Why NP?

I previously shared my journey, to becoming a Family Nurse Practitioner in the blog, The Road to Becoming a Family Nurse Practitioner, however I did not discuss at length why I chose this particular path. I recently had a question from a reader trying to make a decision on her career path, and wondering if becoming a nurse practitioner is the road for her. As I wrote about in the previous blog post, I started college straight out of high school without much direction. When I became interested in the sciences, many of my classmates were either pre-med or pre-pharm. These fields both seemed to be the most lucrative and stable of the other options available, so I began to research these. The school I attended Southern Oregon University, also had a BSN (Bachelor of Science in Nursing) program, which I considered. Having zero experience in healthcare, or having known anyone in these fields made my decision a bit tricky. I ruled out the nursing option because in order to start this program you had to be accepted in the second year of school and once starting this track it would be difficult to change paths to another field, such as pre-med or pre-pharmacy. Furthermore, I was in a program Western Undergraduate Exchange, which gave me reduced tuition, and this program was specific certain majors, oddly enough not including nursing. I decided against pharmacy because I felt that the work would be too isolating for me, and I wanted to have patient interaction. The thought of medical school, although appealing, seemed absolutely daunting. Not only the rigorous training, but the length of time and amount of debt required terrified me. I knew that making a commitment to this would mean I was absolutely sure this was what I wanted to do. I started by getting some experience shadowing a family practice physician and volunteering in the ER. The physician I shadowed was great, and really developed my interest in family practice. As a volunteer I was able to understand the varying roles and functions within the ER. I seemed to moving in the direction of medicine, but still had doubts. When I discovered the careers of physician assistant and nurse practitioner, I also began to consider these fields. Less time in school seemed more appealing. I put off any major decision after I graduated with the goal of getting some practical real-life work experience in healthcare. I moved to Portland,Oregon, however the entry-level job prospects in healthcare were almost non-existent. Even minimum wage jobs in some hospitals or clinics required certifications. I had no money to continue more certifications. In the midst of looking for work I continued shadowing physicians, volunteering at a free clinic, and studying for the medical entrance exam, the MCAT. After taking the MCAT and getting a decent score,  I interviewed for a front-desk position with a female spinal surgeon. When she reviewed my resume, she asked if I was planning on going to medical school. I told her my story and reservations about medical school and balancing a life outside work. She expressed her difficulties balancing her life with kids and family, and in a nutshell said she would have taken a different career path if she did it over again. This really resonated with me, as I did want a family and kids. I put off applying to medical school and started researching PA and NP programs. These two roles are often used interchangeably, however the training and scope of practice is different, as I would learn. The physician assistant programs are usually 2-3 years and often requires 2 years of paid direct patient contact hours, although some programs do not require these hours. Many entering the PA programs are EMTs, many of my coworkers working in the ER were working towards admission to a PA program. I cannot 100% speak for the education in these programs, but from my understanding one major difference in the curriculum of PA vs. NP is the PA program follows the medical education model, rather than the nursing model.  PAs also always practice under a physician's license, and therefore cannot open a practice or bill independently. Historically the PA role came from the need for jobs for army corpsmen returning from Vietnam War, and thus PAs tend to be very strong in the areas of orthopedics, urgent and emergent care. When I worked in ER the PAs definitely outnumbered NPs. The PA programs also are not specialized, and thus require a post-graduate residency or on the job training for specialized fields. The advance practice nurse programs, in contrast all requires a RN license, and hence the skills of a nurse. The programs are usually specialized, and thus clinical hours are usually completed in an area of specialty, rather than a round robin of different acute and outpatient settings. I was drawn to the Family Nurse Practitioner program because I wanted to practice in primary care, and I also found it advantageous to have the experience of a RN as well as the potential to practice independently. What I have found to be most valuable in my education and unique to APRN programs, is the experience as a RN. Nurses spend more time with patients than any other position in healthcare. They are at the bedside when the patient is vomiting, having diarrhea, having a psychotic episode, or comforting a family member while the patient is coding. When you are so close to patients during their time of illness, you have no choice to develop a deeper understanding and empathy for your patients. I'm not saying other healthcare professionals aren't able to develop this level of empathy or understanding, I just feel that this level of contact creates a special understanding. I also feel that nurses have extremely strong assessment skills, and often develop an intuition of when a patient will crash before anyone else. I am absolutely happy with my career, and feel I am doing what I always wanted to do. Do I have any regrets or wish I had gone down a different career path? Sure, but ultimately I feel this was the right choice for me. I sometimes wish I had the higher income and prestige of a medical doctor (MD), but that is not why I wanted to get into the field of healthcare. I sometimes wish I would have just gone straight into nursing and saved myself the additional time of doing the entry-level program, however I just didn't have the insight into APRN degrees at that point in my education. My advice to anyone debating between nursing or another medical degree is to pursue the BSN degree first. This way you are able to later pursue an advance degree in any other field, but also have the valuable experience of being a nurse. Doing the entry-level program was especially challenging, for the fact that while transitioning into the role of the RN, I was also taking the graduate MSN courses. While I was in the MSN program, I sometimes felt that I should have just gone to medical school, as I had spent so many years and energy towards the advance practice degree. The average time after receiving a Bachelor's degree to becoming a doctor is 4 years plus a three year required residency, and often times longer for specializations. In total I spent almost five years to receive both the BSN and MSN degrees. I in no way feel that the nurse practitioner program was a "cop out", as these programs were extremely challenging and the clinical  hours required grueling. I do regret however, that I was discouraged from applying to medical school by one female physician's opinion. When I look back I realized I never sought out any female mentors to give me an insight into balancing a career and family in medicine. All the doctors I shadowed were male, and all my classmates I studied for the MCAT with were male.  I now see on social media so many female physicians mentoring each other, and several doing really challenging careers with several children. I think it's so important to have a mentor, but especially one that you can ask questions about work-life balance and perhaps comes from a similar background or situation as yourself.  I also find that nurse practitioner and physician's assistant programs, because of the brevity in comparison to medical school, lack in some areas. I felt that my particular program lacked education on diagnostic imaging. There are now many residency programs available to NPs and PAs, which I did not elect to do, however I feel would be a benefit especially for a specialization. As a nurse practitioner, there are some areas that require additional continuing education or self-study to fully grasp. My parting words for this post is that there are pros and cons to any graduate healthcare program. In the end, whatever path you take will lead you to a rewarding, lucrative and in-demand job, so you can't go wrong.
2 comments on "Why NP?"
  1. I like your blog a lot. Its informative and full of information. Thank you for sharing.
    Medical Careers

  2. I'm glad you found the post helpful!