A Calling Realized: My Mid-Career Shift to Nurse Practitioner

I am a nurse practitioner. Sometimes, my patients ask me, “Why didn’t you go ahead and just become a doctor?” My two doctorates notwithstanding, I know what they mean: I clearly love the intellectual challenge of medicine and enjoy patient care, so why did I choose this role instead of the better-paid and often more respected role of physician?

Growing up as the daughter of a physician, I found the medical books that littered our home incredibly interesting, and I loved hearing my father talk about the cases he saw at work. However, when the time came to consider my own career, I decided that I didn’t want to go into medicine. It seemed like a wonderful calling that had been diminished into a terrible job: my father endured crushing stretches of long days, missed family events and holidays, and constant exhaustion. He was always away early, home late, and it was notable when he was around on the weekends.

I’d always been a lover of disciplines that consider existential questions. What could be more relevant than trying to make sense of our human lives and deaths? This being so, academia was my first choice of career. I taught, wrote articles, and had the flattering experience of hearing my own work referenced at a conference presentation as germinal in a field. I was certain I was on my way to a coveted tenure-track academic job. However, while I was completing my PhD in American Studies at Brown University, I made a decision that was the undoing of my academic career: I had children.

My oldest child was born with a disability and had significant challenges during her first few years. There was no longer hope of moving for an academic job, when her clinicians and my family supports were local. During one particularly fraught stretch, she was hospitalized for an illness that brought her close to dying. After she was out of harm’s way, I seriously reconsidered my life’s trajectory. Academia was now out of the question, and I needed a job. Having seen the drama of illness and recovery up close, I realized that I couldn’t get away from my deep interest in medicine. The field spoke to the issues that I’d studied in my academic career--questions of meaning and mortality could not be more salient in the immediacy of grappling with illness and death.

Knowing that I had to make a change, I briefly considered medical school, but I was in my early 30s with old science classes on my transcript, and a family to support. Medical school was impractical: the tuition was too expensive, the application process too fraught (who would want a middleaged career changer?), and even if everything went well, I’d be asking a tremendous amount of my family with regard to relocation for training and residency. Further, it would be a long time before I’d make any significant income. Having been raised by a doctor, I’d had no idea what nurses knew and did before I spent time with my daughter in the hospital, and I was amazed at their clinical acumen and the support and education they offered us. Nursing school seemed attainable- it was less expensive and held the promise of a decent job without the need for relocation. There were also possibilities for advancement within the field. That’s the path I chose, and eventually, after working as a floor nurse for a time, I became a nurse practitioner and have been in practice for over 10 years, now holding a practice doctorate in nursing.

I’m happy with this choice, and I enjoy being a part of a multidisciplinary team currently working in hospital medicine. I have worked in a variety of practice settings, and while I have spent most of my time as a generalist, I have also had the opportunity to work in a subspecialty field. I know APRNs who have gone back to floor nursing (with improving reimbursement, a viable opportunity for some), obtained specialty certification, or gone into administrative roles. The flexibility remains a substantial plus of this role--flexibility that my physician colleagues often do not enjoy, saddled in many cases by massive student debt, difficulty changing roles after extensive specialization, and in the case of my colleagues who choose to have children, the overlap between the most intense periods of training and the years usually spent in childbearing and raising small children.

In my practice, I depend on physician experts to create the knowledge that I am applying clinically. My initial training focused on practical patient management, and while my practice doctorate gave me the skills to create new knowledge about how to deliver patient care, establishing the evidence basis of new treatments delivered depends on the scientific training offered as a part of medical education. Further, while many of my advanced practice clinician colleagues go on to distinguish themselves on specialty teams, those teams must be anchored by someone who has the deepest level of scientific training and expertise in the specialty discipline. Meanwhile, my colleagues and I provide valuable insights about integrating the lived experiences of our patients into the plan of care.

While there are border skirmishes between physicians and other clinicians, these need to be contextualized in terms of who benefits from these arguments. I was correct in my initial assessment of the lifestyle of a diagnosing and prescribing clinician: it can be pretty terrible. We are all burdened by the increasing needs of our very ill patients, for whom we care within the context of a medical system whose priorities have little to do with our education, licensure, and the values of our respective disciplines. Nothing weakens a potential transformative force more than infighting. There are valid discussions to be had about collaborative models and clarity in roles and training, but these can be had while moving forward as an allied team, dedicated to improving not only the lives of our patients, but also to meeting our own human needs.

Sarah Petrides, DNP, CNP, FNP-BCSarah holds a doctorate in American Studies from Brown University and a nursing doctorate from the University of North Florida. She has been a nurse practitioner since 2014, currently at St. Vincent Hospital.