Why is it too soon to pursue FNP, My Plan......

NPinWCH · Sep 17, 2011

I want to point out a couple of things. First, you sound like you will have to be working and going to school at the same time. You may not be at work for 60 hours, but you will be working for AT LEAST 60 hours/week during this time with class, work and homework. Then when clinicals start you'll be at your job 40 hours and then at clinicals somewhere in the 15-20 hr/week range PLUS homework and class.

Second, you want to work "Dr's office hours". I work as an FNP in a rural FNP practice. I work M-F and my first patient is scheduled for 8:15, which means I am at work no later than 8:00, my last patient is scheduled for 4:45. Most days I'm at least 30 min behind. So I see that patient at 5:15, if it's an easy, acute thing (it's supposed to be, but isn't always) I'm done with that patient by 5:30. Then there are phone messages that I need to address and critical lab results that need to be dealt with and any documentation that I didn't have a chance to finish. I usually leave the office at 6:30. My days are 10.5 hours long. I often work through lunch, or eat between patients. The other providers in the office (2 MDs and 1 other NP) do the same, so this isn't just me. That comes up to about 50 hrs a week.

My point is, if you want a 9-5 job, working in an office probably isn't going to be what you think it is. Also, there I days I wish I could go back to 3 twelve hr shifts. I wish I could give report to the oncoming shift and not worry, but it doesn't work that way. I go home and worry about patients, worry that I missed something or ordered the wrong tests. I don't do this obsessively, but it does occupy my mind sometimes.

My kids are teens, but if they were young I wouldn't see much of them. I still leave around the time they do for school and when I come home it's still dinner, homework for them and bed (usually for me before them). Also, sometimes I have charting or messages I need to finish from home. I make myself leave at 6:30 so I can see my family at home.

I'm not saying don't do it, but I am saying you might not be realizing how much time you're going to have to invest to graduate with your NP, while working or how much time "office hours" actually take. I love my job, but there is a lot to be said for only working 3 days a week and having 4 days to yourself.

linearthinker, DNP, RN · Sep 18, 2011

^^^ I agree. But, I hear you. I hated 12 hour shifts and was kind of stuck at my job long after I got bored with it because there wasn't really anywhere else that would let me work 8s when everyone else was doing 12s. The 12 hour shift trend was a big reason I wanted a change. That, my sore back and the fact that being anyplace at 0645 is d@mned unreasonable!

I don't think there are too many FT NPs working strictly 8-5. For that reason, I won't work FT. It's just too much time away from home, and I've got too much going on that is more important, frankly. I took a .6 position which means I am supposed to see approx 40 patients a week. I get to make my own schedule, but as long as I am averaging 40, they don't care when I do it. I'm going to try for T-W-Th, but if I find I'm getting stuck there too late, I may do 4 shorter days. There is no way I'd have that kind of flexibility with a FT position. The other NP in the practice is FT, and she is expected to see 70-80 patients a week. She sees her first patient at 9a, and is usually there until 8-9pm. So, she is really working 50-60 hours a week, salaried, so no OT. I think this is pretty typical. We do get productivity bonuses for exceeding the minimum gross, etc. She said she has never done it (been there 8 years, I think). God only knows how many patients/hours it would take to exceed minimum gross! I'm never going to find out, lol.

Better be sure you are actually going to earn what you need to as a NP. Taxes and insurance are about the same everywhere. I am only making a tad bit more than I did as a RN, and most of my classmates are in the same boat, and a few earn less than they made as a RN. If you would potentially have student loan debt to consider, you may be worse off.

It is a different job in every way. It isn't a step up so much as a lateral move into a different profession IMO. More autonomy, yes. But work is work, and there is no way to meet the obligations of a FT provider in 40 hours. At least, I've never met a NP making that happen.

Anyway, that said, I don't think there is anything wrong with your plan at all. go for it!

kyboyrn · Sep 18, 2011

I don't see anything wrong with your plan. As far as the experience thing, I don't think it's 100% necessary, but I definitely think that it's highly, highly beneficial. I work in the ED department as a NP, and I had previously worked there as a nurse for 5 years. Because of all of my experience as a nurse, the transition was very smooth. I knew our hospital's formulary (I knew what antibiotics we have, what pain meds, which steroids, etc.) so I knew what I could and couldn't order. I knew what services we have available and when (not able to do venous dopplers at certain times, etc.), I know what doctors are on call, which ones are likely to admit, which are gonna ive us trouble, etc. I was able to move into the role so much more smoothly than many of the new PA's that hadn't worked there previously as a nurse, because I knew the system and how everything worked, and it didn't hurt already having a good reltionship with all the docs and the other providers when I needed help or had questions.

As far as pay goes, I think it's different as far as how pay compares to nursing in different areas. Where I work, it's well worth it. Around where I trained, went to school, worked as a nurse, and lived there is a very, very significant difference in pay. I make well over double what I made as a nurse and have the potential to make even more by working a few extra shifts here and there (should make well into the six figures this year, my first year, as an NP). I know in some areas of the country, nurses may make that, but I worked as an ER nurse for 5 years and never made more than 45k in one year. Not only do I make double that just with my contracted hours, the company I work for pays my malpractice insurance, gives me a few thousand for continuing education expenses, and offers medical and dental insurance. I also get the opportunity to work extra shifts, and sometimes if they need someone will offer double pay for a shift or two! The only problem is with a job like mine is the hours. I work 12 hour shifts, and until they hired new people and I got seniority, I was working nights (until 2 or 3 am).

Anyway, I love the autonomy, and the respect that I get. I love the fact I make more money. Pretty much, I love being an NP. I liked being a nurse, but after a while, I got to a point I just got tired of doing what everybody told me to do, and I wanted to be able to make decisions, and interpret labs, and formulate diagnoses. I still get to help people, and I get paid more for doing it. I do recommend experience, but for the outstanding student, I don't think it should necessarily be a requirement, but it does help. Some things you just don't learn in a textbook, like being able to identify a "really sick" patient. With experience, you can just look at a patient and know. Okay, I'm rambling. Anyway, I highly recommend the NP route. As far as pay different, see what you can find out for your area, but for me and all of my fellow students, the pay they are making is significantly more than they made as a nurse.

Advanced Practice Columnist / Guide · Sep 18, 2011

While I also personally love the 12-hour shifts, the trend in some Northern California health sytems is a return to the 8-hour shifts for hospital RN's. Kaiser Permanente, for one, only has 8-hour shifts and some of the CHW facilities are also returning to 8-hour shifts. I am not sure if the strong nursing unions and the strict staffing models in California are responsible for these changes but form what I hear, the hospitals are finding that it is more cost-effective than the 12-hour shifts. But then again, RN salaries are very much inflated in Northern California to begin with (new grads are started at 50/hr!).

I have to agree with the above posters. Primary care is never a 9-5 job most anywhere if you're doing it full time. This is one of the reasons why it never was appealing to a large number of med school grads who have huge student loans to pay and are forced to settle for the lower salary range and long hours of primary care practice. The OP also mentioned ER. Again, that is a specialty that requires working odd hours (10 or 12 hour shifts in some places) which will be worth it (at least to me) if there is a significant increase in pay. I have no issue with a new grad RN thinking about going to NP school early on but I would recommend rethinking one's expectations of what it takes to be an NP.

NPinWCH · Sep 18, 2011

The other NP in the practice is FT, and she is expected to see 70-80 patients a week. She sees her first patient at 9a, and is usually there until 8-9pm. So, she is really working 50-60 hours a week, salaried, so no OT. I think this is pretty typical. We do get productivity bonuses for exceeding the minimum gross, etc. She said she has never done it (been there 8 years, I think). God only knows how many patients/hours it would take to exceed minimum gross! I'm never going to find out, lol.

Wow! I'd LOVE to only be expected to see 70-80 patients/week. I see between 20 and 25 patients a day, with an occasional slow day of 15-18. At my current rate of seeing patients I might make the first hurdle to bonus (there are 2, the first of which is the # of patients/half), but I haven't been there a full bonus cycle to see if I will. I do know that the other NP in the office sees a few more than I do and she does bonus.

jaznia15 · Sep 22, 2011

I understand that I'll be doing a lot of hours during school and id love working three days a week as well as of right now I work no less than 48 hours per week to offset taxes and bring home a check decent enough to make ends meet. By Dr's office I also wanted Monday thru Friday no weekends which I know is doable as an NP if I find the right place. I know NP work is just as rough and stressful as bedside nursing if not moreso because of the increased responsibility NPs have with their scope of practice. I Just feel its something I know I wanna do so why wait and I also feel its easier to find a good paying position that offers a more family friendly schedule than the 12 He workday where u know u will have to work a certain amount of weekends and holidays. I worked four years as a cna while pursuing my BSN making minimum wage working every shift since I was classified PRN, I'm used to hard work, I think for me its Just something I need to do while I still have the energy and help with my son with my mother.