Before you even fill out your application, you need to answer these 5 questions. Stop what you are doing and have a seat. You will lose months (if not years) off of your life and money from your bank if you don’t pay attention to the next 5 questions I share with you.
Before we start, here is the definition of a Nurse Practitioner as referenced by the (AANP ) American Association of Nurse Practitioners. (If you’ve visited their website before, this is not new information)
As clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management, NPs bring a comprehensive perspective to health care.
All NPs must complete a master’s or doctoral degree program, and have advanced clinical training beyond their initial professional registered nurse preparation. Didactic and clinical courses prepare nurses with specialized knowledge and clinical competency to practice in primary care, acute care, and long-term health care settings.
To be recognized as expert health care providers and ensure the highest quality of care, NPs undergo rigorous national certification, periodic peer review, clinical outcome evaluations, and adhere to a code of ethical practices. Self-directed continued learning and professional development is also essential to maintaining clinical competency.
Additionally, to promote quality health care and improve clinical outcomes, NPs lead and participate in both professional and lay health care forums, conduct research and apply findings to clinical practice.
NPs are licensed in all states and the District of Columbia and practice under the rules and regulations of the state in which they are licensed. They provide high-quality care in rural, urban and suburban communities, in many types of settings including clinics, hospitals, emergency rooms, urgent care sites, private physician or NP practices, nursing homes, schools, colleges, and public health departments.
Autonomously and in collaboration with health care professionals and other individuals, NPs provide a full range of primary, acute and specialty health care services, including:
- Ordering, performing and interpreting diagnostic tests such as lab work and x-rays.
- Diagnosing and treating acute and chronic conditions such as diabetes, high blood pressure, infections, and injuries.
- Prescribing medications and other treatments.
- Managing patients’ overall care.
- Educating patients on disease prevention and positive health and lifestyle choices.
Specialty areas include:
- Acute Care
- Adult Health
- Family Health
- Gerontology Health
- Neonatal Health
- Pediatric/Child Health
- Psychiatric/Mental Health
- Women’s Health
Sub-specialty areas include:
- Allergy & Immunology
- Hematology & Oncology
- Occupational Health
- Pulmonology & Respiratory
- Sports Medicine
What sets NPs apart from other health care providers is their unique emphasis on the health and well-being of the whole person. With a focus on health promotion, disease prevention, and health education and counseling, NPs guide patients in making smarter health and lifestyle choices, which in turn can lower patients’ out-of-pocket costs.
NP credibility – NPs are more than just health care providers; they are mentors, educators, researchers, and administrators. Their involvement in professional organizations and participation in health policy activities at the local, state, national, and international levels helps to advance the role of the NP and ensure that professional standards are maintained.
Lower health-care costs – By providing high-quality care and counseling, NPs can lower the cost of health care for patients. For example, patients who see NPs as their primary care provider often have fewer emergency room visits, shorter hospital stays and lower medication costs.
Patient satisfaction – With over 870 million visits made to NPs each year, patients report an extremely high level of satisfaction with the care they receive.
Primary care shortage solution – By offering high-quality, cost-effective, patient-centered health care, NPs provide more than 234,000 solutions to the primary care shortage facing America today.
OK. Now that we have that out of the way, let’s talk about what you need to know before you take the leap and fill out that “really thin” and stress-free school application (hint of sarcasm there).
Sometimes referred to as an NP, APRN, CRNP, ACNP, PNP, NNP, FNP with a sprinkle of -AG (Adult-Gerontology) or -BC (Board Certified) slapped on the end for good measure (depending on your specialty).
NP = Nurse Practitioner
APRN = Advanced Practice Registered Nurse
CRNP = Certified Registered Nurse Practitioner
PNP = Pediatric Nurse Practitioner
NNP = Neonatal Nurse Practitioner
FNP = Family Nurse Practitioner
…sigh, you know we love our acronyms.
For example, I’m an ACNP-BC = Acute Care Nurse Practitioner – Board Certified
From this point forward I’m just going to refer to them as NPs for simplicity (and because I’m lazy and don’t want to type out the whole title).
Gone are the days of the “general practitioner” NP. In this day and age, not all NPs are cut from the same cloth. Many years ago (in a galaxy far.. far.. away), most NPs chose the Family NP route and then everyone branched off into whatever sub-specialty that “floated their boat.” It was akin to entry-level nursing school. You got through the program and along the way you discovered what you liked, what you didn’t like and where you would like to end up working. Once you graduated… you then chose a path.
Nope. Not anymore.
Thanks in part to the IOM Report on the Future of Nursing from 2010 (which addressed all nurses at all levels), NPs are now very specialized.
We follow the Consensus Model of APRN Regulation (and Practice) which provides definitions of APRN practice, titles, and specialties, as well as describing the relationships between licensure, accreditation, certification, and education.
Basically, in a nutshell, it states that NP education, training, certification and licensure has to specific and specialized to the area in which you practice. Your skills and training need to be specific to the population and area of focus.
You cannot be a “generalist” who floats from space to space anymore. Sorry.
What does all of this mean for the potential student NP-to-be?
Here is your entire NP education summed up in three sentences. Pay attention.
You have to pick a lane before you start the drive.
Once you pick a lane, you cannot switch lanes until you are done with the entire trip.
If you do not like your destination at the end of your trip. You will have to get in your car, drive even further and take another trip. Incurring whatever additional costs it takes to get you there.
Let’s get to those five questions I was talking about. Answer these five questions BEFORE you begin your research; BEFORE you fill out any paperwork. BEFORE you pay any fees.
If you do not answer these five questions beforehand, you will not only waste several years of your life pursuing a degree and career that you do not want, but you will waste thousands, yes I said thousands, you will waste thousands of dollars on an education that was a rest stop, not a final destination.
1. You have to “know” where you want to end up before you even start.
Yes, you sorta have to predict the future. Deal with it.
An FNP not trained in Acute Care (critical care – ICU) cannot work (treat/see patients) in the ICU. In fact, there are some facilities and geographical locations that won’t allow an FNP to practice within the entire acute inpatient setting (within the walls of a hospital).
Equally, an ACNP (which is usually an Adult NP) cannot care for the pediatric population. Which means most ACNP’s do not work in primary care, stand-alone clinics, express ER’s, or traditional ED’s because they have younger aged patients (although there are workarounds).
2. What type of patient population do you see yourself caring for?
- Adults only?
- Across the lifespan (from birth to death)?
This is a vitally important question you need to answer with as much honesty as possible. Don’t answer this question based on what others are telling you. Don’t base this answer on what your manager, your co-worker, your BFF, your Mom, your neighbor or your favorite internet superstar is suggesting.
Where do you see yourself working day-in-and-day-out with no loss of enthusiasm? What job would you consider not a “job”.
This is an unfair question to ask yourself, because once again… you have to somehow predict the future. You have to guesstimate what the role would be like.
Want help answering this question?
Be brutally honest with your wants and needs. And don’t be ashamed to admit your dislikes. Embrace you, which means accepting your strengths and your weaknesses.
For me, I didn’t want to take care of pediatrics. No kids for me, uh-uh… no thanks. I cared for pediatrics and infants when I worked in the PACU.. nope. Not something I ‘enjoyed’. So when it came time to choose.. it was actually quite easy for me… since I knew exactly what I didn’t want.
And ultimately, I would HIGHLY recommend job shadowing. Shadow the role you are interested in fulfilling. And if at all possible, shadow two people within that role. Find a person who loves their job, and then find a person who hates their job.. and pick both their brains. Figure out the good, the bad and the ugly truth about the role. What is it REALLY like? (Remember what you thought about the world of nursing before you became one? Yep, it’s like that.)
3. Where do you see yourself in 5 years? How about 10 years? What is your final destination?
This is another tough question, but it parlays off of question #2. The answer to this question shapes your entire advanced practice career trajectory. Because while I’m telling you to sort-of predict your future … you truly can’t. So can you be 100% certain you will be standing on the same ground in five years? Or ten years?
Will you move to a different town or state? Will you move to a different part of the world? Are you getting married? Engaged? Do you have children? Are you planning on having children? Do you own a home? Are you planning on renting, leasing or purchasing a home?
All legitimate life-changing personal events that will affect your professional career. Here are other things to consider.
What type of work environment?
Inpatient? (some FNPs are limited on the type of inpatient care)
Outpatient? (ACNPs are limited on the type of outpatient care)
Clinic? (usually for FNPs only)
Acute care hospital? (mostly ACNPs, but can employ other NP specialties)
Remember what I said about changing lanes?
What will be your actual (or intended) geographical location? This has relevance to that area job market. Does this location have jobs available for the job you want? Do some job market research before you waste your time and money.
You could have a great passion for becoming an ACNP… but in 5 years when you move to Topeka, Kansas (or wherever you are moving)… will there be ACNP jobs out there for you to even apply for?
Plan ahead. Trust me. I’ve met too many new NP grads who are jobless because they didn’t do their market research. Dreams are great to have, but they don’t pay the bills homeslice.
4. What type of degree? What type of program? What will be your student status? (full-time, part-time, one class at a time)
- MSN (being phased out)
First of all (as of this writing), the DNP is not a minimum requirement to work as an NP (yet). If I had to guess, this rumored requirement is years away from actually being enforced (probably another decade). I remember when the rumor mill suggested the BSN would be the minimum degree required to practice as an RN… yet here we are almost 15 years later, and there are still ADN / diploma programs out there (yes, I know they are being phased out and hospitals are slowly making the BSN a requirement).
DNP is the terminal degree for an NP. I have my MSN, so if this requirement ever happens… I’ll have to take my sorry butt back to school.
DNP requires a more intensive research pathway in addition to more clinical hours than an MSN degree. At the bedside, the MSN & DNP are no different at the practice level. I work side by side with DNP prepared NPs and we perform the exact same job. Although I’m sure there are probably pay differences.
A DNP degree will also guarantee you a teaching position, whereas my MSN degree will not allow me to teach DNP students (which makes sense). Supervisory positions at the NP level are almost always requiring the DNP terminal degree. These are all things that will matter to you later in your career.
The MSN degree is still an option in many areas of the country… but it’s being phased out. For instance, the program I graduated from no longer exists. It was eliminated before I even graduated.
- What type of program
- Traditional vs. Online or Cohort (it combines traditional with online classes)
- The location of clinical rotations will matter
- Who will be making the arrangements for your preceptors
Now the nitty-gritty of actually being in school. How will your post-baccalaureate adventures play out? How much time & money do you have to dedicate to school? I was able to attend school full-time and work part-time. Many students choose to work full-time and be the part-time student. If you have a family to take care of, you might be only able to take one class a semester.
There’s no wrong answer here.. just know what your answer will be. Because it will affect the other choices you have to make.
Online, traditional or cohort? Have you ever taken an online course before? No? Then I highly recommend you don’t do online NP courses.. because they are no joke. They are tough! I sucked at online coursework… so I stayed far away from them.
Have you ever taken an online course before? No? Then I highly recommend you don’t do online NP courses as your first stab at an online course… because they are no joke. They are tough! I sucked at online coursework… so I stayed far away from them. In fact, I chose to commute 70 miles one way instead of the online option (I’m crazy like that).
The other sick twist to online vs traditional programs is the clinical rotations. Traditional programs are pretty straightforward because you have the physical location of the university to help you. Most schools are “attached” or affiliated with larger hospitals or hospital systems, so making arrangements for clinical rotations is not too painful. You have immediate contacts in both the educational institution and the hospital system(s).
That’s not the case with online programs. You are pretty much on your own. You have to find a preceptor, figure out their availability, determine if they are affiliated with your school, if not you will have to create the affiliation and after all that you are taking a gamble with the actual preceptor and the learning experience.
Is this preceptor a physician or an actual NP? Do they have experience with teaching, let alone teaching an NP student? Do they understand the role of the NP? Have they ever worked collaboratively with an NP? Or are they stuck in the distant past of just dictating orders and treating the NP like a paper-pushing underling? True story.
You go through all the trouble of arranging your clinical experience to only find out you won’t learn a darn thing. Not making this up, it happens. And it happens more often than we’d all like to admit.
Do your homework. Here’s a video I did discussing the online DNP:
Extra credit question: Which national certification exam will you take? There are different types (yep, let’s make things more complicated.)
The take-home message here is that each state decides how they recognize these certifications. There are some states that do not recognize certain certifications as qualifying criteria for attaining NP licensure (yes, I’m not making that up). For instance, my neighboring state did not recognize one of the certifications listed, so I could have taken the exam and passed and the state would not have granted my licensure in their state.
Can you imagine finding that out after-the-fact? Once again do your homework. If you plan on moving or traveling to a different state, find out what the state requirements are for NP licensure.
OK, so after all that, you still wanna change lanes? You’ve graduated and taken your certification exam. You may or may not have worked in your area of choice for a number of years and you realize you love being an NP… but not in the specialty area of your choice.
As an example:
- ACNP wants to practice in a PCP office (or ED, or clinic)
- FNP wants to practice in the ICU
- CPNP wants to work in the ED (or ICU)
5. You can pursue a post-degree certification
Remember what I said earlier. This is an option, but it’s an expensive and lengthy option to choose. You will have approximately 2-3 more years of education & formal schooling ahead of you.
For instance, I’m an ACNP. I work in Critical Care. But maybe, now I want to work in a PCP office? Or maybe I want to work in the ED? Well, I can’t take care of the pediatric population. So I need to go back and get my post-degree FNP certification. Every school institution will have varying options and requirements for these post-degree certifications, so once again, do your homework. I’ve heard the online option is quite popular.
Whew! Well, there you have it. Five questions you NEED to ask yourself before you dive into the “I wanna be an NP” pool. Please keep in mind your state practice acts are the gatekeeper for all this information. Start there and work your way backward.
I’ll leave you with this video I did, which sort of sums up most of my talking points.
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