What It Takes to Become a Nurse Practitioner

while we're getting ready I think in the chat you already have a link for the Ultimate Guide to Becoming a nurse practitioner which Kelsey and I and the rest of our team wrote so it's an interesting read if you're interested in becoming a nurse practitioner we'll cover some of that content today all right it's a couple minutes after the hour should Maria are you ready should we go ahead and get started yeah let's get started sounds good all right thanks everybody for joining today's webinar what it takes to become a nurse practitioner I Am Kelsey Lafayette and I'm here with Maria I'll go ahead and let you introduce yourself first oh sure so Maria Pfrommer I'm the director of Nursing education here at osmosis from Elsevier I've been a nurse practitioner I think it's 20 22 years now and my role here basically Kelsey and I work together and we create videos for both nursing and meded and nurse practitioner so I'll pass it over to Kelsey thank you hi everyone my name is Kelsey I have been a nurse since 2011 and an NP since 2022 I'm located in Iowa and like Maria said I work here at osmosis for the past four years with her helping develop our nursing nurse practitioner content and a lot of our other content as well all right we'll go ahead and get started here is our just real broad overview agenda we're going to start with why to become an NP we'll go over the essential steps to becoming an NP and the essential skills to becoming an NP all that will probably take about 20 to 30 minutes and then the rest of the time we will try to answer as many questions of yours as we can okay so why become an NP well if you pay attention to like us news and World reports they usually do a survey every year on the best jobs and we come up either number one or number two as the best jobs and the best health care job in the world so it's kind of cool and pe's it's such a broad role we can be found U just about anywhere in healthcare these days clinics hospitals emergency rooms Urgent Care nursing home private practices I did I was population Health Nurse practitioner my last role and I worked in the home setting so School settings there's disguise a limit there's just so much you can do with this degree and as clinician s we blend our clinical experience with the added emphasis on management and a lot of what we do too is like Transitional Care we provide very comprehensive perspective because we're coming from the foundational nursing you know which is historically like bedside so we bring that with us as the foundation for our advanced practice there are it is NP week and great resource for you here is a facts so we'll talk about that in just a minute so Cassy I think this was my slide am I correct as far as yes ma'am oh thanks you can't see me we yeah we both of us can speak really fluently on all of these topics but kind of wanted to cover there's a I just kind of want to bring out that a lot of people think a doctorate of nursing practice that is a nurse practitioner and it's not so kind of want to clear up some confusion that we commonly see with the role of the nurse practitioner also from a patient education standpoint my sister is an LPN a licensed practical nurse a lot of times people get us confused with LPN so I just kind of want to differentiate that a little bit so there's several Pathways to becoming a nurse practitioner there is if you have a bachelor's in another in in another field and you've met some standard prerequisites you can actually go into what they call a direct entry program and get your you'll take your NCLEX which is the RN level and then you can get an NP that way we're not really discussing that too much now because it's a little bit more involved than just that so but just know direct entry if you don't have a Nursing degree right now it would be good for you to put in the chat like what your role is it would be helpful for us so we know like how to tailor some of your questions to the standard way is to get a master's in nursing and MSN Masters of Science in nursing and the degree would be for a nurse practitioner these programs are typically post Balor programs so you have to have your BSN typically two to three programs in general it's a 3.0 or better to get into the program and a lot of programs will say you'll need two years of RN experience before becoming a nurse practitioner because they'd like you to have you know a bedside experience first you're prepared at the prepared in roles we'll talk about roles in in a few minutes here but you're prepared in what they call population foci some would say foci tomato but population foci which means that a nurse practitioner is educated to work with a specific population both Kelsey and I are family nurse practitioners we'll talk about roles in a second but there's acute care certified nurse practitioners or pediatric nurse practitioners a whole slew of different nurse practitioners so we'll talk about that in a second as far as the role of a nurse practitioner we can like I said earlier we can be anywhere in Primary Care settings Specialties settings hospitals outpatient clinics much will depend on your certification itself as to which settings you will work in in general you'll usually see Primary Care nurse practitioners whether it be pediatric primary care or adult Gero primary care we're usually in outpatient Primary Care settings Urgent Care things like that your specialty practices U could be either acute care or prime or acute care certified or a primary care certified however it will specifically depend on the specialty and what their what they are Hospital the trend right now is that you should be working towards if you're an FNP I worked as a hospitals for good six years or so and then the trend went to you need to have your acute care certification so a lot of us are going back and we're getting an acute care certified so it much of what you'll be doing will depend on your certification there a lot of benefits it's faster entry into advanced practice for the Master's level because you know you get your Masters and you sit for your boards you apply for state licenser and then you know get your job and you're become a nurse practitioner it is a lower Co cost compared to the Doctorate of nursing practice and it's a very strong clinical Focus in general you'll at least have 500 hours most programs will be 740 hours of clinical in addition to of course the clinical that you've already done in two years of practice so in general you'll see that the average nurse practitioner is about 43 years old Kelsey's quite young to be where she's at right now 43 years old and average of 6,000 hours of practice Yeah those vary you know from year to year but you know and as the programs get a little bit more liberal in in you know the acceptance and what they will accept for hours but if you're 43 years old and you became a nurse when you were 22 23 you have well over 6,000 hours 2,000 hours a year times what 20 years you know do the math there most nurse practitioners have well over well over so just so you know that that's part of it and that's you know at the Master's level you would be fine very comfortable learning the doctor of nursing practice now there are several routes to go with a doctor of nursing practice these are a three to four year program post summer postmaster certificate program so I'm talk about the bachelor if you have a bachelor it has to be usually a BSN in nursing some programs will take you with a bachelor like a as long as you're an RN they will take you with the Bachelor's in another field I have a lot of friends that did you know with bachelors in in business or something like that some programs will take you so you just have to look for those if you have a bachelor's in another field but an RN but then so anyway that's three to four that's a solid four-year trajectory to get your DMP now it will depend on your trajectory so then the next thing I would talk about is the Masters if you already have a master's degree you want to get a doctorate of nursing practice that's at least two years likely three years depending on what you pick as your specialty so now I'm going to talk about so a doctor of nursing practice as I said is not necessarily a nurse practitioner my dnp is in leadership I was already an FNP I went to Duke and they had a leadership degree and that's what you'll typically see is you have two choices is usually maybe more with the DMP but in general you'll see a nurse practitioner DMP and a leadership DMP now the nurse practitioner will take you more time if you're going from either a bachelor's degree to a dnp the way that that goes is you've already passed your board you have a BSN at the once you get the clinical done for your nurse practitioner most programs will allow you they'll sign for you to certify as a nurse practitioner but you don't confer a master's degree and you then continue on with your doctor degree those programs take a little while so you can count on at least four years from a BSN to a dnp and many times I would say five years might be more reasonable if you're trying to work yourself through school and things like that if you have a master's degree and it's not it's a master's degree in nursing but you're looking to get your NP you could do it two ways actually it's one that I didn't talk about you could do a postmaster certificate and get a nurse practitioner that way but in this case you would you have a master's degree you can get a DMP with an NP in between in general that'll take you three years because got a year of clinical for your nurse practitioner so again with the dnp you'll get a much a lot of course work or in advocacy policy quality improvement training the degree in and of itself and the projects that we do we don't do a dissertation what we do is a quality improvement project we're taking establish research and then we're doing a project where we're taking establish research working in a setting and carrying out what we call a Capstone project it might make more sense to give an example here so I have a student right now a dnp student who is involved there's shown there's shown there's research is supporting that there is benefits to give cardiac patients who meet certain inclusion criteria because it will reduce the risk of cardiovascular disease progression and events and so the inclusion criteria for this particular study is and it's tried in true research in other words that that it's going out of pen medicine basically it's showing that there is a lot of benefit if the patient has a higher BMI has Di diabetes and has a cardiac condition so this student what they're doing is the quality improvement project they're doing so there's already a protocol for the prescribing everything that that goes into this this is tried and true research but what she's going to do is they'll get standard education material but she's also going to do coaching sessions and then what we're going to do is then we're going to compare folks that didn't get the coaching sessions they're still getting like visits from an n p and you know prescribing and all of that from the MP but Erin is going to see the difference between the coaching and the folks that got the standard education she's going to compare the two so those are it the type of example so it's not a dissertation career opportunities there's a ton of them mainly executive leadership certainly academic roles it was thought when the DMP first came in out you wouldn't be able to qualify for Rank and promotion in a university setting that is no longer true many of my professors at Duke had their DMP and were full professors so that's that miss is out and very high level clinical practice and most of dmps I know right now they're very much involved in process Improvement projects within the organizations and things like that this is the highest level of nursing practice DMP is considered a clinical practice degree so if you look at just a little bit of a comparison not quite because you know I'm not going to put this out there but an MD is a clinical practice degree and then a DMP is a clinical practice degree the difference is obviously the doctor of nursing practice so yeah just so you know then p PhD is a whole another degree but there's no nurse practitioner involved in that but so when initials like as a long story you can write your initial so MDS if they have a PhD you'll see MD comma PhD because they put their practice degree first many times nurses that have two doctor degrees like myself they may put the PHD and then the common DMP I put my practice degree first like the MDS do it's probably controversial but anyway next slide Kelsey why don't you start us off here and then go into your story so I can take a break and get some water once you've kind of looked at the different types of degrees that there are and kind of had an idea of what you want I usually think like a step before you start looking at programs and applying to programs you should really do some self-reflection on your passion for nursing and your passion for advancing within nursing and because our passion really drives our dedication which is obviously crucial to success for a rigorous MP program which most of them are very rigorous and then of course the very demanding role that comes after you graduate you especially need to be dedicated to being an NP if you're going to be working while you're going to school if you also have kids and a lot of traditional NP students they're doing all these other things while they're also going to school so you really need to know that this is something you love and something you truly want to do if this is a true passion then you'll have that level of like personal fulfillment in this Pursuit which will enhance your career satisfaction and it'll also help you perform well in your role because you'll care you'll really put value in what you do every day it's really not this role really isn't for someone that just wants to make money or diagnose things because it can be a really taxing on your mental health at times your physical health sometimes like it takes a lot so you have to have that strong passion and understanding for what that role entails and I always tell people like if you're not quite sure NPS and nurses in general are really good at networking and helping each other out so you can almost always on like Facebook especially find a good networking group and maybe ask some NPS like, hey could I Shadow you or like can I just chat with you about what your day-to-day life is and so you really get a good clear picture of what this career entails and it can kind of help you guide you through the Journey and what you want to do I'll kind of share my story which I think probably won't be what people are expecting but I went to I started grad school as an NP in 2018 and I had been working as a nurse in Urgent Care and er alongside some really wonderful NPS I was in all of them I had a mentor like I really loved them and I was like you know I I'm getting a lot of positive reinforcement from people being like oh you should you'd be a great NP too you should go back to school be an NP blah blah blah and I was just like yeah I would that's cool and like they're doing well and I really respect these NPS that I'm working with so like I'm just I just applied went to school you know and went to school to be an NP and the pandemic hit halfway through my four years and I really lost my passion I really lost my drive I realized I'm like maybe this isn't what I want to do if this is what the world's going to look like and so I really had I was found myself reflecting halfway through my journey and I decided you know I'm going to I'm still going to finish school I'm halfway through I'm going to finish I can still do lots of other things with my NP and whatnot but I really kind of I wouldn't say I regret becoming an NP but I wish I would have reflected more before going back to school but the great thing about nursing is that you can do so many different things with so many different degrees so I didn't practice very long at the bedside after I graduated I thankfully got a full-time role here at osmosis using my degree to help with education but I think it's just a testament to like you don't have to rush you there's no you know deadline that you have to meet there will always be a school you can apply to so just kind of self-reflect and take time to really make sure this is something you want and that you know if your plans do fall through what else could you do with the degree what else could you do with that schooling so maybe kind of some contingency plans so that's kind of my story and probably one that people don't you don't always hear the stories about like oh maybe I could have done something different I'm still very happy to be a nurse and a nurse practitioner but I think there's something to be said about passion and self-reflection with that being said I'll let Maria share a bit of her story I was just like writing down a few it's been so long it's so funny so it's interesting enough so I always knew I wanted to be a nurse I have a special needs my brother Christopher has special needs and so I worked with him when he was in the Home Care setting and now he's in long-term care because of his very specific needs he's born with a noxy at Birth had a tube feeding I used to suction him I had another brother with a colostomy he had her Bron's disease they found a cure long story there so had these two special needs brothers and always cared for them and just loved working with the nurses when they came to the house I was about 11 years old when I really decided to become a nurse and then sadly just as I was graduating nursing school my father passed away and right before he passed away the he said oh he was so proud that I was graduating and he said maybe we'll get a Dr low out of this Bunch yet so that's my made a name is lower and then he passed away and long story there but as I was going to so that's just keep that in mind for a second because it's not the same but as I as I was on my way so I became an EMT first and I had a I had a doctor's appointment and this is when the role of the nurse practitioner was really first starting and the doctor couldn't see me but they said the nurse practitioner could see you and I'm like what's a nurse practitioner well I'm here to tell you we didn't really talk about this too much because we thought we'd wait until we tell our story so nurse practitioner so I go in I see the nurse practitioner Joan Cella OBGYN and I was like hey you know I'm going to nursing school can you tell me a little bit about your role well she said you know I can diagnose and treat diseases and I can write prescription can pretty much do a lot of what the physician does you know you know depending on you know what you need so she ordered Labs she did everything so I was like wow I had not thought about this particular role so it was just then that I realized was that's I definitely would love to be a nurse practitioner she just you I had then I continued to see Joan cassella for years afterwards the doctor that I had had retired so I knew I want now want to be not only a nurse but then I eventually want to be a nurse practitioner so that is where I went and then so now as far as the career trajectory goes as soon as I got my nursing I became pregnant with my 2 5ye old so I kept going to school and I got into teaching because I wanted to align with my family schedule so as I got my Master's Degree I started to teach with my nurse practitioners that's one of the things you can do with a nurse practitioner and then in the meantime to keep up my practice I would during school breaks and things like that I would work in well I guess they were called Minute Clinics now convenient care clinics Minute Clinics CVS and Walgreens the clinics there and I would keep up my clinical hours there and then I would bounce between that I was a health director at a camp I did urgent care I was a hospitalist I did Subacute rehab rather and then also population health nurse practitioner those were the major roles that I play I've also had my own practice for I mean I taking a backseat to practice but you can also have your own practice we'll talk about that in a second so I think my passion came from my love of my family and wanting to care for folks then seeing that role in action being treated by a nurse practitioner and then from there you know I wanted to now I'm I also educate so I educate nurse practitioners so you know just that whole passion and being at in a position to be able to give back and impart my wisdom I guess on the next generation of n nurses and nurse practitioners which I think osmosis and our team Kelsey can speak to that too we're lucky we're able to do you know to do just that all right Kelsey this your slide yes so okay after you've decided you've done kind of your self-reflection and decided what kind of degree you want you need to choose the right program and things to consider first off the bat for a program is whether you can do full-time or part-time and if you can do full times again a lot of people might have kids or they're being caregivers to family members or they're also working full-time to put themselves through school things like that and then you also need to consider if you will do Best In online or hybrid there's a lot of online NP programs these days important to note is that a lot of the online ones and even I think probably a good chunk of the hybrid ones something to consider and to look into when looking at the program is to determine who assigns your clinical opportunities because a lot of the online programs you are responsible for finding your own clinical preceptors and it's very difficult at least in my area it's a bit saturated and so I've heard of people not graduating on time because they couldn't find a preceptor so that's something you really want to consider when you're picking a program is the school going to choose these for me because usually if the schools are doing it they kind of have an in and a relationship with certain Health Systems and things so it's easier for you to get that and then it also comes back to like do you learn best online is that going to work you know if it's kind of a self-paced thing does that work or do you do better in person where you can go into a classroom which is a more hybrid situation and then just kind of make sure you're looking at the backgrounds of these programs too like make sure they're accredited what's the curriculum look like who's teaching it who's the faculty and then again those clinical opportunities and make sure you're aligning the program with what you are pretty sure you want to do so if you know you want to do Pediatrics you don't want to choose a program that doesn't have Pediatrics or maybe they got really not great things said about their pediatric program so just make sure you're aligning it with your Specialties and then the faculty expertise there once you find your program you have to apply so you need to look into any entrance exams so I think most programs require you to take a GRE if your undergrad GPA was like less than 3.3 3.0 or something like that so you need to kind of look back and see do I need to take the GRE does this program require me to take their ENT entrance exam or something make sure you know what you need to do for that and then you got to go on the search for all the documents as always you know get your transcripts you got to ask people for letters of recommendation you usually have to write a personal statement about why you want to go and then sometimes you'll well actually usually you'll have to do an interview as well with the program and then just some tips for strong applications make sure you're highlighting your relevant experience so if you're applying to be an acute care NP and you've been an ICU for the past 10 years like that's really important to highlight because that will hopefully translate some knowledge there for you make sure you clearly State your career goals and outline that what the program offers and really demonstrate your passion for nursing again that passion comes back if people know that you truly want to do this and you want to help people and you want to be great at it that will come through when you're interviewing when you're writing your personal statements and when you're interacting with the faculty and the people that are accepting you to these programs you can go ahead and go to the next slide there so usually when you apply to these programs you need to already know what your specialty is going to be it's not something that you pick afterwards it's usually you apply to that specialty and these are just kind of the main ones there's quite a few but these as you can see there's the distribution here Family Practice makes up the majority of nurse practitioners at about 70% and fnps very broad scoped so they care for all ages and they do focus a lot on preventative care so they work primarily in like primary care offices things like that where you're kind of doing that long-term preventative and some acute care you know when you have a patient that comes in with a an acute complaint then you've got acute care NPS the next biggest one but it's quite a big CH a big difference between how many are fnps and how many are acute care NPS these are usually Hospital based they're managing critically ill sick patients it's a much fast-paced environment pediatric NPS obviously care for Pediatrics so that includes infants children's adolescence and you've got that very strong focus on growth and development as well as preventative care for that so vaccines and things like that psychiatric is mental health and assessment therapy medication management things like that you got nurse Midwifery SL Women's Health which is Primary Care for Women of all ages that's obstetrical care and surgical Care there's even some newborn care in there because you know that kind of overlap of the end of obstetrics becoming newborn care so you'll kind of see an overlap there and then you've got neonatal nurse practitioner which is that kind of advanced critical care for newborns you'll see a lot of pries some of birth defects other health conditions things like that but overall Family Practice is probably going to remain the biggest because it's so broad of a scope and still some states allow those Family Practice nurse practitioners to work outside of primary care so where I'm from if you're an FMP you can also work in the ER you can also work in the Urgent Care I do just always like to give the caveat that you should always kind of con maybe consult with like a legal nurse consultant or something if you do something like that because there are certain areas where that's can be open you up to legal ramifications if you are say an FMP working in women's health someone might come and say well you're not specialized in women's health so why are you in a women's health thing so it's always something to consider when you're choosing your specialty and then when you're choosing a job too making sure that you have very clear documentation that you have been signed off on all of your tasks and your you know competencies in that specialty so that you cover your behind basically can go ahead and go to the next slide I think that one's yours Maria great you know Kelsey you brought up a really important Point here so Kelsey and I are family nurse practitioners and with that scope you can certainly see patients like we go through an OB rotation we go through every rotation all the populations as well as Women's Health and with that in general so practicing within our scope many times what we'll do is if a patient comes in with an issue that is specific I also follow psych patients many times but what I will do is I will refer them at and then I can follow them from a primary care perspective keeping everything on the same page I can refill their medications certainly I can do an OBGYN exam in Urgent Care Centers you know if they had an STI I treat for that but then I refer them back to their OBGYN and collaborate with them as far as their you know their Primary Care so there's a lot you can do with a different degree so this this slide here it's basically once you become an NP you know what do you what do you have to do to actually practice as an NP in all states you need to be certified in the population foci in order to be able to practice in the state so the first thing you need to do is sit for boards we have here listed this is not the end all to be all list of boards or certifications that you can get as an NP but these are the most common ones recently the psych mental health nurse practitioner the a has a new newer certification out for those folks so just you know like I said don't you know if you Google this or whatever you can see that different there's all different types of certifications here so this this is not meant to be a comprehensive list so basically you sit for boards then you apply for State lure in order to apply for State licensure you're going to have to follow the requirements of that particular State now many of the requirements are actually going to align with what the state practice environment is and to my left and I'm not sure if it's going to be to your right on this screen here this map what is saying here is that there are certain states where you can practice completely autonomously what we call full practice States those are highlighted in green and then reduce practice what that generally means when you see they're in yellow on the map what it generally means is that you need a collaborating physician in order to be able to practice and so doesn't mean you can't function autonomously with your role but it means that you need to have a someone that you could go to if you had questions or whatnot and someone that there's a an official agreement in place what they call a collaborative agreement and then the red states are states where they're very restrictive practices where nurse practitioners certainly would need a collaborating agreement but there may be some very specific things that you can't do so I'm going to kind of go back up to full practice a full practice State General requirements will be things like you need at least 2,000 hours of practice as an NP before you can actually qualify to practice independently in that state you'll see that a lot but anyway a full Practice State means you can come in you can see me I have a license in Florida it's a full practice state for family nurse practitioners as long as I'm practicing as a primary care provider I can see patients in Florida independently without a collaborating agree I diagnose I treat I refer you know I follow I do all of that I bill at basically a nurse practitioner can bill at 85% of the rate of a physician rate so I can I can you know build directly and any time I?m billing actually whether I be in a reduced Practice State or restricted State I can still build the insurance company directly and it depends on the health system as to how they handle that like I worked as a hospitalist and what would happen is the my collaborating physician would also round with me on the patients I would round on the patients I would develop the plan of care do all the scripts all of that then I would collaborate with the physician and then he would ground with me and then they would build at the physician rate not at the nurse practitioner rate they can't build twice but they can so they decide it to do it that way so it will depend on that so anyway going back to you apply for State lure the requirements will vary by state certainly the requirements will also be definitely a little bit stricter in your full practice States you'll need a verification of education so that you actually you know practiced I'm sorry that you graduated you'll also need to show U your certification and you may need practice hours as I said in no school practice State you'll need to do that so if you don't so if you're in a state that's full practice and they're requiring 2,000 hours practice what happens is they will issue you a license but it'll be a reduced practice license like in other words you need the collaborating agreement and then once you get the two or 3,000 hours or whatever it is that that state is asking or requiring then you then show that proof and then you can then go to a full practice license so that's how that goes the other thing you'll probably need I is if you want to prescribe Controlled Substances your schedule two medications you know pain medications anything that falls under controlled substances you'll need a DEA registration so the DEA registration is State based so I have to if I want to prescribe in Flor I have several license several States three four maybe now each state that I prescribe and I need an a DEA they can be pretty expensive they're ?888 right now so per state additional certifications you may need depending on the population you're working with you can certainly anticipate you'll need BLS basic life support but you may also need like when I was in the hospital I carried ACLS Pals is the Pediatric ACLS and then the other part the essential sense is you know like navigating and the transition in and of itself now you're going from a registered nurse to an advanced practice nurse practitioner so you're going to be needing to Network for and job search so you want to just speaking of that like certainly there's LinkedIn and Facebook and there's lots of great groups out there that will help you network within your organization's networking and that's basically when you're going through your rotations a lot of people get jobs straight from the rotations preparing for job interviews and negotiating employment offers I would say start with there's lots of salary surveys out there and in our ultimate guide that's in the chat there you'll see a list of you can see like your standard salary so you would start with that and then negotiate from there you're also going to need continuing ed and professional development as you well first of all get into your first role you may be coming across different disease processes or whatever that you may need professional development with but then also to maintain your license you're going to need continuing education now as a nurse you're going to need so many at the RN level but then you're also going to need the nurse practitioner level as well I hope that covered everything there's a lot there sorry but that was a lot Kelsey is this my slide or yours I think that one's yours and then I've got the next one perfect thanks so what skills do you need to become a nurse practitioner as I said earlier the ban of what a nurse practitioner does is we do Advanced patient assessment and then from there I talk about diagnostic reasoning so somebody comes into your facility with a chief complaint and you're using these di high level diagnostic reasoning skills to figure out what is going wrong with that person and then you develop a differential diagnosis and then you're diagnosing the patient so there's a lot involved in that so you're using a lot of diagnostic reasoning skills critical thinking basically skills so you really need to have the clinical skills Advanced patient assessment you'll have a course in assessing you'll have a pharmacology course called the three pce physical assessment pharmacology and Patho Phys you're going to be getting much deeper into prescribing much deeper into to the health assessment so that you're geared towards diagnostic reasoning diagnosing and treating disease you're going to be prescribing medication so you'll need to know oh certainly ins and outs of the prescription itself how to write a prescription what the indications are so as nurses we know because we do a lot of bedside teaching on medications but now you'll be the one prescribing and then there will be a lot of parameters associated with prescribing you're going to be performing and interpreting diagnostic tests and prescribing the test themselves so you have to order the tests you may be performing them like I did Occupational Health oh that's another one I forgot about veterans exams things like that where I'm actually performing the diagnostic test or you know certainly your ordering labs and then interpreting the diagnostic test and then you're then treating based on the lab so you're developing treatment plans we also do a lot of Transitional Care for example my role as a hospitalist was ensuring that they had everything all the education the prescriptions everything so that they had successful transition from hospital to home then when I was in the Home Care setting ensuring that they didn't go back to the hospital because I would take care of their needs out patients so they didn't have to go to the hospital unless they needed to go to the hospital I mean there's just so many so many skills that you need to become an NP but those are just some brief ones all right and then you also really need to improve and maintain your soft skills which soft skills are those skills that help you communicate really well with others and interact with others that involves effective patient communication I mean nurses need it you need it as an NP too and you'll be communicating differently with your patients as an NP because you will be the one diagnosing them so you're going to need to kind of build that trust with them actively listen I know sometimes as an RN I would you know kind of be doing the intake form and I'd be like yep you can talk to the provider about that and I wasn't really actively listening as much as I should have then you're kind of that fin person that they're going to see the one that's going to diagnose them so you really need to be able to hear what they're saying and respond to them clearly and with an empathetic voice and you also really need to make sure you address cultural humility and tailor care to diverse populations you know there might be things they believe in or don't believe in hesitancies to medications or treatments or lifestyle modifications that you need to kind of hear them out and meet them where they are because patients aren't going to do anything that they don't want to do if you just tell them to do it so you need to really listen and kind of hear where they're coming from and see what you can do to communicate what's best for them you also have to work on your teamwork and collaboration as Maria showed you there's a lot of states that have NPS have full practice Authority so you don't necessarily have to work with a physician or anybody else for that matter but most people are most NPS are going to be working maybe under a physician or alongside a physician with Mas CNAs nurses administrative staff all kinds of people and they all are just important in the patient Journey so you need to be able to really have some great skills and conflict resolution collaborative problem solving to put the patient first and do what they need and then as always empathy and compassion giving that patient- centered care and again this changes when you're an n from when you're a nurse you know a lot of times at least in the US there's a lot of regulations that block us from doing our first plan of care for example you've got a patient maybe with some community acquired pneumonia they need an antibiotic this is the one that I know treats it the best but they can't afford it because their insurance doesn't cover it so now what do you do you know it's going to be different for each patient so you need to be able to have some compassion some empathy and figure out what you can do that doesn't necessarily mean changing completely changing your treatment plan if it's not appropriate but those are things you need to think about in regards to Patient centered care and then also making sure you're laying professional boundaries while still being compassionate you know I've seen some providers cross lines like become Facebook friends with patients and just be a little bit too close to them and I think that will you'll lose your vision of being an objective provider if you do that and again it's a litigious Society so you're opening yourself up to some lawsuits if you do that so just making sure that you can identify your boundaries while still being compassionate is really important we can go ahead and go to the next slide just a heads up we have several questions that we still need to address and we have about 10 15 minutes left okay thank you do I go through this let me go through this so professional skills needed to become an NP you can read the slide here but certainly professionally you're going to be involved more in leadership so leadership development technical proficiency is very important right now most health systems most Healthcare organizations are using electronic health records and also proficiency with medical devices and diagnostic equipment ethics and professionalism you know it's much higher as Kelsey mentioned litigious right litigious Society but also so there's a lot of legal regulations and ethical guidelines need to go by your practice agreements in your facilities is also your collaborating agreement if you have one and of course the state Boards of Nursing Kelsey you mentioned this earlier culture humility you know we are going to be caring for folks from all different diverse backgrounds so we need to understand and respect those backgrounds and care for everyone with without bias so providing culturally sensitive care you know what that patient needs and then addressing Health Care disparities as Kelsey mentioned that prescription is a perfect example many times prescribing something and the patient can't afford it and they never take it and then you wonder why they're not getting better there's a few references for you here U that we you know we went through today there's a ton of resources out there if you're on Facebook there's a lot of great groups out there whether you be a student or you know you want to have your own business whatever there's lots of groups LinkedIn is another great resource as well all right I am going to take this the stop sharing so we can get to the question portion can any NP open a private practice or must it be a family NP it might vary state to state I don't think it does but you do well it does vary state to state because you have to have full practice Authority so you have to be in a green State on that chart and then you can be you don't have to be a family NP I know acute care NPS that have opened their practice I will say if you're like a psych NP you probably don't want to open your own Urgent Care because again you weren't trained in Urgent Care you're trained in Psych so it would be a psych thing so you need to make sure it aligns with your competencies and then share the criteria for acceptance into an NP program this will vary quite a bit between programs usually like Maria said you have to have a certain number of hours as an RN usually about 2,000 which if you worked a couple years you meet that you either need a GPA higher than like 3.0 I think it is or you need to take the gr to get in and then usually you have to do like the transcripts the an interview an actual application with like a personal statement things like that so it kind of depends on what program but a lot of them have that kind of same outline where it's like an entrance exam work having worked as an RN and then like they're kind of like gather the paperwork type things like that Maria I've got a couple questions for you oh I'm doing an acute care adult Geral but I'm not interested in critical care at this point in my life but looking forward to a different specialty that I can concentrate on could you give me guidance so any ideas on where they might look besides critical care so I'm sorry I'm not understanding the question fully so an acute care adult general NP who doesn't want to do critical care umta so like maybe a different area is what I'm reading so I'd be like Urgent Care oh there's so many fabulous opportunities most of them though will likely involve impatient hospitalist is really nice work you know you basically do consults throughout the whole hospital that could be one so if you don't want to be on one unit I was just thinking of the top of my head there's a at pen We Have a Heart Group and they do all of the patients that have cardiovascular disease so they specialize in cardiovascular disease a lot of heart failure things like that and so they actually do follow patients both inpatient and outpatient they have outpatient days with their acute care certifications wonderful role interestingly enough the Urgent Care Centers do not hire in general they do not hire adult gerro acute care nurse practitioners and the reason is because an urgent care center usually sees pediatric patients too so that's why a family nurse practitioner will generally fall into urgent care so yeah I mean just really look around Subacute rehabs will sometimes hire adult gero acute care nurse practitioners particularly if it's oh God what's that one called it's like long-term Hospital they call them ltacs a very interesting role especially with my goodness an ICU background and elac with be a great place yeah you can also do I know some people that have done post doctorate certifications so I've had I've worked with a couple acute care adult NPS that went back like for another year to get their peed certification so they could work in an urgent care and see kids too so that's always yeah postmasters too as well yeah I'm sorry I should have mentioned that I thought she meant with within her certification they me yeah perfect and then where can we find guidelines for practice Authority for our state so a NP is the one that does that practice map that I was showing you the red yellow green that's probably a pretty good one and really have to keep your eyes open because we're continuing to add full practice Authority in a lot of States I think we're up to 29 States now where we have full practice Authority yeah so a NP I would say and you can also a you can look for the full practice Authority or what how much Authority you have but then each state Board of Nursing will help outline what you're allowed to do with like your scope of practice too which is different so if you want to know your scope of practice as well which is like you know what you're allowed to do your actual State Board of Nursing will outline that for you let's see can a person from a red State get license in a green State how is it possible to transition to practice in a different state so I' I've done that several times in my career you just need to meet the practice requirements of the state so if you're in Tennessee for example which is I believe reduced practice if not restricted and you want to practice in Florida and you're an FNP for example Florida requires you know whatever the requirements are and then you just meet those requirements and then you just apply for lenser and you get your license yeah it's not that hard yeah and one there was also a question about NPI number numbers Y which we didn't cover NPI numbers you I believe you need to get your license first and then you can apply for your NPI but everybody needs to have an NPI it's like your personal identification number if you're going to be prescribing working with patients it's really easy it's just like a form you fill out and then they just give you it says it'll take like weeks to get you your number but I remember I got mine in like two hours they just assign you a number and then usually need it to prescribe anything with any pharmacies Medicare Medicaid anything like that but it's of all the things that you have to get after you graduate it's probably the easiest in my opinion yeah you can be a there is it easy to get a job as an oncology NP as an FMP with experiences in oncology RN interestingly enough like a lot of times yes the answer is yes I know several fnps that are oncology NPS and they don't necessarily have oncology RN experience by the way so the answer is yes yeah all right I'll do I can do I think I've got one more here what is the pay for a new NP can it be the same as an RN with four years? experience I would wager I guess that in most places it's going to be more there is in some place I've seen some really abysmal NP salaries so there is a caveat there to you know look at the salary range before you apply to things but for the most part if you're an NP even a new NP you should be getting paid a bit more than an RN but yeah caveat I've seen some pretty abysmal offers I would say like we do have a salary in but you can also sort of Google that as well as always puts out a salvage survey every single year so it will depend on your region cost of living things like that but at least 110 to 60 depending on your specialty yeah I'm actually I'm in Iowa and I'm we're probably the lowest paid for nursing and nursing at all and we're around 990,000 depending like that's that would be maybe like a family practice but yeah we're anywhere from like 90 to 120 there's a there's a question about if you're from India you're an NP in India can you work in the US that one's a little bit tougher it really just depends on your degree I just took a student in that had a master's degree from India into my postmaster certificate program but their standards are pretty much pretty similar to ours you'll need to check with the school on that what their policies are yeah and a lot of times if you've studied in another country you can come work here but you have to kind of jump through the Hoops you know they have to make sure your school is accredited you have to get NP like lure here things like that so there's still a lot of things you'll have to apply to and whatnot but yeah looks like we're running a little overtime there is a question on tele health services for NPS and other states the tele Health restrictions got lifted during Co but many states are now reinstituting them so you're going to need to go by the state practice to back to the Board of Nursing and in some cases tele health is actually regulated by medical board so you also need to look at that so Florida for example is one I do tell Health in Florida but I need to adhere to the medical board as well yeah so just you need to do a little bit more homework on that there there's one more question that was first so I would love it if we can answer there I put it in the chat I can read it out loud if you'd like any advice suggestions on juggling clinical rotations and class work plus staying up on evidence-based information I'm starting my NP clinicals and I feel like I'm kind of lost and overwhelmed I thought this you guys might have some good advice this well if you're definitely osmosis yeah if you're lost and overwhelmed as a an NP clinicals you're probably right where everybody else was I was losing my mind I worked full-time and I went to school full-time and I don't I don't know how I survived but I did I think probably my best thing is just like make sure you have a schedule like I had a planner I was like this is when my stuff is due and I gave myself I moved up my due dates in my calendar so I was like oh if it was actually due on Friday I was putting it in my calendar as due Wednesday and I was just like because I needed to get ahead of stuff otherwise I was going to procrastinate it put it off and you know something always comes up you're like you get stuck at clinicals and you still you have a paper or something do and you didn't give yourself enough leeway so now you're scrambling so be kind to yourself and build in some time and then also actually build in time to like take care of yourself which is always easier said than done but like truly like even if it's just go for a walk around the block after I finish reading this chapter and a textbook or something like that because if you're like if you're also working and you're doing NP clinicals it's like that feels like all you're doing and you're going to lose your mind so get a nice planner build some time into it and give yourself some Grace I would say hit that NP guide too because for clinical there are some free resources that are available like for looking up meds and the DI the you know the prescription and you know what the dosage is and whatnot up to date is great but it's expensive but some organizations actually have it build in their emrs there are oh God clinical pathways built into the emrs so if you have a patient with CHF if you put in CHF and you look for the clinical pathway it'll show you exactly what to prescribe so look at that look at look at some of those if you know if you have availability for that that's great too yeah Stephanie's putting a whole bunch of links in there but there really is we did a bunch of events and things like that that that that covered that as well yeah and blogs all right well thank you everybody for joining and for your insightful questions I think we answered most of them we did record this webinar and you can also register for future webinars if you go to osmosis.org events and the recording of This will be available early next week sometime and remember before you go we do have a free two trial of Osmosis that Stephanie can drop in the chat there so thank you for joining and I hope everybody has a nice journey to becoming an NP thanks everyone helping current and future clinicians Focus learn 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