ACNP vs FNP: My Summarization of the Great Debate

[rauscht]

I, like many others in the forum, have been recently struggling with which NP program to pursue - FNP or ACNP. I've read so many threads and talked with so many people (RNs, NPs, nurse recruiters, professors, deans) and this is the summary that I've compiled.

Does anyone have any thing to add?? Please let me know!

FNP

Pros:

• Care for patients of all ages
  
• Flexible career options (Primary care, ambulatory care, urgent care (?))
  
• Increased need for FNP/PCNP in future of US healthcare
  
• Increased need in underserved populations
  
• Increased opportunity to work abroad
  
• Will learn more about US healthcare system
  
• Increased opportunity to develop meaningful relationships with patients
  
• Often working with healthy patients
  
• Opportunity to open own practice
  

Cons:

• Ineligible to work as NP in hospital setting
  
• Sacrifice in-depth knowledge in one population for more basic knowledge across lifespan
  
• Often working with healthy patients
  
• Mellow work atmosphere
  
• Most likely working 5 days/wk, less $ than ACNP
  

ACNP

Pros:

• In-depth knowledge in adult population
  
• Can work anywhere in hospital (ED, ICU, Floor)
  
• Can follow pt throughout hospital stay (trauma NP)
  
• More fun work atmosphere
  
• Most likely working 3-4 days/wk, more $ than FNP
  

Cons:

• Education limited to adults
  
• Career options limited to hospital setting
  
• Limited ability to develop relationships with patient (?)
  
• Decreased need in underserved populations
  
• Decreased opportunity to work aboard
  

[RNDNPstudent]

In large urban & teaching hospitals they are getting away from FNP in the hospital settings (esp critical care) & they are requiring currently employed FNPs (esp in crit care) to go back & get ACNP. It is the new trend. Rual still uses FNPs due the lack of available ACNPs to draw from & Rural hospitals usually do kiddos.

You still might see them in the ED however Large urban hospitals are usually not seeing kiddos these days because of the availability of Childrens Hospitals more accessible to them.

[RNDNPstudent]

You can do a dual track FNP/ACNP ED focus which is about 88-90 credits or you can do FNP or ACNP then add on at end which will be about 3-4 semesters

[RNDNPstudent]

You can do a dual track FNP/ACNP ED focus which is about 88-90 credits or you can do FNP or ACNP then add on at end which will be about 3-4 semesters post. It depends on what school you are in though

[SopranoKris, MSN, RN, NP]

Just bumping this thread to see if there have been any changes.

I've been debating on which path to follow. I really want to work ED/ICU as a NP when I'm done with school. At first, I was looking at a BSN to DNP program. After speaking with a few NPs at our hospital, all of them have said that I'd need to do ACNP and not FNP if I want to work in the hospital.

There doesn't seem to be any general consensus on the "right" track to pursue when you search online. It seems to vary from state to state, even region to region.

So far, I've found that my state (MI) prefers ACNP over FNP in the hospital setting. I plan to stay in the hospital setting and have no desire to work in private practice, so I'm researching ACNP programs. In the mean time, I'm working on my ECCO & ACLS certifications for my new critical care job.

Anyone else have any input into ACNP vs. FNP?

[Dranger]

Just bumping this thread to see if there have been any changes.

I've been debating on which path to follow. I really want to work ED/ICU as a NP when I'm done with school. At first, I was looking at a BSN to DNP program. After speaking with a few NPs at our hospital, all of them have said that I'd need to do ACNP and not FNP if I want to work in the hospital.

There doesn't seem to be any general consensus on the "right" track to pursue when you search online. It seems to vary from state to state, even region to region.

So far, I've found that my state (MI) prefers ACNP over FNP in the hospital setting. I plan to stay in the hospital setting and have no desire to work in private practice, so I'm researching ACNP programs. In the mean time, I'm working on my ECCO & ACLS certifications for my new critical care job.

Anyone else have any input into ACNP vs. FNP?

Without droning on into a long discussion regarding ACNP vs FNP, I think you are on the right track. The only problematic area for you would be the ED. Either you are going to need to get a FNP cert to see kids or focus on the ICU where ACNPs thrive.

While the FNP specialty is obviously the most marketable, it is not the end all be all for NPs and all of the field intertwined within the profession. Otherwise why would we even have other specialties?

For someone set on inpatient and critical care, ACNP is the most definite way to go.

[mzaur]

I've heard of hospitals forcing FNP/AGNPs to go back and get ACNP cert. If you want to work in ICU/ED then go for ACNP. If you want to work in primary care then go for FNP.

[favthing, APRN]

The Consensus Model is really clear about the intent of ACNP for in-patient. The NP on the unit where I work is an AGNP-prepared NP. Otherwise, I see a lot of Clinical Nurse Specialists, but few NPs at the hospital where I work. There a more PAs in the traditional clinical roles. A lot of ACNP programs consider only critical care experience as an entrance requirement, so this limits a lot of potential students. I applied for two ACNP programs, both which do not require the two-year critical care experience that I often see, but I will see. I anticipate that I will do a AGNP and the post-grad program for ACNP.

[twozer0, NP]

The Consensus Model is really clear about the intent of ACNP for in-patient. The NP on the unit where I work is an AGNP-prepared NP. Otherwise, I see a lot of Clinical Nurse Specialists, but few NPs at the hospital where I work. There a more PAs in the traditional clinical roles. A lot of ACNP programs consider only critical care experience as an entrance requirement, so this limits a lot of potential students. I applied for two ACNP programs, both which do not require the two-year critical care experience that I often see, but I will see. I anticipate that I will do a AGNP and the post-grad program for ACNP.

Just to be clear, there are several states who arent even close to implementing the consensus model. Those states you will often see overlap between NP roles in different settings. You will likely continue to see this for the years to come as well. https://www.ncsbn.org/5397.htm

Also, the big caveat here is in the actual model itself "scope of practice of the primary care or the acute care CNP is Not Setting Specific but is based on patient care needs" (https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf).

The model itself is pretty clear that patient care needs come first. If the patient is an inpatient or an outpatient, it does not matter as long as the care needs are the priority. This is why you will see ACNP in outpatient (although less likely) and FNP's doing inpatient. Of course an FNP will not be managing a patient in the ICU like an ACNP might, what you will see is a continuation of care from the outpatient setting that transitions to inpatient (hospitalist, specialst group). This squabble about who is better shouldnt even exist as both roles have a purpose and that is to provide the patient with care, the setting is just a location to practice.

[favthing, APRN]

Exactly, it is about patient-centered appropriate care. Just as the medical model of specialization targets specific populations for physicians, NP preparation is trying to target training according to patient population. Lol, the lingo is so funny here, as in-patient vs out-patient generally does dictate level of acuity, but it seems when professional nursing attempts to improve educational preparation in response to changing times is always attacked with petty hang-ups. Thanks for the reminder.

Nobody here is saying Primary or Acute is better. Myself, I am trying to decide upon the best preparation for my targeted interest, which is sub-acute care. The medical director of the program where I hope to one day be a NP said they are trying to hire Acute NPs, as he even brought up the consensus model and the acuity of patients, etc. And simply that.

[ghillbert, MSN, NP]

PA recently changed their nurse practice act so that FNP's can not work in an in patient setting and are requiring ACNP or PACNP to work in the hospital setting.

Source for this? I practice in PA and haven't heard anything like that.

[jdartis]

Inaccruate. FNP can work in any setting including inpatient hospital..........

[traumaRUs, MSN, APRN]

3 hours ago, jdartis said:

Inaccruate. FNP can work in any setting including inpatient hospital..........

This might be possible where you currently live but the Consensus Model is real and has been adopted by many states. FNP education and clinical experience is NOT geared to inpatient care, it is for outpt only.