The Road to becoming a Family Nurse Practitioner

I decided early on in college I wanted to be in the medical field, however it took me some time to choose the path towards Family Nurse Practitioner. I started undergraduate with little direction, although in high school I gravitated towards the arts and humanities and I assumed I would end up picking a major in that field. I had no one in my family in the medical field, or really had much experience with ill family members, so a career in the medicine was not something that crossed my mind. I did take an anatomy class in high school, which I ended up loving, but I didn't see it as anything I wanted to do. My first semester in college I took an introductory biology course as a requirement. When I found myself neglecting my other subjects and rigorously taking notes from my biology textbook and acing every exam, I thought maybe I should go into the sciences. I did just that the following semester. A lot of my classmates and others majoring in the sciences were on the pre-med track, and I thought I may look into this option. I shadowed several primary care doctors, volunteered in the Emergency Room, and realized I did indeed want to go into medicine. As I approached the end of my four years in college, I was ambivalent about which path I wanted to take. Was medical school right for me? Physician's Assistant, Pharmacy, Nursing, Biomedical engineering, and medical technician, were all among other options I considered. After college I spent more time volunteering in clinics, working in labs, and shadowing doctors. After a lot of research and time, I decided to pursue the Family Nurse Practitioner route via the entry-level master's programs. For those unfamiliar, these programs are for individuals with a bachelor's degree in a field outside of nursing. The Master's entry programs usually consist of an accelerated "pre-licensure" BSN program, in which case my program the pre-licensure portion was an accelerated 20 months. After this you are eligible to take the NCLEX RN certification board exam. During  the post-licensure portion of the program, you may specialize in the master's area you wish. My school, Azusa Pacific University, offered Family Nurse Practitioner (FNP), Adult Nurse Practitioner (ANP) Pediatric Nurse Practitioner (PNP), Psychiatric Nurse Practitioner, and Clinical Nurse Specialist (CNS).  Unless you already know for sure you want to work in a particular field, such as pediatrics, I would recommend doing the FNP track. The reason is that the family nurse practitioner can work with all age groups and in most settings, and thus is most marketable. The "pre-licensure" portion of the program is full-time, and working during this time is discouraged. I had a part-time job as a CNA during most of the program, which was great experience, however balancing both was tough. After the "pre-licensure" portion you are required to obtain hours as a registered nurse to be eligible to apply for the nurse practitioner license. This requires getting a job as a RN. What was not made clear to me when starting this program, was that getting a part-time or per diem job as a newly graduated RN is nearly impossible. The other difficulty in this portion of the program is that it is nearly impossible to get a day-shift position as a newly-graduated RN. This means you will likely be working full-time nights as a new RN while starting the graduate-level courses for the post-licensure part of the program, including clinical hours which is as time-consuming as a full-time job. For this reason, less than half of the cohort starting my program did not continue on and obtain the masters. The advantage to my program was there was no minimum credit requirement to stay enrolled, so I was able to adjust my course load based on what I could manage. When I started the graduate-level courses I was also in a new-grad program at the hospital where I was hired, so I only started taking one class that semester. I also took off school during the summer when I was married. The master's portion took me 3 and a half years, because I attended school part-time and was working full-time. Some of my coworkers who were experienced nurses, completed a MSN program in 2 years while working full-time, however neither one of them were married nor had kids. Some of my classmates completed the masters in less than two years, however they were working part-time jobs or per-diem jobs. However, if you are planning on going through the Master's-Entry level nursing, I would highly recommend getting experience in a hospital as a RN. In the FNP program, all my clinical rotations were in outpatient clinics. Although my goal was to work in an outpatient setting, the experience in the ER was so formative in my career and personal life, I wouldn't trade it for anything. If you are interested in going into the FNP program, or really any field, I think working in the ER is extremely beneficial. You will encounter every type of patient from neonates, psychiatric, obstetrics, gynecology and gerontology. My nursing skills were fully developed by working in the ER, as you do IV starts, foley catheters, NG tubes and assist with intubations multiple times a day. Furthermore, my assessment skills became strong after working in the ER. You never know what a patient's diagnosis is walking through the door, and after some time in the ER, anticipating orders and being able to identify "sick" from "stable" became second nature. Without having worked in situations where you see the "worst-case" scenarios in all areas of medicine, you may not fully understand the complications of disease states in otherwise healthy patients when working in an outpatient setting.

On a personal level working in the ER made me a stronger individual. The tone of the ER in most cases is high-stress and fast-paced. I remember when I was a new nurse being appalled at the way I was spoke to by patients and coworkers alike. After some time my skin became much more thick, and I was able to keep my cool when a patient was swearing at me at the same time  an irate doctor was yelling at me over the phone because he was talking to fast for me to catch his orders.
The ability to deal with grief and unexpected death is another reason my time in ER was valuable. Unlike other units of the hospital, where death is sometimes predictable or anticipated, the ER is often where families are completely blindsided by the death of a loved-one, and in these cases the grief is often raw and difficult to experience. I remember during the first week in the ER a patient had passed away in several hours after being fully alert and had walked into the ER. The family was inconsolable, and I wasn't even able to make eye contact with them because it was so upsetting and uncomfortable to me. Being able to deal with grieving individuals is essential to any area practice, because the effects of this type of grief are life-long. After witnessing patients die, young and old,  I became better able to talk openly with patients about loss.
The ER is also becoming a place where people receive their primary care, despite the increase access to primary care. Working in the ER I was exposed to almost every condition encountered in primary care. There are plenty of opportunities now for FNPs in ER, and the pay is usually higher than other specialties. The hours are not regular, but if you enjoy procedures and fast-paced work, consider this area of practice.
If you are considering an advance practice nursing degree, there will be considerable amount of sacrifice in terms of time and money, but I believe it's well worth it. Share your comments or stories below.

Pinning Ceremony 2011

MSN graduation with original cohort classmates 2014
RN residency cohort 2011
1 comment on "The Road to becoming a Family Nurse Practitioner"
  1. Congratulation!