The NP Dilemma

I am normally a woman who has no trouble making decisions. Examining the issue, weighing pros and cons and coming up with a reasonably quick answer it typically not a problem. Now, that doesn’t include asking me which restaurant to choose for dinner. But, for the past few years, another difficult dilemma has plagued me. I have thought about it, sometimes ad nauseam, I have pondered it, I have discussed it and yet, here I am – unable to choose. What is this huge question plaguing me? To advance my role and further my education in order to become a nurse practitioner.

So many people have given me their opinions, over the years. To be completely candid, there really hasn’t been one that believed that progressing into a nurse practitioner role wouldn’t be a perfect fit for me. But, my heart is torn… You see, I became a nurse for that hands on care. That type of care that wouldn’t be as frequent if I was to move on to NP.

Many moons ago, I decided one day – and I cannot tell you the reasons why or how- to become a nurse. So many people around me questioned my decision. “But, you hate blood!” “Can you really empty a bedpan?” “You are in your late 20s and going back to school?” But, this stubborn and hardheaded woman wouldn’t take no for an answer. I got all of my ducks in a row and applied to West Penn Hospital School of Nursing. I patiently waited for a decision, and still those naysayers were chirping about how I shouldn’t go for a 2 year program but rather a 4 year degree. But, I knew what I wanted. I wanted to have an abundance of clinical experience before I graduated. When I finally received the acceptance letter, the excitement and nervous anticipation were beyond compare. I was going to be a nurse! That is, until a routine exam revealed a thyroid tumor, which of course, just as my luck always is, was malignant.

As I called the school to tell them that I wouldn’t be able to attend, my grief was palpable. The kind soul on the receiving end assured me that they would hold my place, but, that I would have to wait an entire year to start. This might have discouraged some, but, that next year was full of treatments, doctor’s appointments and taking part in virtual classes, which were the supplemental ones needed to complete the nursing program.

My drive for becoming an NP does not have that same intensity that was once present when becoming an RN. I can say that there are moments when excitement trickles in and the idea of NP is beyond appealing. But, does it match my love of being a nurse and more specifically a hospice nurse?

Hospice nursing is a passion. Each admission is like a giant puzzle that requires focus, attention to detail and lots of education for families. It’s about analyzing medication lists and recommending discontinuation and helpful additions. It is finding solutions that families thought impossible to reach. It’s about face to face, tear to tear, emotion to emotion heart wrenching communication. You are their guide. The conductor of the very final train ride. And when that train reaches the station, hopefully, all of the education, support and interventions lead to the best possible end in the worst possible circumstances.

Becoming an NP would likely take me away from that.

Not to mention, 2 years of studying… sacrifices and sleepless nights. Am I cut out for that again? Will I be able to balance it all? Let’s not even get started on student loans. I am going to be paying until I die.

As a more diagnostic role, my interactions and contacts might be more limited. On the flip side, being able to diagnose, order proper medications and treatments would also be beneficial to patients and satisfying to me. But, would that be enough to satisfy this still wanting bedside care nurse after over a decade of experience?

If it’s not already clearer than the Caribbean waters, this isn’t something I am taking lightly. My viewpoint is that an RN should not even be considered for an NP program unless she/he has at the very least 5 years of hands on bedside experience. How can one call themselves an advanced practice nurse when they don’t have much practice experience? There are many schools out there that will accept a pulse and email address, providing them with the bare minimum education and clinical experiences just to say that they graduated another NP. Most schools boast ridiculous acceptance rates with the only prerequisite being 1 or 2 years of nursing experience!!! Maybe I was a late bloomer, but, I felt no where near confident as a nurse until maybe year 5. So, they take someone with no experience and provide minimal education and then place them in a role that demands that they call on the non existent prior experiences that they should have had!? No thank you. I will pass on that.

There is a doctor that I am lucky enough to work with and call a friend. He is by far, the smartest doctor I have ever worked with. Having been tossing this NP idea around for a while, I asked him his thoughts. He took a day or so to ponder it – I got a little worried, to tell the truth, because I thought maybe he thought I couldn’t cut it as an NP.

His response was “I don’t have a response. You are an excellent bedside nurse and it would be such a shame and disservice to lose you. But, if you feel burned out and think that gaining more skills would be the best for you, I think that you would be a fantastic NP and I would be happy to work with you. But, this has to be your choice. Secretly, I hope the right answer is you stay as an RN because communities need a strong, clinically savvy nurse, who has the tender and empathetic care you provide. “

I guess it’s back to pondering I go.

By Helen Haddick BSN RN CHPN

RN who has just left critical care in the hospital for hospice. Join me for my journey Please feel free to leave comments and like if you enjoy this

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