Acute vs. Primary Care NP? Can't decide

  1. 1 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. Visit  EGVnurse} profile page

    About EGVnurse

    Joined Aug '12; Posts: 55; Likes: 45.

    12 Comments so far...

  4. Visit  ghillbert} profile page
    0
    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.
  5. Visit  ryguyRN} profile page
    0
    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
  6. Visit  iamunafraid} profile page
    1
    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.
  7. Visit  ERNURSEDAD} profile page
    1
    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.
  8. Visit  ERNURSEDAD} profile page
    0
    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.
  9. Visit  narcolepticnurse} profile page
    0
    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.
  10. Visit  apocatastasis} profile page
    1
    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.
  11. Visit  nomadcrna} profile page
    0
    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. Visit  BostonFNP} profile page
    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.
  13. Visit  Annaiya} profile page
    0
    Just a comment on autonomy, my experience has been that clinic based NPs have a lot more autonomy than inpatient ones. In the inpatient setting, there are so many people checking things behind you, questioning orders, discussing plans of care, etc. that you are a lot more constrained in what you can do. Whereas, in the clinic, you see your own patients all on your own. No one else is assessing them, treating them, etc. I think the clinic setting is more routine, so it depends on if you'd find that boring, but I don't think you need to worry about not having enough autonomy.
  14. Visit  nrsintrning} profile page
    0
    Quote from narcolepticnurse
    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.
    Does anybody know exactly what it takes to get the ACNP cert after accomplishing the FNP? I'm in the process of starting applications and am struggling with the very same FNP (or AGNP) vs ACNP dilemma...
  15. Visit  juan de la cruz} profile page
    0
    Quote from n.a.norcal
    Does anybody know exactly what it takes to get the ACNP cert after accomplishing the FNP? I'm in the process of starting applications and am struggling with the very same FNP (or AGNP) vs ACNP dilemma...
    It depends on the school.

    Typically, such question is easily answered if you are planning on attending the same school for your post-Master's. You would put the curriculum from both programs side by side (i.e., FNP vs ACNP) and figure out what courses are the same for both and which courses are not present in the second NP specialty you're trying to obtain.

    It can be tougher doing the post-Master's in another school where similar courses you've already taken are known under a different name and would need to be assessed for equivalency. The short answer is that since ACNP programs tend to be shorter than FNP (less total credit hours due to less content as courses only cover adult population), 4 semesters worth of courses (or less) would likely cover what the FNP program lacked to enable you to earn ACNP certification.


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