Acute vs. Primary Care NP? Can't decide

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    For about a year I've been working as a RN on a 30-bed med/surg unit (post renal transplant and orthopedic) in an urban 926-bed Trauma 1 hospital.

    I'm interested in going back to school to get my Master's. But I can't get started because I can't decide on a program!

    I know one thing for certain: I'm interested in endocrinology/diabetes management.

    I enjoy the fast-paced acute care setting so I've considered Acute Care NP/CNS. Newly diagnosed diabetes, ICU admissions, DKA, HHS, endocrine disorders, etc. Awesome! I would love to do consults and education. But I feel like I'm already developing HTN & GERD from being stressed out...

    Then I think I would love to have time/freedom to build long-lasting relationships with patients and families, to address psycho-social issues surrounding chronic illness diagnoses. That leads me to FNP programs. But I'm afraid I'd get bored/frustrated in an outpatient clinic...lack of autonomy/time/resources/support...

    What have been your experiences as Acute Care NPs/CNS's? As Primary Care NP's? What have been some of the rewarding and frustrating aspects of your job? Do you prefer inpatient or outpatient? Do you have a job that allows you to work in both settings? Peds or adults?

    I want to make sure I'm realistic and CLEAR about my future career goals before I get started on this very long journey...

    Thanks!
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  3. 12 Comments so far...

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    From what you've said, if you decide on adult, which in diabetes management is a totally different ballgame than peds, I would do ACNP. There is a lot of usage of ACNPs in hospital endocrinology services, both inpatient and then follow up in outpatient clinic, so you could get both the acute illness and the follow up.
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    You could try just taking some grad level classes as a nondegree seeking student (like adv pharm, patho...) and get more experience in other areas of the hospital (ICU). I work in a CICU and they use NPs and that made me realize I do not want that for my life.
    Last edit by ryguyRN on Jun 13, '13 : Reason: add to post
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    The greatest piece of advice I got when I started my journey into graduate school and deciding on my end goal of Acute vs. Family NP is this: "Who do you see yourself taking care of 10 years from now?"
    That answer will determine what path you take.
    Due to the implementation of the Consensus Model, the scope of practice of NP's is becoming very specialized. So you can't float in between disciplines (An FNP can't take care of acutely ill, and ACNP can't take care of peds and/or a primary care clinic).
    As an ACNP you could specialize with endocrine. I think the snag you'll run into is WHERE you treat the patients, in the hospital versus an office.
    You'll find out as you do your research there is a lot of red tape and 'practice setting' rules and regs that will limit your practice.

    Best of luck with your decision.
    antania31 likes this.
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    Here's an educated observation from an APN (certified nurse-midwife) who has taught many APN's in physical assessment, women's health, community health, etc. The ACNP role is still relatively new in the APN world. Many only work in ER's or ICU's. Some as hospitalists, etc. However, there are MANY an FNP working in inpatient roles; in acute care settings. FWIW, I'd recommend you go FNP. Why? More job options and opportunities. Let's say you tire of the acute care setting...you then have outpatient settings and/or retail healthcare positions you can consider who will not hire an ACNP. Just my opinion as an APN of 19 years.
    abrey72 likes this.
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    PS: I'm also an ER nurse and have been an ER asst mgr. We used FNP's in our fast track and one ACNP on the trauma team.
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    I too struggled with this. Right now I'm in an FNP program. I definitely want my career to end in primary care, but I also love the fast paced environment of acute care and thought I might want to continue working in that setting for awhile. The FNP path was the only option when I started, but the university will be starting its ACNP program soon. The advice I was given (and this might only be applicable to my area) was to finish out the FNP program because I would have more options as far as jobs. I could then just keep taking classes and also get my ACNP certification so I would have that option available as well- it wouldn't take that much more time. Right now, that's my plan.
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    Quote from ERNURSEDAD
    However, there are MANY an FNP working in inpatient roles; in acute care settings.
    As I commented in another thread, boards of nursing are cracking down on this. From what I hear, according to Texas BON, FNP scope of practice does not include inpatient work.
    ghillbert likes this.
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    A few boards of nursing. Many others are quite content with allowing FNPs to practice where ever they choose as long as they can show the training.
    All the states that I practice in are fine with FNPs practicing ER and inpatient medicine.
  12. 0
    Another vote for the flexibility of FNP or AGNP over ACNP.

    I work in primary care but also cover all of my patients in the hospital, so I do a bit of both. The only place I don't cover is the units.


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