Aug 12, 2019
5
1
So I have a Biology degree and was looking for programs to apply for to eventually become a NP.

I can either do a Accelerated nursing program and eventually apply for a MSN later to end up becoming a NP or a entry level master's program for people with a non-nursing Bachelor's degree.

I'm assuming the MENP might be a quicker path towards the goal. Am I wrong about this? Which would be the best action to take? What are the pros/cons of both?
 

pamac

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Mar 30, 2010
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Do the accelerated bachelors and then NP school. Most likely it’s just as fast if certain circumstances are followed. But overall the reasons I like that route have to do with the latitude it gives you. I’ll lay it out for you.

Entry level masters typically are set up to be done in person in a handful of cities. You spend the first year or so getting your RN. The problem is that often you get the RN, but they don’t have a way to opt out and hold a BSN degree before you continue on to get the masters as an NP. You’ll have the RN certification, but not the BSN degree. The programs I looked at didn’t have an off ramp so to speak, where you could opt out of the NP and be well positioned. Anyway, you get an RN, and then you start he NP portion, and oftentimes they set it up so you can work a little while you work on the NP. The NP school is also in person as well. They tend to be expensive too. I think they mostly take three years.

If you do an accelerated bachelors that takes a year, then you can start working and decide if you are ready to jump right into NP school while you work, or else take some time to be a nurse. It gives you that latitude. You won’t have to relocate to the handful of towns that have a school that offers a direct entry NP degree. If you do a year in an accelerated BSN program, and then immediately do an NP program, you could conceivably be practicing in just over 3 years. So what you end up with with that pathway is to create your own direct entry program, but have the freedom to stay local, and work while you go to school, or even take a break and just be a nurse for a while. Most folks I know take some time to work and make some money not be a student for a little bit. I did a bit of that, although I probably should have just kept on working towards my Np instead of taking a couple years off. I feel like its also cheaper to go ABSN to NP rather than the direct entry NP program, especially when you factor in how much you make as a nurse while you do NP school. Despite someone on here that insists most nurses start out at $35,000 per year (which simply isn’t true unless you are unlucky enough to live in a small subset of backwoods locales in the country), I started out as an RN around $60k I think. I’m in a state where cost of living is low, but wages also can be a bit lower. I went through school working full time. I’m simply not sure about the arrangements in a direct entry program and how it works bout for people to work as an RN.
 
Jun 25, 2019
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Do the accelerated bachelors and then NP school. Most likely it’s just as fast if certain circumstances are followed. But overall the reasons I like that route have to do with the latitude it gives you. I’ll lay it out for you.

Entry level masters typically are set up to be done in person in a handful of cities. You spend the first year or so getting your RN. The problem is that often you get the RN, but they don’t have a way to opt out and hold a BSN degree before you continue on to get the masters as an NP. You’ll have the RN certification, but not the BSN degree. The programs I looked at didn’t have an off ramp so to speak, where you could opt out of the NP and be well positioned. Anyway, you get an RN, and then you start he NP portion, and oftentimes they set it up so you can work a little while you work on the NP. The NP school is also in person as well. They tend to be expensive too. I think they mostly take three years.

If you do an accelerated bachelors that takes a year, then you can start working and decide if you are ready to jump right into NP school while you work, or else take some time to be a nurse. It gives you that latitude. You won’t have to relocate to the handful of towns that have a school that offers a direct entry NP degree. If you do a year in an accelerated BSN program, and then immediately do an NP program, you could conceivably be practicing in just over 3 years. So what you end up with with that pathway is to create your own direct entry program, but have the freedom to stay local, and work while you go to school, or even take a break and just be a nurse for a while. Most folks I know take some time to work and make some money not be a student for a little bit. I did a bit of that, although I probably should have just kept on working towards my Np instead of taking a couple years off. I feel like its also cheaper to go ABSN to NP rather than the direct entry NP program, especially when you factor in how much you make as a nurse while you do NP school. Despite someone on here that insists most nurses start out at $35,000 per year (which simply isn’t true unless you are unlucky enough to live in a small subset of backwoods locales in the country), I started out as an RN around $60k I think. I’m in a state where cost of living is low, but wages also can be a bit lower. I went through school working full time. I’m simply not sure about the arrangements in a direct entry program and how it works bout for people to work as an RN.
Come on man. Quit the attacks. Let's be professional. My area that I live in is very rural but wages in in rural areas are a little higher than the big cities I am referring too. I just looked last night that the average RN salary (so all experience levels) in a major city of a population over 300k was $41k per year. That city is 2 1/2 hrs from me. Another big city of 200k that is 45 mins from me their average salary for RNs is $43k per year. More money in a smaller town with a lower COL. RNs will make a few bucks more per hour way out in the sticks where we live. But that is average for 2018 and 2019. So my wife starting at $35k 5 years ago is true.... please stop embarrassing yourself.
Now back to the OP. Maybe look into PA school the science background you would like more, you have better core rotations with standardized clinicals and specialized rotations in parts of medicine you are interested in. Also you have more laterality to change specialities than NPs do. You will have to go back to school to make a major specialty change as a NP. Such as if your a psych NP and hate that and want to do ER or peds or family you must go back to school to get certified. If your a ANP and want to so peds now then you must go back to get your PNP or FNP. The PA laws are already changing or have changed in most states where they are very similar to NPs. Yes there are 20+ states that have independent practice but that really doesnt affect us. Maybe in family practice but overall you will have a job and be find. OTP is coming soon. Good luck!
 

pamac

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Mar 30, 2010
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Come on man. Quit the attacks. Let's be professional. My area that I live in is very rural but wages in in rural areas are a little higher than the big cities I am referring too. I just looked last night that the average RN salary (so all experience levels) in a major city of a population over 300k was $41k per year. That city is 2 1/2 hrs from me. Another big city of 200k that is 45 mins from me their average salary for RNs is $43k per year. More money in a smaller town with a lower COL. RNs will make a few bucks more per hour way out in the sticks where we live. But that is average for 2018 and 2019. So my wife starting at $35k 5 years ago is true.... please stop embarrassing yourself.
Now back to the OP. Maybe look into PA school the science background you would like more, you have better core rotations with standardized clinicals and specialized rotations in parts of medicine you are interested in. Also you have more laterality to change specialities than NPs do. You will have to go back to school to make a major specialty change as a NP. Such as if your a psych NP and hate that and want to do ER or peds or family you must go back to school to get certified. If your a ANP and want to so peds now then you must go back to get your PNP or FNP. The PA laws are already changing or have changed in most states where they are very similar to NPs. Yes there are 20+ states that have independent practice but that really doesnt affect us. Maybe in family practice but overall you will have a job and be find. OTP is coming soon. Good luck!
Your numbers aren’t correct. $35,000 per year comes out to less than $20 per hour. I think you are mistaking RNs for LPNs, because there’s just no reconciling reality with what you keep insisting is the norm, except as maybe a remote outlier. Even 5 years ago, your numbers wouldn’t be accurate for most places. The only embarrassing thing is that you keep sticking to that line. Urban situations are traditionally better paying for nurses overall because there are more options and competition. The rural places can see some recruiting challenges that encourage high wages in some cases, but any nurse knows it’s not typically the case to see dramatic changes in wages that put them well above cities. Rural areas also struggle with funding their staff, and are facing hospital closures at a steady pace. It’s a big problem, and has been for some time. Sorry bud... not convincing anyone.

So now let’s let’s cover state to state regs. You did acknowledge that independence for NPs is a thing in about half of states, most recently Illinois and Virginia. Optimal team practice is the new goal for PAs that essentially places supervision of PAs under “the practice” vs having specifically mandated and delineated physicians to supervise them. It’s better to have OTP when compared to direct supervision, I guess. However, in my mind it doesn’t really change much because PAs under OTP are still required to work for a practice and be supervised at that level, which means physicians will still have the most say in PA scope of practice. OTP doesn’t include such things as independent billing, or other goodies, but it’s more progress than PAs have ever seen. OTP is operating in less than 5 states I think. California just passed OTP, which puts them almost to where NPs are, which is fine because NPs will be independent there next year or the year after, which will leave PAs in the dust. The nurses are working California hard to get independence, and it’s just a matter of time.

Lateral mobility is an option for PAs that NPs don’t have to the same extent. It’s what PAs were meant to be able to do. In reality, there are catches. For one, employers are gradually looking for things on resumes like PA residencies, CAQ certs, and experience in the specialty. It’s just part of a tightening job market. Don’t get me wrong, PA mobility was once a huge draw for me when I was interested in PA school. But in reality, your skill set takes a hit when you jump around too much. You can jump from ER to derm, or psyche to ER, but you’d have to confront a new learning curve to do so. It’s not impossible, but not something that someone would want to do very much because it risks watering down your expertise. But I guess you could be looking at it enhancing your marketability if you were to go from something like ER to urgent care. All I know is that I don’t see as mich jumping around as I did 10 years ago. My PA friends typically try to stay out and advocate for being rewarded by their employers for increased familiarity with the specialty that comes with time. But indeed, as a PA, that latitude will be more accessible. However, as a nurse, you typically get good enough exposure to the medical field that you settle into a realm that you feel comfortable in. I’m a Psyche NP... that’s really all I’ve been interested doing. And if I ever were get sick of that, I find a program to do a post masters certificate at, and then get some good rotations with a great colleague, and change gears. It does happen, and I’m seeing quite a few FNPs pursuing psyche right now. You still have options, but they require more training to take advantage of. A lot of excellent insight can be provided regarding the PA field over at the PA forums website. There are hundreds of threads that highlight a lot of the challenges and positive aspects of PA practice.

If PA interests you, it’s a good option to look into. I don’t like many of the limitations, and for me as an independent provider, being a PA would represent a significant hinderance. But under most circumstances, many or most roles in my state would be very similar if you compared what NPs and PAs are doing in the day to day work environment. My peers in primary care that run their own practices seem to enjoy it, but it’s a lot of work, and not as lucrative vs if I spent a lot of time running my own psyche clinic. I’m not a glutton for punishment, and don’t have a desire right now to work for myself full time.

So anyway, certainly consider PA. It’s a great field. Well trained folks who do have great training. If you are set on NP, I’m a big fan of creating your own fast track NP program by combining the accelerated BSN with a follow up NP.
 
Last edited:
Jun 25, 2019
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Your numbers aren’t correct. $35,000 per year comes out to less than $20 per hour. I think you are mistaking RNs for LPNs, because there’s just no reconciling reality with what you keep insisting is the norm, except as maybe a remote outlier. Even 5 years ago, your numbers wouldn’t be accurate for most places. The only embarrassing thing is that you keep sticking to that line. Urban situations are traditionally better paying for nurses overall because there are more options and competition. The rural places can see some recruiting challenges that encourage high wages in some cases, but any nurse knows it’s not typically the case to see dramatic changes in wages that put them well above cities. Rural areas also struggle with funding their staff, and are facing hospital closures at a steady pace. It’s a big problem, and has been for some time. Sorry bud... not convincing anyone.

So now let’s let’s cover state to state regs. You did acknowledge that independence for NPs is a thing in about half of states, most recently Illinois and Virginia. Optimal team practice is the new goal for PAs that essentially places supervision of PAs under “the practice” vs having specifically mandated and delineated physicians to supervise them. It’s better to have OTP when compared to direct supervision, I guess. However, in my mind it doesn’t really change much because PAs under OTP are still required to work for a practice and be supervised at that level, which means physicians will still have the most say in PA scope of practice. OTP doesn’t include such things as independent billing, or other goodies, but it’s more progress than PAs have ever seen. OTP is operating in less than 5 states I think. California just passed OTP, which puts them almost to where NPs are, which is fine because NPs will be independent there next year or the year after, which will leave PAs in the dust. The nurses are working California hard to get independence, and it’s just a matter of time.

Lateral mobility is an option for PAs that NPs don’t have to the same extent. It’s what PAs were meant to be able to do. In reality, there are catches. For one, employers are gradually looking for things on resumes like PA residencies, CAQ certs, and experience in the specialty. It’s just part of a tightening job market. Don’t get me wrong, PA mobility was once a huge draw for me when I was interested in PA school. But in reality, your skill set takes a hit when you jump around too much. You can jump from ER to derm, or psyche to ER, but you’d have to confront a new learning curve to do so. It’s not impossible, but not something that someone would want to do very much because it risks watering down your expertise. But I guess you could be looking at it enhancing your marketability if you were to go from something like ER to urgent care. All I know is that I don’t see as mich jumping around as I did 10 years ago. My PA friends typically try to stay out and advocate for being rewarded by their employers for increased familiarity with the specialty that comes with time. But indeed, as a PA, that latitude will be more accessible. However, as a nurse, you typically get good enough exposure to the medical field that you settle into a realm that you feel comfortable in. I’m a Psyche NP... that’s really all I’ve been interested doing. And if I ever were get sick of that, I find a program to do a post masters certificate at, and then get some good rotations with a great colleague, and change gears. It does happen, and I’m seeing quite a few FNPs pursuing psyche right now. You still have options, but they require more training to take advantage of. A lot of excellent insight can be provided regarding the PA field over at the PA forums website. There are hundreds of threads that highlight a lot of the challenges and positive aspects of PA practice.

If PA interests you, it’s a good option to look into. I don’t like many of the limitations, and for me as an independent provider, being a PA would represent a significant hinderance. But under most circumstances, many or most roles in my state would be very similar if you compared what NPs and PAs are doing in the day to day work environment. My peers in primary care that run their own practices seem to enjoy it, but it’s a lot of work, and not as lucrative vs if I spent a lot of time running my own psyche clinic. I’m not a glutton for punishment, and don’t have a desire right now to work for myself full time.

So anyway, certainly consider PA. It’s a great field. Well trained folks who do have great training. If you are set on NP, I’m a big fan of creating your own fast track NP program by combining the accelerated BSN with a follow up NP.
Good points. I agree with looking into both. My wife made $19/hr ad a new RN and alot of my friends now start out around $21/hr now. At 36 hours per week $35k is $20 and change per hour so no I ain't wrong and I know what RNs are and LPNs are. I have 3 RNs at my clinic and 1 LPN. My wife is a RN. I know the difference. The sorry part is that your think I'm lying. That's what's incredible about you. What do I have to gain about lying on this topic? Really? I know how much my wife made. Keep trying to discredit me.
 

pamac

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Mar 30, 2010
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Sigh......You aren’t even close to correct, and that’s the problem with why you keep pushing this. I’m in a lower cost of living state in most parts. I’m in a lower wage state in most parts. I was an RN longer ago than your wife. My facility I worked at was not known to try to beat the competition on wages. And I still started several dollars more per hour than $19.00. And you are saying that you know people that are starting out NOW as RNs at $20 an hour, when new RNs in my whole region (the one where COL is low and wages aren’t considered anything to write home about) are starting mid $30’s/ hour?

Here’s another thing.... in the clinic environment, RNs make less than hospital based RNs. They also don’t get a crack at differentials or overtime. They typically sacrifice those for a steady 8-5 M-F, no nights, weekends, or holidays, low stress job. Let’s say that one of those clinic nurses was lucky enough to swing a job that pays equal to the $35,000 you insist that hospital nurses make where you are (which like I said is not likely).... then those clinic nurses are pulling $16.80 at 40 hours. That’s how I knew you were just throwing things out there.

But even if.... if... RNs in some place in America make that incredibly (and strangely convenient for your argument) low wage, would it be smart to use that unique circumstance as the conventional wisdom by which we base our conversation? Or instead, don’t you think that me, as someone who still is technically an RN, who actually knows what nurses make, should have a better idea of what someone can expect to make upon graduation. People aren’t lining up in droves to get into nursing school because they start at/or make $35,000 per year. I checked salary.com all over the country, and that’s what medical assistants make in places like Florida, Louisiana, Missouri, Iowa, and Colorado. I made almost twice that much my first year as a nurse, and part of that year we were prohibited from overtime. I also had very few differential opportunities.... in a lower paying locale. It’s not like I was on the west coast or in some unique circumstances. If a nurse is coming out of school making $35,000, I can say with confidence that they are either foolish as one can be, or else are in the most undesirable location in the country. But that wage is far, far less than typical.

Let’s use 2017 stats compiled by the BLS. I found their numbers to be consistent with what I saw as a nurse:


So if you want to have a conversation, come with something meaningful and accurate to say. I actually think you sound suspiciously like another poster who coincidentally also is married to an NP, doesn’t like the idea of PAs being independent, disregards RNs constantly, and always compares the lowest possible numbers on nursing and NP statistics with the highest possible PA statistics to pad numbers in their favor. Every NP school to him is online and direct entry, and every NP has no experience as a nurse, and every NP has completed the minimum standards.

So keep taking about professionalism, and I’ll keep on laughing at you.
 
Last edited:
Jun 25, 2019
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Sigh......You aren’t even close to correct, and that’s the problem with why you keep pushing this. I’m in a lower cost of living state in most parts. I’m in a lower wage state in most parts. I was an RN longer ago than your wife. My facility I worked at was not known to try to beat the competition on wages. And I still started several dollars more per hour than $19.00. And you are saying that you know people that are starting out NOW as RNs at $20 an hour, when new RNs in my whole region (the one where COL is low and wages aren’t considered anything to write home about) are starting mid $30’s/ hour?

Here’s another thing.... in the clinic environment, RNs make less than hospital based RNs. They also don’t get a crack at differentials or overtime. They typically sacrifice those for a steady 8-5 M-F, no nights, weekends, or holidays, low stress job. Let’s say that one of those clinic nurses was lucky enough to swing a job that pays equal to the $35,000 you insist that hospital nurses make where you are (which like I said is not likely).... then those clinic nurses are pulling $16.80 at 40 hours. That’s how I knew you were just throwing things out there.

But even if.... if... RNs in some place in America make that incredibly (and strangely convenient for your argument) low wage, would it be smart to use that unique circumstance as the conventional wisdom by which we base our conversation? Or instead, don’t you think that me, as someone who still is technically an RN, who actually knows what nurses make, should have a better idea of what someone can expect to make upon graduation. People aren’t lining up in droves to get into nursing school because they start at/or make $35,000 per year. I checked salary.com all over the country, and that’s what medical assistants make in places like Florida, Louisiana, Missouri, Iowa, and Colorado. I made almost twice that much my first year as a nurse, and part of that year we were prohibited from overtime. I also had very few differential opportunities.... in a lower paying locale. It’s not like I was on the west coast or in some unique circumstances. If a nurse is coming out of school making $35,000, I can say with confidence that they are either foolish as one can be, or else are in the most undesirable location in the country. But that wage is far, far less than typical.

Let’s use 2017 stats compiled by the BLS. I found their numbers to be consistent with what I saw as a nurse:


So if you want to have a conversation, come with something meaningful and accurate to say. I actually think you sound suspiciously like another poster who coincidentally also is married to an NP, doesn’t like the idea of PAs being independent, disregards RNs constantly, and always compares the lowest possible numbers on nursing and NP statistics with the highest possible PA statistics to pad numbers in their favor. Every NP school to him is online and direct entry, and every NP has no experience as a nurse, and every NP has completed the minimum standards.

So keep taking about professionalism, and I’ll keep on laughing at you.
Salary.com also says nurses in my area make 75k on average Haha I literally just text 2 of my friends that ar RNs in the hospital. One is a PICU nurse with 4 years experience and night supervisor and the other is a CCU charge nurse day shift. The picu RN makes $23 per hour and the CCU nurse with 7 years experience makes $25 per hour. She said the ceiling was $30 per hour. My wife only work in a level 1 trauma center. I know alot about nursing as I am married to one. I know clinic nurses are lower paid. My friend that is a picu nurse worked 1 year at a local UC and started at $17/hr 5 years ago. So not sure what your think I'm lying about. I hired several MAs at my clinic and they start out at $9.25/he. The LPN that I worked with and interviewed at my 1st PA job 5 years ago was started out at $12.75/hr and she had 2 one years experience and it is in one of the poorest most rural areas in my state. I am telling you your stats online are not accurate. Again how much more proof do I need to give you. I can text more nurses I know if you would like.
 

pamac

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Why are all the statistics accurate for me and where I work, and yet aren’t for your “sources”. At the very least that would represent your area as an outlier, wouldn’t it?

In fact a lot of new nurses are being picked up for high wages, and have been for several years, much to the frustration of more experienced nurses. That’s why there’s a common notion among RNs that the way to get raises is to jump around every few years to different facilities because if you stay in one place, you usually only get a meager raise every year that may help offset cost of living increase.

One thing that I might be willing to entertain is that maybe where you are is just really poor (and therefore an outlier). If nurses are making $35,000, and by comparison you are making like $75,000, then I could buy that. My hunch is that for some reason you are paid well, because that fits with your narrative where PAs are always awesome and nurses and NPs aren’t.
 
OP
I
Aug 12, 2019
5
1
One of the MENP programs that I've been thinking about is in a state where it recently created independence for a nurse practitioner, nurse midwife or clinical nurse specialist.

-> The MENP program is 2 years and the tuition would be 75,000$ over those 2 years. I already asked but you will not receive a BSN degree during this period but you will receive a MS in Nursing with obviously the ability to take the NCLEX to become a RN.

-> Also have the ability to apply for PA schools with a great GPA but my healthcare experience hasn't been the best compared to others. I have one university option in state that would cost around 40,000$ for 2 years but I would need to take the GRE in order to apply for it which seems really annoying. Most of the other PA schools cost about the same out of state as the MENP program ($80Kish). I really want to apply for this year's cycle but the GRE portion has me worried as I would prefer to apply without it obviously but I guess it's needed. In most of the MENP programs, you can avoid taking the GRE as long as your GPA was over 3.2 in undergrad.

-> the ABSN that you mentioned definitely seems like the best bang for your buck. I can finish a program in about 12-16 months for about 30,000$ in tuition then I probably have to work for a year or so and gain experience and get into a NP program afterwards. Downfall is I'd rather not work too long as a RN but I understand the experiences of doing it before you become a NP.
 
Last edited:
Jun 25, 2019
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Why are all the statistics accurate for me and where I work, and yet aren’t for your “sources”. At the very least that would represent your area as an outlier, wouldn’t it?

In fact a lot of new nurses are being picked up for high wages, and have been for several years, much to the frustration of more experienced nurses. That’s why there’s a common notion among RNs that the way to get raises is to jump around every few years to different facilities because if you stay in one place, you usually only get a meager raise every year that may help offset cost of living increase.

One thing that I might be willing to entertain is that maybe where you are is just really poor (and therefore an outlier). If nurses are making $35,000, and by comparison you are making like $75,000, then I could buy that. My hunch is that for some reason you are paid well, because that fits with your narrative where PAs are always awesome and nurses and NPs aren’t.
Cause the same sources you are stating I looked up info for myself, RNs and other RNs out of state and they are not accurate. Salary.com says nurses in my area average $75k which is not true and then you go to a different website and it says $41k average for the exact same zip code. Also 5 years ago all providers NPs and PAs started around $55k-$60k. They have sense gave a $7/hr increase across the hospitals in the area. My wife was doing a PRN gig at a local minute clinic last year 2018. She was given the hiring pay ranges from her manager and starting pay was $29 with ceiling at $52/hr. At my first job with a big hospital system (they are in 6 or 7 different states) I was also given the ranges for outpatient family medicine and I was started at $33/hr (I worked with the health system for over 5 years prior to that in another position before Pa school) so I got a little bump. Bee graduates started at $29/hr. The ceiling was around $105,000k. So no we aren't in a weird rural area as I described the size of 2 towns around me. Lastly I spoke with 2 of my friends last night like I said in my other poster and they are saying the exact same thing. This is all over the state except about a $5 more per hour in the far north of the state.
Back to the OP: take GRE and apply to PA school. If you dont get in then do the ABSN as you will get better clinical experience as working as a nurse which is important plus its cheaper. In 20 years you wont even know the difference except you have more money. Not paying off student loans forever. Good luck!
 

pamac

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Mar 30, 2010
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Cause the same sources you are stating I looked up info for myself, RNs and other RNs out of state and they are not accurate. Salary.com says nurses in my area average $75k which is not true and then you go to a different website and it says $41k average for the exact same zip code. Also 5 years ago all providers NPs and PAs started around $55k-$60k. They have sense gave a $7/hr increase across the hospitals in the area. My wife was doing a PRN gig at a local minute clinic last year 2018. She was given the hiring pay ranges from her manager and starting pay was $29 with ceiling at $52/hr. At my first job with a big hospital system (they are in 6 or 7 different states) I was also given the ranges for outpatient family medicine and I was started at $33/hr (I worked with the health system for over 5 years prior to that in another position before Pa school) so I got a little bump. Bee graduates started at $29/hr. The ceiling was around $105,000k. So no we aren't in a weird rural area as I described the size of 2 towns around me. Lastly I spoke with 2 of my friends last night like I said in my other poster and they are saying the exact same thing. This is all over the state except about a $5 more per hour in the far north of the state.
Back to the OP: take GRE and apply to PA school. If you dont get in then do the ABSN as you will get better clinical experience as working as a nurse which is important plus its cheaper. In 20 years you wont even know the difference except you have more money. Not paying off student loans forever. Good luck!
Obviously you want to maintain confidentiality about where you are at, which is a good idea, but I have to say that that place seems to me to be uniquely awful in terms of wages for everyone. For PAs and NPs to start at $55k-$60k is worse than I’ve ever heard. I’m not kidding that I really haven’t heard anything that bad. I thought stories of NPs starting at $75,000 was unbelievable. But if what you are saying is the case, it seems to be reflected across the board.

My stance is that knowing what I know about my area, along with all the folks I’ve worked with that moved in from all over the county, and the travelers who worked with me, I can say with confidence that most places aren’t like that. My scope of knowlege really encompasses a lot of the area well west of the Mississippi, because I know people from all over, and having visited places and talked to recruiters, I’m familiar with a lot of the wages. If everywhere was like what you say, then I would even suggest anyone take a long hard look at even being a nurse. But if cost of living is super low, and everyone around you has that kind of wage depression, then sure, don’t go out and spend mortgage sized money on an RN degree, or consider simply moving away. Cheap housing in a place like that is a blessing, but even if houses are cheaper in those kinds of places, cars, gas, goods and services typically cost the same across the nation.

I’m frugal. I’m the guy Dave Ramsey tells everyone to be like. But I also feel like there are costs that go into delaying things because you think it’s cheaper. I mostly suggest people take out the loans and go to PA or RN or NP school sooner and get in the market making better money. Whether they want to be frugal after they get the income up is up to them. Smart people address the debt quickly.
 
Jun 25, 2019
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Obviously you want to maintain confidentiality about where you are at, which is a good idea, but I have to say that that place seems to me to be uniquely awful in terms of wages for everyone. For PAs and NPs to start at $55k-$60k is worse than I’ve ever heard. I’m not kidding that I really haven’t heard anything that bad. I thought stories of NPs starting at $75,000 was unbelievable. But if what you are saying is the case, it seems to be reflected across the board.

My stance is that knowing what I know about my area, along with all the folks I’ve worked with that moved in from all over the county, and the travelers who worked with me, I can say with confidence that most places aren’t like that. My scope of knowlege really encompasses a lot of the area well west of the Mississippi, because I know people from all over, and having visited places and talked to recruiters, I’m familiar with a lot of the wages. If everywhere was like what you say, then I would even suggest anyone take a long hard look at even being a nurse. But if cost of living is super low, and everyone around you has that kind of wage depression, then sure, don’t go out and spend mortgage sized money on an RN degree, or consider simply moving away. Cheap housing in a place like that is a blessing, but even if houses are cheaper in those kinds of places, cars, gas, goods and services typically cost the same across the nation.

I’m frugal. I’m the guy Dave Ramsey tells everyone to be like. But I also feel like there are costs that go into delaying things because you think it’s cheaper. I mostly suggest people take out the loans and go to PA or RN or NP school sooner and get in the market making better money. Whether they want to be frugal after they get the income up is up to them. Smart people address the debt quickly.
Yes very low COL where 1 acre of land still cost less that $2,000. I agree with schooling and getting into the money market sooner but if you have a option to spend 1 more year in school and Dave $40k in student loans (plus interest) it would be smarter to go to the cheaper school IMO. I really have no hard feels for you or NPs. I just get upset when I see nurses working 1 year going to a online school with little clinicals (and everything else that comes with that like 14 hr shifts, weekends, nights etc) and get their degree and make as much as me or more (speaking in my area). I busted my butt doing alot more than my wife and it makes me mad that NPs in almost every state have more privileges, better laws etc. Maybe that's why I'm so sour toward you and I apologize. I will tone it down. Thanks for a nice reply.
 

pamac

7+ Year Member
Mar 30, 2010
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I think there is more I agree with you in overall than disagree with.

I would be the first person to say that PAs are better trained in school, and often in clinic. I’d also add that because of that, they should have practice latitude on par with NPs. I see the PA model of training as serving the student most effectively. You don’t see PA students going out and having to find their rotations. PA students also tend to have a solid science background, which is never s bad thing. I have one too, and it’s helped me a ton among my NP peers.

I’m starting to get a bit annoyed at folks in nursing wanting to get on the bandwagon of NP school, but I guess the reasons I don’t get too bent out of shape yet are because A) I can’t blame them.... nursing at the bedside is hard, B) I did the same thing, and never intended to stay in nursing, even before I was a nurse C) it’s reasonable to want to improve your career prospects, and D) it’s not as easy as it sounds to get through school, so it doesn’t seem as bandwagonish. However, talk to me when new NPs invade psyche to point that it depresses my own wages... I’ll probably be less enthused about NP wannabe’s.

Nursing fluff classes? Yes, there are lots of them, and yes, I agree that a more robust coursework like pathophys or pharm would be a good substitution for community nursing theory, etc. Any improvement in quality is a good thing.

Yes, I’ve seen a handful of terrible bat-sh— crazy NPs with weird ideas and methods, because all they had to do was strap in and plug through NP school, and there wasn’t much to filter them out of the process. Fortunately they are the minority, but that’s more of a problem with NPs because PA school is so competitive, and doesn’t suffer fools or overly eccentric personalities.

I have a clear perspective regarding NPs and their deficiencies and downsides. I lived with that as a floor nurse through experiences such as when an idiot NP would stroll by and give terrible instruction on something that I was good at, or else they assumed that because they were an NP that somehow endowed them with extra insight in regular nursing, which isn’t the case (Becoming an NP doesn’t mean that your RN skills are somehow top notch). I had an new NP who hadn’t worked the floor for 15 years prior try to get me in trouble because she thought I was injecting something the wrong way. I was certified in that action and she never was. But she thought she was an expert.

The main reson I suggest NP in this environment is because there simply isn’t enough space in PA schools or leniency surrounding grades for most folks to head that direction, so we have individual people with individual needs, hopes, and dreams asking for advice. I had a great clinical and academic background with a few blemishes, and even I was looking ahead to having difficulty getting into PA school in the middle of the economic crash when everyone with good grades was fleeing to healthcare to have access to solid careers. There is room in healthcare for folks with sub 3.8 GPAs, and I know this because there was a time when PA schools had more lenient standards, and took those kinds of students. The interest in the career has driven the educational institutions to be picky, they didn’t get to that point until they had lots of good students applying in droves.

I also don’t fret too much about folks doing NP direct entry programs because there are few of those programs, and they are actually pretty intense. The prerequisites are typically robust, they are expensive, and they generally take only really good students. And as far as folks who want to do RN school then immediately go to NP school... I find most people who hope to do that end up taking a break to work after they finish RN school, so the problem solves itself. Nursing school is made harder than it needs to be by nutty instructors who eat their young. After going through that, most students aren’t up for immediately going to more school. They take a break, make some money, get some experience. So with that in mind, why not suggest they indulge in pursuing it. They can go that route if they feel compelled to, or they can do what most folks do and realize that a hiatus might be useful for them to keep their sanity.

As far as independence, I’m a believer in workplace freedom. I’m an employee with a physician boss that essentially oversees our work if they want to. Most places around have that kind of arrangement that allows for that. There isn’t a formalized process, but there’s also really nothing that would prevent any workplace from having that management structure. The PAs that work there generally function just like the NPs. So here’s no reason that they shouldn’t be independent too. It doesn’t wreck the landscape to have a handful of NPs that are able to open their own clinic or have the latitude to not have their ability to practice immediately stop the moment that their supervising physician quits and moves. Everyone should be a mobile, independent provider that is fairly evaluated by their board of practice. There is a remedy for poor performing independent NPs in the form of the boards of nursing. NPs generally don’t need a big brother. Neither do PAs. OTP is a step up, but it shouldn’t end there.
 
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