Broadening His Horizons

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By Donna Cardillo, RN, MA, CSP, FAAN

Jordan (not his real name) had been a nurse for five years when he contacted me. He felt disillusioned with the profession: He wasn’t getting the respect and recognition he deserved, and he wanted greater autonomy and more time to spend with patients. He had decided to shift gears and become a physician assistant (PA).

“I need more from a profession,” he told me. “I’m just not getting what I need from nursing.”

We obviously needed to talk.

To start, I suggested that he broaden his horizons and his nursing experiences: He’d spent his entire career as a staff nurse at the same facility. I reminded him that nursing is probably the most diverse profession on the planet and that it literally offers something for everyone. We discussed options like occupational health, public health, and community education because those positions offer a great deal of autonomy and the opportunity to focus on wellness and to develop long-term relationships with patients.

Although he was intrigued, Jordan remained hesitant about staying in nursing. He still didn’t think it offered him what he was looking for.

I told Jordan that it didn’t make sense for him to completely change professions and scrap all of the great nursing education and experience he had acquired. Since he was already considering going back to school, I recommended that he consider becoming a nurse practitioner.

Jordan thought that PA and NP career paths were similar and believed he could finish PA school more quickly. It was time to set the record straight.

Jordan wasn’t aware of some the subtle practice differences between NPs and PAs. For example, PAs are trained in the medical model and are essentially extensions of the physician. They focus on the treatment of disease and injury. NPs work within the nursing model, which is more holistic with a focus on prevention and wellness. And while both PAs and NPs can write prescriptions and order tests (prescriptive rights vary from state to state), PAs must be supervised by a physician in all states; NPs can work without physician supervision in more than half the states. PAs work under the physician’s license, whereas NPs work under their own license.

“But what about the job market?” Jordan asked. “I heard the market is saturated with NPs and most of them can’t find jobs.”

Not so, I advised him. NPs are working in an increasing number of roles in every practice setting. Many are creating new roles for themselves, too, since they’re still “the new kids on the block” to a certain extent and are vastly underused.

We discussed how once a nurse elevates his credentials, he then has to also elevate his networking, self-marketing , and negotiation skills to find or create opportunities. I assured Jordan that the opportunities were definitely out there for NPs who were willing to change their mind sets, expectations, and aspirations. I also mentioned that NPs have virtually endless opportunities of places and practice settings, whereas PAs are more limited.

After seriously considering this new option, Jordan asked how he could ensure his success as an NP if he opted to go that route. I outlined a plan that included having businesscards made immediately and then updated with new credentials once he completed his graduate education.

“You have to create a professional image and be able to market yourself in any situation, stay in touch with contacts, and make it easy for people to reach you,” I said

I also encouraged him to join an advanced practice nursing association as a student and then to continue with that membership after graduation. That included getting out to local chapter meetings and occasional state and national events. I underscored the importance of staying connected to peers in this new role for support, information exchange, and mentoring.

I encouraged Jordan to start making contacts and developing relationships with experienced NPs, physicians, and other healthcare leaders. To get an idea of the different opportunities available, I asked him to talk to NPs who work in a variety of settings. If he found a physician practice he’d like to be associated with, he could start to gauge their openness to working with NPs.

Today Jordan is a certified adult nurse practitioner who has a collaborative practice in a busy cardiology office.

“I love the autonomy I have in this role,” he says. “The docs treat me like a peer and recognize and value my unique role in the practice. The patients love me, and I have built up quite a following. I can see now that taking my nursing practice to the next level was the right way to go. Today I encourage other nurses who feel as I once did to consider the same path.”

Copyright Gannett Healthcare Group ( All rights reserved. Used with permission.

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