Nurse Practitioner School – Making the Decision

Making the decision to go back to school for my nurse practitioner (NP) degree wasn’t an easy one.  My plan had always been to work as a nurse for a year or two, then go to grad school part-time while working full- or part-time and having my employer pay for part or all of the cost of tuition.  Fast forward to 8 years post-BSN and I was now a mother of 3 and 5 year old boys and employed full-time as a nurse case manager.  It was rewarding to help patients, but I was far from being entirely satisfied in my then-role.  I faced a choice that boiled down to two options: continue in my current path as a BSN trained nurse, or pursue an advanced degree.

Many things crossed my mind in the months leading up to my decision.  If I did decide to pursue an advanced degree, which one?  The main tracks were management, education, or clinical.  I rather quickly ruled out an advanced degree in nursing education.  I like teaching patients, their family members, and other staff or co-workers, but couldn’t see myself doing it full-time for nursing students.  I have friends with their MSN in Education and they are passionate about it.  I was not.  Scratch out the education track.

Management?  I considered this one rather seriously.  I could see myself enjoying an administrative role, but I wasn’t ready to give up clinical practice just yet.  Additionally, many of the nurse managers and nurse executives that I’ve met worked long, long hours.  I had 2 small children and didn’t want to spend precious time away from them – this was one of the reasons why I was considering leaving my then-job as it was requiring more and more overtime.  Scratch out the management track.

So, clinical practice.  This appealed to me the most then and still does.  A degree as an NP would be hard work, but it would allow me to do many of the things that I wanted to be able to do as a case manager.  I also liked that a return to primary care was a return to my healthcare roots, having started as a medical assistant in family practice.  It was also appealing to focus more on “fire prevention” as compared with “fire fighting”, which I frequently did while working as an ER nurse.  Lastly, I liked the options that would be available to me.  As an NP, I felt that the time that I spent away from my family in either a full- or part-time capacity would net a larger return on investment than as a BSN trained nurse.  Having the option to work part-time was particularly appealing and I felt that working part-time as an NP would be more financially rewarding than working part-time as a BSN-trained nurse.  I liked the thought of having more control and say-so regarding my schedule, something that I was sorely lacking during those few months leading up to my decision.  Another appeal was the opportunity to advance my own knowledge regarding health and medicine.  I’d always felt that my BSN-training was more than adequate, but the longer I worked as a nurse the more aware I became of my limitations and shortcoming with that degree.  I wanted to know more and I wanted to do more, and I wanted it to be worth both my and my family’s while.  So, NP degree it was.

I don’t think I was too naive about getting my NP degree, emphasis on the “too” in that statement.  There was absolutely some naivete.  I’d spoken with my personal NP and some of her first words to me about becoming an NP were, “It’s not what you think it is.”  She described a high-stress, demanding job where NPs were required to care for a panel of patients the same as an MD but without an MD’s training.  She spoke of hours spent away from her family, weekends on email about patients, and last-minute calls to her husband about coming home late once again.  She stated that there had been times where she wished she could go back to being “just a nurse”, even though she had no plans to leave her current position.  She also mentioned that many NPs hit a wall and burn out after about 4 or 5 years, choosing to go into a different role because they can’t manage the stress.  My personal NP knew that I struggled at times with being anxious and taking on too much, so she was careful to point out that these were things that could easily lead to feeling overwhelmed as an NP.

It took the wind out of my sails to be sure, but it was a good wake-up call.  If I was going to be an NP, I needed to have someone give me a firm shake and make sure I knew what I was in for.

I went ahead with my plans and enrolled in school full-time (that decision is another blog post).  It’s been a tough 3 semesters and I’m about to embark on semester 4 (with only one more semester remaining after that – time has flown).  Following that, it’ll be taking the national certification exam, securing a job, and keeping my head above water while learning the many things that graduate school can’t and doesn’t teach you about being an NP.  I have been told that the first 2 years as a new NP are some of the hardest.  Bearing that in mind, I’ve decided to hold off on any decisions regarding a DNP until after those first 2 years are done and dusted.

So, this is an outline of my thought processes leading up to my grad school decision.  We all come here from different places and I’ve left out many other things that were part of my decision – the time invested in school, financial costs and benefits, what I’d be giving up, what I’d be gaining – but hopefully this will give you an idea of things to think about.  Or if you’re already on your NP journey then hopefully it is something to which you can relate.

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