Acute Care Nurse Practitioner

Bonnie Blue · Mar 10, 2002

I am attending Vanderbilt University's Bridge MSN program to become an ACNP. The school's web site has information the ACNP specialty. Also, the American Association of Critical Care Nurses has information on ACNPs. Hope this helps.

live4today, RN · Mar 11, 2002

Matt, after reading many of your post, especially the ones on the Cardiac Care Forums here, it would be a great loss to the Cardiac Care Area of the hospital for you to leave Cardiac Nursing. You post like one heck of a nurse, and I am always impressed with your knowledge and critical thinking when you post. However, I'm sure you would make a wonderful Acute Care NP, too, so if that's where you feel your passion leading to, go for it! I, for one, wish you a lot of success in your nursing endeavors!

mattcastens · Mar 11, 2002

Thank you, Renee, that's very nice of you. I really have no desire to leave cardiac nursing, I just want to change my focus in it a little bit. Whichever advanced practice degree I end up pursuing will help me in my care of cardiac patients. Also, I counted out the years the other day and, since I still have to get my BSN, I figure I still have a good six to eight years of direct patient care to give to the hearts of others.

Thanks again! :kiss

lalaxton · Mar 11, 2002

Matt,

I too am an ACNP, actually in Cardiology at the moment although most of my experience has been in internal medicine. Consider this, as an ACNP many facilities will ask you to do some CNS type of work, eg. educating staff, developing policies and procedures, consult as an expert nurse, etc. Depending on what state you live in a CNS can usually not write orders independently, only make suggestions. Most states let ACNP's write orders and be somewhat more independent. So my suggestion is if you like more hands on, direct patient care/medical management type of work go the ACNP route with the understanding that you will probably also be functioning to some degree as a CNS. I know several CNS's who have done post-MSN ACNP programs to be able to have more autonomy in their work and have more flexibility in the job market. (For example, I recently moved from Louisiana where I was able to get a job as a CNS because I had my MSN but I would not have been able to work as an NP if I had a MSN/CNS.)

If you are interested I can send you a copy of my job description (that I wrote myself since I am the first ACNP in this facility) for reference but you may be able to get that information at the sites that Bonnie refered you to.

mattcastens · Mar 12, 2002

Having done a little more research, I have a couple more questions...

I've discovered that there is no ACNP program here in Minnesota. Is it safe to assume that because of that there are no regulations for that practice in the Minnesota NPA? In other words, does this mean that ACNPs are not allowed to practice in Minnesota?

If that is the case, and if I went on to become an ACNP educated and certified in another state, could I practice as an Adult NP in Minnesota until specific practice acts were written, or would I only be able to work in the states with such practice guidelines?

Finally, at the soonest, it would be about three or four years until I could start school for ACNP (I still have to get my Bacelaureate first). Judging by current practice, do you think it's likely that this is an area of nursing that will expand to other states such as Minnesota? Would it be worth it to ge my certification if I want to stay in Minnesota? I realize this last question is pure speculation. What I'm trying to assess is the growth factor of the ACNP specialty.

Thanks for the help so far!

Tim-GNP · Mar 13, 2002

I must tell you- consider what it is that you want to do. I don't know what practice is like in MN, but I know where I am at, once you have those prescriptive privileges, you can kiss your days as a nurse goodbye!

I have precepted a few GNP students, and Gerontological CNS students. The sad thing is that most NP programs fail to tell you is that once you have the ability to write prescriptions, you are often used as cheap medical labor. Your knowledge of nursing [while it may inform your advanced practice role] is of no interest to your organization, only your ability to engage in acts of medical diagnosis and treatment.

You must keep in mind the role of the academic institution--- they must procure a student body to assure the financial strenght of their institution. They will TELL you that prescription writing is only one part of the NP role, and they will focus on the other domains of practice; but I am here to tell you that [like many other things in nursing education] what is taught is but a shadow of reality.

Consider your goals carefully- If it's the advanced practice nursing role you want, then the CNS is the way to go. If you want to kiss nursing as you now know it goodbye, then the NP is the way to go. If I could turn back the hands of time, I would have gone for my Gerontological Clinical Nurse Specialist only [i did the combined CNS/NP role in my MSN program].

Good luck with whatever you decide.

grouchy · Mar 13, 2002

Tim, I could live with the medical model. How's the job market? Here in CT, I know several NP's that are working as RN's, but I recently read in U.S. News and World Report that the market for acute care NP's is heating up. Also, I have a friend who graduated about 5 years ago as a CNS from a prestigious school and had difficulty finding a job. Now, I seem to see a fair number of CNS ads on the internet, so I don't know if the job outlook is improving.

mattcastens · Mar 13, 2002

Originally posted by Tim-GNP
Consider your goals carefully- If it's the advanced practice nursing role you want, then the CNS is the way to go. If you want to kiss nursing as you now know it goodbye, then the NP is the way to go. If I could turn back the hands of time, I would have gone for my Gerontological Clinical Nurse Specialist only [i did the combined CNS/NP role in my MSN program].

Good luck with whatever you decide.

So then my question, Tim, would be: considering that you can't go back for your GCNS only, how do you incorporate nursing philosophy into your practice as a GNP? While the organization you work for might see you as cheap medical labor, what do you do to maintain your identity as a nurse?

Tim-GNP · Mar 13, 2002

Excellent question--- my days are structured so that there is no time for a nursing philosophy [seriously, I don't get to take a lunch most of the time]. My day is 100% structured in medicine.

The only time my nursing philosophy comes out is at the bedside, when I am examining someone---- THEN, I get to be a nurse [not for very long], but that's it- the medical orientation of what I do has taken the front seat to what I must do. When you're seeing someone for an episodic health event, and must elicit the cardinal areas of investigation of their complaint, then you don't have a lot of time for much else [especially when you have 15 other patients to see].

Grouchy, the job market is very contingent upon the area and the specialty. Here in PA, the vast majority of schools offer FNP programs. I had to go to New York to find a GNP program. I have never had a problem finding a job. Many of the FNP's I know do something other than NP because the market is literally saturated with FNP's [the other thing that these NP programs fail to tell potential new students].

I hope this helps.

grouchy · Mar 13, 2002

Thanks for the reply!

lalaxton · Mar 13, 2002

Tim,

Great answers! I wish I could be so eloquent! I just have one thing to add, I agree that most of my job is medicaly oriented but I feel that I do most things (even writing orders) with a nursing perspective. For eg. I am constantly having to remind the docs that they must consider the whole patient not just their area of expertise. I feel that my basic nursing training still colors much of what I do and how I treat and approach my patients and that my NP training has just added another dimension to the job instead of replacing it with another model. I still do thorough assessments as I did as an RN, maybe not give the patient the right med by the right route etc. but make sure it is ordered that way, look at nutrition and comfort issues, pull together the whole multidisciplinary team when needed, in short I feel that I am the bedside RN's resource and partner in the care of our patient.

Yes I do see 12-15 patients a day and sometimes this can be hectic, maybe since I work with Cardiac patients and some of the management can be fairly routine, I have time to practice this way. I do work in a smaller community hospital and that may help me have more time (we refer many patients needing complex procedures to other facilities) but that is why I chose this facility over a larger urban setting because I did not want to become just a 'physician extender'. So I have to disagree with you, I think that yes, NP's are still nurses, just with an added dimension.

and Matt, you're best bet as to the ability of ACNP's to practice in your state is best addressed by your state Board of Nursing. Give them a call!