Tag Archives: nursing as a second career

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.


Filed under APRN education, nursing education, nursing faculty jobs in Hawaii, Nursing in Hawaii, Obamacare

Especially for the older nursing student – it’s not about what you know

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Nowadays nursing is a popular choice for older students, whether it’s a person who already has a college degree (and is going for Master’s Entry into Nursing, or MEPN), or an LPN going back to get the degree, or somebody who needs to change careers.

Nursing school is a shock to the system

Regardless of how you got to nursing school, you find yourself back in college, back on the treadmill of studying, exams, seminars, group projects – everything. It’s a shock and a transition. For many, the shock is eased by the fact that you needed to take prerequisite courses before you finally got on the bus through nursing school, and this served to get you back into Study Mode. But it is still a shock as you learn what it is that nurses do.

through it all, there is something not to say.

“I already know everything I need to know, I am simply here to get the credential, sit for the NCLEX, and get a job. I don’t want to hear about all this theory. Just tell me what I need to do to pass the exam.”

(yes, I have heard actual students say those exact words.)

I would be the first to admit that getting a job is an okay motivation for choosing nursing, though it takes more cleverness right now than it did a year or two ago ( and yes, the job market will improve in a year or two, by the time you graduate). But if you repeat this statement in front of a faculty member, don’t be surprised if they raise an eyebrow… or two. Usually the response will be “Oh Really?” but that is not what the faculty member is thinking…….

What the faculty knows, that you don’t know

Here is why. Nurses are not paid for what they do, nurses are paid for how they think. This is such an important motto, it ought to be a tattoo (which is of course, the best way for The Youth of Today to study it).  Oh yes, we are teaching you how to insert a foley catheter, how to prepare a medication, how to start an IV, and a pile of other skills. But the skills in and of themselves do not compose the nurse. Don’t get me wrong – you need to be excellent at those skills and more. But, you need to learn how to think about patients in a wholistic manner, and also learn when not to do the skill, or when & how to change the way you do it to fit a given situation. this is the thinking part. Assessment-Plan-Intervene-Evaluate. A nurse is not a Junior Doctor; no matter how much we teach you about medicine that is only part of the nurse’s role.

for the older student

It’s possible that your faculty member may not be familiar with the term “Role Socialization” – but that doesn’t mean you can ignore this concept. Some people look at it and focus on the socialization part – thinking that maybe we mean you should be friends with your classmates. No, that is not even remotely what it means. Role socialization is the way a sociologist would describe the process of becoming a Nurse with a capital N.

Ask Yourself: How would a real nurse deal with whatever situation you are now facing?

The flip side of the coin

Here is a hint: if you ever want to impress your faculty member, ask them “How am I doing with role socialization?” and see what they say. They will most likely be impressed at the sophistication with which you are approaching the work.

If you are having difficulty getting it, the lack of role socialization will show up in your work. When you do patient care, you will miss things that you shouldn’t, and people will give you negative feedback about your “priority setting.” Or else, “lack of caring behavior” – which is of course, a dagger to your heart. A nurse’s number one job is to “care.” – we’ll go into that at some future date.

One solution? just do a websearch on the term.  You will find that there is a whole other universe out there among nursing scholars. The process of role socialization, and it’s success or failure, is a strong current in nursing education. Most of the links to it are to be found in scholarly journals. Looking for a research project?

One small Jedi mind-trick that real nurses use

Here is one tip: if a patient ever asks you a question, resist the urge to give them the answer. Always continue the dialogue by asking a followup question to clarify what ever they just said.

Boys vs Girls

I have two daughters. My wife and I, being children of the sixties, thought we would raise them in a gender-neutral way. Yes, we taught them to enjoy sports and boisterous play, such as throwing a football and go camping, and (later) to drive a stick. I built them a sandbox and got them a toy dump truck and a toy back hoe. But, even without our prompting, the two young ladies would spend time playing with dolls, doing hairplay with each other, and the like. To have kids is a fascinating experience in how girls learn to be girls and boys learn to be boys. Gender roles. the best example of socialization. Hey, I didn’t create the system, I simply bow to the fact that it exists.

Just for Men

Now, for the male student:

There are special challenges in role socialization for men who enter nursing. My best advice is to find the book “You Just Don’t Understand: Women and Men in Conversation” by Deb Tannen. Yes, it was published twenty years ago.  But it is still a classic. It’s a guide to clear communication when gender roles are different. It’s kind of book you can pick up and read from randomly yet you still will get something out of it. And on Amazon, you can get a copy for less than a dollar, plus shipping and handling.

Whenever I have a male student who is having trouble adjusting to nursing school, I lend them this book. Right now, I have no copies left…… hmmmmmm…..

Just one excerpt:


“For girls, talk is the glue that holds relationships together. Boys’ relationships are held together primarily by activities: doing things together, or talking about activities such as sports or, later, politics.” (pg. 85)

“Women and men are inclined to understand each other in terms of their own styles because we assume we all live in the same world. [A] young man in [Thomas Fox’ college] writing class noticed that his female peers refused to speak with authority. He imagined the reason to be that they feared being wrong. For him, the point was knowledge, a matter of individual ability. It did not occur to him that what they feared was not being wrong, but being offensive. For them, the point was connection: their relation to the group.” (pg. 179)

If that hasn’t whetted your appetite, I don’t know what will…… remember, it’s not about what you know, but how you think….

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