Myths about becoming a nurse practitioner – things to consider about grad school in nursing

If this were a bookstore, you would read the back of the book-decide to buy. Find this on Amazon at https://goo.gl/PGTW30

 

UPDATE:  as of February 3rd, 2015, this entry has 38,633 (thirtyeight thousand, six hundred and thirty three) separate views. It’s the single most popular blog entry I have written. Please feel free to add your feedback and comments. 

UPDATE #2 My book, The Sacrament of the Goddess, was published in April 2014 in USA.  Click here to see reviews on Amazon and order a copy. see the cover on the left, below. People  in USA think of Everest when they think of Nepal. Or maybe the earthquake of April 2015. Right now, the political situation in Nepal is precarious; and one aspect of working in a Low Income Country is the feeling of being out on a limb. My book explores the peculiar terror of being a neutral medical volunteer when everyone else is choosing sides. It’s a fast-paced pageturner! The book has nothing to do with APRNs, but might give you some insight as to why any body would ever want to be a nurse…. why not buy it and become one of the cool people? 

related link about paying for NP education, click here!

Disclaimer: I myself went to grad school fairly early in my career – after just one year as an RN. In those days (the 1970s) the federal government supported nursing education with generous grants and stipends which we knew would not last forever. I did not incur any debt for grad school, whatsoever. sweet!  I continued to work as an RN after grad school, and the MS credential surely came in handy when I finally needed to have it. So – I am in favor of graduate education.

Buzzwords. The Trend Du Jour.

Advanced Practice Nursing is a big buzzword nowadays and we are using the idea of it to attract people to the nursing profession. Throughout the USA there is a proliferation of “three-year’s wonder” programs, the idea being that the student does an entire nursing program the first year, then takes NCLEX, then spend two more years getting their MSN and NP while they work part-time as an RN. It’s particularly attractive during the down economy we are experiencing, because there are plenty of people out there with prior BS degrees who are looking for a fulfilling job. It is oh-so-seductive to think they can gain the RN skill in just one year.

Okay, so it’s a wave – lots of schools and universities are offering these programs. there are plenty of stats to provide a rationale for the career track we are inventing.

The aging of the population

The lack of Medical Doctors to provide primary care

the overall need for RNs to replace the RNs in the baby boom who will be retiring soon.

etc etc etc

I am not disputing those trends, but I am bemoaning some things that seem to be getting lost along the way.

Myth One – no need to learn basic personal care

To begin with, role socialization into nursing goes out the window when the time is compressed. Many of the persons who come from these programs seem to me to be unaware of how nurses work as a team, how nurses work in a hospital, and how to do any kind of personal care for a sick person. In other words, such things as cleaning up “fecal incontinence.”  When this comes up in conversation, they say “oh, well, I am going to be a nurse practitioner and I will be in an independent practice, I don’t need to learn those things.”

Oh Really?

My retort would be: If You are hoping to get a part-time nursing job to put yourself through school while you get the next two years of grad school under your belt, you will be judged according to the standard of the nurses around you, not to the other standard. It is extremely unlikely that you will be getting anything other than a staff nurse job while you work during school. 

also, don’t discount what a staff nurse learns. accountability and integrity are a big piece of the socialization process. A staff nurse in a labor-intensive setting like a hospital, gets daily role modeling from the older nurses. daily mentoring. any new nurse needs to develop trust with those already in the setting, and people will trust you more if you aren’t afraid to get your (gloved) hands dirty.

Think about this: if a patient has been incontinent of feces, no real nurse ever just lets them lay there. Never ever. You may not have to clean them yourself, but you do need to know how. Being clean is a critical element in the dignity of human beings. a very simple precept, really….. and if you as a student disrespect this, you will not gain the trust of the nurses around you.

Myth Two – independent practice

The next myth for Advanced Practice is that “I will be in an independent practice and I am not going to need to learn to work in the kind of subservient hierarchy that a traditional staff nurse needs to navigate through”

If that is truly the case, you will need to borrow money to rent office space, hire a billing agency, advertise to the community, all those things just like you were opening up a furniture store. Ask yourself if you have the business skills to do it, or to get a loan. There are some great resources out there, I particularly recommend one book by Carolyn Buppert; but – is that what you want to do? Most Medical Doctors gave that up twenty years ago, the hassle of “hanging out a shingle” was way too much. We are training you to provide population-based care, which means many of you will be making frequent rounds in a Long Term Care Facility, as part of a group practice. The retired frail elderly population of USA is burgeoning, right? your job will consist of freeing up time for the doc you work with so they can focus more on the technical side.

The small population of ARNPs who will be doing more acute care will be drawn from among those nurses who went the hospital- nursing route and solidified their skills before they enrolled in NP school.

let’s reserve the topic of subservience for some future blog, shall we?

Myth Three

I will be making a lot more money than a staff nurse

In many states the recertification requirement for any ARNP is 40 to 80 hours per year. If you maintain dual-certification, you may have more. This works out to ten working days per year where you are in classes (or being online). When you are in class, you are not seeing patients, and your income is affected. You will also have to pay higher malpractice costs. If you are in a family specialty, you will have many patients who don’t have insurance.  All these things detract from the bottom line.

Myth Four

If it doesn’t work out, I can always fall back on a job as a faculty member somewhere.

Yes, we do have a shortage of nursing faculty. and the minimal requirement to teach is a Master’s Degree. This is one that puzzles me.  For years now there has been such emphasis on going the NP route, that very few nurses enroll in an education track for graduate school. The result? a shortage of faculty, now being filled by recruiting from among those Master’s Prepared nurses who are unsatisfied with an NP job, and who get hired to teach.

There is a problem with this. A converted-over NP with a MS degree does not automatically have the clinical knowledge base to teach in an inpatient clinical setting; and they also don’t have any course work in pedagogy, the science of teaching, how to lecture, how to construct a valid exam, none of the things an educator needs to know in order to be effective.

So far this trend has been under the radar. Any school of nursing where the administration is addressing this, will be ahead of the game.

Myth Five “I can work as an RN after the first year, and use that money to pay for the second and third years, so it’s really not so expensive after all!”  go to my latest blog entry to explore this one. Plan carefully.

Got it off my chest!

So, what you have just read was a “rant” –  the kind of complaining I always dislike. If I were to stand up at a professional meeting,  I am sure there would be  a pregnant pause when I was done. People would look around the room, and then some sweet and wise person would bravely ask And what do you propose that we do about this?

My answer would be:

for the student: realize that you are entering a profession with a long history of service and where you will learn from all those around you in any setting you enter. The more responsibility you are given, the more direct (and sometimes brutal) the feedback will be.

study the idea of role socialization. don’t let it be a hit-or-miss proposition. realize that your thinking style will be changed by becoming a nurse. oh yes it will…..

don’t disrespect the basic skills of personal care. paradoxically, the more likely you are to work in critical care, the more you will need the kind of  teamwork and excellent personal care skills you learn at a basic level.

don’t disrespect the work done by staff nurses, whether it is in a hospital, long-term care facility, or other setting. not ever.

for the schools: be realistic when advertising what a fast-track program can provide and how it fits into a clinical track. When a MEPN student is disrespecting the work of staff nurses, call them out.

emphasize the whole role socialization piece. Insist that the skills portion of undergrad curriculum is rigorous and incorporates socialization, not simply mechanical performance.

insist that converted over NPs who take on a faculty role be given the maximum in mentorship

reclaim the nursing focus of advanced practice nursing. I think it is too easy to slip in to a purely medical model…..

I am fully aware that I will get feedback on this one……. I don’t pretend that this is the end-all and be all of the discussion – But, as oif you have another idea, 2016 this comment section is closed.

Should a new nurse go to graduate school right away if they can’t get a staff nurse job?

Funny you should ask… I will answer in a minute, but before you read on, please take a look at my book about hospital care in a Low Income Country. My book won’t help you get a nursing job, but it will remind you of the value of nursing.  And why not go the right of the screen, and click oon the little box that says “sign me up” ?????

It’s a tight economy for nurses

The job market has changed from just two or three years ago. This past month, three different new graduates told me they were worried about their prospects of getting  a staff nurse job. Each of the three asked me the same question.

“If I can’t get a nursing job right away, should I go to graduate school?”

And

“What track should I take? Is it better to be a nurse practitioner or a nursing administrator?”

The pros:

You will have more credentials.

You will be doing something productive.

In the long run, you can get it over with before you have other responsibilities.

The cons:

Running up more debt in student loans.

Not having enough experience to draw upon.

Still having job search trouble after graduating.

As always, the answer that fits you depends on your circumstance. If you are young and your parents will still foot the bill this is different from being say, thirty and with two kids.

My story

For me personally, I went to grad school after being an RN for a year, worked in ICU while in school, and then took a management job for ten years after grad school. I knew I wanted to teach eventually, and the MS degree was always in the back pocket, just in case. By the time I made the move, I had two kids and a house and a mortgage; I was living in rural Maine far from the nearest graduate program. Having the credential allowed me to make a career change within the nursing profession that would have eluded me if I needed to go back to school right then. So, the timing was auspicious.

I did my grad school in a “Clinical Specialist” track, what would now be lumped in with other ARNPs. There was a window of opportunity in the nineties, when the ARNP standards were revised during which I could have become an NP with nine more post-Master’s credits, but I decided not to at the time. The classes would have been 65 miles away; it would have cost $2500; I would have needed to do a clinical placement in an MD office practice. Finding the MD sponsor would not have been a problem, but I always did ICU and the thought of looking at otitis all day or dealing with management of HPTN, was not appealing. Those things are important but in my heart of hearts I wanted to be doing hospital-based acute care.

Call me a traditionalist.

How many NPs do we need?

For awhile there, the federal government was subsidizing the expansion of NP programs around the USA. There are statistics to say we need these primary care providers, but I wonder. When layoffs and restructurings happen in the health care industry, reductions in clinic staff always seem to involve the NPs before the doctors. I just don’t think the underlying reimbursement structure is well-established enough. And if you are a family NP? There are fewer kids nowadays and family care includes a lot of clients who lack insurance. This has been true for decades. Even in the 1980s, both of the two pediatricians in town had less take home pay than I did as ICU manager of the local hospital (they had office overhead, employees, etc).

What does an ARNP do all day?

A friend of mine in Maine is a women’s health APRN. She spends her whole work day doing contraceptive counseling, pelvic exams, and fitting diaphragms, IUDs and depo-provera inserts. She loves what she does. Simply gushes with enthusiasm. I don’t want to deny the importance of women’s health – it is critical. But would I want to do that? No way.

There is significant Continuing Education required to be an ARNP – to maintain certification takes 80 hours per year (varies from state to state).  this is a sizeable investment of time and money. Yes, we need to stay current in our field. But this is time spent away from patient care activities.

How to fix the nursing job market

In My Humble Opinion, we need to fix the gridlock in Washington DC before the health care situation will be improved. We have a series of paradoxes: lots of patients; lots of need; a huge cohort of older nurses preparing to retire in the next few years; and a larger supply of newer ( younger) nurses waiting in the wings. But jobs in health care are being held hostage by Congress. We need to get some grownups in charge back in the Capitol Building.