Ricekrispie

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Hi all, I recently withdrew from medical school after completing 3 semesters. I was passing my classes but the amount of time and effort required to do so was having severe detrimental effects on my physical and mental health, and I decided this is not the correct path for me. I'm now discerning what my next steps should be. I know I want to work in healthcare, and I want to pursue a career as a midlevel provider. I think this will be a much better fit for me, both in terms of work-life balance as well as level of intensity and duration of training required to get there. My options thus far are as follows:

1. Accelerated BSN program at a private school 4 hours away; 13 month program beginning in January. Would then pursue an NP program while working.
Cost: $36,000 tuition/fees + ~$6,000 in living expenses.
Pros: Lowest cost - could stay with family in the area to significantly reduce cost of living). Program has good reputation.
Cons: 200+ applicants for 12 seats and the program director has not seemed optimistic about my chances on the phone. Would need to take 15 credits of prerequisite courses prior to January (another ~$4,300 in tuition for prerequisites).

2. Accelerated BSN program at a for-profit institution 1 hour away; 18 month program beginning as soon as July or October (courses start quarterly). Would then pursue an NP program while working.
Cost: ~$45,000 tuition/fees + ~$25,000 in living expenses.
Pros: no prerequisites, close to significant other, guaranteed acceptance.
Cons: I have read online that degrees from programs with no prerequisites are viewed negatively by some employers, and I am concerned that earning my degree from this kind of program may put me at a disadvantage when I try to gain admission to an NP program (I'm not sure if this concern is valid or not?). Online reviews of the school say it is difficult and a lot is self-taught, but with my background as a medical student I would think this would be less of an issue for me. Clinical rotations are not completed at a major medical center, but rather are scattered around the area at community/private clinics etc.

3. PA program at my home institution; 24 month program beginning summer next year.
Cost: $44,000 tuition/fees + ~$45,000 in living expenses.
Pros: would require least amount of time, close to significant other during didactic time.
Cons: odds of acceptance unknown, program director has not been very optimistic in emails. Clinical placements are scattered around the area with the potential of being placed 7+ hours away from my significant other. Program's mission is to generate and retain PAs for rural towns in my home state, and I do not think this is my ideal practice setting, I'd prefer to be in an urban location eventually. Current students have said program is disorganized and has a high drop-out/failure rate. Cannot practice independently.

4. Earn LPN/RN at local community college, then complete an RN to BSN program while working. Would then pursue an NP program while working.
Cost: ~$20,000 tuition for RN + ~$10,000 for BSN; ? living expenses (depends on ability to work while in school).
Pros: possibility of being employed at least part-time while completing coursework. Close to significant other.
Cons: takes a long time (3-4 yrs).


Sorry for the long post. Any advice as to which of these sounds like the best option is very much appreciated!
 
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I think PA is the best option if you can secure a spot at your home institution... Are you sure the overall COA is ~90k? That is cheap!
 

IknowImnotadoctor

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I would go NP due to cost unless you are debt free from medical school.
 

pamac

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I’ve posted about hard numbers on numerous occasions if you look through the past posts. A lot of what I said was back of the napkin estimates. Feel free to peruse those and see what matches your situation closest, in addition to any suggestions I make here.

There are a couple of ways to look at your pathway as far as burdens. I break down my biggest concerns regarding career path into two... time and debt. A third concern might be how feasible it is to actually pursue the dream based on life circumstances.

Despite what anyone says, admission counselors included, you have a good shot at PA school, as evidenced by the fact that you landed a spot in medical school. You’ve been through the portions of medical school that eclipses anything you’ll see in PA school. Because of that, the subject matter in Pa school and NP school will be fairly easy for you. Nursing school is a different beast altogether because you’ll have to adjust your thinking to the way nurses do things, but that shouldn’t be hard for someone with your study habits. But you can’t count on a particular PA program deciding to choose someone else for a seat just because they have lots of applicants. That’s true of any program, nursing or PA. When they have lots of applicants, they have more options to tell good people “No”. If you were telling us that you were applying to 5 schools, I’d say that you are certain to get into at least one, if not more. If you apply to Pa programs next month, you still wont be actually attending school until fall of 2020. That’s where we are in the cycle. That puts you graduating in 2022.

Financially, PA school is expensive. Very few are as cheap as $44,000. If you don’t get into a cheap program, then you face a bunch of schools with $100,000 tuitions, not to mention living expenses. That adds to your debt because you also can’t work during school.

The nursing routes have potential to take longer. That can be a pain, but it also has some perks. If you start in fall of 2019 in a yearlong accelerated program, then get into NP school quickly, you could be done by 2022, but have a lot less debt due to being able to work as a nurse through NP school. For me, my costs for my education were offset by the $82,000 or so I made per year as an RN. NP school can be obtained for as cheap as $30,000 total or less.

For me, I decided against PA because I wanted to be able to practice independently from the start if I wanted to. There aren’t currently any places that allow that for PAs. I wanted my license to be truly my own, not simply a ticket that lets me practice under another provider. It allows me to practice and bill under my own name and take on patients and assignments without having to check with a supervising physician. I can literally go out and make money from cash paying clients. I’ll always have a way to work. In the end, that was ultimately what drew me towards NP school. Someday PAs might have places where they are as independent as NPs, but that time isn’t now. Most of the NPs I know in psyche either are on their own, have been on their own, or are going to be on their own at some point. It’s up to them. A friend of mine takes a handful of private patients each day and makes over $200,000 per year working less than they did before they started up on their own. Meanwhile, psyche PAs in my area make what every other PA makes. My friend has a close relative who is a psyche PA and was shocked that psyche NPs make $60k more than they do. The difference is independence. It’s not that way for everything, but it’s a good example how independence can matter.
 

sb247

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If you are going to apply to be a midlevel, stop saying midlevel until you are one (because it might slip in front of adcoms and despite being accurate it is treated like a very derogatory term by many midlevels).

Despite my personal preference for PAs having a higher baseline standard of training and being the safer practice pathway because they are at least usually supervised by a doctor you cannot ignore the economics that the nursing lobby has been able to pull off. If I were in your shoes and money was my major concern I would absolutely run in the direction of bsn-> (crna/np)

I’ll leave the ethics of unsupervised midlevels out of it, the above advice is economics
 

pamac

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You’ll leave the ethics out of it, but In the same breath you insert it by mentioning that you are leaving it out. Lol!

You suggest “midlevel” is a derogatory term that should be avoided, yet use it three times because it’s part of your vernacular as a way to be derogatory.

You tear down NP’s, yet suggest that you feel compelled to endorse the NP pathway. Again, this is another subtle way to be derogatory by complimenting their craftiness as pulling the wool over everyone’s eyes.

Do you troll this transparently on other subjects and in person?
 
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pamac

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Many of the psychiatrists in my area just want a larger slice of the pie like any other businessman out there. Nobody is in a dead sprint to come to psyche as a specialty, and they are satisfied that 3 month waiting lists for new patient evals. For some reason, many of them feel like it’s important to have a supervisory arrangement to watch NPs help people, even though under almost all circumstances, and even in really tightly controlled states for NPs to practice in, the supervision takes the form of cursory glances at a literal handful of patient charts. And for their trouble they only ask that NPs hand over control of everything to physicians so that it can be dispersed back out to NPs. The corporate giants are taking over and are calling the shots in their practices, and aren’t asking physicians what they think of the arrangements they want to make. That’s the reality. It doesn’t make sense to treat practice like a little kingdom anymore.
 
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If you are going to apply to be a midlevel, stop saying midlevel until you are one (because it might slip in front of adcoms and despite being accurate it is treated like a very derogatory term by many midlevels).

Despite my personal preference for PAs having a higher baseline standard of training and being the safer practice pathway because they are at least usually supervised by a doctor you cannot ignore the economics that the nursing lobby has been able to pull off. If I were in your shoes and money was my major concern I would absolutely run in the direction of bsn-> (crna/np)

I’ll leave the ethics of unsupervised midlevels out of it, the above advice is economics


You’ll leave the ethics out of it, but In the same breath you insert it by mentioning that you are leaving it out. Lol!

You suggest “midlevel” is a derogatory term that should be avoided, yet use it three times because it’s part of your vernacular as a way to be derogatory.

You tear down NP’s, yet suggest that you feel compelled to endorse the NP pathway. Again, this is another subtle way to be derogatory by complimenting their craftiness as pulling the wool over everyone’s eyes.

Do you troll this transparently on other subjects and in person?
The above post by sb247 is not trolling. It will likely be inflammatory, as evidenced by the million other threads on here that devolve into "NP's are destroying medicine", but that's not sb247's fault, that's just what happens when you share an opinion on such a hot button topic (which is the topic of the thread I might add).

sb247 never said "midlevel" is derogatory, rather that adcoms to NP and PA schools may view it that way, so OP should try to break the habit of using that term. Useful advice.

Lastly, I think the advice given is very good, and the exact kind of thing that someone seeking career advice should hear. Sb247 recognizes that NP is a economically sound option, but that it lacks the same level of standard of training as PA's. These are two things anyone considering the career options should consider. He also hints at the ethical concerns that many share with regards to independent midlevel practice without being overly detailed/derogatory. OP can look into this further if it concerns him/her.

Unless I'm missing some extremely layered sarcasm this sounds like very good career advice from which personal biases/opinions have been recognized, yet distanced from the objective realities of the viability of each field
 

sb247

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You’ll leave the ethics out of it, but In the same breath you insert it by mentioning that you are leaving it out. Lol!

You suggest “midlevel” is a derogatory term that should be avoided, yet use it three times because it’s part of your vernacular as a way to be derogatory.

You tear down NP’s, yet suggest that you feel compelled to endorse the NP pathway. Again, this is another subtle way to be derogatory by complimenting their craftiness as pulling the wool over everyone’s eyes.

Do you troll this transparently on other subjects and in person?
I'm not trolling. I meant what I said it's good advice.

Midlevel is an accurate and appropriate term. It's also one that is being pitched as derogatory by midlevels now so, no, I wouldn't use it around midlevel admission committees. Yes, I do use it in real life.

And legislatively speaking, yes, I do think NPs have pulled the wool over everyone's eyes. But if a poster her is chasing money and isn't questioning the ethics of independent NP practice, you can't deny the advantage to being part of a lobby that successful. Politically speaking, nurses have been incredibly effective at self-promotion
 

pamac

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You frame it as a choice that only someone who chases money and doesn’t question the ethics of independent practice would make.

Sigh.... it’s transparent, at least. I guess I’m just impressed that with every breath, you try to bake in plausible deniability with each statement.

SB289: “If you don’t mind smelling of feces, then sure... NP is a great choice for making filthy lucre....”

Later on: “I don’t understand why you think I’m dissing on you....I said you could make a lot of money and that’s a compliment. And I didn’t say every NP would smell bad to other NPs.”

And on, and on, and on.

It’s usually your own medical directors that are choosing NPs and PAs to fill posts. The ethics don’t seem to bother them.

It really should be easy for a physician researcher to come up with clear cut evidence that settles this beyond any doubt. I’ve seen a study showing advanced practice providers order tests at a higher rate than physicians (don’t know what the samples consisted of... new NPs, experienced NPs, residents or physician providers). But maybe overall cost savings meant it wasn’t a big enough turnoff for any states to back off of independence that has been already granted. If this is the hot button issue that is claimed, the evidence should extend beyond the anecdotal. You could slam the door on further NP independent expansion once and for all with a bit of parchment covered in compelling data.

I guess I just question why the model needs to continue as consisting of a physician overlord that reads over 5 charts a month (if even that), and requires a formal agreement with a paternalistic regimen. Why are the states that form the old guard on this mostly in the south where many of the poorest health outcomes persist? It all carries the faint aroma of convenient concern trolling.
 

sb247

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You frame it as a choice that only someone who chases money and doesn’t question the ethics of independent practice would make.

Sigh.... it’s transparent, at least. I guess I’m just impressed that with every breath, you try to bake in plausible deniability with each statement.

SB289: “If you don’t mind smelling of feces, then sure... NP is a great choice for making filthy lucre....”

Later on: “I don’t understand why you think I’m dissing on you....I said you could make a lot of money and that’s a compliment. And I didn’t say every NP would smell bad to other NPs.”

And on, and on, and on.

It’s usually your own medical directors that are choosing NPs and PAs to fill posts. The ethics don’t seem to bother them.

It really should be easy for a physician researcher to come up with clear cut evidence that settles this beyond any doubt. I’ve seen a study showing advanced practice providers order tests at a higher rate than physicians (don’t know what the samples consisted of... new NPs, experienced NPs, residents or physician providers). But maybe overall cost savings meant it wasn’t a big enough turnoff for any states to back off of independence that has been already granted. If this is the hot button issue that is claimed, the evidence should extend beyond the anecdotal. You could slam the door on further NP independent expansion once and for all with a bit of parchment covered in compelling data.

I guess I just question why the model needs to continue as consisting of a physician overlord that reads over 5 charts a month (if even that), and requires a formal agreement with a paternalistic regimen. Why are the states that form the old guard on this mostly in the south where many of the poorest health outcomes persist? It all carries the faint aroma of convenient concern trolling.
I don't at all think physicians are blameless in the inappropriate spread of midlevel practice or in the inappropriate levels of supervision actually performed by some of them

Plenty of blame to go around. And yeah, it stinks

(please reply/quote if you're going to be replying to me, it creates an alert and makes it more likely that I know you are replying)
 

pamac

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Naw.... you don’t reply to any pertinent topic anyway. You cherry pick the one that you feel you can answer. You didn’t touch on anything regarding the research, nor the need for a structure of supervision that conveniently plays exclusively to the benefit of physician providers. That’s your jam. Drive by disses. You’ll be back to do some token responses, but it’s the same boring approach next time. I could save a lot of time and just succumb to your appeal to your own authority on the subject. Carry on.
 

IknowImnotadoctor

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Naw.... you don’t reply to any pertinent topic anyway. You cherry pick the one that you feel you can answer. You didn’t touch on anything regarding the research, nor the need for a structure of supervision that conveniently plays exclusively to the benefit of physician providers. That’s your jam. Drive by disses. You’ll be back to do some token responses, but it’s the same boring approach next time. I could save a lot of time and just succumb to your appeal to your own authority on the subject. Carry on.
He blocked me because I called him out on the same behavior, which has been going on for years. He might block you too, which wouldn’t be a big loss.
 
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sb247

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Naw.... you don’t reply to any pertinent topic anyway. You cherry pick the one that you feel you can answer. You didn’t touch on anything regarding the research, nor the need for a structure of supervision that conveniently plays exclusively to the benefit of physician providers. That’s your jam. Drive by disses. You’ll be back to do some token responses, but it’s the same boring approach next time. I could save a lot of time and just succumb to your appeal to your own authority on the subject. Carry on.
I’ve always tried to answer in good faith, you just don’t like the answers. I’ll continue to try.

I don’t think it would be ethical for a doctor to set up the research for a non-inferiority. We already believe on trade shouldn’t be practicing independently. I still haven’t seen a good study yet by the nps and it would be their responsibility to to produce one because their training is significantly less than doctors.

I agree with you that the way some docs do supervision is little more than cashing the check (or more accurately getting a small portion of the hospital cashing the check). That’s also inappropriate. Midlevels should be properly supervised, both them and docs paid ample time to discuss cases and review treatments standards. That’s not always what’s happening and I’m as unimpressed with it as you are.

Again, using the “reply” feature would be helpful and appreciated
 

pamac

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Thanks for condescending to “try” to educate me. And again, with each breath, disrespect.

It’s convenient to pass the buck on the issue of rigorous studies. I’m still a bit perplexed as to why one can’t be funded and examined by the critics. We study EVERYTHING under the sun, but this can’t be done because of ethics? And no other entity could be engaged in the process? Sure... back to the superior position of your side. There’s the theme.

You sing the same siren cry that reminds me of those who argue that true socialism hasn’t been tried, except in your case you suggest that “some” docs practice inadequate supervision. This may be news to you, but almost all docs that supervise don’t meet up to your mythical standards. Proper supervision is not “always” practiced? Try “never” practiced. So given that fact, maybe it would be easier to simply formalize the long existing status quo of independence rather than try to do the impossible by engaging in the moonshot that you endorse.

You seem to suggest that there is a public health emergency at hand with Nps providing awful care, and yet in half of states, the sky has not fallen with Nps having a more favorable practice arrangement than the poor performing states with physician supervision, like those of the south.

Before I close, let’s revisit the question of research where you have a clear comparison that could be made between states with independent Np practice, and states without. How hard would it be to examine outcomes based on the distinct contrast? Are we back to the ethics of it at this point?
 

sb247

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Thanks for condescending to “try” to educate me. And again, with each breath, disrespect.

It’s convenient to pass the buck on the issue of rigorous studies. I’m still a bit perplexed as to why one can’t be funded and examined by the critics. We study EVERYTHING under the sun, but this can’t be done because of ethics? And no other entity could be engaged in the process? Sure... back to the superior position of your side. There’s the theme.

You sing the same siren cry that reminds me of those who argue that true socialism hasn’t been tried, except in your case you suggest that “some” docs practice inadequate supervision. This may be news to you, but almost all docs that supervise don’t meet up to your mythical standards. Proper supervision is not “always” practiced? Try “never” practiced. So given that fact, maybe it would be easier to simply formalize the long existing status quo of independence rather than try to do the impossible by engaging in the moonshot that you endorse.

You seem to suggest that there is a public health emergency at hand with Nps providing awful care, and yet in half of states, the sky has not fallen with Nps having a more favorable practice arrangement than the poor performing states with physician supervision, like those of the south.

Before I close, let’s revisit the question of research where you have a clear comparison that could be made between states with independent Np practice, and states without. How hard would it be to examine outcomes based on the distinct contrast? Are we back to the ethics of it at this point?
The reply button. It’s at the bottom right of each post on my screen and likely the same on yours.

I don’t think the proposal to just compare states with independent midlevels vs states without works well because there are a lot of other confounding issues there, but if you post one we can go through it together
 
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pamac

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Sure...... I’ll go ahead and do that......
 

IknowImnotadoctor

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pamac

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Yeah, it would be impossible to do a study that would compare the performance of non physician providers in independent states vs states with onerous supervision, right? If non physician independent providers were a scourge upon the landscape, as suggested by everyone with a critical opinion and an anecdote, then it really is surprising that some group within the healthcare realm (and it doesn’t have to be directly associated with the AMA or like minded individiuals... it could be the University of Minnesota sociology department), would step in and throw together an analysis. There are studies out there on extremely obscure topics, why not a more potentially pressing public health topic?
 

pamac

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If a study shows no evidence of wide disparity, then cost becomes factored in. And if cost is skewed towards savings due to advanced practice providers in independent roles, then in today’s environment, that becomes a plus for bending the cost curve down. That’s not a study that those who oppose APP independence from them want to have floating around.
 
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I mean something like this can't exist, if all the posters on this site are correct.
All authors are from 'Columbia School of Nursing'... Really!

The school that had their students took the watered down step3 and 50% still failed
 

IknowImnotadoctor

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All authors are from 'Columbia School of Nursing'... Really!

The school that had their students took the watered down step3 and 50% still failed
Actually that step 3 myth isn’t true. It’s been covered in another thread and debunked. Here is the thread where you will see this study that wasn't a study with an n of 31 using an unvalidated exam 10 years ago: KEVINMD blog post on NP. (even neonatologist is fooled) If you had read the RCT meta analysis you’ll see bias was one their exclusion criteria. You’re 0/3 with that post. Great job.
 
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Ricekrispie

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I’ve posted about hard numbers on numerous occasions if you look through the past posts. A lot of what I said was back of the napkin estimates. Feel free to peruse those and see what matches your situation closest, in addition to any suggestions I make here.

There are a couple of ways to look at your pathway as far as burdens. I break down my biggest concerns regarding career path into two... time and debt. A third concern might be how feasible it is to actually pursue the dream based on life circumstances.

Despite what anyone says, admission counselors included, you have a good shot at PA school, as evidenced by the fact that you landed a spot in medical school. You’ve been through the portions of medical school that eclipses anything you’ll see in PA school. Because of that, the subject matter in Pa school and NP school will be fairly easy for you. Nursing school is a different beast altogether because you’ll have to adjust your thinking to the way nurses do things, but that shouldn’t be hard for someone with your study habits. But you can’t count on a particular PA program deciding to choose someone else for a seat just because they have lots of applicants. That’s true of any program, nursing or PA. When they have lots of applicants, they have more options to tell good people “No”. If you were telling us that you were applying to 5 schools, I’d say that you are certain to get into at least one, if not more. If you apply to Pa programs next month, you still wont be actually attending school until fall of 2020. That’s where we are in the cycle. That puts you graduating in 2022.

Financially, PA school is expensive. Very few are as cheap as $44,000. If you don’t get into a cheap program, then you face a bunch of schools with $100,000 tuitions, not to mention living expenses. That adds to your debt because you also can’t work during school.

The nursing routes have potential to take longer. That can be a pain, but it also has some perks. If you start in fall of 2019 in a yearlong accelerated program, then get into NP school quickly, you could be done by 2022, but have a lot less debt due to being able to work as a nurse through NP school. For me, my costs for my education were offset by the $82,000 or so I made per year as an RN. NP school can be obtained for as cheap as $30,000 total or less.

For me, I decided against PA because I wanted to be able to practice independently from the start if I wanted to. There aren’t currently any places that allow that for PAs. I wanted my license to be truly my own, not simply a ticket that lets me practice under another provider. It allows me to practice and bill under my own name and take on patients and assignments without having to check with a supervising physician. I can literally go out and make money from cash paying clients. I’ll always have a way to work. In the end, that was ultimately what drew me towards NP school. Someday PAs might have places where they are as independent as NPs, but that time isn’t now. Most of the NPs I know in psyche either are on their own, have been on their own, or are going to be on their own at some point. It’s up to them. A friend of mine takes a handful of private patients each day and makes over $200,000 per year working less than they did before they started up on their own. Meanwhile, psyche PAs in my area make what every other PA makes. My friend has a close relative who is a psyche PA and was shocked that psyche NPs make $60k more than they do. The difference is independence. It’s not that way for everything, but it’s a good example how independence can matter.
Thank you very much for your reply. Do you think it's reasonably likely that I would be able to enter NP school directly after finishing my BSN? I've done some investigation into NP programs and it seems that most of them recommend/prefer at least a year of RN experience (although I've seen in your past posts that you don't think it's necessary, and I agree with your reasoning).
 

IknowImnotadoctor

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Thank you very much for your reply. Do you think it's reasonably likely that I would be able to enter NP school directly after finishing my BSN? I've done some investigation into NP programs and it seems that most of them recommend/prefer at least a year of RN experience (although I've seen in your past posts that you don't think it's necessary, and I agree with your reasoning).
I don't believe that going right from BSN to NP is good for your career. It may be a red flag during hiring. If you spend 2 years after BSN as a full time RN, then start grad school after that, when you graduate with your NP you will have between 4-5 years of nursing experience. That will make a better resume for your future. There's pro's and con's to both decisions, this is just my opinion as an actively working NP.
 

Ricekrispie

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I don't believe that going right from BSN to NP is good for your career. It may be a red flag during hiring. If you spend 2 years after BSN as a full time RN, then start grad school after that, when you graduate with your NP you will have between 4-5 years of nursing experience. That will make a better resume for your future. There's pro's and con's to both decisions, this is just my opinion as an actively working NP.
Thanks for your reply. In other threads on this forum I've come across discussion of the NP field being oversaturated; do you think this is a valid concern?
 

pamac

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I’ve seen folks make that jump right into Np school, and it works, especially for someone with a premed degree like biology. Considering your time in medical school, and you definitely will do fine with a quick transition. I’ve seen nurses who did that and struggled, but they were typically folks that only had nursing degrees behind them. You’ll have at least two years as an RN while you attend Np school, and you’ll probably find NP school to be much more manageable than medical school.

Employers aren’t paying you to be an RN, they are paying for an NP. They know that. It’s a different skill set. There are aspects that are certainly helpful, but the question I asked myself when I was considering “getting experience” was “is this experience worth sacrificing A) the difference between RN wages and NP wages in my field (roughly $80,000 more for each year I stayed on the sidelines) and B) the additional time that I would have spent learning the trade as an NP vs as an RN.

So consider this.... is an NP better served over the course of 10 years if 5 of those years were spent as an RN, or are they better served if 2 of those years are spent as an RN and the rest as an NP? My employer and patients would suggest that they are more appreciative of each additional year of NP practice and experience rather than me wasting time as an RN. Not all experience is the same. One regret I have is that I didn’t go faster than I did. I made great friends and loved a lot of things that I did as a nurse, but it didn’t do me many favors professionally. It hits you when you have a cruddy day as an RN and realize that you could have been an NP at that point if you had started the process sooner.
 

pamac

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I’ll jump in even if this wasn’t directed entirely at me.

Over saturation always seems to be on the horizon. So many RNs are opting for Np school for a number of reasons. Mostly because RN work is not getting any better as far as workload and expectations of employers. I spent more time documenting minutiae than I ever spent with patients, which isn’t a terrible thing unless you have several patients that need your presence. But employers want it all... take tons of workload, and make sure you are customer service oriented. That doesn’t work for long before you are burnt out, and it doesn’t feel good to be a good nurse that isn’t appreciated because management wants to treat it like a hotel stay.

However, I see everyone that graduates NP school getting jobs. In my field of psyche, people typically have many job offers, even before they are done with school, and most are very good offers. Psyche is very taxing in a way that folks that aren’t well suited for it become tempted to walk away from, but all my FNP friends would love to have the paychecks that psyche folks make, along with the schedule and lifestyle.

I’ve always been of the opinion that the field will never be saturated for those who are good at what they do. But I think I live a charmed life because I like psyche, I’m in psyche, and there is a large need for psyche, because others don’t really want to do psyche. And I can testify that the money is good, but not enough to make it worth it if you dread walking into work each day to deal with difficult people. I confess that I really only know the market I’m in, and have insight into the markets where my classmates were in. Even many of them didn’t quite know their markets well while e were in school talking about it. Most of them underestimated their value and went on to adjust it much higher. Some folks have taken jobs that they really could have done much better salary wise if they had just negotiated. It’s kind of the curse of the new NP to be nervous and take a job early on because they were spooked by concerns of a tight job market that didn’t pan out.
 

Ricekrispie

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I’ll jump in even if this wasn’t directed entirely at me.

Over saturation always seems to be on the horizon. So many RNs are opting for Np school for a number of reasons. Mostly because RN work is not getting any better as far as workload and expectations of employers. I spent more time documenting minutiae than I ever spent with patients, which isn’t a terrible thing unless you have several patients that need your presence. But employers want it all... take tons of workload, and make sure you are customer service oriented. That doesn’t work for long before you are burnt out, and it doesn’t feel good to be a good nurse that isn’t appreciated because management wants to treat it like a hotel stay.

However, I see everyone that graduates NP school getting jobs. In my field of psyche, people typically have many job offers, even before they are done with school, and most are very good offers. Psyche is very taxing in a way that folks that aren’t well suited for it become tempted to walk away from, but all my FNP friends would love to have the paychecks that psyche folks make, along with the schedule and lifestyle.

I’ve always been of the opinion that the field will never be saturated for those who are good at what they do. But I think I live a charmed life because I like psyche, I’m in psyche, and there is a large need for psyche, because others don’t really want to do psyche. And I can testify that the money is good, but not enough to make it worth it if you dread walking into work each day to deal with difficult people. I confess that I really only know the market I’m in, and have insight into the markets where my classmates were in. Even many of them didn’t quite know their markets well while e were in school talking about it. Most of them underestimated their value and went on to adjust it much higher. Some folks have taken jobs that they really could have done much better salary wise if they had just negotiated. It’s kind of the curse of the new NP to be nervous and take a job early on because they were spooked by concerns of a tight job market that didn’t pan out.
Thank you for this insight! What about the job market for FNPs? I know the money isn’t as good, but it’s still a fair amount above that of an RN, and I do feel drawn to a career as a provider; I just don’t have enough experience with psyche to know if it’d be a good fit for me.
 

IknowImnotadoctor

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Thanks for your reply. In other threads on this forum I've come across discussion of the NP field being oversaturated; do you think this is a valid concern?
I’ll jump in even if this wasn’t directed entirely at me.

Over saturation always seems to be on the horizon. So many RNs are opting for Np school for a number of reasons. Mostly because RN work is not getting any better as far as workload and expectations of employers. I spent more time documenting minutiae than I ever spent with patients, which isn’t a terrible thing unless you have several patients that need your presence. But employers want it all... take tons of workload, and make sure you are customer service oriented. That doesn’t work for long before you are burnt out, and it doesn’t feel good to be a good nurse that isn’t appreciated because management wants to treat it like a hotel stay.

However, I see everyone that graduates NP school getting jobs. In my field of psyche, people typically have many job offers, even before they are done with school, and most are very good offers. Psyche is very taxing in a way that folks that aren’t well suited for it become tempted to walk away from, but all my FNP friends would love to have the paychecks that psyche folks make, along with the schedule and lifestyle.

I’ve always been of the opinion that the field will never be saturated for those who are good at what they do. But I think I live a charmed life because I like psyche, I’m in psyche, and there is a large need for psyche, because others don’t really want to do psyche. And I can testify that the money is good, but not enough to make it worth it if you dread walking into work each day to deal with difficult people. I confess that I really only know the market I’m in, and have insight into the markets where my classmates were in. Even many of them didn’t quite know their markets well while e were in school talking about it. Most of them underestimated their value and went on to adjust it much higher. Some folks have taken jobs that they really could have done much better salary wise if they had just negotiated. It’s kind of the curse of the new NP to be nervous and take a job early on because they were spooked by concerns of a tight job market that didn’t pan out.
Much of what PAMAC said is true, but just to play devils advocate as a new hire NP and seeing what the physicians are looking for in a new NP, they do not even interview new NP's who don't have many years of RN experience. I am not saying this is something you are going to find across the board, but for my particular role, it is 100% true. They want NP's with years of nursing experience; because they want to know that if you walk into a patient's room who is about to code you will react immediately and you wont need time to open the EHR and check their last lactate and procalcitonin. That's wisdom that can't be taught in school, and it's what many, many physicians are looking for in their new NP's.
 

pamac

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I’ve not seen that. What I have seen is new grads brought in for inpatient roles en masse, and when friends of mine with lots of RN experience under their belt graduated later on, they weren’t picked up because the market had tightened, and guess what?... the new grads now had several years of NP experience as a head start. That literally happened at the facility I was at. Who would be hired over you at your facility... an experienced NP or a new grad with a few more years of RN experience? Remember.... a new grad is still a new grad. Thats how it works. That’s why when I was hired as a psyche RN with a couple years in psyche, I was more valuable than either the new grad with psyche tech experience AND the RN transferring from the ER that had 8 years of RN experience.... because neither of them knew psyche.

So who do you want to live your life and work your career for.... yourself or the standards someone else has? That’s very nice that a hiring entity would like to have as much experience as possible from a hire. I would expect that. But are they going to make up for the income you lose out on from languishing in a job that you don’t like? Look at things this way.... are you farther ahead by waiting five years to start in the job of your dreams, or are you better off starting much earlier as an NP, and probably getting to that dream job sooner, albeit after spending some time in an urgent care (while still making better money than an RN)? There’s really no way to get away from the fact that more time spent as an NP is much more valuable career wise than time spent in a totally different job as a nurse.
 

pamac

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I feel like you are suggesting that to be a good football player, one should spend as much time as a water boy rather than suiting up and practicing with the team.
 

IknowImnotadoctor

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I feel like you are suggesting that to be a good football player, one should spend as much time as a water boy rather than suiting up and practicing with the team.
Water boys aren’t on the field, while an RN is. I’m not telling him to wait a decade, but 1-2 years of solid full time ICU nursing experience before starting NP will pay him(or her) back with interest when they are interviewing. I know this because I just went through it.
 

pamac

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Again...that experience is not as valuable as 2 years of NP experience. But, the two years of experience he or she would get in an ICU while in NP school, sure, why not? But if you are suggesting 4 total years as an RN, you are suggesting something that isn’t in his or her financial or professional best interest. You like that because you did that. I did that as well, but see that there is a better way, and that better way is to not waste time doing that if you want to maximize your potential sooner.
 

IknowImnotadoctor

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Again...that experience is not as valuable as 2 years of NP experience. But, the two years of experience he or she would get in an ICU while in NP school, sure, why not? But if you are suggesting 4 total years as an RN, you are suggesting something that isn’t in his or her financial or professional best interest. You like that because you did that. I did that as well, but see that there is a better way, and that better way is to not waste time doing that if you want to maximize your potential sooner.
I continue to disagree with you that RN experience isn’t extremely necessary for your role as a NP. Maybe in psych it’s less valuable, but in my role I couldn’t have been hired without my nursing background, even if I had 2 extra years as a NP. Full stop.
 

pamac

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For the individual, you have to consider their own professional timeline, not an abstract notion of how things seem to you like they should be. For that individual, what would provide them the best way to get done with school and on with life? That’s where the advice to pay dues falls out of line with reality for the individual. You are placing so much weight into your subjective preference that you are overlooking the person in front of you who has already spent 3 semesters in medical school, and has several years of hard work ahead of them. It’s a bit much to suggest a few more years for the sake of something that I’ve already demonstrated is suspect. Yes... you had a great result from your job search because of extra time as an RN. But if you had gotten out in the workforce sooner, you could be right where you are as well, and had more money in your pocket.
 

IknowImnotadoctor

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For the individual, you have to consider their own professional timeline, not an abstract notion of how things seem to you like they should be. For that individual, what would provide them the best way to get done with school and on with life? That’s where the advice to pay dues falls out of line with reality for the individual. You are placing so much weight into your subjective preference that you are overlooking the person in front of you who has already spent 3 semesters in medical school, and has several years of hard work ahead of them. It’s a bit much to suggest a few more years for the sake of something that I’ve already demonstrated is suspect. Yes... you had a great result from your job search because of extra time as an RN. But if you had gotten out in the workforce sooner, you could be right where you are as well, and had more money in your pocket.
I can only share my own personal experiences in the hiring process. Just as you can only share your personal experiences. What might be more helpful is to hear from people who do the hiring since we are in disagreement here. Might be a good avenue for the OP to pursue. Thankfully he has plenty of time to make a decision.
 

pamac

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That last comment seems to fly in the face of the full stop you threw out there, but here we are.

I can agree to disagree because the merits of what I said are out there for anyone to consider. I just don’t believe in putting artificial barriers to your own dreams. If you want to be a cop, the best place to do that is as a cop. The best place to learn to be a doctor is in medical school, and an accountant is as an accountant. I don’t believe that anyone that wants to be a nurse needs to be a CNA for a few years. Would that make them a better nurse? Surely. But is it the best advice to suggest to someone that wants to be a nurse? Absolutely not. Get your nursing degree and be a nurse as quickly as you can so you can be a better nurse quicker. Nobody looks at the nurse with two years as a CNA and two years as an RN as superior to the RN with 4 years if their performance is the same. And who will perform better?
 
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pamac

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You are not going to learn more about being a nurse than from being a nurse. Same thing for NP. If your RN experience gives you insight into the role from a perspective that is pertinent to the workflow there, then that’s more of an issue of being enlightened to the niche rather than a reflection of superiority surrounding the merits of your RN experience. You’d be back to being a fish out of water if you went to some other environ like urgent care or psyche, or anything outside of that. So there’s another argument against languishing has an RN. If you languish in the wrong place, you dilute your supposedly critical RN experience.