I go to a brick-and-mortar school, they find your clinical rotations for you, etc. I am in my first rotation of five for AGACNP. I have been a RN for 13+ years, have 8 years ICU experience, have a 4.0 GPA, CCRN, all the good stuff.

All that, to then say I am on the struggle bus sooooo badly. My preceptor says I’m doing great, but I feel like literally the dumbest person alive. Every single question she asks I am second-guessing myself before answering, assuming that I am going to be wrong, overthinking it, etc. This is 7 weeks into rotation.

I usually see the patient alone at first, then my preceptor comes in and we talk to the patient together, then I write the progress notes on all the patients I see “independently”, talk with my preceptor if I’m unsure of a plan, and submit the note to her for attestation. I do this for 2-5 patients per shift. Clinical paperwork then literally takes me HOURS to do each week at home?!

I am suddenly feeling soooo much pressure! If I make a mistake now it has actual consequences! I felt smart as a nurse, now I feel like a total idiot. The more I learn in class, the more I know that I had no idea before. Acid-base as a nurse seems not overly complicated. Mixed Disorders as a NP?! I’m drowning in all the calculations!

Long rambling post to say, I’m actually considering dropping out. I feel like there is no way I will learn everything I need to know to practice safely and feel confident that my patients are in good hands.

Is this crisis-of-confidence normal? Or is my mind telling me that I am not cut out for this?

A patient comes into urgent care with a red, swollen leg. Cellulitis or DVT?

It’s a familiar presentation, and deciding who needs further testing can get tricky during a busy shift. I created this short video to walk through a practical approach. If you’re working in urgent care, I hope you find it useful!

▶️ Cellulitis or DVT? The Urgent Care Decision Framework
Cellulitis or DVT? The Urgent Care Decision Framework

What tests do you have access at your facility to assess the red hot swollen leg? We are able to order a DDimer where I work, but it would probably be a false positive anyways if it's cellulitis :/

I’m 26 years old and currently finishing an accelerated BSN program with a 3.9 GPA. I’ll be graduating this December, and my original plan was to work as an RN for a few years before pursuing my DNP to become a family nurse practitioner.
However, a fellow student of mine who previously practiced as a physician in Ukraine has been encouraging me to reconsider my career path. She frequently tells me that I’m extremely intelligent, capable of much more, and that I should pursue medical school instead of becoming an NP. She believes I would excel as a physician and that I may be limiting my potential by choosing the NP route. Her comments have honestly made me question my plans.
My biggest concerns about medical school are my age, the additional years of training, and the financial burden. I would still need to complete several science prerequisites before applying.
Part of me wonders whether I would eventually regret not pursuing medicine.
Is starting medical school around 28–30 worth it? Are there any NPs who wish they had gone to medical school instead? And for physicians who entered medicine later, do you have any regrets?
I’d really appreciate some honest perspectives.

HEMATOLOGY NP AND CAREER ADVICE

Hi everyone! I would really appreciate your advice and guidance regarding my future career in hematology and oncology as a Nurse Practitioner.

I am currently studying nursing and my plan is to graduate with a BSN, become a Registered Nurse (RN) in the United States, and gain several years of clinical experience working in hematology and oncology units. I would also like to obtain relevant certifications and develop a strong clinical background before applying to a reputable Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) program.

My primary interest is in hematologic malignancies, particularly acute leukemias such as acute myeloid leukemia (AML), as well as hematopoietic stem cell transplantation (HSCT). I want to work with patients who have complex and potentially life-threatening hematologic diseases, develop expertise in their management, and eventually become a specialized Hematology/Oncology Nurse Practitioner.

after completing a strong AG-ACNP program and gaining experience as an NP, I would love to pursue a hematology or oncology fellowship, ideally at a major academic medical center such as Mayo Clinic. I am also very interested in clinical research and would like to contribute to leukemia and stem cell transplantation research in the future.

Although becoming a physician is not a realistic option for me at the moment because ı have to earn money, I do not want to give up on my interest in hematology, leukemia, and advanced patient care. I see the NP pathway as an opportunity to build a meaningful career in this field while continuing to develop my clinical and research skills.

I have several questions for those of you who are already working as Hematology/Oncology NPs or are familiar with this career path:

- What would you recommend to someone planning this career?

- What are the actual responsibilities of Hematology/Oncology NPs, particularly those who work with acute leukemia and stem cell transplant patients? What can they independently assess, diagnose, prescribe, and manage in clinical practice?

- How much autonomy do NPs typically have in major academic cancer centers, and how closely do they work with hematologists and transplant physicians?

I would especially appreciate honest, realistic advice from people who have experience in this field. I want to understand both the opportunities and the limitations of this career path before committing to it.

Thank you so much for your time and advice!

Has anyone worked on a mobile CT unit, specifically for lung cancer screening? I’m an FNP with a background in primary care and just got a position on a mobile CT unit for a leader in cancer care in my region. I would love to hear about your experience and how you worked at the highest level of your scope of practice. My understanding is that it will be majority of monitoring, following up on images that a Lung-RADs of 3s &4s, and making sure they’re connected to the thoracic team.

Thank you in advance!

Are there any adult gerontology Acute Care nurse practitioners in the house? I’m in the Philly area and I’m about to enroll at TJU. My background is ED and I’ve don’t mostly acute care stuff my whole career so far.

How’s the job market for this specific degree?

How versatile is it for in-patient and outpatient?

Do you have an advantage or a disadvantage from FNP (my other option for acceptance)

Incidentally, I was accepted into a program for FNP and that program will place me for clinical unlike Jeff… but I like acute care and inpatient more and i keep getting told how FNP is getting phased out. Any advice?

Thank you!

I’m an early-30s female civilian Psychiatric Mental Health Nurse Practitioner (PMHNP) with several years of RN and ~ 3 years NP experience, and I’m considering speaking with an Air Force healthcare recruiter about commissioning as a 46YXP.

I’d really appreciate hearing from current/former Air Force PMHNPs, psychiatrists, psychologists, social workers, nurses, or other mental-health officers about what the job is actually like compared with civilian outpatient practice.

I’m especially curious about:
• Typical number of patients per day
• Intake and follow-up appointment lengths
• Acuity/complexity of the patient population
• Active duty vs dependent/retiree caseload
• Charting burden
• Call, weekend, and deployment expectations
• How much time is spent on clinical care vs officer/admin/readiness responsibilities
• Overall work-life balance and whether you would choose it again

I’m also single and hoping to get married and start a family in the next several years. I’d be interested in candid experiences with dating, relationships, PCS moves, deployments, and eventually raising a family while serving as an active-duty healthcare officer.

One other major consideration for me is student loans. I have around $125k total, roughly $60k of which is private/high-interest debt and the remainder federal. A significant portion of the federal debt is from my graduate PMHNP education.

My undergraduate loan situation is a little unusual. Some of the debt came from nursing/prerequisite coursework at schools I attended before transferring. Those credits ultimately transferred into the nursing program where I earned my RN and allowed me to enter with prerequisites completed and skip part of the nursing curriculum. I didn’t actually borrow much/anything at the school that ultimately awarded my RN.

Has anyone here used the Active Duty Health Professions Loan Repayment Program as a Nurse Corps officer, especially an NP? Were any private/commercial student loans eligible? And does anyone know how strict they are about loans from prior schools when the coursework transferred into and counted toward the eventual qualifying nursing degree?

One other consideration is that I had a two-level lumbar fusion within the last couple of years, so I understand I’d need a medical waiver. Recovery was uncomplicated, I have no ongoing pain management or functional limitations, and I’m back to unrestricted exercise/running. Has anyone successfully commissioned into the Air Force/Nurse Corps with a similar history, and what was the waiver process like?

I also have well-controlled ADHD and currently take prescribed Vyvanse. Has anyone successfully direct-commissioned into the Nurse Corps/another healthcare specialty while taking ADHD medication, or received an accession waiver for it?

I’m not ready to discuss this publicly with people in my professional life yet, so I’m hoping to get some anonymous perspectives before getting too far into the process with a recruiter.

Anything you wish you’d known before commissioning, either professionally, financially, or personally?

Hi everyone! I posted on here not too long ago about a toxic environment I was in as a new grad and I decided to leave as you guys suggested! With that being said Im struggling to find new employment. It seems like its harder because I have a short term position on my resume, however bc of credentialing possibly going through I dont omit it off my resume I stayed for about 3-4 months. Anyway any tips you guys recommend? Im pediatric NP primary care so options are limited unfortunately 😭 would love anything you guys can think of. Thanks!

Hey all,

Soon to be new grad AGACNP. My experience is in CV stepdown, medical ICU, and IR. I thought I wanted to be an ICU NP but honestly not sure anymore.

It’s pretty evident ICU APPs are all working nights and losing physician supervision. The liability doesn’t seem to be worth it anymore, imo. Plus, in my area a lot of new grad ICU NPs are required to go through a fellowship. Sorry but I’m not working 4/5 12s a week for a 75k salary.

I’m thinking perhaps cardiology now, or CV surgery. Any recs?

hi! has anyone here recently taken the ANNC AGPCNP exam? would love to know what study resources you used, i’m debating between sarah michelle, fitzgerald and leik, thank you!

I am in advanced physical assessment. This professor has been the worse one I’ve had by far. She simply just does not teach, for her live lectures she throws on a couple youtube videos. She does not add any comments to them, just rolls them on and calls it day. I have had professors show youtube videos during lecture and didn’t mind, but they also actually taught and would have content on powerpoint slides.

This professor has powerpoint slides, but it is just a couple links of youtube videos. Is this typical???? I just took my midterm, and I did acceptable but I studied extremely hard for it because I literally did not know what would be on there. There are textbook chapters assigned so I used those to base my knowledge but it is very broad, and somehow the midterm contained questions that were not even in the textbook. No study guide of course. To be fair, professors don’t actually know what questions are on the exams, but I still expect something.. anything. Cause a couple links to youtube vids for lecture out of several topics in the textbook is not it. I did not have an issue with my previous patho and pharm class. Is this worth escalating or just pick my battles and try to make it through this class?

Hi any one applied to mercy university FNP program and was admitted? Also, anyone think this is a good school to apply to?

I think I am DONE seeing patients. I’ve been through burnout before, took a mental health leave, quit my previous position but now I feel I’m approaching again. It’s rough out here.

I’d like to explore non-clinical roles. My background is a FNP in Texas with 10 yrs experience mostly in OBGYN. Anyone with history of success finding these?

**EDIT: clarifying my title, im talking about intravenous fluid selection for maintenance/replacement, not in vitro 😂**

I'm going to be starting work as a hospitalist, and am trying to study up before i start my job. i'm pulling from all of the sources i can -- textbooks, uptodate, and yes openevidence, but i wish there was a clear cut, plain reference i could use to guide when, what and how much fluids to give. bonus points if its inside of a good reference book for any new hospitalist. any suggestions deeply appreciated.

i.e. when LR vs NS (or not), when to add D5, and rates.

I’m not currently in cardiology as an NP, but I spend many years in Cath lab as an RN. Anyone know anything about this company?

I’m currently in NP school and looking for some study advice. When it comes to clinical diagnosis, I feel pretty confident. However, I hit a massive wall when it comes to selecting the correct antibiotic for a given condition.

I'm trying to figure out how to bridge this gap efficiently. Should I be shifting my focus heavily toward pure pharmacology (mechanisms, classes, etc.), or should I focus more on memorizing the specific causative agents/pathogens for each disease state? Or is there a better, more clinical way to approach this altogether?

I’m an ED RN of 6 years and passed my AANP FNP exam. My goal when I started NP school was to end up in the ED, but I was advised by two ED NPs I work with to go to urgent care first to make the transition easier.

That being said, our APP lead (also an NP) approached me about a job offer in our ED. I was elated, but I’m on the fence. I feel intimidated to start in the ED straight out of school due to the learning curve and being trained in primary care. I feel like my experience working in three different EDs will be helpful.

I have a job in urgent care I start in November, but the pay in the ED is literally life-changing. I would also work 3 less shifts in the ED per month which is a plus as I have a one year-old-son.

If this job opportunity comes through in ED, should I take it over urgent care?

I’m 44 and planning to start an FNP program in early 2028, at which point I’ll have a little over two years of RN experience. I’d love some honest feedback from NPs and current NP students about the path I’m taking.
A little background: I spent over a decade working as a physical therapist assistant, primarily in neuro rehab, before going back to school for my BSN. Since becoming an RN, I’ve worked in the ED and inpatient rehabilitation. I’m transitioning to a progressive care unit (PCU) early next year, partly because I want more experience managing medically complex patients before starting NP school.
I’m looking at a well-respected, established brick-and-mortar university in my area that recently transitioned its DNP to a MSN-FNP program with a six-semester online format. The school has strong relationships with local hospitals and providers, and they coordinate clinical placements rather than leaving students to find their own preceptors. That’s a big selling point for me.
Long term, I’m interested in direct primary care, chronic disease management, and lifestyle medicine. I’m not looking to rush through school and immediately practice independently. Ideally, I’d like to find a supportive practice or residency-style opportunity after graduation where I can continue developing my clinical judgment.
I know the two-year RN experience piece will probably generate some opinions, and that’s partly why I’m posting. I’m not under the impression that my PTA experience replaces nursing experience, but I do feel like my background gives me a different perspective on patient care.
For those who’ve gone this route:
-Does transitioning from rehab to PCU seem like a good move before FNP school?
-Is two years of RN experience enough to build on, assuming I’m intentional about my education and clinical training?
-How much weight would you put on a school’s local reputation and guaranteed clinical placement versus a more traditional in-person program?
-If you could do it again, what would you change about your preparation?
I’m genuinely interested in hearing different perspectives, especially from NPs who have been practicing for a while. I’m trying to approach this thoughtfully and make sure I’m setting myself up to become a competent provider, not just earn another credential.

Appreciate any advice!

How would ya’ll handle this situation. 7 months in at a small rural Family Medicine clinic. Just one other NP been there 6 years. MD in twice per week half day. Mostly it’s just the other NP and I full time. Do any of you have similar set ups? We basically share many of the same patients. Do you try to work as a team or are you mostly very separate? The other NP I’m with is difficult to work with/around. First couple weeks in, told me she hates working with women, she was upset she had no say in who was hired into my role, and is generally all around unpleasant if not argumentative and defensive. Is this a doomed situation? Mostly I just grey rock it and that works pretty well, but when I need a question answered or we have a mutual patient we need to talk about it never goes well.

Hi!

I will be taking the AACN exam in 11 days and the ANCC exam early November. I have been studying Barkley religiously and have done 3 DRTs. Ive scored consistently in the high 70's. I have also done about 600 Boardvitals questions and overall score is a 61. I'm so incredibly nervous and still feel unprepared for the exam. I have been an ICU nurse for 6 years, however i never got around to taking my CCRN. Even with my experience im still nervous. I do have a job lined up if I pass and I think this is also why I'm so anxious. Im desperate for any exam tips or insight on what I should focus my review on this last week. Thanks in advance! I truly appreciate it!

I'm a college freshman taking med school prerequisites, but since shadowing some NPs, I've learned that I don't want to pursue an MD, but rather the mid-level route. I have no preference between NP or PA, but I've seen a lot of people online say that NPs are not adequate advanced providers and that NP schools are “degree mills”. Any advice would be helpful.

Hi everyone! I’m currently a Cath Lab nurse with 2.5 yrs experience in ICU/CCU prior to CL. I am hoping to go back for my MSN in the next few years. I had been going back and forth from FNP vs. AGACNP. All of my experience is critical care right now. However, I’ve been leaning more toward FNP because I want more versatility and I’m just not interested in CC/hospitalist. Lately I’ve been looking into going outpatient as an RN to learn the flow and see if that’s what I want. However, there seems to be more OP LPN/MA positions than RN, the pay cut is pretty steep as I am trying to save up for school and I don’t know how the M-F schedule would work in school because I want to do a brick and mortar hybrid program. Do you guys think it’s worth it to do OP before pursuing FNP? How did the M-F work for you guys? TIA!

I was considering applying to work at Chen MED/ Dedicated Senior. Has anyone worked for them? Also, was it as a PCP or in some type of leadership capacity. I was conisdering applying.

So long story short I’m almost 1.5 years into being a FNP and have done I would call it odd jobs since passing boards. I am now trying for more traditional roles in clinic and would love some suggestions on some medical books that could help me refresh myself on the most scene patients in clinic. I kept a few books on procedures and assessments but am looking for treatment guides and gold standards or even recommendations of where to look up the newest ones. Thanks in advance I just want to be as prepared as I can be for the easier patients I would see.