CNA to RN

[dmjacobsen]

Sigh..... I feel like this thread is a warzone!

I don't really understand why you would feel this way. Sure, we're having a little misunderstanding -- as is the nature of online communication -- but it seems that we're all being relatively civil here.

Let me tell you MY experience with being a CNA. <snipped for brevity>

I still assert that the work of a CNA does not, in any way, directly correlate to working as an NP or PA. Yes, I will agree that being a CNA will help one in the first month or two of RN school -- which is a route that I recommended against. Yes, I agree that being a CNA will give one insight as to the working environment on a hospital floor -- which is an environment that practitioners see very little of, as they spend more time in the work room and less time at the bedside. I will not, in any way, concede that working as a CNA will give one insight as to what it's like to actually work as a midlevel.


Being a CNA is very physically difficult, dirty work that -- as you've shown by sharing your own experience -- would turn someone off to working in healthcare. That should be chalked up as one more reason to NOT become a CNA. Perhaps your life's path would have taken a different turn if you'd instead gotten a job in an outpatient OB clinic, where the work environment was quieter and the daily duties were not so physically exhausting. But, perhaps not. Who knows?


I'll still push for shadowing a midlevel to see if that's what one actually wants to do with their life. And, I'll still push for OP to go to PA school rather than the considerably longer nursing path to NP.


As a side note, CNA attrition from the profession is extremely high, cited at 72% after five years in one article[SUP]1[/SUP]. I think that this is a pretty good indicator of how difficult and stressful the job is. 37% of new nurses were ready to change careers after just one year, in one study[SUP]2[/SUP]. One study on NP's showed that 5.5% were ready to leave the profession at the time of survey[SUP]3[/SUP]. A study modeling physician assistant supply for the future noted that the mean attrition rate from the profession was 5%[SUP]4[/SUP], which is pretty close to the NP rate. I think that those numbers illustrate pretty well that the job of NP/PA is significantly more satisying than the job of CNA or nurse, which further negates the idea of using the experience in one profession as a basis for how much one will enjoy working in the other.


References


1. How to Prevent CNA Burnout | Chron.com
2. https://www.aacn.nche.edu/media-relation...tageFS.pdf
3. http://fpb.case.edu/news/Docs/Fitzpatric..._Dec10.pdf
4. Predictive Modeling the Physician Assistant Supply: 2010

[humboldtjake]

I asked this question originally because TESC said that CNA would cut off my time to get a RN from them as I have a BA degree. PA sounds attractive too, but NP would be shorter because I can do an accelerated and a 1 year online MSN. I am a physician and nurse recruiter and NPs have way more autonomy in the USA than PAs. Most states they practice on their own without supervision.

By the way I am doing this ONLY so I can own medical corporations in CA and other corporate medicine states. I don't care about being a clinician. In CA, a RN can own 49% of a medical practice, which is the same amount as a PA and NP. Only a MD/DO, DDS, and DC can own 100% of a medical corporation in CA.

[Jonathan Whatley]

I asked this question originally because TESC said that CNA would cut off my time to get a RN from them as I have a BA degree.

You know that the only way you can qualify as an RN through TESC is through a one-year program in Trenton, New Jersey, two days a week at TESC and two days a week in hospital?

Currently, their class size is limited to 30 people. I expect admissions to be highly competitive. Very specific requirements for admission include Anatomy and Physiology with Lab (8 semester hours), Microbiology with Lab, Chemistry, etc. I don't see any avenue for CNA credit to apply towards the degree, but it wouldn't hurt an application.

PA sounds attractive too, but NP would be shorter because I can do an accelerated and a 1 year online MSN. I am a physician and nurse recruiter and NPs have way more autonomy in the USA than PAs. Most states they practice on their own without supervision.

IIRC, this came up before, and no one could find a one-year online MSN in Nurse Practitioner studies, only in fields like nurse education that absolutely wouldn't meet educational requirements to become an NP. Can you identify a single one-year online MSN in NP studies?

By the way I am doing this ONLY so I can own medical corporations in CA and other corporate medicine states. I don't care about being a clinician. In CA, a RN can own 49% of a medical practice, which is the same amount as a PA and NP. Only a MD/DO, DDS, and DC can own 100% of a medical corporation in CA.

I think allnurses.com would be a great source of information with respect to your plan.

[sanantone]

I don't really understand why you would feel this way. Sure, we're having a little misunderstanding -- as is the nature of online communication -- but it seems that we're all being relatively civil here.



I still assert that the work of a CNA does not, in any way, directly correlate to working as an NP or PA. Yes, I will agree that being a CNA will help one in the first month or two of RN school -- which is a route that I recommended against. Yes, I agree that being a CNA will give one insight as to the working environment on a hospital floor -- which is an environment that practitioners see very little of, as they spend more time in the work room and less time at the bedside. I will not, in any way, concede that working as a CNA will give one insight as to what it's like to actually work as a midlevel.


Being a CNA is very physically difficult, dirty work that -- as you've shown by sharing your own experience -- would turn someone off to working in healthcare. That should be chalked up as one more reason to NOT become a CNA. Perhaps your life's path would have taken a different turn if you'd instead gotten a job in an outpatient OB clinic, where the work environment was quieter and the daily duties were not so physically exhausting. But, perhaps not. Who knows?


I'll still push for shadowing a midlevel to see if that's what one actually wants to do with their life. And, I'll still push for OP to go to PA school rather than the considerably longer nursing path to NP.


As a side note, CNA attrition from the profession is extremely high, cited at 72% after five years in one article[SUP]1[/SUP]. I think that this is a pretty good indicator of how difficult and stressful the job is. 37% of new nurses were ready to change careers after just one year, in one study[SUP]2[/SUP]. One study on NP's showed that 5.5% were ready to leave the profession at the time of survey[SUP]3[/SUP]. A study modeling physician assistant supply for the future noted that the mean attrition rate from the profession was 5%[SUP]4[/SUP], which is pretty close to the NP rate. I think that those numbers illustrate pretty well that the job of NP/PA is significantly more satisying than the job of CNA or nurse, which further negates the idea of using the experience in one profession as a basis for how much one will enjoy working in the other.


References


1. How to Prevent CNA Burnout | Chron.com
2. https://www.aacn.nche.edu/media-relation...tageFS.pdf
3. http://fpb.case.edu/news/Docs/Fitzpatric..._Dec10.pdf
4. Predictive Modeling the Physician Assistant Supply: 2010

I understand what you're saying, but now we know that the OP has a very unconventional goal.

[dmjacobsen]

I asked this question originally because TESC said that CNA would cut off my time to get a RN from them as I have a BA degree. PA sounds attractive too, but NP would be shorter because I can do an accelerated and a 1 year online MSN. I am a physician and nurse recruiter and NPs have way more autonomy in the USA than PAs. Most states they practice on their own without supervision.

By the way I am doing this ONLY so I can own medical corporations in CA and other corporate medicine states. I don't care about being a clinician. In CA, a RN can own 49% of a medical practice, which is the same amount as a PA and NP. Only a MD/DO, DDS, and DC can own 100% of a medical corporation in CA.

Now, *this* is where this thread might really turn into a warzone. I'll try to keep myself in check, but I'm actually dumbfounded and offended that someone would go to RN school when that person has a self-reported lack of interest in being a clinician. What you're telling me is that you're potentially going to bump someone out of an RN program who actually has a desire to be a nurse. banghead

Still, let's explore this idea further, as much as I feel like scum for even continuing to participate in this. If an RN can own the same amount of a medical corporation that an NP/PA can own, then you're really wasting your time even mentioning NP/PA programs. Just get the RN, invest in your company, and be done with it. But, how much value do you really think you're going to bring to a medical corporation with no clinical knowledge? Do you really think you'll find a physician that *needs* your 49% investment along with your newly-minted RN, NP, or PA license, with no experience to speak of that is valuable in the clinical environment? I think that you far overestimate how much you bring to the table with your experience as a healthcare recruiter.

Additionally, your point about NP's being able to practice independently is a moot, since you'll only be able to own 49% of the medical practice in your scenario. This means you'll still need a physician as co-owner. In that case, if you were a PA, you'd just use your physician partner as your medical supervision.

I just can't imagine a scenario where this would actually be a feasible plan, unless you have a family member who is a physician and also has financial management skills that are too poor for them to be able to figure out how to start a medical practice on their own.

Sidenote: You ain't gettin' your NP in one year. It's just not gonna happen.

[Gaz]

I think the effort required to become a Nurse Practitioner is overkill if the end goal is to maintain ownership in a medical corporation. Social workers qualify for the same 49% ownership. What about an MSW? No prereqs, it can be done online while still working full-time.

I think if you try to go the nursing or PA route you'll discover many unanticipated road blocks. It would not be worth your time. Even the accelerated degree from TESC would require you to pack up and move to NJ. Your entire life would need to change.

[humboldtjake]

Now, *this* is where this thread might really turn into a warzone. I'll try to keep myself in check, but I'm actually dumbfounded and offended that someone would go to RN school when that person has a self-reported lack of interest in being a clinician. What you're telling me is that you're potentially going to bump someone out of an RN program who actually has a desire to be a nurse. banghead

Still, let's explore this idea further, as much as I feel like scum for even continuing to participate in this. If an RN can own the same amount of a medical corporation that an NP/PA can own, then you're really wasting your time even mentioning NP/PA programs. Just get the RN, invest in your company, and be done with it. But, how much value do you really think you're going to bring to a medical corporation with no clinical knowledge? Do you really think you'll find a physician that *needs* your 49% investment along with your newly-minted RN, NP, or PA license, with no experience to speak of that is valuable in the clinical environment? I think that you far overestimate how much you bring to the table with your experience as a healthcare recruiter.

Additionally, your point about NP's being able to practice independently is a moot, since you'll only be able to own 49% of the medical practice in your scenario. This means you'll still need a physician as co-owner. In that case, if you were a PA, you'd just use your physician partner as your medical supervision.

I just can't imagine a scenario where this would actually be a feasible plan, unless you have a family member who is a physician and also has financial management skills that are too poor for them to be able to figure out how to start a medical practice on their own.

Sidenote: You ain't gettin' your NP in one year. It's just not gonna happen.

Hey bud,

I am a business man. By owning 49% then I can't get kicked out of the company. If I am a layperson with none of the clinical requirements then I can be kicked out of being the "management organization" for the practice. It is really to save my ass from all the work and then getting kicked out by a greedy MD. I know that this has happened to a lot people. I could do a MSW, but I think I only qualify after I am a licensed clinical social worker which is like another 2000 hours of supervised training. I will need to do a little more research.

Btw there are at least 5-6 FNP schools in one year. University of Miami has one. Vanderbilt has one. I just need a placeholder MD for the 51%. I work with doctors all day I have to say that 60-70% have no desire to run their own practice. With the passage of Obamacare more like 80% have no desire to run their own practice. THey just want a pay check and not have to deal with insurance companies. Like I said I recruit doctors and nurses and staff them at clinics. If you're looking for work when you graduate, I have plenty of work in Memphis. I run a national locum tenens company.

[Jonathan Whatley]

I am a business man. By owning 49% then I can't get kicked out of the company. If I am a layperson with none of the clinical requirements then I can be kicked out of being the "management organization" for the practice. It is really to save my ass from all the work and then getting kicked out by a greedy MD.

The MD or other clinician, who's really doing the work, can just walk out and restart their own practice elsewhere. If they don't want to manage their own practice, it can be with another practice group. Good luck enforcing a non-compete clause in California. If you're looking at the very limited "section 16601" exceptions where noncompetes may be enforceable in cases of a business sale or partnership,

A non-compete may “literally” fall within section 16601, but it is still void if it is a sham to evade the public policy against such provisions. Bosley Medical Group v. Abramson, 161 Cal. App. 3d 284 (1984). In Bosley, a doctor was hired by a medical group and was required to purchase nine percent of the corporation’s shares. The agreement required him, upon termination, to resell his stock and prohibited from competing. The court refused to enforce the non-compete as a sham because the share purchase and sell-back provisions made little sense except as a device to prevent the doctor from competing. Id. Though the agreement literally fell under section 16601, a literal interpretation “would permit a major public corporation to require any employee to purchase one of several million shares and to enter into an agreement not to work for a competitor—an absurd result, and contrary to this state’s policy prohibiting such agreements.” Id.

With Limited Exceptions, Non-Compete Clauses Are Not Enforceable in California (Navid Yadegar and Navid Soleymani, Yadegar, Minoofar & Soleymani LLP)

Btw there are at least 5-6 FNP schools in one year. University of Miami has one. Vanderbilt has one.

You also said "online." Miami's NP programs don't appear to be online at all. Vanderbilt's program isn't very online. From their Family NP program: "This intense program of study is offered in a modified distance format with monthly visits to campus. Students attend on-campus sessions approximately one week each month." Further it includes "Hands-on learning through 630 hours of supervised clinical practice – in clinical settings located in the Middle Tennessee area or in selected sites across the United States." Family Nurse Practitioner MSN (Vanderbilt). Vanderbilt's programs in other NP disciplines, e.g. Emergency NP, seem to have similar requirements.

Further, if there are only something like 5-6 programs in a one-year schedule in a highly competitive field like NP studies, and the two that come to mind are from Tier I national universities, getting admitted to one of them – probably against nurses with impressive clinical experience and professional recommendations – will be another choke point in your plan.

[dmjacobsen]

Further, if there are only something like 5-6 programs in a one-year schedule in a highly competitive field like NP studies, and the two that come to mind are from Tier I national universities, getting admitted to one of them – probably against nurses with impressive clinical experience and professional recommendations – will be another choke point in your plan.

This. A thousand times this.

NP programs, especially highly-competitive ones like Vanderbilt, place a lot of value on experience. Even in my less-prestigious NP school, this is true. I applied for their program and got in on the first try with a less-than-stellar academic record, but with 6 years' experience under my belt at the time of application. A friend of mine -- who started with me -- had been applying for 2 years straight before she was accepted. She graduated from a highly-regarded (at least locally) health sciences college, managed a 4.0 GPA for the entirety of her BSN, and was repeatedly rejected. After she got 2 years' experience, she was golden.

I'm still not sure what exactly OP is going to accomplish here. OP does not want to be a clinician, but wants to find a "placeholder" MD that will own 51% of the corporation while doing none of the work. Who's going to do the work, then? I'm guessing OP will hire some midlevels to work in the practice, but that's just wasted income when you have two practitioners who aren't even using their license. The only way that this scenario would be profitable would be if there were multiple clinic sites (i.e. the Doc-in-a-Box model) overseen by OP and the placeholder MD. Again, however, if you have someone at the helm of this operation who has no clue how things are done by the grunts on the ground, I can't imagine how this organization would be successful.

But, I guess I'm digressing from the original purpose of this thread.

All in all, PA is still the way to go. OP will *not* be able to get into a one-year MSN/FNP. It simply will not happen without years of experience as an RN, which will delay entry to and graduation from the program to a point far beyond the potential graduation date of a PA program. If the goal is not to practice medicine independently -- or at all, as the case may be -- then NP is not needed. If you need a physician to own 51% of the business anyway, then you might as well use them as your supervising physician.

Here's a breakdown, again, of how long each program will take:

RN alone = 2 1/2 years minimum, for an accelerated program (1 year pre-req's + 1 1/2 years RN program)
NP = 4 years minimum (assuming 2 1/2 years for RN + 1 1/2 years for NP)
PA = 3 years minimum (1 year for pre-req's, 2 years for PA program)

If you're going to spend that much time in school, might as well spend the extra 6 months and come out as a midlevel.

[Jonathan Whatley]

humboldtjake, you might look at this:

How a non-licensed person can work with a medical practice, including the use of an administrative / management services company (Matt Dickstein, mattdickstein.com)

The focus is on California law and the author is a California attorney. Similar strategies might also be possible in other states with corporate practice of medicine laws similar to California's.

The management service company is a common structure that non-licensed persons use to participate in a medical practice. Here non-licensed persons perform the administrative and back-office functions permitted by law (see above), thereby freeing the physicians to spend more time on patient care. Usually the physicians provide patient care through a professional medical corporation that they wholly own, while the non-licensed persons provide their services through an ordinary corporation or an LLC that anyone can own. The two sides use contracts to link the management service company with the medical corporation and to provide the terms of service and compensation.

The key is to provide goods and services to the medical practice without tripping any of the prohibitions above. For example, the non-licensed person can lease office space and certain equipment to the medical practice, or provide back-office administrative services including accounts payable and billing services, or help with traditional marketing, or provide staffing of non-licensed personnel. None of these functions, in themselves, involve ownership or profit-sharing in the medical practice.