ACNP vs FNP: My Summarization of the Great Debate

Tinabeanrn · May 22, 2012

Nice summary. As an FNP you can work in an in patient setting. In fact we work in the inpatient setting all the time :). My preceptors were all FNPs and one worked for the GI service in patient and another works in the chest pain center of the ER. FNPs also can work in the ER and see kids there :). We also qualify for loan forgvieness when working with the uninsured or underinsured patient population.

40love · May 23, 2012

There are several FNPs that work with our intensivists in our ICUs. They do most of our central lines, A-lines and manage the critical care. The MDs love it b/c they don't have to be on call at night. We love it because they are nurses, and quite often, used to be ICU nurses. I say, if you KNOW you always want to do adult critical care then do ACNP. If you think you may want to get out of the hospital at some point and do more preventative care, then get the FNP. Just my opinion (I'm an ICU nurse getting my FNP).

rauscht · May 31, 2012

Thanks guys, I really appreciate your input. It's weird, after talking to my school's MSN administration (deans, admissions, HR, etc.) I thought that FNPs couldn't work in a hospital. It seems like all the "higher ups" are trying to segregate the specialties and create more of a separation among FNP/ACNP. But then when I talk to actual NPs, NP students, or NP preceptors, I find out that there are so many opportunities where FNPs work in in-patient settings. I'm sure down the road it will be different, but for now it definitely seems like FNP is the most flexible option!

Think I'm going for FNP :)

Thanks!

jjrodriguez, BSN, RN · May 31, 2012

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!FNPPros:
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
ACNPPros:
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

Thank you very much for this summary!I still am not 100% sure which route take: FNP or ACPNP? There are aspects of both that I love. However, reading about how FNPs can also work in the ICU setting would make me want to choose FNP.I am graduating with my BSN this December and am beginning to look for NP grad school options. Threads like these are enjoyable to come across, so thanks again!

Aymese · Jun 17, 2012

When I see FNPs working in the hospital, they are mainly in the ED, particularly because of their peds portion of training. With regard to FNPs working in ICU, I do not feel that they are educationally prepared to work in this area as an APN. One may have many years of critical care experience as a nurse, however transitioning to FNP in critical care, you are still operating off your RN training in critical care, not your advanced practice training in acute care. With the growth of acute care NP programs and certification over the last 15 years, my bet is that the practice of hiring FNPs in critical care will become less common.

AtomicWoman · Jun 23, 2012

With the new APRN consensus model, it will be more and more difficult to get an in-patient job with an FNP. Around here in the Philadelphia area, hospitals are hiring acute care NPs for in-patient, not FNPs or ANPs. Here is a quote from the acute care NP competencies: "The adult–gerontology ACNP provides care to patients who are characterized as 'physiologically unstable, technologically dependent, and/or are highly vulnerable to complications' (AACN Scope and Standards, 2006, p 9). These patients may be encountered across the continuum of care settings and require frequent monitoring and intervention. The role encompasses the provision of a spectrum of care ranging from disease prevention to acute and critical care management to 'stabilize the patient’s condition, prevent complications, restore maximum health and/or provide palliative care'". (Source: http://www.aacn.nche.edu/geriatric-nursing/Adult-Gero-ACNP-Competencies.pdf) In an FNP program, you are not going to get training in taking care of patients who are physiologically unstable, technologically dependent and/or highly vulnerable to complications. That's not the focus of what FNPs do. You won't, for example, get training in inserting central lines, as one of the posters mentioned.

I'm not saying don't become and FNP. I'm saying if you do become an FNP, do it with the understanding that it is likely you will not be working in an in-patient setting.

shellenthal · Mar 18, 2013

Does anyone know how much longer it would take to get a degree in both? Or maybe to get an FNP then do a post-graduate degree in ACNP? I think that may be another option but am not sure I would want to go to school for that long again... Has anyone gotten both degrees at the same time?

ChristineN, BSN, RN · Mar 18, 2013

OP what state are you in? The reason I ask is that 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. Perhaps this is why your school is telling you this.

I struggled over the decision as well. Since I have worked with peds and adults, I ended up doing an FNP, but am seriously considering doing a post-master's ACNP after graduation. I hope that with both I will be more marketable and better qualified to work in an ER type setting as a mid-level.

allnurses Guide · Mar 18, 2013

[*]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

A few comments about some of the things you listed under cons as they are not necessarily true.

I have many FNP colleague that work inpatient in various roles. I work in primary care but cover all our patients in the hospital.

Most of my patient panel is complexly and chronically ill. Most of my colleagues in primary care are the same. We tend to cover the sicker patients because we get longer appointment windows.

I work 4 days a week with limited call. I don't have to work nights or weekends like many of my inpatient colleagues that rotate. I make slightly more than most inpatient colleagues.

Much of these will vary depending on where you work. Each place is different.

Sabotai · Mar 21, 2013

Some hospitals do not hire FNPs for ICU internists. Duke is a primary example of one that does not. I am getting both my ACNP and FNP because I intend to work as a ICU NP, but because you work 6-7 24 hour shifts a month I intend to work elsewhere in an ED or at another clinic.

CoolhandHutch, MSN, RN · Mar 31, 2013

The major issue is not the setting but acuity of the patient. Do primary care/family MDs only practice in the clinic? No, they see patients in the hospital. Do they see patients in the ICU? Typically no. Point is, the consensus model provides that your patients you care for match your formal training..NOT where these patients are physically.