I got into nursing school! Yay! Now what? Do I go?
April 15, 2015 10:30 AM   Subscribe

I was accepted into a very competitive BSN program for fall admission. Hooray! I've been working so hard for the past year and a half to make this happen, and now that it happened I'm starting to question whether it's the right thing for me after all.

I'm 34 years old and this is a career change for me. I have recent experience as a caregiver, I loved my prerequisite courses (which I aced), and I am certain that patient care is what I want to do. How I go about achieving that goal is less clear to me. I feel an intense need to just get on with the business of having a career already, and originally I thought I'd spend two years in nursing school, then work as an RN for a bit... and then go back to school to end up as a nurse practitioner or physician's assistant.

Then someone asked me why I didn't just apply straight to nurse practitioner programs, since I have a hard science degree already and would be eligible for some programs. I didn't know that was an option, of course, until application deadlines had already passed. So is it a better idea to wait another year (ugh) to apply to those programs and cut right to the chase? Or should I spend two years on my BSN first? (It has not escaped my notice that the well-respected nursing school I've been accepted to does not offer an NP option without an RN license first, and the straight-to-NP programs in my area are all at expensive private schools.) And would I find it more difficult to get hired as an NP if I don't get experience as an RN first?

I am aware of ABSN programs but prefer not to go that route, just to get that out of the way.
posted by adiabat to Education (12 answers total) 4 users marked this as a favorite
I think all of your reservations for immediately pursuing your NP/PA are valid. I have been almost in your shoes, except I was an LPN trying to decide whether to do an bridge-ADN, second degree-BSN, or second-degree NP program. I decided to get my RN first so that I could get my feet wet in a variety of settings before deciding what I should specialize in for my NP. Congratulations on getting into nursing school, and good luck!
posted by pintapicasso at 10:36 AM on April 15, 2015

How far past the deadlines for the NP programs are you? Admission deadlines aren't set in stone. I might call around and see if admissions departments think they'd have space for you this coming year, and if you'd be a suitable candidate. The worse thing they could say is no and no, and then you're left with what you already have.
posted by ThePinkSuperhero at 10:56 AM on April 15, 2015 [2 favorites]

My wife decided to go from Respiratory Therapy to Nursing in her early 40s (and is now 48), so I have some of an understanding of the challenges you have in store. My wife got her RN at a local junior college. She has worked in an ER and several nursing homes, and she is now on a MedSurg floor at at local hospital. She is now in an RN to MSN/NP program and she and told me that her experience with actual nursing has improved her confidence clarified her desire to advance in a nursing career. I don't think that getting a nursing degree and working as an RN would be a waste of time. You would be providing quality medical care, you will make contact with patients and their families in a range of circumstances. All of which will serve you well when you start an advanced degree program.
posted by Billiken at 11:07 AM on April 15, 2015

I would work as an RN first, both to decide for sure what you want to specialize in and because as I have heard it, many places don't want to hire you as an NP without RN experience and I don't think an NP without RN experience would really have any idea what they were doing.

Also, you mention that the straight-to-NP programs (this is a thing? All the programs I saw when I was applying required that you get your BSN first as part of the program and then continued on -- I don't know that you can get an NP license without holding an RN license first but I could be wrong) are expensive ... A lot of hospitals will pay for at least part of your NP while you work them as an RN, and it's a degree that can be done part time, unlike PA school.

Just my two cents!
posted by queens86 at 11:07 AM on April 15, 2015 [1 favorite]

I'm also a career change nursing student, but in Canada, where things are a bit different. (I'm in a direct-entry MSN/RN program.) In your position, I would probably stick with the RN, especially since it's only two years.

If you have any thoughts about working outside of the States during your career, you would be better off with the RN. In Canada at least, it's required to have an RN before becoming an NP, and USA NP degrees are not recognized as far as I know. This may vary in other countries, but it's something to think about.

Something to think about might be whether your reasons for not going ABSN possibly apply to direct-entry NP programs as well...?

And finally, if you start the RN program this fall but keep thinking about the NP program (or aren't liking your RN program), you could always apply to the NP for fall 2016 and drop out of your RN program if you get in. It's a bit weird, but it's an option that could keep you moving forward regardless.
posted by snorkmaiden at 11:31 AM on April 15, 2015

I'm an RN and I work with a lot of advanced practice nurses. Those who worked as an RN before pursuing advanced practice are noticeably more skilled and have a far broader understanding of how to work successfully as a team with other people who have overlapping scopes of practice.
posted by jesourie at 11:44 AM on April 15, 2015 [5 favorites]

Advanced practice nurses typically have a practice focus and a specialized skill set. Unless you know for sure that you want to be a nurse-midwife or a pediatric NP or whatnot, I think that it's not at all a bad idea to learn the basics of nursing and do a range of clinical rotations in a BSN program to get an idea of what you would like to be doing as an advanced practitioner. Plus, as noted above, once you are working as an RN, a lot of hospitals have tuition reimbursement programs available for nurses who are pursuing advanced degrees. I think that going to a direct-to-NP program is likely to be substantially more expensive while not necessarily shortening the process by a lot or providing a better clinical education.

One additional thing to think about is the hiring environment for RNs vs NPs. At the last place I worked, there was a very strong nursing union and the nurses all wanted to stay at the hospital for seniority/benefit reasons, and there was also tuition reimbursement. What ended up happening is that a lot of nurses got their NPs while working at the hospital and then continued to work as RNs until an internal NP job opened up. That meant that someone coming in with an NP who was not already working at the institution as an RN was at a very distinct disadvantage since HR tried to exhaust internal options first. This is going to vary from place to place though.

If you want to stay in your city, it might be a good idea to do some informational interviews with a range of nurse practitioners and PAs and find out what your local environment is like in terms of the jobs available and the experience needed for different kinds of jobs. There is a surprising amount of local variability in hiring practices due to differences in unions/labor contracts, employer policies, and state law (regarding how independently NPs and PAs can operate). For example, at my last job, NPs were much more likely to be working in outpatient primary care practices but the hospital inpatient services and most of the surgeons I knew worked with PAs--this was mostly due to restrictions around writing prescriptions and also the union. Depending on what you eventually decide to specialize in, it might be a good idea to find out what degree that "typical" person doing that has.
posted by The Elusive Architeuthis at 12:33 PM on April 15, 2015 [1 favorite]

I think some of this will depend on the region you are living in. [On preview, what The Elusive Architeuthis said.] And also will mainly be relevant for your first job, less so for subsequent jobs.

I am a career-changer too (had a bachelor's in a science field but totally non-clinical) and did a direct-entry MSN/NP program that was 3 years long. Like you, once I had decided to make the change, I really just wanted to get going, which is why I opted for one-stop shopping! I worked as an NP for several years in a couple different settings, and now am working in an RN role and not practicing as an NP. So there is really a lot of flexibility regardless of the path you choose.

New grad RNs can have a terrible time getting hired, or no problem at all, depending on the local job market. If you haven't already, check out the allnurses.com message boards to see some of the trials and tribulations of new grads.

I had no problem finding an NP job after graduation, despite never having worked as an RN. I know some really great NPs who have been practicing for decades and never worked as an RN. Certainly any amount of clinical experience obtained during RN practice is going to stand you in good stead, but the roles are really very different. Working as an RN on a hospital med-surg floor or in a long-term care facility is going to give you skills that are totally different from what you will need to, say, diagnose and treat acute illnesses or manage chronic diseases in an outpatient setting as an NP.

If you are thinking you would like to work in an acute care setting as an NP, definitely getting hospital RN experience would be a plus and might be mandatory for some types of jobs. For the outpatient realm, not so much. But even that is not an absolute (I worked in a hospital doing inpatient palliative care consultations for a couple of years, again, without RN experience - and ditto for several of my NP colleagues) .

So the good news is, you have lots of options, and there is no one right path. It sounds like, from where you are right now, there is no big advantage to switching gears and holding off for another application cycle to do a direct-entry NP.

Whatever you decide, good luck!
posted by tentacle at 12:35 PM on April 15, 2015 [1 favorite]

I think if you want to be an NP, your best option is an NP program that allows you to take time off to work after you complete the RN portion. I totally agree with this:

Those who worked as an RN before pursuing advanced practice are noticeably more skilled and have a far broader understanding of how to work successfully as a team with other people who have overlapping scopes of practice.

But also it is a rough job market (but better than a few years ago, depending on the state) and in many places the only new grad RNs who get jobs are the ones who are already enrolled in an NP program.

Being an NP is pretty different from being a nurse, but there are parts of nursing that are better than NPing... You might find you like nursing better. I personally hit the jackpot and got a nurse case manager position after a year of (highly stressful) floor nursing. This job suits me very well and I did not need an advanced degree to get it (although many case manager positions do require that).

In conclusion, I agree with those who say see if you can still apply late to programs which have already closed. Otherwise, probably just go ahead and go to RN school instead of wasting time. You may also be able to transfer…
posted by latkes at 1:20 PM on April 15, 2015

tentacle makes a hugely important point about the difference between the inpatient and outpatient settings w/r/t advanced practice. The vast majority of RN education focuses on patient care in the inpatient/acute care setting, and that experience can only benefit you if your eventual goal is to be an NP in an inpatient/acute care setting. If you want to provide primary care in an outpatient/clinic setting, you of course need to know the basics of RN practice, but inpatient experience is probably not going to be as valuable to you.

My experience as an RN has been exclusively in the inpatient/acute care setting and my opinions reflect only that frame of reference.
posted by jesourie at 1:21 PM on April 15, 2015

The one straight to NP program that I vaguely know requires that their students work part time as RNs as they finish the NP portion. However, I cannot speak to how well this serves them as far as preparation/experience is concerned.
posted by bobobox at 5:45 PM on April 16, 2015

Response by poster: Thanks for all the insight and perspective! I realized while reading your answers that I gravitated toward any answer that said I should accept the BSN admission and felt, I don't know, weirdly defensive about [perfectly good] advice to wait it out for an admission cycle. I guess that was the clarity I needed! I sent in my acceptance yesterday and I feel excited and not at all ambivalent about it, thanks to all of you.
posted by adiabat at 11:24 AM on April 19, 2015

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