to have happened in the last year. Jobs that had 7 applicants 15 months ago now have 30 in my area. Maybe just lots of these online programs saturating the market? I don't know. Everyone seems suprised. When I started school this was not the situation at all... so no, I didn't really sign up for a scenario where moving across the country and working 80 hours a week for $60,000/yr was the plan or expectation for myself and my family. Since my RN time is meaningless I guess I should have just gone to school 6 years ago instead of wasting my time becoming a leader and "mastering" the role before going on. Figuring out how to navigate this and contemplating working in a setting/specialty (clinic) that I am entirely unfamiliar with feels a bit odd since the learning curve there will be much steeper than the learning curve inpatient where I have spent my entire career and done all of my training.

ICU isn’t a required rotation at most med schools since the bread and butter is everything else.  It’s not a fair comparison - day one intern vs 10 year nurse. They have pulm cc fellowships for a reason. The foundation that intern already has will allow them to ramp up very very quickly. They already know all of the anatomy phys pharm path etc they need for ICU likely they just aren’t used to the situation. 

Edited by Tegridy

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kdawnz is a MSN, NP and specializes in AG-ACNP-BC.

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9 hours ago, Numenor said:

 

You don't want to move? See this is the problem with the NP world. Everyone wants a well paying job in their city without any flexibility or sacrifice. MDs literally move multiple times for their career without batting an eye and make pennies for years, but a one year gig to professionally boost their career far above their peers is too much for NPs. I am speaking generally here but this is what I have seen on this board. Look, this is the reason why the NP market is getting saturated and crap online schools are king. Convenience over all. 

 

WOW!, pretty harsh there. I never said I wouldn't move regionally and have applied for jobs in 8 states. It is not being entitled to say that the current reality over the past year in terms of NP market saturation was not the reality when I started school or even 18 months ago. I have a spouse with a job, a child, and obligations related to that. Because I didn't go to NP school as a young pup of 25 I don't have all the freedom in the world to work 80 hours a week and move 3000 miles away for very low pay. My husbands job gives him some flexibility, but not much. Given the fact that there are no fellowships or internships in a 2000 mile radius around me, I don't think I'm being crazy, lazy, or stupid for thinking staying somewhat regionally would be feasible. Especially given that 80% of the NP's I have worked with over my entire career in 2 different large trauma centers was locally grown. 

 You seem to have a lot of malice towards NP's in general. It's sad that you think so poorly of so many of your colleagues. I wonder, is every physician you've ever worked with God's gift to medicine? That certainly hasn't been my experience. There are good and bad, as there are in nearly every profession. Any fully formed physician's depth and breadth of knowledge is far beyond mine, but I am not looking to run a pulmonary service solo or be a trauma surgeon. I am there to help, and I'm not an idiot so am certainly capable of managing basic things even as a new grad and hopefully can become more and more helpful over time. If your program didn't prepare you for even this then I'd have some concerns about your schooling. 

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Tegridy specializes in Former NP now Internal medicine PGY-1.

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10 hours ago, Numenor said:

I am looking at basic math here. The average residency program for MDs is 10-12k hours (plus the thousands as med students...), the average NP program is 600. RN experience in no way accounts for that gap, it just simply doesn't. You will see this when you are the one calling shots and there isn't an MD to fall back on for the real decision making like when you were an RN. You don't know what you don't know, that is the hardest part of the job. 

I came into the NP world thinking we were prepared, the residency program showed me that as a whole NPs are NOT prepared to function independently and certainly not right out of school.

They aren't managing 8 patients independently I can guarantee you that and procedure are just procedures. I have done paras, thoras and CVC/art lines etc etc. Anyone can be trained to do these. There is no NP straight of school or in most settings managing an ICU patient solo. They round, write the notes, call consults and put in orders. The management at the end of the day is dictated by the attending. Lets not fool anyone here. 

You don't want to move? See this is the problem with the NP world. Everyone wants a well paying job in their city without any flexibility or sacrifice. MDs literally move multiple times for their career without batting an eye and make pennies for years, but a one year gig to professionally boost their career far above their peers is too much for NPs. I am speaking generally here but this is what I have seen on this board. Look, this is the reason why the NP market is getting saturated and crap online schools are king. Convenience over all. 

FWIW I belonged to an ACNP facebook group for board prep. I was horrified at the dozens of questions asked knowing these NP students were literally at graduation. It was straight terrifying.

I always see a lot of anti physician posts by nursing on fb groups yet many ask really simple questions everyone should know. TBH they should just let the anti physician nurse type open up a nurse only hospital and see how it goes. Many of the mid level bolstering folks would get what they think they want. I was on one group today and they don’t even know that DOs are the same thing as Md and think FNP is a more legit degree then neck popping DOs. It’s sad to not even know what each healthcare degree entails when one is a professional. 

Edited by Tegridy

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11 hours ago, Numenor said:

I am looking at basic math here. The average residency program for MDs is 10-12k hours (plus the thousands as med students...), the average NP program is 600. RN experience in no way accounts for that gap, it just simply doesn't. You will see this when you are the one calling shots and there isn't an MD to fall back on for the real decision making like when you were an RN. You don't know what you don't know, that is the hardest part of the job. 

I came into the NP world thinking we were prepared, the residency program showed me that as a whole NPs are NOT prepared to function independently and certainly not right out of school.

They aren't managing 8 patients independently I can guarantee you that and procedure are just procedures. I have done paras, thoras and CVC/art lines etc etc. Anyone can be trained to do these. There is no NP straight of school or in most settings managing an ICU patient solo. They round, write the notes, call consults and put in orders. The management at the end of the day is dictated by the attending. Lets not fool anyone here. 

You don't want to move? See this is the problem with the NP world. Everyone wants a well paying job in their city without any flexibility or sacrifice. MDs literally move multiple times for their career without batting an eye and make pennies for years, but a one year gig to professionally boost their career far above their peers is too much for NPs. I am speaking generally here but this is what I have seen on this board. Look, this is the reason why the NP market is getting saturated and crap online schools are king. Convenience over all. 

FWIW I belonged to an ACNP facebook group for board prep. I was horrified at the dozens of questions asked knowing these NP students were literally at graduation. It was straight terrifying.

What you are saying actually makes total sense and I too am disconcerted by the caliber of our NP professionals, as more and more schools make the barrier to entry almost zero.  Maybe if providers would start refusing to precept students from these schools, we could create our own barrier.

However, you are comparing newly graduated NPs and the expectation of moving for a job to newly graduated MDs.  MDs have a certain culture - they get an undergraduate degree, compete to get into med school, compete for residencies (and have to be willing to move at that point), compete for fellowships, and of course, are willing to compete and move for jobs.  All throughout this time, they go where they are accepted/or get a job.  The effort is large and so is the reward.

For NPs, the path is different.  We can often go to nursing school locally.  Grad schools used to require moving but now, we can basically go from our own kitchen stool.  And now we are expected to move for a job?  And one that barely pays more than the one we already have?

MDs don't already have a job.  They are getting their first one.  NPs, following a traditional route, are usually working while they are in school.  It's like, you want me to uproot my whole life to find a job that gives me another $20K?

If you are becoming an NP without being a nurse, perhaps you are a little more willing to move...maybe it feels there is more to lose in that scenario.  But usually this is not your first job and you may be moving an entire family.  This still often happens with docs but they are usually expecting it and the reward...after residency...is larger.

I personally have wanted to be an NP for many years.  But when do we rethink paying good money for a well-known brick and mortar school and having to move our families across the country for $100K?  Is it worth it?

 

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Numenor has 8 years experience as a MSN, NP and specializes in Internal Medicine.

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11 hours ago, Polly Peptide said:

What you are saying actually makes total sense and I too am disconcerted by the caliber of our NP professionals, as more and more schools make the barrier to entry almost zero.  Maybe if providers would start refusing to precept students from these schools, we could create our own barrier.

However, you are comparing newly graduated NPs and the expectation of moving for a job to newly graduated MDs.  MDs have a certain culture - they get an undergraduate degree, compete to get into med school, compete for residencies (and have to be willing to move at that point), compete for fellowships, and of course, are willing to compete and move for jobs.  All throughout this time, they go where they are accepted/or get a job.  The effort is large and so is the reward.

For NPs, the path is different.  We can often go to nursing school locally.  Grad schools used to require moving but now, we can basically go from our own kitchen stool.  And now we are expected to move for a job?  And one that barely pays more than the one we already have?

MDs don't already have a job.  They are getting their first one.  NPs, following a traditional route, are usually working while they are in school.  It's like, you want me to uproot my whole life to find a job that gives me another $20K?

If you are becoming an NP without being a nurse, perhaps you are a little more willing to move...maybe it feels there is more to lose in that scenario.  But usually this is not your first job and you may be moving an entire family.  This still often happens with docs but they are usually expecting it and the reward...after residency...is larger.

I personally have wanted to be an NP for many years.  But when do we rethink paying good money for a well-known brick and mortar school and having to move our families across the country for $100K?  Is it worth it?

 

I am convinced most RNs go into NP school because it is drilled into our heads as the "next step". There is little to no thought involved. This is a cultural problem at the very most core. My BSN professors were literally flabbergasted when students said they just wanted to do bedside. They always pushed for graduate school but never for clear reasons.

Being a bedside is perfectly okay and we need to change our culture to support that. If all the RNs leave the bedside to go to low tier NP schools (literally the trend) we are screwed.

Also, I wouldn't take 100k in any situation unless the job was so brainless and without responsibility. 100k is certainly not worth it if you function in any even semi autonomous role.

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Numenor has 8 years experience as a MSN, NP and specializes in Internal Medicine.

252 Posts; 619 Profile Views

14 hours ago, kdawnz said:

WOW!!, pretty harsh there. I never said I wouldn't move regionally and have applied for jobs in 8 states. It is not being entitled to say that the current reality over the past year in terms of NP market saturation was not the reality when I started school or even 18 months ago. I have a spouse with a job, a child, and obligations related to that. Because I didn't go to NP school as a young pup of 25 I don't have all the freedom in the world to work 80 hours a week and move 3000 miles away for very low pay. My husbands job gives him some flexibility, but not much. Given the fact that there are no fellowships or internships in a 2000 mile radius around me, I don't think I'm being crazy, lazy, or stupid for thinking staying somewhat regionally would be feasible. Especially given that 80% of the NP's I have worked with over my entire career in 2 different large trauma centers was locally grown. 

 You seem to have a lot of malice towards NP's in general. It's sad that you think so poorly of so many of your colleagues. I wonder, is every physician you've ever worked with God's gift to medicine? That certainly hasn't been my experience. There are good and bad, as there are in nearly every profession. Any fully formed physician's depth and breadth of knowledge is far beyond mine, but I am not looking to run a pulmonary service solo or be a trauma surgeon. I am there to help, and I'm not an idiot so am certainly capable of managing basic things even as a new grad and hopefully can become more and more helpful over time. If your program didn't prepare you for even this then I'd have some concerns about your schooling. 

NP market saturation is nothing new. It's been in the pipeline for years with the advent of online programs with 0 effort willing to take anyone with a BSN and paycheck. The accreditation bodies are a joke.

I have no malice towards NPs. I am one! I am just perplexed at this delusion that we are somehow equivalent to physicians (literally mentioned on here almost weekly) and should have the same autonomy. Practically and logically it makes 0 sense. I have a bone to pick with NP cheerleaders because I have literally applied to jobs that told me flat out they were hesitant to hire another NP because the previous ones were completely lost in the sauce. Garbage tier NPs and NP schools make ME look bad before I even start a job.

It is not a far off notion to feel that a profession, which churns out most of its providers via online schools with 0 to little standards, is in deep trouble. Not every single mom with 3 kids and 0 time is cut out to be a provider and that's okay. We should not bend our educational standards to fit every need in the world. I have literally seen multiple facebook NP blog posts saying NP hour requirements are too long and need to be cut down. My lord...

Yes, of course its just my programs fault that my education was lackluster. Nope, not a systemic problem at all. Yeah I saw NP school was a joke and I turned around and fix my educational deficiencies the best I could with a residency and it made me a vastly better prepared provider. More should do the same. In fact, hundreds try to and apply 1-2 slots in each programs which are becoming more and more common because most hospital systems come to find out NP education horribly underwhelming.

Look, you haven't started working yet and being a student is a far flung comparison to when your name is actually on the chart as primary. You will see what I mean with the onus is on you to fix your patient and Google won't save you. 

13 hours ago, Tegridy said:

I always see a lot of anti physician posts by nursing on fb groups yet many ask really simple questions everyone should know. TBH they should just let the anti physician nurse type open up a nurse only hospital and see how it goes. Many of the mid level bolstering folks would get what they think they want. I was on one group today and they don’t even know that DOs are the same thing as Md and think FNP is a more legit degree then neck popping DOs. It’s sad to not even know what each healthcare degree entails when one is a professional. 

That's hilarious and sad at the same time. Maybe I should have told our DO chief resident today he should try better next time and become a legit doctor with a MD. LOL...

Edited by Numenor

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Tegridy specializes in Former NP now Internal medicine PGY-1.

215 Posts; 688 Profile Views

6 hours ago, Numenor said:

NP market saturation is nothing new. It's been in the pipeline for years with the advent of online programs with 0 effort willing to take anyone with a BSN and paycheck. The accreditation bodies are a joke.

I have no malice towards NPs. I am one! I am just perplexed at this delusion that we are somehow equivalent to physicians (literally mentioned on here almost weekly) and should have the same autonomy. Practically and logically it makes 0 sense. I have a bone to pick with NP cheerleaders because I have literally applied to jobs that told me flat out they were hesitant to hire another NP because the previous ones were completely lost in the sauce. Garbage tier NPs and NP schools make ME look bad before I even start a job.

It is not a far off notion to feel that a profession, which churns out most of its providers via online schools with 0 to little standards, is in deep trouble. Not every single mom with 3 kids and 0 time is cut out to be a provider and that's okay. We should not bend our educational standards to fit every need in the world. I have literally seen multiple facebook NP blog posts saying NP hour requirements are too long and need to be cut down. My lord...

Yes, of course its just my programs fault that my education was lackluster. Nope, not a systemic problem at all. Yeah I saw NP school was a joke and I turned around and fix my educational deficiencies the best I could with a residency and it made me a vastly better prepared provider. More should do the same. In fact, hundreds try to and apply 1-2 slots in each programs which are becoming more and more common because most hospital systems come to find out NP education horribly underwhelming.

Look, you haven't started working yet and being a student is a far flung comparison to when your name is actually on the chart as primary. You will see what I mean with the onus is on you to fix your patient and Google won't save you. 

That's hilarious and sad at the same time. Maybe I should have told our DO chief resident today he should try better next time and become a legit doctor with a MD. LOL...

It doesn’t make sense to me either. Part of me feels like NPs without residency should have severely restricted practice or not be able to practice at all. Before all the NP hate comes in for this comment one has to remember that a medical degree is near worthless without residency.  If you want what docs do do a residency at least. A one year residency would be great for all NPs but the nursing boards would have to admit defeat to let that happen. Something they would never do. 
 

Nurses always rant and rave on how dangerous medical interns are but seem to bat an eye at newly minted NPs with much fewer clinical hours. It’s almost as disingenuous as politics. 

Edited by Tegridy

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