Is an advance practice degree worthwhile?


While working as staff nurse in a hospital, I often heard from coworkers that earning an advance practice degree is not a wise investment of time or money. Bedside nurses make good money and only work three days out of the week, so what's the advantage of earning a degree where you will make the same amount or less money and work five days a week? First of all, these assumptions are not necessarily true, but I will address that momentarily. Yes, an advance practice degree program is a huge monetary and time commitment, in addition to a significant amount of stress, so you must have a good reason to earn the degree. To define an advance practice degree, this refers to Master's of Science degree in nursing  (MSN) or Post-Master's Doctorate or Phd in nursing within area of expertise. Certified Nurse Midwife, Clinical Nurse Specialist, Nurse Anesthetist, and Nurse Practitioners, are all examples Master's-prepared nurses with advance practice degrees. There has been conversation in the nursing community about streamlining all advance practice degrees to doctorate degrees, however currently the Masters and Doctorate degree programs are separate entities.  In the midst of completing a MSN nurse-practitioner program, I definitely wanted to quit a number of times, and questioned the value of earning the degree. I had stable job as staff RN, and earned a salary that allowed for a comfortable lifestyle. During the last year I was completing the nurse practitioner MSN program, I was simply-put, "burnt out". While pregnant working full-time, juggling my course work, I encountered a set-back in one course, which led me to feel the degree was not worth the sacrifices. I was completely ready to quit the program, but with some encouragement from family and friends, I continued on with the program. Retrospectively I think this is a completely normal reaction in any intensive Master's program, regardless of the field. After sacrificing your social life, family time, sleep, and money, it's normal to think "for what?"

One of my coworkers in the ER would brag as how he was making $150,000 as a staff nurse, and would be taking a pay cut if he were to become nurse practitioner (of note he was working two night-shift jobs). Yes, you can make great money as a registered nurse working bedside. The overtime and extra shifts are always available. Working three days a week you are able to work two jobs, as many of my coworkers did. This is not easy money, however. One reason to consider an advance practice degree, is the physical nature of bedside nursing. Being on your feet for twelve hours and moving patients takes a toll on your body. An recent article here by a ICU nurse in the Huffington Post explains why the 3 days work week of a nurse is so exhausting.  Not many people want to or are able to work all the way out into retirement as a bedside nurse. Without an advance practice degree there are not a lot of options outside of bedside nursing, other than case management, house supervisor, or nursing informatics (almost all these positions require a BSN). Many hospitals now require a Master's for nursing director positions or any upper management position. Nurse educator positions almost all require Master's education.

The argument that you will make less money with a MSN than a RN is not accurate. My first job as a nurse practitioner (NP) in the emergency room I was paid hourly, and was receiving $20.00 + more an hour than as a RN working in the ER after four years. In addition, I was still working 12 hours shifts at that time, so the argument that you will be working five days a week is also not accurate. Currently, working at a urgent care/internal medicine clinic, I still make $15.00 an hour more than I did as a bedside nurse. If 12 hours shifts are your preference, this is still possible with an advance practice degree. Many urgent care clinics hire NPs and have 12 hour and 10 hour day shifts. If you choose to work overtime as a RN, yes there is a potential for more money. Furthermore, if you have 10 years plus of nursing experience, you may not see a drastic or any pay increase with an advance practice degree. I should make the disclaimer that in California in light of high cost of living considerations, RNs are paid among the highest salaries in the country. In the Bay Area of California, the salaries are even higher for RNs. My friend who currently works as ER nurse in a region of the Bay Area, definitely earns more than I as a NP. However, cost of living in this region is also higher.

The cost of a MSN program should also not be a deterrent to earning an advance practice degree. There are so many well-paying jobs available in these fields, that the degree will be worth the money. After completing the nurse practitioner degree I had multiple job interviews and several offers, even before having passed the national board certification. In addition, so much funding is available for education, especially for specialty areas such as education and psychiatry. There is such a need in these fields that there is a lot of federal funding and grants available to pay for education in these areas. As mentioned in a previous post, I completed a Master's-entry level program, which consisted of a pre and post-licensure segments. I took out federal student loans during the pre-licensure portion of the MSN program, as the course load did not allow for work, and I  and needed money for living expenses. I was working full-time throughout the post-licensure MSN program, and paid for each semester out of pocket to avoid any additional student loan debt. This was financially taxing, however it was doable on the salary of a registered nurse. I wasn't able to do any lavish vacations or shopping, but I was able to pay both tuition and my bills. The hospital I was employed at also offered tuition reimbursement, which covered at least one semester of part-time tuition a year. Most hospitals do offer some sort of continuing education or tuition reimbursement funding to full-time employees. There are also federal and state programs offering loan forgiveness in exchange for a commitment to work in a medically under-served regions, such as national health service corps. More information on this loan forgiveness program is available here.

Lastly, an advance practice degree allows for you to challenge yourself and gain expertise in an area you are interested. For me it was primary care and preventative health. Although I loved the complex cases and excitement in the emergency room, working in the ER reaffirmed my decision to work in primary care, as there is such a need for preventative medicine and primary care. There are so many other areas of advance practice, for any specialty area of interest. Certified nurse midwife, clinical nurse specialist, nurse anesthetist, and acute care NP, are all advance practice degrees with practice in hospital settings without traditional business hour work schedules.

I think being a bedside nurse is an incredible and challenging job, and there are plenty of reasons to love being a bedside nurse. Once my life settles down, I have considered working as a ER nurse per diem so I may keep up my skills and still remember how to respond in a code. I am glad however, I stuck it out and completed the MSN degree. So many more doors have opened, and I love the new challenges and opportunities I have to make a difference in the lives of my patients. My advice is to contemplate your reason for pursuing an advance practice degree. If money is the only motivator, consider salaries and cost of a graduate program, but that may not be enough of reason to pursue an advance practice degree. Consider your long-term goals, area of passion in health care, and also consider what setting and hours are most compatible with your life. In the future of this blog I plan to feature advance practice nurses in different settings monthly to bring about more understanding and information about these professions. If are interested in being featured, please send me your information or comment below!
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