A female nurse practitioner (LPN) earns her Nursing MA in rural Alberta, Canada via distance education. Follow her real-life success story.
â€œWherever you live, whatever your background,Â a modern college education is as close as your mailbox, phone, or PC.â€
This article concerns Diane Burlock, a determined woman who successfully managed to earn her Master’s degree in nursing while still employed as a nurse practitioner. If you are also interested in pursuing a nursing career, please read our How to Become a Registered Nurse guide. Since there are so many advantages to getting an online nursing education, we now offer another new article featuring the six main reasons to study nursing online.
On the surface, Diane Burlock may appear to be just your run-of-the-mill working mom, but underneath she hides the grit and determination of a modern-day wonder woman. She’s a wife and mother, but she’s also working on a Master ofÂ Science degree in Community Health Administration and Wellness Promotion while employed as a full-time nurse practitioner. With so much already going on in her life, we didn’t bother to ask her about her hobbies.
In her day job as a nurse practitioner, Burlock travels throughout the five regions of the Northwest Territories and northern Alberta, Canada providing primary healthcare services to patients. In its own unique way, Burlock’s story demonstrates how earning a living and getting an education are tightly interwoven. While it may have been more difficult a few years ago, today you can work and learn now matter how far from the city you may live.
“If it were not for distance education,” Burlock ponders, “I might not be a nurse practitioner today. I’d probably be a Registered Nurse, but I most likely wouldn’t have finished the professional degree needed to become a practitioner. And I certainly wouldn’t be finishing my Master of Science degree.” So what does a Nurse Practitioner do and why was Diane was eager to become one?
As was once the case with receiving an advanced degree, it seems that your location can greatly affect your job requirements. When asked to briefly describe her career choice, Diane suggests that the job requirements of a nurse practitioner can vary depending on your physical whereabouts. Burlock comments, “All nurse practitioners are advanced nurses trained to be more independent in their assessment and treatment of patients, but where you live can make a big difference in what you do.”
For her job, Burlock travels throughout northern Canada working at what are called “nursing stations.” Much like a doctor’s office, nursing stations are a lot like regular medical clinics except that they are equipped with an emergency room, a chest and limb X-Ray, blood analysis equipment for hemoglobin and white blood count, a formulary (pharmacy), and a two-bed hospital ward. Patients needing short-term observation or treatment but not sick enough to warrant flying them out to a hospital can stay overnight in this mini-hospital.
Burlock explains the importance of a nurse practitioner in these remote regions.”Where I work, nurse practitioners are the only on-site health officer,” she comments. “We obtain medical histories, perform physical examinations and general health assessments. From these, we diagnose health deficits and form a treatment plan.” Usually, these deficits are relatively low-key infections, such as a urinary tract infection, ear infection, or an infected puncture wound. Burlock also sees a lot of common communicable diseases, like strep throat and pneumonia, on the job. While most cases are easily treatable, however, nurse practitioners like Burlock must also learn to diagnose and treat some chronic conditions, including asthma, high blood pressure, heart disease, and lung disease. “There’s the usual emergency room stuff, too,” warns Burlock. “The suturing of lacerations [stitching cuts and wounds] and removing imbedded foreign objects like fish hooks and glass.” According to Burlock, the job of nurse practitioner can be fairly trying sometimes.
“In my situation,” says Burlock, “I am often very isolated.” She provides insight into what it is like to be a nurse practitioner in a rural area. “When elaborate testing is required, we have to fly the patient out to a larger facility.” While most would probably think that working in heavily populated area would be more challenging, Burlock hints at the distinct difficulties of working out in the country. “We must rely more on our physical diagnosis and consultation-seeking skills than city practitioners, who have ready access to sophisticated diagnostic equipment and tests.” Based on her diagnosis, the nurse practitioner may prescribe medications and other treatments, sometimes including physical therapy. Nurse practitioners like Diane Burlock help prevent disease and promote health with screening, family planning services, prenatal monitoring and care of the pregnant woman. The nursing station often sets aside morning hours for clinic and afternoon hours for health and wellness promotion.
What about babies? If doctors and hospitals are so far away, do nurse practitioners deliver all the babies, too? “We don’t routinely deliver babies,” Diane reports, adding with a chuckle, “Though we do deliver a surprise package on occasion. Usually, the nurse practitioner will assess the progress of the pregnancy and schedule a “fly out” to the nearest hospital at least two weeks before the mother’s due date, depending on the expected risk.
While nursing stations have established procedures, Burlock informs us that things don’t always go as planned. “In reality,” Burlock snickers, “Women we’ve never seen before sometimes drag themselves into the nursing station when they’re already in labor. But even the best-monitored pregnancy can deliver early, so we are ready and able to handle the occasional unanticipated delivery.”
Whether they successfully get the expecting mother on a plane in time or deliver the baby in the nursing station themselves, rural nurse practitioners follow-up with growth monitoring, childhood immunizations, and general health check-ups throughout the baby’s early years and beyond. At Diane’s and other nursing stations, considerable counseling and family health education are included in their health services.
Nurse practitioners also ensure the health of their patients by referring them to related health services and resources as needed. When medical issues go beyond the scope of mid-level practice, nurse practitioners must refer patients to appropriate doctors and other specialists. They also arrange for patients requiring intensive care and long-term care to be transferred to appropriate tertiary facilities, such as hospitals and skilled nursing homes.
Growth of the Nurse Practitioner Field
The nurse practitioner movement first began about 25 years ago in an effort to provide primary healthcare services to under-served rural area unable to attract primary care doctors. As the career of nurse practitioner became more accepted, their practices started spreading to the inner city, another area commonly shunned or overlooked by most respected doctors.
In the beginning, nurse practitioners served the patients no one else cared to treat. More recently, the revolt against the big price tags now attached to most healthcare services has led government agencies and insurance programs to seek out ways to transform healthcare from being a system dependent an acute care (high-tech hospitals and emergency rooms) to one more focused on primary care settings (offices, clinics, HMOs). The challenge lies in figuring out how to get medical care to more people on a shrinking budget. As mid-level practitioners with mid-level salaries, nurse practitioners are willing to work where they are most needed and are thus starting to meet this urgent need.
Often members of a healthcare team, today nurse practitioners work in both rural and urban settings, active in the following settings:
- Public Health Departments
- Rapid Care Clinics
- Group Practice Offices
- Corporate Occupational Health Clinics
Nurse practitioners also work in nursing homes as mid-level primary care practitioners. Some set up their own private practices, while others join nurse practitioner group practices. While their plea to receive more independence from doctors was once automatically dismissed, nurse practitioners now enjoy receiving advanced training in clinical assessment and more liberal state licensing laws. Licensing laws in many states still say that nurse practitioners must be “supervised” by a physician. Partly motivated by a concern for public protection, these supervision laws were also passed in hopes of preventing doctors from revolting against the nurse practitioner movement, slowly starting to steal some of their thunder. Today, rural nurse practitioners offer services once provided by the “country doctor,” before that position was obliterated in the post-World War II demand for specialization, behemoth urban medical centers, and the abandonment of rural practice.
As Diane Burlock points out, “In remote areas like the ones I visit, it’s a nurse practitioner or it’s nobody.” In these situations, “supervision” has a very loose meaning. “A doctor might hold a clinic once or twice a month,” Diane explains, “to treat very ill patients, to glance over your records, and discuss cases with you just to see how you’re handling things.” In some instances Burlock’s monthly ‘supervision’ isn’t even always in person. During Canada’s long and often severe winter climate, physician supervision often comes by way of “phone or fax.”
How Much Does a Nurse Practitioner Make?
According to Burlock, a nurse practitioner working in Canada gets “a base wage of about $54,000 Canadian.” Burlock notes that this base salary can include a few extras, as well. “There is extra pay for being on-call, for call-backs, and for being in charge of a nursing station, which can bring the pay up to $75,000 to $85,000 Canadian per year.” There are perks to boot. At her job, Burlock enjoys a paid trip “out” at least once a year, a 50% rent subsidy, and additional hardship pay because she works in such isolated areas. Not bad!
It’s harder to pin down nurse practitioner salaries in the United States. Ultimately, it seems to depend on who you listen to. A nurse practitioner may start out anywhere from $30,000 to $40,000 per year. That works out to $14 to $20 per hour, depending on the salary and the exact number of hours per week worked . Managed care is common in the Pacific Northwest, and the average salary for nurse practitioners can range between $49,500 and $54,250 a year. The national average hovers around $45,000 per year. Keep in mind: the average figure is diluted by a lot of entry-level salaries. Large salary increases come with each additional year of experience. Increases tend to level off at around $60,000-$70,000 per year. In certain specialties, however, advanced practice nurses can earn in excess of $100,000 per year (1).
This probably sounds like a lot of money. Imagine, however, that you are a healthcare administrator with a primary care position open. A new doctor juggling a dozen 25-year school loans at 8-to-10% compounded (tax non-deductible) interest and a career span shortened by 11-15 years due to considerable post-secondary education and training needs a six-figure income just to keep afloat. On the other hand, you could hire a nurse specialist to do the routine stuff (generally 75-80% of a doctor’s cases) for only $50,000 to $75,000 a year. Those select nurse specialists demanding $100,000 or more a year render the mid-level services of a physician specialist expecting to earn $200,000 or more a year. Do the math. Who would you hire?
You probably think the same way that most do. In both rural and urban settings, third-party payers are starting to balk at paying a doctor’s fee for services that a more affordable mid-level practitioner can also perform. In HMOs, rural and inner city clinics, and other group practice settings, practices are expanding as nurse practitioners are being hired before doctors. As a result, mid-level practitioners are starting to earn more money and respect.
Career guidance experts predict the persistently steady demand for nurse practitioners and other clinical specialty nurses to continue. This demand will allow nurse practitioners to continue earning $50,000 to $100,000 a year, depending on their specialty.
As the only on-site health officer, educator, counselor, referral agent, and public health officer, your authority is revered, says Burlock. “Others know that the position is demanding, so if you fulfill your duties to the best of your ability and act as a positive role model within the community, then you will be respected as well.” In talking with Diane Burlock and reading her notes, it seems that many rural patients and community leaders treat nurse practitioners with the same kind of respect once accorded to the “country doctor.”
Nurse Practitioner Training Requirements
In Canada, Burlock says that the minimum requirement for becoming a nurse practitioner is an R.N. license, a Bachelor of Nursing degree and two to three years of rural nursing experience. If they pledge to serve two years employment in their sponsoring region, new university graduates can receive a subsidy and take a fast-track intensive nurse practitioner course provided by the government.
In the United States, nurse practitioner training takes a little longer and usually requires more schooling. Usually, a nurse will earn a B.S.N. (Bachelor of Science in Nursing) or B.N. (Bachelor of Nursing) and take the Registered Nurse licensing examination. After three or more years of experience, s/he attends graduate school to receive an M.S.N (Master of Science in Nursing) or an M.N. (Master of Nursing) in a nurse practitioner specialty. While this is the general path, specifics can vary somewhat. Some nurses, for example, will take their R.N. licensing exams before completing their Bachelor of Nursing degree. Requirements can vary from one state to another.
Nurse practitioners may specialize in any of the following areas:
- Neonatal (premature birth) Practice
- Pediatric and Adolescent Health
- OB/GYN and Women’s Health
- Family Practice
- Psychiatric/Mental Health Practice
- Occupational Health
Not always called a nurse practitioner, advanced practice nurses may have different titles, including Nurse-Midwife (labor and delivery) or Nurse Anesthetist (anesthesiology).
There are basically three routes to becoming a registered nurse (RN) today. Two-year community colleges and vocational-technical schools offer associate degrees in nursing, often leading to “technical nursing” careers. Four year colleges usually offer the B.S.N. (Bachelor of Science in Nursing) or B.N. (Bachelor of Nursing) degree, usually beginning “professional careers” in nursing.
Basically, technical nurse training focuses on direct patient care, whereas professional nurse training depends more on the decision-making aspect of patient care and managerial responsibility. Taking more courses and staying in college longer sometimes pays off, as professional nurses tend to make more money and enjoy more opportunities for advancement into management or clinical specialty fields.
Another popular route to a technical nursing career is a hospital-based diploma program. There are advantages and disadvantages to this route. Historically, hospital diploma programs exist because, women were barred from enrolling in most universities in the United States before the twentieth century. Hospitals trained their own nurses by apprenticeship. Rural areas are often more desperate for nurses than metropolitan areas, so hospitals sometimes find it is easier to “grow their own” in a nurse training program than to recruit from the nearest university. Tuition costs are a lot more affordable in hospital programs, too. If you’re lucky, you may even get your training free of charge if you promise to remain working in the area for a certain period of time after you graduate.
A hospital-trained nurse often gets a lot more direct patient contact and more practical, hands-on training than nurses trained in most college programs. The main disadvantage to graduating from a hospital diploma program, however, is that hospital-trained nurses tend to get pegged as “hospital nurses.” It may be harder for you to branch out into other fields with a hospital diploma than it would be with a college degree in nursing. With hospitals downsizing now, this could be a severe drawback. Still, don’t despair if you are a hospital-trained nurse. It isn’t hopeless. Read on.
Distance Education Opens New Opportunities for N.P.s
Due to the shortage of certain specialty nurses, some rules and traditions are now being stretched. More colleges are now offering “outreach” programs allowing diploma-trained nurses to demonstrate their knowledge in exchange for college credit. Those credits are then applied towards a B.S.N. degree, allowing hospital nurses to complete their degrees via distance education, by satellite television, computer, or independent study.
This is exactly what Diane Burlock did. She earned an R.N. through a hospital diploma program, then worked as a rural nurse for 12 years. When Burlock entered the Northwest Territories, she completed a post-R.N. completion degree: the at-a-distance Bachelor of Nursing from Athabasca University, then eligible to enter practice as a nurse practitioner.
Burlock is now making excellent progress toward a Master of Science (M.S.) degree from the California College for Health Sciences. “If it were not for C.C.H.S. and its at-a-distance M.S. degree program,” says Burlock, “I probably couldn’t earn a Master’s at all.”
When asked about the benefits of distance education as opposed to earning a traditional degree by going to classes, Burlock had a lot to say. “I can study when I have time and go at my pace,” says Burlock, “Not according to some preset schedule. I can keep my job. The best part is, the California College of Health Sciences program allows me to schedule classes that are related to my current work assignments. They mesh. It’s so much easier to take in new ideas when you can see the application in your daily work!”
When it comes to the drawbacks of distance education, Diane speaks of her individual limitations before downing the program. “For myself,” Burlock says, “self-motivation can be difficult, unless I work out a plan of action with definite steps. While many find that working on their own slows their progress, I’ve found that taking two courses at a time (rather than just one) gives me the variety I need to keep up the pace.” While Burlock suggests that self-determination and perseverance are needed to complete a distance education degree, she also expresses gratitude for other people in her life. “I could not have gotten this far without the cooperation of my family. Many times, they have been a much needed source of encouragement.”
Diane Burlock is already a full-fledged nurse practitioner. She doesn’t really need a Master of Science (M.S.) degree from California College for Health Sciences. So why is she working so hard to get it? “There are many reasons,” explains Burlock. “Self-improvement, you know, to broaden my knowledge. But, also, because nurse practitioners do a lot more than emergency and regular clinical care. In my job, I’m a family life educator, health educator, and a counselor. (Luckily, nursing stations have recently started providing a professional social worker.) Anyway, you need many skills. The course content at C.H.H.S. directly supports my career and makes me a better nurse practitioner.”
“Plus,” she adds, “the Master’s degree gives me more opportunities. Once I receive it, I can apply for administrative relief positions. When I go to a one-nurse station, I can be left as Nurse-in-Charge. This means not only more responsibility, but also a pay bonus. Luckily, I’ve found the content of my C.H.H.S. Master’s-level courses directly helpful in these situations.”
Except for her hospital-based R.N. credential, Diane Burlock has completed all of her degrees from a distance while living in a rural area, even while working in remote and isolated outreach stations. How remote is remote, you ask? Diane has an answer. “For six months of the year,” says Burlock, “my principal means of transportation to work is snowshoe and snowmobile.” Talk about determination!
Rural Areas Need You More
The primary care and specialty nursing shortage discussed earlier is worse in rural areas than in the city. Furthermore, employers tend to be far less persnickety about the details of your credentials, whether they come from a big name school or a small distance education program. As it should be,if you’ve got the skills, you’ve got the job in rural areas. While there are only a few still left today, there once were many one-year non-degree certification programs in United States for more experienced nurse similar to the intensive program offered in Canada.
In a bid for greater status, prestige, and independence, the nurse practitioner profession in the United States has pushed to increase higher educational requirements. Non-degree certification programs are fading and may disappear altogether. Check with your state licensing agency to see if they provide alternate career pathways to experienced nurses.
In the end, you may only go as far as receiving a B.S.N. via distance learning. You may even have to leave town to earn your nurse practitioner Master’s degree. But, as a rural nurse practitioner, the chances are extremely good that you’ll be able to come back. Backwoods men or women desiring a good-paying, exciting, evolvingâ€”and yes, admirableâ€”career should consider becoming a nurse practitioner.
Shortly after this article was written, Diane Burlock wrote DegreeFinders to let us know she finished her Master of Science degree. Her husband, Doug, added at the bottom of the note: “And in record time too (according to CHHS).” Just a tad proud of her, Doug? Good for you, Diane. Congratulations!
If you have a back-to-school success story that illustrates the value of distance learning, please contact us so we can feature it right here on DegreeFinders.com. Or, leave a comment below and tell us all about it!
(1) The following figures were produced by the State of Washington and the U.S. Department of Health and Human Services.
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