New Ways to Practice

Marie Lindsey, RN, PhD, CS, FNP, chair of the Illinois Nurses Association Council of Advanced Practice Nurses, advises nurses to begin by examining their professional practice. “Staff nursing is honorable work, and we need competent and compassionate staff nurses,” she says. However, some nurses want different challenges.

Richard Ferri, PhD, ANP, ACRN, a private-practice NP in Provincetown, MA, agrees that nurses must determine how they want to practice. “The bottom-line question they have to ask is whether they want to practice ‘medicine.’ You have to want to make medical diagnoses and treatment. We dance around terminology by creating convoluted terms, but all day long I do physical assessments, make diagnoses, and prescribe medical and nursing treatments.” Potential employers, says Ferri, are interested in whether NPs have acute-care experience and can suture, diagnose, cast, and interpret x-rays. He also suggests that nurses have a minimum of five years of clinical experience before returning to school.

Ferri considers medical practice as a set of skills that have always been used by a variety of professionals, including NPs, midwives, osteopaths, and dentists. NPs differentiate their practice by their approach to care and the treatments they prescribe. Patient education and counselling are the hallmarks of an NP’s practice, according to Ferri, and he estimates that’s how he spends 80% of his time.

“When nurses treat patients, we are more patient centered and include more patient education,” Ferri says. “We take the cultural factors into account.”

Hospital-based nurses may be attracted to NP practice because of the opportunity to treat patients throughout the course of their illness, instead of only seeing patients during crisis. “ICU nurses may realize that they’re intervening at the end of the process,” says Lindsey, “[but they may wish] to intervene to prevent disease and promote health.”

She also cautions nurses to pay attention to the passions that drive their professional practice. The day comes when you realize that you want to change directions. “When that realization gnaws at your stomach, then graduate school is the right decision,” Lindsey says.

No Financial Guarantees

Many nurses consider a NP career, at least in part, because they assume it offers more money and better hours. But Lindsey warns, “If you’re looking to make more money, it may not happen.” In fact, experienced staff nurses may earn more than a beginning NP because of salary differentials for working off-shifts, weekends, and holidays. Instead of being at the top of the salary hill as a staff nurse, newly graduated NPs move to the bottom of a new heap, where they may be expected to pay their dues through long hours of demanding work. Although nurse midwives and nurse anesthetists usually earn more than even the best paid staff nurses, they also work longer hours with significant on-call time. “The trade off is you usually have more regular hours, without shift work,” says Lindsey. “But the shift work is what makes money, so you may not make more money as a NP.”

NPs have more options of legally organizing their practices. Some choose to remain employees of managed-care organizations, public clinics, or large primary-care practices. Others, including Ferri, become small business owners by developing a private practice. “If you have an entrepreneurial spirit, it can be very exciting,” he says, “but it’s frustrating to deal with reimbursement.”

Change in Lifestyle

Many nurses are surprised by the degree of upheaval in their personal lives created by NP school and the ongoing accommodations in lifestyle required as a result of practicing as a NP. Lindsey coaches prospective students to expect conflicts between school and home: “The majority of grad students are married and many have children. As students you have to say no to your family and activities at times when you’re accustomed to saying yes. That’s a challenge.” Ferri notes that the potential conflicts continue after graduation, “When you’re in private practice, the on-call issues are real, and your personal life is on hold.” Prospective students are encouraged to talk openly with their partners and families about the changes that will occur in their lives as a result of their new professional role. Nurses who were the backbones of their families by always supporting others will need their families’ support returned during school and later.

Without question, NP programs are demanding. “Even the most focused students are shocked and amazed at the amount of work involved,” says Lindsey. “Compared to what they’ve already accomplished in school, the bar is much higher in grad school.” Students must also complete the frustrating task of learning a new professional role. After being an expert staff nurse, they return to novice status in an entirely new role.

Lindsey hopes that students feel proud of the investment they’re making in their careers and that their development is worth the sacrifices. “They’re adding to the profession and to their personal growth by becoming an advanced practice nurse,” Lindsey reminds students. “They’re not running away to the circus.”

After searching your soul and talking to everyone who will listen, you’ve decided to change your professional practice and personal life-style to become an NP. You’ve also concluded that the change is worth the amount of energy and money that must be invested. To find the right school, try the following suggestions:

• Read the catalogues from prospective schools to gauge the school’s focus and the qualifications of the instructors. Do they practice as NPs?
• Determine the amount and kinds of clinical experiences the program provides.
• Talk with recent graduates from a prospective school. Is the program primary care and clinically oriented, or is it filled with “convoluted and fluffy theory,” as Ferri calls it?
• Talk with practicing NPs for their opinions of prospective schools.
• Read the U.S. News & World Report ranking of graduate programs at www.usnews. com/usnews/edu/beyond/bcrank.htm.
• Examine the websites of prospective schools.Contact the American Association of Nurse Anesthetists, 222 South Prospect Avenue, Park Ridge, IL 60068-4001; (847) 692-7050.
• Contact the American College of Nurse-Midwives, 818 Connecticut Avenue, NW, Suite 900, Washington, DC 20006; (202) 728-9860.
• Contact the National Alliance of Nurse Practitioners, 325 Pennsylvania Avenue, SE, Washington, DC 20003-1100; (202) 675-6350.
• Contact the National Association of Nurse Practitioners in Reproductive Health, 1090 Vermont Avenue, NW, Suite 350, Washington, DC 20005; (202) 408-7025.
• n Contact the American Academy of Nurse Practitioners, LBJ Bldg, PO Box 12846, Austin, TX 78711; (512) 442-4262; www.aanp.org.

Jeffrey Zurlinden, RN, MS, ACRN, is a frequent contributor to Nursing Spectrum.