<p>It depends a lot on local circumstances. Locally, one of our large hospitals laid off a lot of experienced RNs recently. The silent but unspoken thought is that it was because they are expensive compared to nurse’s aides and others with less experience and lower on the pay scale. The nurses who do have jobs CAN make 6-figures with overtime, from all I’ve heard and are generally treated well. </p>
<p>There is a healthcare crisis in many places, partly because (I’m told) low reimbursement rates from insurers & government (as well as lots of uninsured patients getting treatment) which leads to high #s of patients for # of nursing staff. It is true that some folks do have to relocate to get experience to get jobs in the “more desirable” locations, like most professions. I was surprised that with all the talk of nursing shortages, there are RNs in HI & elsewhere who have difficulty finding a job paying a decent wage. I believe it goes back to the reimbursement and our ailing healthcare system.</p>
<p>While this may be true to an extent, hospitals are required to maintain a minimum nurse/patient ratio, so this is not a bit part of the equation. Yes, hospitals are trying to get away with the bare minimum these days and make up for it in LVNs and CNAs, but it won’t last.</p>
<p>Many undergrads go to medical school with an English degree. I am told that a background other than science can be even preferred. Nurse practitioners are only functioning as basic primary care practitioners so please do not feel so threatened. I have full respect for MD’s what they do and how hard they work. On a primary care level nurses do well and Pathophysiology is taught as well as extensive Physical Assessment. I have been quite satisfied with the knowlege base of many nurse practitioners I have had.</p>
<p>This is quite true - I went to medical school with a philosophy degree.</p>
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<p>Why should we not (especially the FP and IM docs)? They are advocating for the independant practice of medicine and are circumventing the governing body of that profession by going through the board of nursing.</p>
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<p>Yes, it is taught, but not nearly as in depth as in medical school, which is my point. Not nearly well enough for the independant practice of medicine. And as you pointed out, just knowing the facts isn’t enough. You need practical experience - which is why physicians must go through years of residency working long hours under the supervision of attendings before being allowed to practice independantly. The DNPs want to waltz out of their couple of years of classes and hang up a shingle for primary care.</p>
<p>Look, I have nothing against MLPs (midlevel providers) per se. Just the way the NPs are going about it, turning their degree in to a doctorate and claiming equivalency with physicians, when it is so plainly not. A PA with more than twice the classroom and clinical training of an NP ([EVMS</a> - MPA: Course Curriculum](<a href=“http://www.evms.edu/hlthprof/mpa/curriculum.html]EVMS”>http://www.evms.edu/hlthprof/mpa/curriculum.html)), and who must take the licensing exam (the PANCE) over again each time he/she recertifies, never gets to practice without physician supervision… ever. What makes the NPs so qualified?</p>
<p>I know when we were in Vermont, Stowe to be exact, couldn’t find a FP in a 15 mile radius, NP aplenty. Filling a need where ANY practitioner is better than none. Around me locally, you wouldn;t find a NP practicing independently. Not sure it is even allowed.</p>
<p>Despite the article in the Boston paper and the current situation in Boston, there is a signficant nursing shortage throughout the country. In order for many hospitals to provide safe levels of patient care, nursing departments often hire “agency” nurses for anywhere from 3 to 6 months. These are registered nurses who work for outside agencies, often from other countries or cities in the U.S… These nurses must be oriented to new hospital environments, procedures, policies, etc. each times their assignment changes. Their salaries are often twice, if not more, the cost of nurses employed by the hospital, and become a major factor in costs overruns.</p>
<p>There are areas of the U.S. that experience fluctuations in the nursing shortage-and areas with large numbers of retired adults where the demand for nursing care will remain fairly constant. If I were interested in going to college now for a nursing degree, I would ultimately set my goal as one to develop an “extended practice role”-e.g. nurse practitioner, certified nurse midwife, etc. Regardless of WHO, WHEN, and HOW health care is reformed in the U.S., the expanded role of the professional nurse will play a significant difference in making higher quality care more accessible and affordable.</p>
<p>samiamy, I think that link is for a recruiting firm, not a specific job. Note that it’s for “Part Time, Temp, or Per Diem Employment”.</p>
<p>Lots of interesting stuff here. There is no doubt that nursing is a great profession, and it has obviously worked out very well for folks like anothermommy, who entered healthcare several years ago. Hopefully it will continue to be a good career path for the current generation of aspiring nurses as well, but clearly certain geo locations and positions may be more competitive than in the past. Which brings me back to my original conclusions for people interested in nursing (or teaching):</p>
<p>No field is safe in today’s turbulent economic environment,
Think twice before taking on big loans,
Whatever your field, be prepared to relocate.</p>
<p>"A PA with more than twice the classroom and clinical training of an NP (EVMS - MPA: Course Curriculum), and who must take the licensing exam (the PANCE) over again each time he/she recertifies, never gets to practice without physician supervision… ever. What makes the NPs so qualified? " A PA with more than twice the classroom and clinical training of an NP (EVMS - MPA: Course Curriculum), and who must take the licensing exam (the PANCE) over again each time he/she recertifies, never gets to practice without physician supervision… ever. What makes the NPs so qualified? </p>
<p>You cannot compare apple to oranges and I do not think nurses are trying to have a competition here. Nursing Education has alot of classroom time, believe me I unfortunately remember it well but most of the relevant education took place in the clinical setting with research on the side. A nursing education highlights the clinical experience versus in depth microbiology that you will not need and forget later. I work with PA’s. I am not claiming to know their classroom experience but they do not function in a more superior manner than NP’s or nurses I work with and most clinicians need to continuse to keep up with literature and remain current. What you did many years ago in the classroom as you go down the road becomes less important. You need to practice passionately continue to learn, this work ethic makes a better and safer clinician not distant classroom experince. My point here is increasing the length of the test and adding useless classroom time, is not pratical. A nursing education combines science with alot of clinical time. The end product is what should be measured.</p>
<p>samiamy,
If you apply to those jobs you likely now will hit a wall and not get a call back. Many of the hospitals are posting the positions but the cost effective strategy here is to not hire into them and drag their feet, until things become very desperate and beds get closed for lack of staffing. Also, the ones that do finally get hired, compete with each other and the better degree will make the difference here. Positions are being posted but the jobs do not exist, at least not in this economy. Nurse’s are working very hard now to keep the patients safe with lesser staff. It is a very hard job, all jobs in the hospital now are stressful.</p>
<p>^ the BSN degree is more geared toward nursing administration type jobs. It clearly isn’t a requirement for the RN license, so there is no difference in pay for the same job (at least where I’ve lived). A hospital would be out of their minds to require a BSN for all nurses. </p>
<p>Iscarus,
I never learned anything about administration for my BSN degree, and you cannot get a job in administration with one in our hospital. You need a masters and alot are getting it in administration, not clinical. A BSN, is an entry level degree for a clinical job, all the nursing education is for clinical practice. Your statement is not accurate in todays city hospitals. Again, I am not claiming to know what is happening in the community setting. Things may be different there.</p>
<p>You seem to have experience in the nursing field in the Boston area. Let’s assume that a college student does decide to go for a BSN at a four year institution. Based on your experience, does the choice of school matter as much as the degree? Are some four year programs more desirable than others to prospective employers?</p>
<p>I second what Ibnhfi is saying. I also work in Boston in an ICU also If my child were going into nursing I would insist on a B.S.N. I remember the nurses in the nursing home I worked in scoffing at me getting a BSN . “You are just going to shuffle papers” I can assure you I do not. Nursing has come to far to go backward. (I know I will get flack for this). Nurses don’t want tobe like doctors, but they are strong patient advocates, and many times you owe your life to their assessment and swift action. To be professional we need to be educated. period. I have stated before, I do not believe you need to go to a private school and be in that kind of debt. I have seen a slight advantage(foot in the door), to schools that provide a co-op experience. Not enough to be worth 100k in debt!!!</p>
<p>A college prepared nurse is now considered an entry level position. In my community based hospital it is the degree desired to start. There is a differential included in your salary. We have a clinical, repeat, CLINICAL(bedside nursing) career ladder and to progress up, you have to have a BSN, not BS in whatever. This has become more the standard. We have more BSN prepared nurses than AAS. Many “return to work or change of career” people opt to go the AAS route because it is more cost effective and a shorter time to sit for your nursing boards. Many of the CC and AAS programs have geared themselves for these type of individuals, making it attractive to go to school in evenings and on weekends plus augmenting some of the classes online. I do not promote going to an expensive private school for nursing, because a state school is just as good and when you graduate, the pay is the same and nobody really cares where you went. Also there are many scholarship opportunities and incentives to go to school for nursing as well as loan forgiveness programs if you work in under served communities. Johnson and Johnson is another good source for tuition assistance.<br>
In my county 2 major hospitals closed and one very large tertiary care facility is laying off 2000 people including nurse on down the line, so there are many people looking for work. There are jobs out there but you have to be willing to stretch your wings, go to where there are jobs.
As far as NP’s, sorry but I dont agree with some of the comments here. NP’s are mid level primary providers, they do not operate independently, it is against the law. They provide a extremely good service to many people who otherwise would have no access to care. Many physicians choose not to work in areas that are poor because the pay is low and they have all these loans to pay back. Also NP’s have filled the need for things that physicians no longer wanted to do or needed more help with like admitting patients during the night,Pt teaching, follow up after surgery, etc. Plus many physicians have hired them in their private practices to augment their services do more of the scut work. We actually have a physician shortage all across the county.</p>
<p>Isokermom,
Yes, some programs in Boston do stand out more in Boston. Northeastern’s coop program offers an amzing nursing education and our staff has been very impressed with the work ethic and level of preparation these students have when on coop. Because of their coops, they have an easier time getting jobs. They make good money during their coops too. I really enjoy working with them.</p>
<p>milkandsugar,
you are right, if a nurse did not have the knowledge to know when an order was contraindicated to the patient’s life and recovery, then the hospital would be a dangerous place. For years, nurses have been silently advocating for the patient when physicians were either too busy or not visible at the bedside. If you do not have a well educated nurse to screen a new resident’s learning experience, patients will suffer. Unfortunately, nurses are becoming too busy and their ability to be advocates is being compromised. We also need to be better at advocating for ourselves, and work better in a multidisciplinary sense. We all need to be group players in healthcare. It is changing in some ways for the better and worse.</p>
<p>“NP’s are mid level primary providers, they do not operate independently, it is against the law.”</p>
<p>In fact, NPs DO practice independently w/o any requirement for physician involvement in 23 states (mostly in the west). In 12 of these states there is no requirement for physician involvement in order to prescribe. The vast majority of NPs in these states would certainly have a collaborative relationship with MDs and other members of the health care team. As someone stated earlier, many NPs provide primary care and often in underserved areas. They also function as specialists in hospitals and in clinical practices with a variety of other providers.</p>
<p>Another thing that is quite interesting is the assertion in this report that NPs should be completely independent of physicians in all states because of stats saying that NPs are less prone to malpractice suits than physicians. That argument has so many obvious flaws, its amazing that they published it. They compare malpractice suits against all NPs to those against all MDs/DOs. As in, all physicians, including those in high risk specialties doing high risk procedures that an NP would never do in a million years. Of course their incidents of malpractice suits are going to be lower if they are only doing simple primary care. They should compare themselves to primary care docs (FP, IM, etc.) and see where they stand. Even then, they don’t do nearly as much as a physician due to the differences in training. And malpractice lawyers are always going to go for the perceived “deep pocket” - i.e. the malpractice insurance of a physician, not an NP. </p>
<p>The whole argument is indefensible. Yet the rallying cry on page 11 is “Yes We Can!” :rolleyes:</p>