My Possible Career Change to Nursing

[Rotate]

I just recently celebrated my 31st birthday and in addition to realizing I am no longer invincible I have also realized I would like to consider the possibility of changing careers. Healthcare is interesting to me and appears to be a relatively stable and "in demand" field. There are several physicians in my family and I am fairly confident that I do not have the desire or motivation to go to medical school. I like the idea of interacting with patients and having some sort of autonomy in my job. This is how I came to be interested in nursing. My long term plan would be to become a NP or CRNA to practice more independently.

I have two young children (3yrs and 1yr) and a working wife. We have no debt and 12 years left on our home mortgage. I have a bachelors degree in finance and am currently flying for a major airline. The mergers, bankruptcies, furloughs and time spent away from home are not a very inspiring career path for me or my family.

Any words of advice on how to get started? After talking with a friend who is a CRNA and neighbors who are both NP's, I really like the idea of one of these two specialties. Is there anything I should consider doing to prepare for one of these two fields?

Ideally I would like to get started while still working my current job until that is no longer feasible.

Thanks for your input! Don't know if it helps, but I am located in Houston.

---

Members don't see this ad.

 

[AnnoyedByFreud]

I just recently celebrated my 31st birthday and in addition to realizing I am no longer invincible I have also realized I would like to consider the possibility of changing careers. Healthcare is interesting to me and appears to be a relatively stable and "in demand" field. There are several physicians in my family and I am fairly confident that I do not have the desire or motivation to go to medical school. I like the idea of interacting with patients and having some sort of autonomy in my job. This is how I came to be interested in nursing. My long term plan would be to become a NP or CRNA to practice more independently.

I have two young children (3yrs and 1yr) and a working wife. We have no debt and 12 years left on our home mortgage. I have a bachelors degree in finance and am currently flying for a major airline. The mergers, bankruptcies, furloughs and time spent away from home are not a very inspiring career path for me or my family.

Any words of advice on how to get started? After talking with a friend who is a CRNA and neighbors who are both NP's, I really like the idea of one of these two specialties. Is there anything I should consider doing to prepare for one of these two fields?

Ideally I would like to get started while still working my current job until that is no longer feasible.

Thanks for your input! Don't know if it helps, but I am located in Houston.

NP isn't a specialty in and of itself - there are specialties within NP (Family practice, peds, women's health, acute care, etc.) It sounds like you have a solid reason for pursuing nursing, though I would say the role of an NP compared to CRNA is quite different. Since it sounds like you're unsure about what type of advanced practice program to pursue, I think it would make sense enroll in an accelerated BSN and get some work experience as an RN for a few years and then go on for the advanced practice degree.

 

[pamac]

I just recently celebrated my 31st birthday and in addition to realizing I am no longer invincible I have also realized I would like to consider the possibility of changing careers. Healthcare is interesting to me and appears to be a relatively stable and "in demand" field. There are several physicians in my family and I am fairly confident that I do not have the desire or motivation to go to medical school. I like the idea of interacting with patients and having some sort of autonomy in my job. This is how I came to be interested in nursing. My long term plan would be to become a NP or CRNA to practice more independently.

I have two young children (3yrs and 1yr) and a working wife. We have no debt and 12 years left on our home mortgage. I have a bachelors degree in finance and am currently flying for a major airline. The mergers, bankruptcies, furloughs and time spent away from home are not a very inspiring career path for me or my family.

Any words of advice on how to get started? After talking with a friend who is a CRNA and neighbors who are both NP's, I really like the idea of one of these two specialties. Is there anything I should consider doing to prepare for one of these two fields?

Ideally I would like to get started while still working my current job until that is no longer feasible.

Thanks for your input! Don't know if it helps, but I am located in Houston.

Are you a pilot?

 

[pamac]

I've been a nurse for about a year, and plan on going to school to be an np (even been thinking of crna lately). As an RN I literally run my butt off. It's 13 hours of nonstop work. Granted, I'm a day shifter, which is guaranteed busy, as opposed to when I worked nights it being intermittently busy. I enjoy the pace, and it's the only way I would want to work, but it's grueling. If you are giving up a good job to spend time nursing, you might find it's literally more like being a waiter sometimes that being a "healthcare professional". So options to get from point A to point B (np or crna) might give you the most satisfaction rather than languishing on a hospital unit taking care of noncompliant patients.

 

[Dejavu]

I've been a nurse for about a year, and plan on going to school to be an np (even been thinking of crna lately). As an RN I literally run my butt off. It's 13 hours of nonstop work. Granted, I'm a day shifter, which is guaranteed busy, as opposed to when I worked nights it being intermittently busy. I enjoy the pace, and it's the only way I would want to work, but it's grueling. If you are giving up a good job to spend time nursing, you might find it's literally more like being a waiter sometimes that being a "healthcare professional". So options to get from point A to point B (np or crna) might give you the most satisfaction rather than languishing on a hospital unit taking care of noncompliant patients.

I am an MD now, but I started out being an RN, years and years ago. Then went to CRNA school. Practiced for a decade, then quit a perfectly good job to try for med school. Luckily, made it.

It took me two weeks to decide that I didn't want to be a floor nurse. They can lead a miserable existence. Due mainly to nursing administration and policies and procedures getting in the way of providing patient care. The well-known saying is that nursing eats their young. The nursing administrators will try to find ways to justify their own existence by coming up with policies, projects and nit-picky job evaluations that make it seem, to the top level guys, that they are actually doing something. When it comes time for their job evaluations they can point to all these things as evidence of a job well done.

Obstructionist to good pt care at best, malignant at worst.

Then there are the doctors to deal with...

My gut instinct? Stay the hell away from nursing and the years it will take to even get there.

Better the Devil You Know. You are flying, for God's sake.

 

[pamac]

I am an MD now, but I started out being an RN, years and years ago. Then went to CRNA school. Practiced for a decade, then quit a perfectly good job to try for med school. Luckily, made it.

It took me two weeks to decide that I didn't want to be a floor nurse. They can lead a miserable existence. Due mainly to nursing administration and policies and procedures getting in the way of providing patient care. The well know saying is that nursing eats their young. The nursing administrators will try to find ways to justify their own existence by coming up with policies, projects and nit-picky job evaluations that make it seem, to the top level guys, that they are actually doing something. When it comes time for their job evaluations they can point to all these things as evidence of a job well done.

Obstructionist to good pt care at best, malignant at worst.

Then there are the doctors to deal with...

My gut instinct? Stay the hell away from nursing and the years it will take to even get there.

Better the Devil You Know. You are flying, for God's sake.

Completely true about nursing and busy work procedural hurdles. Most of my day consists of navigating through systems set up to dumb down my nursing judgement and follow implemented "best practice" routines that academic nursing arrived at as a way to justify their existence. I'm all for performance improvement, but many improvements at this point can involve introducing a high degree of tedium that interferes more than it helps. While I'm struggling to stay in line with all the basics, there's a never ending queue of additional items to keep up with that can serve as distractions. Then there are facility cost cutting measures that are passed off as best practice. Case in point, extra supplies in a room. Admin says no to that. My nursing judgement says a patient blows through certain linens quickly. Save myself a walk to the supply (as well as a couple hand washings?) by stocking up? Nope. Linen costs money to wash. Smile if you are within 10 feet of a visitor (and admin will send strangers to audit that). There's a million more where that came from. But you do your best and figure out how to make things happen. It can seem micromanaged a lot, though.

I really like being a nurse, but if you fly planes through the air, I'd think hard about giving that up. There are crna schools that might take you without a great amount of floor experience, but most want to see it. That floor time might be something that could make you question the switch you made. I eased into it and have always worked in the medical field, but it might be a shock if you aren't prepared.

 

[Rotate]

Are you a pilot?

I am, for United.

Thank you everyone for sharing your experiences, they were all viewpoints that I had not considered. From what I can gather I think that shadowing several different types of nurses may be what I need to do. Becoming a EMT has also been suggested to me in order to get my feet wet a little before making the decision to dive in head first. I know that this is something I can do while keeping my current job.

I had no idea there was so much office politics involved. Its a shame that this sort of behavior is intertwined in health care also, wouldnt it be great if everyone could check their ego at the door!

I can appreciate the nurses "eating their young" analogy. Aviation is very similar. Most people would be shocked (in a negative way) to find out what kind of salaries and working conditions new pilots deal with, and many of these pilots are in the front of a regional jet with 70 passengers in the back who are depending on their "A" game. We are treated well at the major's but you never know whats coming around the corner next.

Thanks again for all of the advice, I will keep my post updated as I continue to look in to this career change!

 

[fab4fan]

Nursing is not an "in demand" job right now. Due to the proliferation of nursing programs (some good, many shady), nursing has become oversaturated in many areas.

You have no idea how demeaning it can be to be asked to make posters about how great your nursing staff do their job. It used to be you were judged by your ability to provide good patient care. Now you're judged by how good you are at arts and crafts.

If you have a stable job as a pilot, I would really think long and hard about a career change to nursing.

I would suggest you put these questions to members of www.allnurses.com.

 

[AnnoyedByFreud]

I think you need to shadow more providers. If you fall in love with NP or CRNA, then go for it. You don't have to languish at the bedside if you don't want to, you can go directly into the NP role (not true for CRNA, but you could move to the boonies and work one year in the ICU and then go to CRNA school). This is a route that is sometimes criticized, but at the end of the day, if you know what you want to do, focus on it and do what you need to do to get there. I find bedside nursing intolerable and will have never worked as a floor nurse before becoming an NP.

 

[sarjasy]

It took me two weeks to decide that I didn't want to be a floor nurse. They can lead a miserable existence...The nursing administrators will try to find ways to justify their own existence by coming up with policies, projects and nit-picky job evaluations...

Yup. Just had my job eval. Got dinged for not writing my name on the white board in the patients room consistently enough. Apparently, it is quite important for sedated and intubated patients to know the name of their nurse for the day.

 

[sarjasy]

I find bedside nursing intolerable and will have never worked as a floor nurse before becoming an NP.

I find it nearly intolerable as well. And for you with your background (I think you are doing psych NP?), working on a floor in a hospital really isn't that relevant. However, for many NP specialties, BSN+MSN without RN clinical experience isn't sufficient.

 

[sarjasy]

While I'm struggling to stay in line with all the basics, there's a never ending queue of additional items to keep up with that can serve as distractions. Then there are facility cost cutting measures that are passed off as best practice.

This. Constant re-charting on why a patient has a foley, having to put on plastic barrier gowns just to walk into a patients room that's on contact isolation to push "silent" on an alarming IV pump, and my favorite -- having to chart that I've provided education to my sedated, intubated patient. Keep in mind though, that much of the nonsense is driven by JCAHO, state health departments, CMS, et al., not just your hospital, so it's not just nursing. RN-level nursing is no doubt the worst, but physicians, NP/PA's, CRNA's all have to wade through similar crap, and no doubt the ACA will only make it worse.

 

[pamac]

This. Constant re-charting on why a patient has a foley, having to put on plastic barrier gowns just to walk into a patients room that's on contact isolation to push "silent" on an alarming IV pump, and my favorite -- having to chart that I've provided education to my sedated, intubated patient. Keep in mind though, that much of the nonsense is driven by JCAHO, state health departments, CMS, et al., not just your hospital, so it's not just nursing. RN-level nursing is no doubt the worst, but physicians, NP/PA's, CRNA's all have to wade through similar crap, and no doubt the ACA will only make it worse.

The Jcaho stuff doesn't bug me. The facility can't do much about that. Watching them shift everyone around to send someone home early and save an hour of a nurses salary gets my goat. Auditing how much I smile blows my mind. I'm not miserable by any means, or else I'd move on, but if you go into it with misinformed expectations, the letdown could be huge.... Especially if you walk away from something as rad as being a pilot. I like the personal growth I've had as a professional in that high stress environment, but in a few years I'll be ready for something new. Every difficult patient I handle properly is that much more experience I've tackled. The bills get paid. I get time off. I'll be able to make money while I go back to school to become an NP. Sometimes I think a position in admin would be sweet. Heck... I wish I were a pilot.

I once held out my hand to catch feces "emerging" hoping it wouldn't soil the bed I just made (had gloves on).

 

[AnnoyedByFreud]

I find it nearly intolerable as well. And for you with your background (I think you are doing psych NP?), working on a floor in a hospital really isn't that relevant. However, for many NP specialties, BSN+MSN without RN clinical experience isn't sufficient.

This can be true, and it really does depend on the person and their background, specialty, etc. However, there are jobs outside of bedside nursing that I think can contribute to NP competency. I think to be an inpatient NP (like ACNP), then yes, RN experience in an acute setting is vitally important. However, for other specialties, I'm less than convinced, especially if the NP residency trend continues. My point is that nobody has to slave away at the bedside if they don't want to.

 

[sarjasy]

This can be true, and it really does depend on the person and their background, specialty, etc. However, there are jobs outside of bedside nursing that I think can contribute to NP competency. I think to be an inpatient NP (like ACNP), then yes, RN experience in an acute setting is vitally important. However, for other specialties, I'm less than convinced, especially if the NP residency trend continues. My point is that nobody has to slave away at the bedside if they don't want to.

The individual does matter, and its not to say a DE NP can't eventually figure it all out. I'm afraid however your lack of RN experience has caused you to not understand the critical importance of it for most all NP/APN specialties. Again, for psych, DE NP may be fine - maybe. But I cannot see how any other specialty can graduate from DE without being under-prepared (I include PA's without solid prior experience, though their additional clinical hours helps).

I graduated at the top of my class from my BSN. Not only that, I graduated with Highest Distinction as the top student in the entire college (that housed my nursing program) with a 3.986 overall GPA (4.0 in sciences). However, my MICU/SICU experience has been invaluable in my FNP program, especially in FNP clinicals. One cannot imagine how helpful intensive care experience is in managing primary care patients unless you've been there - it seems a stretch otherwise. My individual ability and preparation is not enough to overcome experience. And I am saying this as someone that considered and has defended DE in the past. I even went to nursing school specifically to be an FNP, so every class I took (A&P, chem, micro, patho, physical assessment, pharm, etc.) I approached and studied as a future provider, not as a future RN. But I was completely wrong. There are about 5-10% of students in my FNP program with little to no RN experience -- they are lost compared to those of us who do, and if they graduate and if they pass boards, they will be underprepared to practice even as a basic, new grad FNP. It will take them much longer to get up to speed. NP/APN schools were created and designed to produce providers based on previous experience.

 

[sarjasy]

I once held out my hand to catch feces "emerging" hoping it wouldn't soil the bed I just made (had gloves on).

And were you smiling (where admin folks could see you) when you did it?

 

[AnnoyedByFreud]

The individual does matter, and its not to say a DE NP can't eventually figure it all out. I'm afraid however your lack of RN experience has caused you to not understand the critical importance of it for most all NP/APN specialties. Again, for psych, DE NP may be fine - maybe. But I cannot see how any other specialty can graduate from DE without being under-prepared (I include PA's without solid prior experience, though their additional clinical hours helps).

I graduated at the top of my class from my BSN. Not only that, I graduated with Highest Distinction as the top student in the entire college (that housed my nursing program) with a 3.986 overall GPA (4.0 in sciences). However, my MICU/SICU experience has been invaluable in my FNP program, especially in FNP clinicals. One cannot imagine how helpful intensive care experience is in managing primary care patients unless you've been there - it seems a stretch otherwise. And I am saying this as someone that considered and has defended DE in the past. I even went to nursing school specifically to be an FNP, so every class I took (A&P, chem, micro, patho, physical assessment, pharm, etc.) I approached and studied as a future provider, not as a future RN. But I was completely wrong. There are about 5-10% of students in my FNP program with little to no RN experience -- they are lost compared to those of us who do, and if they graduate and if they pass boards, they will be underprepared to practice even as a basic, new grad FNP. It will take them much longer to get up to speed. NP/APN schools were created and designed to produce providers based on previous experience.

I appreciate your reply, though I can't help but disagree. My DE program is ~20 years old and has a track record of graduating many, many DE NPs who have gone into primary care settings just fine. This is not to say that RN experience isn't useful - it certainly is. But, there are other ways to become competent. I should also clarify that my program is geared towards DE students and does not assume that people have decades of RN experience, so the training is likely different from a program that expects its NP students to already have significant experience. Anyway, that's just the way I see it. I am aware that others disagree. For that reason I'm glad I'm in psych, since I'll hopefully face less opposition and shi* from RNs than some of my colleagues in other specialties. My program has been around a long time and has an excellent national reputation. It has been producing DE NPs for many years without a problem. The CNS and ACNP tracks require all DE students to step out and work as RNs for at least one year, but the rest of the specialties can go straight through.

 

[Nasrudin]

I appreciate your reply, though I can't help but disagree. My DE program is ~20 years old and has a track record of graduating many, many DE NPs who have gone into primary care settings just fine. This is not to say that RN experience isn't useful - it certainly is. But, there are other ways to become competent. I should also clarify that my program is geared towards DE students and does not assume that people have decades of RN experience, so the training is likely different from a program that expects its NP students to already have significant experience. Anyway, that's just the way I see it. I am aware that others disagree. For that reason I'm glad I'm in psych, since I'll hopefully face less opposition and shi* from RNs than some of my colleagues in other specialties. My program has been around a long time and has an excellent national reputation. It has been producing DE NPs for many years without a problem. The CNS and ACNP tracks require all DE students to step out and work as RNs for at least one year, but the rest of the specialties can go straight through.

You're still ridiculously unprepared. It's just that your patients and your supervisors will be taking up the slack for a 5-10 years of your practice. You're perceived lack of resistance is a simple matter of us needing warm bodies in psych. The fact that you interpret this as the overall preparedness of your clinical training is indicative of your lack of clinical training.

I have tons more health care experience than you, a 4 year physiology degree, and now close to 4 years of medical school. After 6 months of general medicine and neurology I will then begin at the trailhead of psychiatry training. I don't feel prepared for any of it. I feel perpetual unease as an acting intern on general medicine wards now.

A nurse with 5-10 years of good experience knows the patterns of care for many diseases. S/he knows how to read the signs and symptoms of sick patients. When to pick up the phone and say "No! not later, you come now!" to the appropriate services. You're partially right that these critical skills can be built in different ways but you're gravely wrong in concluding that direct entry NP programs are capable of even dangerously approximating the production of an independent clinician.

Not in medicine, not in psych, not in anything. Not today. Not in the future. Not ever.

 

[GasDreams]

So you don't have the motivation or time for medical school but you think you will to become a CRNA?

 

[NYCGuy86]

The individual does matter, and its not to say a DE NP can't eventually figure it all out. I'm afraid however your lack of RN experience has caused you to not understand the critical importance of it for most all NP/APN specialties. Again, for psych, DE NP may be fine - maybe. But I cannot see how any other specialty can graduate from DE without being under-prepared (I include PA's without solid prior experience, though their additional clinical hours helps).

I graduated at the top of my class from my BSN. Not only that, I graduated with Highest Distinction as the top student in the entire college (that housed my nursing program) with a 3.986 overall GPA (4.0 in sciences). However, my MICU/SICU experience has been invaluable in my FNP program, especially in FNP clinicals. One cannot imagine how helpful intensive care experience is in managing primary care patients unless you've been there - it seems a stretch otherwise. My individual ability and preparation is not enough to overcome experience. And I am saying this as someone that considered and has defended DE in the past. I even went to nursing school specifically to be an FNP, so every class I took (A&P, chem, micro, patho, physical assessment, pharm, etc.) I approached and studied as a future provider, not as a future RN. But I was completely wrong. There are about 5-10% of students in my FNP program with little to no RN experience -- they are lost compared to those of us who do, and if they graduate and if they pass boards, they will be underprepared to practice even as a basic, new grad FNP. It will take them much longer to get up to speed. NP/APN schools were created and designed to produce providers based on previous experience.

Interesting, thanks for your perspective. This is why I avoided DE APN programs. Though, I have noticed that some DE NP programs require you to work for a year prior to beginning the graduate program, FWIW.

It's interesting, working as a tech, I've noticed that when talking to a few of the nursing students that come through our unit on rotation have absolutely no interest in being a bedside nurse, and want to go immediately into NP. For me personally, as much as I desire that advanced practice role, and know that that's my end goal, I also want to fully embrace nursing as a profession, and practice as an RN (though let's be honest, med/surg isn't for me), since, at least from my perspective, that's how "advanced practice nursing" was designed. I also think that this is a strength when some bring up arguments about how PAs are supposedly better prepared than NPs. Plus, I'm interested, at least at this point, in ACNP, so it makes even more sense.

As for practicing as a nurse, well, I guess I'll see when I'm actually practicing, since all I have is somewhat of an outsider's perspective having worked as a tech/PCA for years. I definitely do see the BS about smiling/patient-visitor satisfaction, how they keep on adding new forms for documentation, staffing issues, the storing linen issues, and everything else that makes it more difficult to actually be a professional nurse. It's funny, one of the nurses I work with asked me on the weekend, "are you sure you still want to be a nurse??".

 

[NYCGuy86]

I am, for United.

Thank you everyone for sharing your experiences, they were all viewpoints that I had not considered. From what I can gather I think that shadowing several different types of nurses may be what I need to do. Becoming a EMT has also been suggested to me in order to get my feet wet a little before making the decision to dive in head first. I know that this is something I can do while keeping my current job.

Being an EMT is good. However, if you'd really like to see how the hospital setting works (and not just when you bring the patient to the ED or do inter-facility transfers...I was an EMT-B for 3 years), why not volunteer? EMT-B will definitely give you more of a feel for being a healthcare provider (though sometimes this depends on how the organization you're working/volunteering for uses EMT-Bs), as you'll be able to do assessments, give a limited number of medications (for more you'd have to be a paramedic or EMT-I if they have that), etc. However, it may be easier for you to check out the websites of the hospitals in your area and see if they have volunteering programs. With that, while you won't be doing anything interesting or exciting, you may be able to see interesting things, see how the physicians, nurses, and others work, and if it's really something you'd be interested in (especially observe the RNs to see if that's something you could see yourself doing prior to being an NP, at least if inpatient practice is your goal). Most likely at least one of the hospitals in your area has NPs and/or CRNAs that you could talk to/observe in practice (sometimes difficult though). I think that may be the best plan.

 

[fab4fan]

I appreciate your reply, though I can't help but disagree. My DE program is ~20 years old and has a track record of graduating many, many DE NPs who have gone into primary care settings just fine. This is not to say that RN experience isn't useful - it certainly is. But, there are other ways to become competent. I should also clarify that my program is geared towards DE students and does not assume that people have decades of RN experience, so the training is likely different from a program that expects its NP students to already have significant experience. Anyway, that's just the way I see it. I am aware that others disagree. For that reason I'm glad I'm in psych, since I'll hopefully face less opposition and shi* from RNs than some of my colleagues in other specialties. My program has been around a long time and has an excellent national reputation. It has been producing DE NPs for many years without a problem. The CNS and ACNP tracks require all DE students to step out and work as RNs for at least one year, but the rest of the specialties can go straight through.

I can see how you would believe that in psych previous experience caring for acutely ill patients wouldn't be necessary. The problem is, psych patients can get sick, and sometimes their symptoms present as if it were an acute psychiatric illness, when, in fact, they have something physically wrong with them.

I worked in psych for four years, and I can think of several patients whose physical illness was written off as part of their psych. diagnosis. One of those patients ultimately died; her provider was a psychiatrist with 30 years experience. It was very frustrating for me to try to communicate what I felt was going on with the patient, only to be brushed off by the patient's doctor. If he, with all his experience, could drop the ball in that case, what about the provider who has no clinical foundation? The other cases I referred to were also managed by psychiatrists with many years of experience. If you think the nurses are giving you a hard time, maybe it's because they're seeing something you are not.

 

[pamac]

Being an EMT is good. However, if you'd really like to see how the hospital setting works (and not just when you bring the patient to the ED or do inter-facility transfers...I was an EMT-B for 3 years), why not volunteer? EMT-B will definitely give you more of a feel for being a healthcare provider (though sometimes this depends on how the organization you're working/volunteering for uses EMT-Bs), as you'll be able to do assessments, give a limited number of medications (for more you'd have to be a paramedic or EMT-I if they have that), etc. However, it may be easier for you to check out the websites of the hospitals in your area and see if they have volunteering programs. With that, while you won't be doing anything interesting or exciting, you may be able to see interesting things, see how the physicians, nurses, and others work, and if it's really something you'd be interested in (especially observe the RNs to see if that's something you could see yourself doing prior to being an NP, at least if inpatient practice is your goal). Most likely at least one of the hospitals in your area has NPs and/or CRNAs that you could talk to/observe in practice (sometimes difficult though). I think that may be the best plan.

Precious hce really is a plus. It's not even so much the knowledge, but like was said its the difference between "watching" someone do hard things, and "doing" hard things. Watching someone walk across a tightrope is a different experience than walking the tightrope. As a new grad nurse with all the other new grads all hitting the floors at the same time, you can tell the ones that had prior health care foundations that they built off of. I guess the question becomes "how much experience is enough" as far as bedside nursing before NP school.

 

[sarjasy]

I appreciate your reply, though I can't help but disagree. My DE program is ~20 years old and has a track record of graduating many, many DE NPs who have gone into primary care settings just fine. This is not to say that RN experience isn't useful - it certainly is. But, there are other ways to become competent. I should also clarify that my program is geared towards DE students and does not assume that people have decades of RN experience, so the training is likely different from a program that expects its NP students to already have significant experience. Anyway, that's just the way I see it. I am aware that others disagree. For that reason I'm glad I'm in psych, since I'll hopefully face less opposition and shi* from RNs than some of my colleagues in other specialties. My program has been around a long time and has an excellent national reputation. It has been producing DE NPs for many years without a problem. The CNS and ACNP tracks require all DE students to step out and work as RNs for at least one year, but the rest of the specialties can go straight through.

I don't mean to pile on, or make you feel like you are being picked on. Also, I will maintain that for psych NP's, perhaps RN-level experience isn't as important. I also don't think anyone would say that "decades of RN experience" is required either. And I would add that your previous background is helpful in your specialty. However, your lack of RN experience will hinder your potential, even if you don't see it now and even if others tell you otherwise.

I understand you are now in your program and can't really change things. I am in something of the same boat. I will have nine months of full-time nursing prior to beginning my APN program, and then whatever amount of RN-level experience I pick up working part-time in my 28-month program (4000-5000 critical care hours total by the time I graduate). I would, in retrospect, liked to have more, but I can't change things now. My point is, I did not realize how helpful and important "bed side" experience is until I started doing it, believing initially that having no RN experience was perfectly fine, as you believe now. But now that I've done it, I see it much differently.

Working at the bedside in critical care titrating drips, performing physical assessments (neuro, cardio, pulm, etc.), monitoring vitals and hemodynamics, monitoring ventilation, reconciling/restarting home meds for critically ill patients along side physicians (and knowing when and when not to), spending 12 hours at a time with patients with various chronic problems (DM, CHF, COPD, A. Fib, PNE, renal failure, ETOH, you name it) with an acute overlying illness (MI, stroke, CA, ARDS, sepsis, MODS, ileus, myxedema, GIB, etc.). All the while ordering/reading/interpreting labs and other diagnostics, making rapid clinical decisions based on the patient's history, condition and diagnostic results, and having in-depth discussions daily regarding the patient with pulmonologists, cardiologists, endocrinologists, psychiatrists, nephrologists, infectious disease, gastroenterologists, orthopedists, hematologists, neurologists, etc. as well as PT, OT, RT, dieticians, social workers, and case managers. That can give you a foundation to the art and science of medicine that you simply cannot get in a classroom, from a book, or from the limited clinical hours in your MSN, even working as "only" an RN. The experience provides the basic knowledge needed for sound clinical judgement and instinct.

None of that experience makes you an MD/DO, of course. But it does lay the foundation to be trained as an APN. Furthermore, I am not saying critical care experience is mandatory for all APN's. It is simply to illustrate that experience as an RN is much more than wiping butts, consoling family members, and passing meds. It is about acquiring the foundational clinical experience and knowledge necessary to progress to advanced practice nursing.

 

[NYCGuy86]

I don't mean to pile on, or make you feel like you are being picked on. Also, I will maintain that for psych NP's, perhaps RN-level experience isn't as important. I also don't think anyone would say that "decades of RN experience" is required either. And I would add that your previous background is helpful in your specialty. However, your lack of RN experience will hinder your potential, even if you don't see it now and even if others tell you otherwise.

I understand you are now in your program and can't really change things. I am in something of the same boat. I will have nine months of full-time nursing prior to beginning my APN program, and then whatever amount of RN-level experience I pick up working part-time in my 28-month program (4000-5000 critical care hours total by the time I graduate). I would, in retrospect, liked to have more, but I can't change things now. My point is, I did not realize how helpful and important "bed side" experience is until I started doing it, believing initially that having no RN experience was perfectly fine, as you believe now. But now that I've done it, I see it much differently.

Working at the bedside in critical care titrating drips, performing physical assessments (neuro, cardio, pulm, etc.), monitoring vitals and hemodynamics, monitoring ventilation, reconciling/restarting home meds for critically ill patients along side physicians (and knowing when and when not to), spending 12 hours at a time with patients with various chronic problems (DM, CHF, COPD, A. Fib, PNE, renal failure, ETOH, you name it) with an acute overlying illness (MI, stroke, CA, ARDS, sepsis, MODS, ileus, myxedema, GIB, etc.). All the while ordering/reading/interpreting labs and other diagnostics, making rapid clinical decisions based on the patient's history, condition and diagnostic results, and having in-depth discussions daily regarding the patient with pulmonologists, cardiologists, endocrinologists, psychiatrists, nephrologists, infectious disease, gastroenterologists, orthopedists, hematologists, neurologists, etc. as well as PT, OT, RT, dieticians, social workers, and case managers. That can give you a foundation to the art and science of medicine that you simply cannot get in a classroom, from a book, or from the limited clinical hours in your MSN, even working as "only" an RN. The experience provides the basic knowledge needed for sound clinical judgement and instinct.

None of that experience makes you an MD/DO, of course. But it does lay the foundation to be trained as an APN. Furthermore, I am not saying critical care experience is mandatory for all APN's. It is simply to illustrate that experience as an RN is much more than wiping butts, consoling family members, and passing meds. It is about acquiring the foundational clinical experience and knowledge necessary to progress to advanced practice nursing.

Thanks again! It's so often that many non-nurses, even other healthcare professionals (physicians, PAs, RTs, etc) don't really have a perception of what nurses do, beyond "wiping butts, consoling family members, and passing meds" and just mindlessly "following orders" (I'm certainly not saying that's Annoyed). The benefit of what you describe to being an NP or any other type of Advanced Practice Nurse is clear (and of course this isn't limited to critical care nursing, but all other fields of nursing).

Can't wait to start nursing school in the fall!

 

[AnnoyedByFreud]

Oh wow, so many replies. Hmmm. I'll just say the following and hopefully it will address most of the replies:

1. One massive assumption here is that I didn't have experience in healthcare prior to starting my program. In my program you don't get in if you don't have experience in your field and I am no exception. I've got years of psych assessment experience obtained before starting my program, like most of my classmates in their respective specialties. Half my class already had an MPH before being admitted (or other masters, but mostly MPHs) and had been doing clinical research or public health work with their populations of interest. Some were EMTs, ER techs, etc. A few have doctorates. My program does not just pick up people who have good grades and zero HCE (I think this is more common in direct entry PA programs).

2. I specifically mentioned a lack of floor nursing not being a hindrance. Many of us are working as nurses in outpatient or research capacities, where we work with patients every day. I currently have a job like that and I see geripsych patients and do assessments on them for research, though I am not working as a floor nurse in this role.

3. Seriously, I'm not joking when I say that the majority of DE programs out there all housed in the top (most competitive) nursing schools. We are talking about Hopkins, Penn, Columbia, etc., and not Phoenix or Walden or whatever. My cohort had a 12% admission rate. These programs do not admit the average nursing student. I've talked to a lot of NPs and many feel that not having floor nursing experience is not a big deal at all, especially given that the direct entry model is nothing new or untested, but has actually existed for quite some time. I really don't know what to say, other than that it just isn't a big deal around here. The DE grads in primary care specialties get hired with no problems from my program and from all the other programs I was admitted to (I asked for hiring data for everywhere I was admitted).

4. The only research study done on this topic found that NP competence was not related to RN experience (as measured by MDs!!!).

I think one reason why the 'floor RN experience = better NP' doesn't necessarily hold true is because RN experience varies so widely, and so do NP roles. I think being an ICU nurse is fantastic experience for becoming an ACNP. After that, I'm just not seeing that it is a necessity when looking at the data nor in my experience in working with NPs in a lot of settings in a major metropolitan area. Is RN experience helpful? Of course! I know how useful RN experience is because I am an RN and I work alongside other RNs. Right now in my NP clinical I'm working with RNs and psychiatrists in an emergency setting and you'd better believe I know the value of what the RNs are doing for the patients and it's a pleasure to work with them and learn from them.

However, I also believe that any experience where you are thinking critically about the care and health of your patients is useful, whether it's RN experience or not. I wouldn't be so myopic as to say "You need -insert arbitrary number- of med surg experience before you can do XYZ" because it really depends on the person, their background, how quickly they learn, and what type of setting they want to work in. If that person is bright and already comes from a background where they are thinking critically and working with patients, then yes, they can learn a lot and fast. Will they still need guidance when they graduate? Yes. All new NPs do. For that reason, I think the DE model for NPs is not the disaster that many like to paint it as.

Alright, you all have my permission to flame on!

 

[fab4fan]

No flaming from me. Based on my experience, I just disagree with you.

So, do you already have your nursing license?

 

[AnnoyedByFreud]

Yes. I've had my license since mid summer. Those of us who did the accelerated RN program last year had to pass NCLEX over the summer before coming back for the MSN in the fall, so we are all licensed RNs now. Some of us are working as RNs in various capacities while we are in NP school, but we live in one of the most saturated areas of the country for RNs, so it's really hard to find work. A couple managed to snag new grad residencies and chose to take time off to work as RNs and not return to school for the MSN yet, and some might decide to work as RNs once they graduate with their MSN, since RNs make a crazy amount of money around here. However, most will work as NPs once they graduate (that is the reason we went to school in the first place). It all depends on people's preferences and life circumstances.

 

[JoBreeze]

Can a person do direct entry into acute care NP?

 

[NYCGuy86]

Can a person do direct entry into acute care NP?

From what I've seen, if you go to a direct entry NP program and choose the acute care NP, after completing the BSN portion and obtaining RN licensure, you have to work at least one year as an RN before beginning the masters program. Direct entry to FNP seems to allow you to go straight into the NP program without RN experience. ACNP programs in general ask for at least one year of acute care nursing experience, whether direct entry or not.

 

[Zenman1]

You're still ridiculously unprepared. It's just that your patients and your supervisors will be taking up the slack for a 5-10 years of your practice. You're perceived lack of resistance is a simple matter of us needing warm bodies in psych. The fact that you interpret this as the overall preparedness of your clinical training is indicative of your lack of clinical training.

I have tons more health care experience than you, a 4 year physiology degree, and now close to 4 years of medical school. After 6 months of general medicine and neurology I will then begin at the trailhead of psychiatry training. I don't feel prepared for any of it. I feel perpetual unease as an acting intern on general medicine wards now.

A nurse with 5-10 years of good experience knows the patterns of care for many diseases. S/he knows how to read the signs and symptoms of sick patients. When to pick up the phone and say "No! not later, you come now!" to the appropriate services. You're partially right that these critical skills can be built in different ways but you're gravely wrong in concluding that direct entry NP programs are capable of even dangerously approximating the production of an independent clinician.

Not in medicine, not in psych, not in anything. Not today. Not in the future. Not ever.

I had 37 years experience (med and psych) before going for Psych NP. Recently I've picked up Grave's disease, started treatment for a patient with undiagnosed Tourettes, and started Megace on a patient with unexplained weight loss. Was going to try Mirtazapine but dang-it his labs showed low WBC. My previous experience helped so much it's rediculous especially since great majority of psych patients have medical problems also. You have to remember many non-psych drugs cause psych symptoms and many medical conditions do also, remember: MEND A MIND
Metabolic
Electricla
Neoplastic
Drug
Arterial
Mechanical
Infectious
Nutritional
Degenerative

And all the pregnant people that keep showing up....

 

[Nasrudin]

I had 37 years experience (med and psych) before going for Psych NP. Recently I've picked up Grave's disease, started treatment for a patient with undiagnosed Tourettes, and started Megace on a patient with unexplained weight loss. Was going to try Mirtazapine but dang-it his labs showed low WBC. My previous experience helped so much it's rediculous especially since great majority of psych patients have medical problems also. You have to remember many non-psych drugs cause psych symptoms and many medical conditions do also, remember: MEND A MIND
Metabolic
Electricla
Neoplastic
Drug
Arterial
Mechanical
Infectious
Nutritional
Degenerative

And all the pregnant people that keep showing up....

This is exactly what clinical experience teaches you, what kind of things could happen. What could go wrong. What does. You can know that different ways. But you can't pull out of thin air. It comes from somewhere.

It's precisely why as docs, especially new ones like me, if we're wise, when experienced good nurses who care about what they're doing talk about their patients, we shut the f@ck up and listen. But you earn that. It's not given to you. Not being given it ='ing resistance is a worrisome notion.

 

[Dranger]

This is exactly what clinical experience teaches you, what kind of things could happen. What could go wrong. What does. You can know that different ways. But you can't pull out of thin air. It comes from somewhere.

It's precisely why as docs, especially new ones like me, if we're wise, when experienced good nurses who care about what they're doing talk about their patients, we shut the f@ck up and listen. But you earn that. It's not given to you. Not being given it ='ing resistance is a worrisome notion.

It goes both ways. New resident physicians and med students are like new officers in the military or a new mid-level manager at a corporation. A brand spanking new officer walks in with his advanced education/commission and is now in charge. He holds the highest rank in his platoon at the ripe age of 22 and his right hand man, the platoon sergeant, with 15+ years of experience is meant to guide and mentor this new leader even though he is of lesser rank. Wanna now how many new officers come in hard charging and fall flat on their face? A lot. No difference in the hospital. Nurses can make or a break you and on the flip side a good doctor can be an excellent teacher and deliverer of care which leads to a great shift. This is how it works in critical care, I don't know what residency you are in but I assure you a good RN doesn't have to earn anything from a PGY1 that doesn't stem from a mutual symbiotic relationship. Can RNs learn a lot from new docs? You betcha, but they also have to earn our respect as well. Unfortunately boards don't always filter a$$hats.

 

[Dranger]

For the OP, I know a few pilots and they are underpaid, overworked and stress to the max so I see where you are coming from.

For you I would look at getting a accelerated BSN, then try to get some ICU experience ASAP. Most likely you might have to work on a medical floor before ICU takes you but that's okay. After getting a few years of ICU experiences you can try for CRNA school which isn't exactly a cakewalk. The schools are pretty competitive and the pre reqs are similar to med school. If CRNA doesn't work out you could try for FNP or ACNP. I always recommend getting a few years of RN experience before NP school, just a personal preference.

 

[Nasrudin]

It goes both ways. New resident physicians and med students are like new officers in the military or a new mid-level manager at a corporation. A brand spanking new officer walks in with his advanced education/commission and is now in charge. He holds the highest rank in his platoon at the ripe age of 22 and his right hand man, the platoon sergeant, with 15+ years of experience is meant to guide and mentor this new leader even though he is of lesser rank. Wanna now how many new officers come in hard charging and fall flat on their face? A lot. No difference in the hospital. Nurses can make or a break you and on the flip side a good doctor can be an excellent teacher and deliverer of care which leads to a great shift. This is how it works in critical care, I don't know what residency you are in but I assure you a good RN doesn't have to earn anything from a PGY1 that doesn't stem from a mutual symbiotic relationship. Can RNs learn a lot from new docs? You betcha, but they also have to earn our respect as well. Unfortunately boards don't always filter a$$hats.

Of course I agree. But this sentiment argues in my favor. We have this thing in medicine called a residency. Designed exactly with the machinery to move the student to a working physician. Part of that is most certainly earning respect and trust.

 

[JoBreeze]

The god complex intern is largely a fantasy of the nurse that lacks external validation. Plenty of nurses are disrespected by the intern's very existence.

 

[d2305]

Take the prerequisites for PA school, and try to get accepted. Beats having to learn nursing theory.

 

[joeDO2]

The god complex intern is largely a fantasy of the nurse that lacks external validation. Plenty of nurses are disrespected by the intern's very existence.

Haha this comment made me laugh. I think there is definitely some truth to it. From what I've seen so far, the percentage of interns that are seen afraid, constantly apologetic, and getting eaten alive by nursing for existing, outnumbers those with a god complex 99:1.

 

[princess_chellebelle]

Yes. I've had my license since mid summer. Those of us who did the accelerated RN program last year had to pass NCLEX over the summer before coming back for the MSN in the fall, so we are all licensed RNs now. Some of us are working as RNs in various capacities while we are in NP school, but we live in one of the most saturated areas of the country for RNs, so it's really hard to find work. A couple managed to snag new grad residencies and chose to take time off to work as RNs and not return to school for the MSN yet, and some might decide to work as RNs once they graduate with their MSN, since RNs make a crazy amount of money around here. However, most will work as NPs once they graduate (that is the reason we went to school in the first place). It all depends on people's preferences and life circumstances.

Just curious, where in the U.S. are you? Which school are you in currently?

 

[Justine]

If you want to be a hospitalist with adults, I would recommend PA school because it's less time and money than getting your BSN and then getting your Master's degree. You should shadow a couple of PAs and NPs in different specialties to get a feel for what are you are interested.

I felt pretty sad reading about all the admin nursing stuff that folks have been talking about. I just wanted to say that it doesn't have to be that way. My hospital isn't perfect by any means, but I love my job and feel like I'm an important part of the hospital team and my docs/NPs/PAs take my opinion seriously. I guess the large caveat is that I work in NICU and that adult medicine is extraordinarily different.

 

[pamac]

At my facility, the hospitalists are physicians and NPs. The PAs that I briefly see are usually surgical and doing brief rounds. The folks in the area are used to seeing docs stop in, but I've yet to see someone throw a fit when a nonphysician provider stops in. We all work together well as a group between the nurses, physicians, and pa/nps. In fact, there is a tremendous degree of respect shown among everyone. I've had great doctors sit down and explain stuff to me and humor me on things that I'm not up to speed on. It's rare that there's a clash on philosophies. A lot of that could be to the fact we are as busy as we can be. I might be spoiled where I am now. When you are working alongside folks that see how hard you work, and you see how hard they work, it seems like it's just easier to find solutions to keep from getting bogged down. The residents come into that environment and fit in well too. We treat them with respect. We treat the new nurses and aides well. The folks who don't want to play ball stick out like a sore thumb and find it hard to get work done. But the bosses are the bosses, and the docs are the gatekeepers for writing the orders I need to get stuff done (and in a timely manner), so I do what I need to do to keep things fluid.

Doc wants to keep the patient happy, so it helps to keep the nurses happy. Nurses want to keep the patient happy, so it helps to keep the doc happy so they can enable you to do things for the patient that will make that happen. Sometimes, I need someone with Godlike power to come in and talk to the patient and tell them what's up, to write an order for something, to take the heat for something the patient doesn't want me to do but needs to get done, to grease the wheel with another physician who is being a pain in the neck to RNs but will listen to another physician, to go to bat for me when another nurse peer won't, to resuscitate a patient, to fill me in on the back story of a patient they've known a lot longer than I have.... The list goes on.