“The City”

San Francisco. A place I’ve always wanted to live. Also the home of the school I’ve been itching to attend ever since I heard the phrase “Master’s Entry Program in Nursing”. If I were to line up “plus” and “minus” columns under the name of each school to which I applied, UCSF would win hands down.

So why the allure? Location, location, location. The more comfortable I become back here in California, the less willing I am to leave. I can’t imagine staying in my home county – does the show The O.C. ring any bells? – but my mom and brother are here, I have cousins galore in the Bay Area, and my sister will more than likely be in Berkeley beginning next August. And I would be living in a city that has so much to offer in the arts, entertainment, food and fun, with the ocean on one side and the beautiful forests of northern California on the other. I mean…

And then there is the school itself. Consistently ranked as one of the top 5 nursing schools in the country, in both educational quality and in NIH funding, I really couldn’t go wrong with a Master’s in Nursing from UCSF. The possibilities are endless. Plus they offer a direct track onto the specialty I suspect will become my life’s work: acute care pediatrics, more than likely focusing on pediatric oncology (we’ll touch on that subject and the horrified look on people’s faces when I tell them what I want to do in another post).

I’m no Pollyanna. I’m fully aware that 1) Nursing school ANYWHERE is going to be hell at times and 2) UCSF specifically still has kinks that need to be worked out. (Thanks to Nursing Zen by the way, for giving me an inside look at the program.) From what I can gather, while the school itself is second-to-none in its graduate nursing education, MEPN is relatively new and the instructors and preceptors face the challenge of turning complete novices who can’t even take blood pressure into graduate-caliber RNs in only a year. Just typing that sentence is intimidating. It is no small task and I suspect that the faculty sometimes struggle to figure out how much time they need to give to their rookies when they have students and advisees with the training and skills to not demand quite as much hands-on clinical training.

But master’s-entry programs are popping up everywhere and I doubt this issue is limited to UCSF. So I can’t really hold it against them. I can just anticipate that with every year the program improves and that they admit students who have initiative. Hopefully I’ll be among that crop. The pool is mighty tight.

There is also that nagging thought that what if I get into acute care peds and hate it with the fire of ten thousand suns? It’s been made pretty clear that switching specialties is next to impossible and you damn well better have good reasons for your choice on that application. Though I feel confident about where I am headed, part of me whispers, “How can you know what you will do with your nursing degree until you’re an actual nurse?” Would I be better served to go the more generalist route and specialize later once I get my hands dirty? But if I specialize now and stick with it, I’ll be an acute care pediatric nurse practitioner by the time I’m 30 and ready to take on the world. And again, that being female issue lurks in the back of my head. The longer I wait to delve into a specialty, the less time there is to gain valuable experience and opportunities before the question of starting my own family creeps in. Especially if I elect to work abroad for a while after I graduate. I know women nowadays start families later and have many more options and I don’t really think the “clock is ticking” but it is something to think about.

Then there is the reality of living in a city, which I’ve never really done before. Durham doesn’t count, Davidson and Orange County WAY don’t count and while Accra (look it up) is way more city than any American could handle, it being in another country means I can’t really compare it to city life in the good ol’ U.S. of A. Not that living in Accra didn’t teach me a thing or two about toughness. But I digress… parking in SF sucks, commuting in the Bay Area REALLY sucks and rent is through the roof. I’d be signing up for a challenge way beyond just the nursing program.

But again, it’s a challenge I would relish. Having lived a relatively sheltered life and knowing that I could never ever cut it in New York or L.A., I still feel that urban living is something we all should experience and now’s as good a time as ever. I’ll more than likely retreat back into suburbia at some point but I’m young, I’m adventurous and I might as well live it up.

Of course this whole internal dialogue could be a waste of time if I get the dreaded thin envelope in December. We’ll just have to wait and see…

Holding Pattern

Not much to report here. I have a feeling it will be that way for a while as I twiddle my thumbs and await news, hopefully of the good variety.

My next hurdle will be a phone interview with one of the programs a week from Monday. I’m actually really excited about it. They sent us a DVD that was basically a compilation of clips from Discovery Health documentaries about the nursing profession. We’re supposed to watch and take notes and use our observations to reflect upon our own goals during the interview. What an innovative, creative interview tactic! Gotta love it.

I also gotta love that they send out their final decision before Christmas, BUT they don’t make you commit and put down a deposit until March, since they know that’s when most other schools notify you of your admission (or not). Other less generous schools might still make you fork up the nonrefundable cash to hold your spot, if you’re not yet sure you know where you want to go but don’t want to lose a guaranteed spot either. Definitely another mark in the plus column for them.

UCSF says their interview notification letters go out in mid-December. Interviews are January. PLU apparently doesn’t do interviews so they just tell you whether you’re in or you’re out in late February.

So there you have it. Coming soon: a play-by-play of the interview in all of its glory, soon to be followed by either one-line posts proclaiming “WOOOOOOHOOOOOO!” or “I didn’t want to go there anyway. Harumph.”

Dilemma Solved

Entry-level MSN it is. After a lot of research, I have come to the conclusion that three years in an intensive program will get me on the right track to gaining the clinical skills I need to be an effective nurse. All three of the programs to which I applied encourage you to work part-time as an RN once you pass your boards and begin the graduate-level work. So it’s not like I’ll only be in school without working too. I’ll be learning in the classroom and on the floor. My courses at Davidson gave me the critical-thinking skills and leadership experience I need to succeed in an advanced practice role, and navigating my nursing prereqs successfully has shown me that not only can I do this, but I am utterly fascinated by what I am learning. So there you have it.

Besides, I’m already investigating what I’ll be doing beyond my MSN (I’m a nerd like that). The DNP – Doctor of Nursing Practice – at University of Washington is looking mighty appealing. It’s the same level as a Ph.D., but focusing more on the clinical and patient care aspects than research. From what I’ve read, doctorate-level nurses will be where it’s at in a few years. Just call me Doctor Nurse Teeny. I might as well accept that I’m going to be in school until I’m old and gray.

In other news, the ABS program I was considering at OHSU is out. I’m not even bothering to apply. For one thing, their application fee is $120. Ri-freakin-diculous! For another, their latest NCLEX pass rate was 80%. Compared to 95% and above at the other three. And then there is the little matter of a BIO 101 prerequisite I can’t seem to weasel my way out of. Another school didn’t just waive that requirement for me, they OFFERED to do so. They brought it up! ‘Guess they figured that if I can handle Microbiology and Pathophysiology, I know my Bio. No such luck with OHSU. That would mean having to take a class next semester rather than giving myself some time to learn a little Spanish, freshen up on my prereq course content, and just plain chill out for a few months before diving into the deep end.

This is all assuming I get into one of the three programs, of course. Otherwise it’s back to Durham for 16 months. You can’t go wrong with a BSN from Duke but I’m not about to move 3,000 miles back if I can help it. Methinks that ship has sailed…

The Dilemma

There are two kinds of nursing programs (in addition to the community college ADN or transferring as a junior into a traditional BSN) for people like me, who are diving into a new career after already earning a degree in something else. One is the accelerated BSN, which condenses a 4-year undergraduate degree into about 16 months. Since you already have a college education, they figure you only need the nursing courses and clinical experience. You get out quickly and are ready to practice as an RN, assuming you pass your boards. The program at Duke was an ABSN.

The other option is the entry-level Master’s in nursing. Also known as “alternate entry”, it is a three-year program that ultimately ends with a graduate degree and the opportunity to enter advanced practice nursing immediately. The curriculum prepares you for work as a nurse practitioner, clinical nurse specialist, clinical nurse leader or other options higher up on the nursing totem pole. It also qualifies you to teach at most nursing schools. Typically the first year provides clinical training and coursework to prepare you for the NCLEX (nursing boards); you take the exam at the end of that year, hopefully pass, and can work part-time as an RN while you are in your second and third years of graduate study.

So here’s the question that’s been nagging at me for some time. Are the entry-level MSN programs doing an injustice to their students, and to the field of nursing, by transforming individuals who have never given a bed bath or started an IV into advanced practice nurses three years later? Isn’t clinical experience the cornerstone of nursing? Then again, this country is in a nursing drought and the field is in desperate need of individuals who can get their graduate education completed and turn around to teach the next generation of students. There are a number of incentives and scholarships for students who agree to become nurse educators within a few years of graduating. But again on the flip side, can we be good educators if we’re barely out of the gates ourselves?

As nursing schools across the country become accredited to offer entry-level MSN programs, will we sacrifice clinical expertise for those few extra initials we get to put behind our names? I am struggling mightily with this question personally and professionally. I am 27 and have been in school forever. The thought of getting my nursing degree, practicing and then having to go back to school to get my Master’s is daunting. And there’s no question that I want to go back and get my Master’s, heck maybe even my Ph.D. By the time I’m a nurse practitioner, I could be in my mid-30s and facing a whole new dilemma: when to start a family of my own. Damn, it’s great to be a woman. The entry-level graduate programs I am considering (and I have applied to three of them) are tempting in that I will reach my goal that much sooner and be able to become a leader and teacher in my field that much more quickly. But my hands-on experience will be limited. As much as I am a nerd, I am interested in nursing not only for what I get to learn in the classroom. I want face time. Am I seeking authority I don’t deserve and for which I am not prepared or am I simply trying to move along in my own vocation? Do I need more patient contact before I can claim that I am advanced in my profession?

Medical students have to go to school for one year more than I would, and they get to be called doctors. But they have years more of training before they garner the respect and authority of a chief resident or attending.

Can you tell I have NO idea what to do???!!!

It begins … again

You know that old cliche, “Sometimes life just throws you curveballs”? Well I’d say the last year has been one big series of ‘em. Actually, they were more like spitballs.

At this time last year I was working in Durham, North Carolina, intent on being admitted to Duke University’s Accelerated BSN program. After discovering my vocation as a nurse in an extremely roundabout way, I was ready to get started. And I got in to Duke. All set. PDA purchased. Check. Summer reading done. Check. Future classmates met. Check. Roommate found. Check.

Then my dad got cancer. Lung cancer, to be exact, despite the fact that he had never smoked a day in his life. Because he had none of the risk factors, it was extremely advanced by the time they caught it. Mets all over his body. It wasn’t looking good. I thought originally that I could make it through Duke and then find a nursing job closer to my hometown in southern CA. But halfway through his chemo regimen, it was clear to all of us that time was short. Duke allowed me to defer and I moved home to be with my father and my family.

Dad lived another two months after that. I got to be there for our last family vacation, and I got to help take care of him when he became really sick. His home health nurse taught me all about patient-controlled analgesia and IV nutrition. I learned the hard way what it means to have a terminal disease. Of course, Dad’s job was the hardest of all.

My father was the world’s biggest family man, the world’s best father, a soul beloved by so many. Watching him die was the hardest thing I have ever had to do. But I am glad I was here. And someday, I’ll be a better nurse for it.

So here I am, starting the process anew. I still have a spot waiting for me at Duke but I’m also applying to programs here on the West Coast. If there’s anything positive I learned over the last year, it’s the importance of being near people who love you.

I was surprised and delighted by the number of blogs out there by nurses and wannabe nurses. My favorites are linked to the right. So I figured why not add to the fray and give folks an inside glimpse at the life of a student nurse-to-be, a student nurse, and someday soon, a full-fledged RN? It’s been a long time coming but I have no regrets. Welcome to my journey…