Friday, February 3, 2017

Why become a NP?

A couple of weeks ago in therapy, my therapist asked me to come up with a list of why I wanted to become an NP now (versus later) and how it would help me accomplish my goals. So I thought this would be a good exercise to share for others who might be thinking of doing the same. Of course everyone will have a different list, but I'll share mine.

First, I think defining what a Nurse Practitioner (or NP for short) is will be helpful. I get asked this a lot. In order to explain what a NP is, you have to start with nursing. In the USA, a registered nurse (RN) is a license that you have to take an exam for. There are various ways to get a RN education, but typically it's through a diploma program usually through a hospital (few exist today), a community college associates degree, a 4-year undergraduate degree, or a master's entry graduate degree (I did this route). They vary in length form 12 months-4 years depending on the pre-requirements and degree. The shorter programs usually require more up front pre-requisite classes like biology, anatomy, physiology, chemistry, psychology, nutrition, microbiology, writing, and statistics (generally speaking). My program was a 12-month RN program followed by a six-quarter master's program, also known as a MEPN/MECN/Master's entry/graduate entry totaling 3 years and about $120,000 in student debt. Once you complete a RN program, you're eligible to take the NCLEX exam for your state (each state has a licensing board). You must pass your NCLEX to get your license to practice in your state. Each state has different rules, like in California medical assistants (non licensed staff) can take blood pressures, but in New York a nurse is required to do these.

After passing the NCLEX, you can move forward into one of the Advanced Practice RN (APRN) specialties of which there are four. Midwifery (except in some states like New York, it's not a nursing license but a separate professional license), Certified Nurse Anesthetist (CNA), Nurse Practitioner (NP), and Clinical Nurse Specialist (CNS). And once again, after completing a program, you take your National Board Exam to become licensed. In every state, APRNs can do most of the same things. And nurses like nurse practitioners work off protocols, allowing them to do more than the basic RN role by following "Standard Protocols". In my current job at Kaiser I'm in an Extended Nurse Role (or RNX as they call it), which is super cool. I work off of standard protocols agreed upon by the physician team to be able to titrate only certain medications under certain conditions. In some states like New Mexico, NPs can practice independently but in California, we have to work with a physician. It doesn't mean a physician has to sign off on everything like Physician Assistants, but rather there has to be a physician available at all times to provide guidance at least by telephone.
So I want to be a nurse practitioner (I think). But why? Where I live, nurses earn more than NPs. Nurses tend to work hourly shifts and NP work doesn't end at 5 PM, there is often charting to catch up and especially in the beginning, there is a steep learning curve. So then is it worth it? I think then at this point it comes down to what you want to do. I love my nursing work, it's very fulfilling and I get to work at the highest scope of practice in so many of the roles that I've had.

Nurses mean income in 2015 was $71,000 (and according to some studies, the lucky number to be happy with your income was $70,000, so why ask for more right?). For NPs it was $101,260. So quite a bit more on a national average. If we look at my local area more specifically, if you work for the county as a nurse the starting pay is $120,250. For NPs for the same county it is $148,954. For another nearby county starting RN pay is $108,908 and for NPs it's $136,968. So it's abaout $30,000 more annually for a NP job than for a RN job.

The other benefit is that for RNs working in positions that HRSA considers Medically Underserved Areas (MUA) are able to apply for loan forgiveness. There are programs for RNs as well. Where I live in an urban area, there are no clinics or hospitals that qualify, but about 40 miles away there is a clinic and then 15 miles away there is another one.

Finally, my financial situation is a challenging one. So I'm wondering if it's a good time to further pursue my education. I'm already $200k in debt from my BA, MPH, and MS degrees. My goal is to pay down as much of my student loan as soon as possible. So of course that goes against my returning to school because the program I'm looking into costs $675/unit and its a 31 unit program (though I could skip out on some classes if I want to save the money--though I'd rather just review the material) for a total of about $21,000. Adding that much to my total debt would go against my financial goals in several ways.

  • I can't earn as much while I'm in school. While I'll still be working my part-time and per diem jobs, it means I can't have the full-time job earning that $120k job I could have and pay down my debt.
  • I'm adding $21k to my $200 debt
My husband has been helping me pay down my debt by allowing us to use savings and stock to pay it down, I really owe him so much for not only supporting my academic goals, but also my financial goasls.

I think the other costs like time, emotional investment, hard work, and patience I think I can handle for 13 months. The deadline for the FNP post-masters program was yesterday 2/1/2017 so I'll be hearing back in the next 6-8 weeks on whether I got in or now! If I remember the info session correctly, they'll spend all of February 2017 reading applicaitons.

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