hi everyone,

i have a career dilemma - I'm a new grad np who was offered the option of part time GI (primarily inpatient) and part time spinal ortho (both clinic and OR) in the city versus full time intensivist in a more rural area 1.5 hrs away from home.

the personal benefit of the former is close proximity to family, friends, and the city (I am definitely a city girl). while the latter is a dream job that not to mention is offering >1.5x the income plus benefits so I don't have to finagle the minimum from the part time positions

at this point I am leaning toward the former, but a part of me doesn't want to walk away from the job I eventually want. I like that specialties give me a more minute understanding of disease mgmt. but I also feel that the icu will give me an extensive crash course in most of inpatient work. there are other smaller nit picky issues I have with each side but it basically boils down to the dilemma of jobs I like but aren't crazy about in a geographically desirable area versus job I would love in geographically undesireable area.

if theoretically I were to eventually go from gi+ortho to say icu would that be laughable? or would I be able to find someone (in the city) who is willing to train given I have at least some inpatient np experience? and fyi I am a new grad family np with no hospital RN experience...

i am incredibly blessed to stumble upon both opportunities given my gross under qualifications in all aforementioned fields so this is like a "first world problem" in the nursing world (and literal actual world as well) but I would much appreciate any advice.

thanks so much!!!

Are you FNP or adult/critical care ?

Are you FNP or adult/critical care ?

Definitely an important question.

Also, what kind of orientation/training are any of these jobs offering?

I would go with the specialty you like in an undesirable location with the thought that you can hang around and learn along the way and hope to transfer to a better city later armed with the experience you have attained.

However, big city ICU NP groups in academic centers I'm familiar with require ACNP's because these programs are usually found there...I'm speaking San Francisco, NYC, Portland, Nashville. That could make it difficult for you to make the transition.

carachel2 and atomicwoman: family... good question about a training program. no formal program from either sides altho spinal and gi have both worked with new grads PAs/NPs and the intensivist currently works with physician residents. both sides expect about six months of training before I even begin being somewhat productive.

juan de la cruz: thanks for the info. I will likely do a post cert if this case.

thank you all for your input. I had serious career fear of missing out after writing this post and will likely go with the icu offer. hip brunches and latte art can certainly wait. should probably hit the books now...

I seem to be the only ever concerned about FNPs hopping into the ICU with *zero* training in their FNP program. I do understand that some schools offer elective rotations in the hospital, but most in my area do not. I am relieved that most programs are beginning to require Acute Care NPs and not just FNP with training.

I seem to be the only ever concerned about FNPs hopping into the ICU with *zero* training in their FNP program. I do understand that some schools offer elective rotations in the hospital, but most in my area do not. I am relieved that most programs are beginning to require Acute Care NPs and not just FNP with training.

It certainly is a decision that must be made with a great deal of thought and rather than responding with my own personal bias (as an ACNP myself) I will post a legal expert's opinion on the matter here:

Medscape: Medscape Access

I have to agree with carachel2. I graduated in May 2014 with my FNP. I was an ICU nurse was five years and did trauma ER prior to that. I interviewed for a hospitalist position and was really considering it until they decided they wanted me to cover ICU as well.

You can teach anyone to intubate or put in a central line but when you're the main decision maker having zero experience as an intensivist, and in FNP training, they don't let you set foot in the hospital. I think the OP needs to seriously think about the situation and not just the pay.

I would like to become a hospitalist or intensivisy but I am looking into post master's certificates.

thank you for your concerns everyone! while the salary is a great bonus, it is not my main reason for going with one job or the other. i will be doing only hospitalist coverage until I am ready to take on more. in any case I am still weighing my choices but for now more i am more inclined to sacrifice a little quality of life for a cool(er) job. the process of composing these posts is incredibly helpful to my decision making.

My thoughts-i also graduated as a FNP with no hospital experience. I would not have considered an inpatient hospitalist position, let alone an intensivist position. My training did not encompass acute care treatment and I feel it would have been out of the scope of my practice. I'm not saying you couldn't be successful. FNP programs are simply not geared toward treating that patient population.

I may be making an assumption about you here, but if you're young and unencumbered, take the job in the city! You won't be at work 24/7 and wouldn't it be more fun to have all the resources of the city at your disposal? You can gain some experience and keep your eyes open for a full time position.

This is just my opinion. I believe strongly in having a balanced work/personal life, and I would be hard pressed to give up one for the other. I know I wouldn't do well in a rural setting, so I guess my personal bias is shining through here! Best of luck in whatever you choose.

BCgradnurse: yes, that is exactly my dilemma. i always tell loved ones "at the end of the day, work is just work" but have a hard time applying this to real life! i also understand and agree with your assessment - my FNP program did not dip at all into acute care (which i find unfortunate given diseases do not compartmentalize themselves into in- and outpatient). and while i was fortunate to briefly precept in an inpatient setting + select subspecialties, i will certainly admit that i am not trained for acute care. however...i took an immediate liking to acute care as a NP student, and am convinced this is what i want to do. but we'll see in several months time whether this remains my opinion...

Have you checked with your state board to see the rules for an FNP working in acute care? Several state boards will not allow this since it is well outside the scope of your training.