Advice from acute/critical care NP's - page 3

Well I'm not exactly looking for advice as much as looking to hear about your job. I am still up in the air as far as whether I'd like to become a CRNA or critical care NP. I have looked into both... Read More

  1. by   caldje
    Quote from Atl_John
    For me it is not so much about specializing, but it is what will give me the best education so I can specialize later on, and two what will give me the best education so I can provide the best absolute care for my patient.
    I dont understand. Just a couple of posts ago you said you refuse to take more pre reqs but now you say you want the best education possible. I think you should consider taking those pre reqs to geta good foundation to build on to become a practitioner. Also consider, if you are choosing NP for the "autonomy" but what to go into surgery I am afraid you might be a little surprised. The only autonomous surgical providers are physicians.
  2. by   Atl_John
    caldje,
    Let me rephrase. I was going to have to take more Pre-reqs for PA school. I have everything that I need for NP school. I don't see how taking a second Bio course is going to make me a better practictioner.

    I know that the surgeon is the only autonomous one in surgery, I have no problem following the lead of the doctor. I am talking about while in practice having more autonomy. (chart review,ability to sign alone on meds etc) I may be in for a surprise I realize with that but at least I have the choice as a NP if I don't like it I can move somewhere where I do.
  3. by   DaisyRN, ACNP
    [font="comic sans ms"]hey there,
    i thought about the same thing before i went to acnp school and decided against crna because i think i would not get enough patient interaction. what i have found (and been told by several) is that people that have been in nursing a long time, that have become "tired of dealing with people's crap," but want to pursue an apn role, choose crna because you put them to sleep, make sure they wake up, and then go about your way. you dont have to "deal with them" as some have told me. i, on the other hand, like to talk to my patients, teach them, monitor progress, and feel as though i am making an effort to improve their status quo. as a crna, you will be swimming in bucks, but its the same thing over and over, and i dont think i would feel like i would was "making a difference."

    also, in my opinion, if a new rn wants to go right into crna school, then he or she probably went into nursing for the wrong reason... $$$.



    Quote from caprn77
    well i'm not exactly looking for advice as much as looking to hear about your job. i am still up in the air as far as whether i'd like to become a crna or critical care np. i have looked into both professions quite extensively as well as the training involved. i have also shadowed a crna at my hospital. i know that crna salary is generally higher than that of an np but i would really hate for salary to be the deciding factor in which profession i choose since money doesn't mean squat if your miserable at work. what i'm looking for is any acute/critical care np's who are willing to share info about your job such as what responsibilities you have, what hours you work, where you work, what you would change if you could, and if your willing to share info about pay. maybe hearing from some more people who do the job for a living will help me out in making my decision. i am also putting a similar posting in the crna area. thank you.
  4. by   DaisyRN, ACNP
    [font="comic sans ms"]
    hey there,
    like pinoy was saying... in my acnp program, we have 4 clinical semesters where we have to acquire a minimum of 168 hours each (for my program's requirements). the first two are standardized, meaning 1st rotation, internal medicine - outpatient clinic, 2nd rotation - general/internal medicine - inpatient, and then for the last two, you can choose any thing you want.

    for me, i am interested in a hospitalist role (which i am with right now for my 2nd rotation) and will probably do either an intensivist rotation next semester (so i get more exposure to icu mgmt), or a cardiology/pulmonary/nephrology rotation to get specialized training so i will be able to manage these more common disease processes in a hospitalist type role after graduation.

    some others in my class want to work with surgical patients, so they are doing surgical rotations next semester. others want to learn the skills, i.e. central lines, a-lines, chest tubes, etc. so they are going to do a rotation in a neurotrauma icu that is known for being student-friendly when it comes time to do the procedures.

    so, really... its all up to you. as much as i feel the acnp role is a good fit for me, you might need to consider talking with core0. he's a pa that can give you better insight into the pa program itself.

    Quote from atl_john
    yes there is they do have one, only catch is you have to work or for minimum of 2 years before hand, pa schools you don't. i originally went to nursing school so i could go to pa school since i wanted to do surgery, to say that its complete gone would well be an over exaggeration, but i like the autonomy that np's seem to have, and i don't have to take anything extra to be a np.

    its a real shame that np programs do not have a surgical component like pa programs do i'm not talking about rnfa you can have that without being a np. i'm talking real rotations in surgery etc just like pa's have to do. if i were to try to do uab's pa program which is a surgical program i would actually have to take more pre req classes honestly i'm not interested in taking more pre-reqs for anything. i've thought about emory''s i actually have all their pre-reqs. i'm just really curious as to why np programs don't incorporate surgery. i would love nothing more than to work for a ortho. surgeon as his midlevel being a fa and seeing patients in the hospital/er/or. love to do things like long bone reductions.
    Last edit by DaisyRN, ACNP on Jun 9, '07
  5. by   caldje
    Quote from Atl_John
    caldje,
    Let me rephrase. I was going to have to take more Pre-reqs for PA school. I have everything that I need for NP school. I don't see how taking a second Bio course is going to make me a better practictioner.

    I know that the surgeon is the only autonomous one in surgery, I have no problem following the lead of the doctor. I am talking about while in practice having more autonomy. (chart review,ability to sign alone on meds etc) I may be in for a surprise I realize with that but at least I have the choice as a NP if I don't like it I can move somewhere where I do.
    a lot of states dont require chart review for PAs and the ones that do usually only require a small ammount of charts reviewed.. just like some states require chart review for NPs.

    Also, in all 50 states, a PA can write and sign their own prescriptions, and can also writ eorders in hospitals.
  6. by   Atl_John
    caldje,
    I know, I have no problem with PA's, I wanted to be one before I went to nursing school even interviewed at a PA program for a masters. I love PA's, but I love nursing more. I would love nothing more than to be precepted by a PA, core0, for instance, which I have mentioned to him already. I have absolute respect for PA's and the roles that they play. I have worked with many PA's before I went to nursing school, and have a PA writing a letter of recommendation for me for NP school. I just believe my fit will be better as a NP.

    I am not sure why you mentioned all that you did below I never said PA's couldn't do any of those things. I know many on here are not friendly towards PA's which is unfortunate but I am not one of those folks. If and when I become a NP I will be one that sees PA's a colleagues not some inferior form of midlevel. There is no need to become defensive with me when it comes to PA's I admire you for you for your knowledge and skills and look forward to one day working with other PAs' and learning from them.


    Quote from caldje
    a lot of states dont require chart review for PAs and the ones that do usually only require a small ammount of charts reviewed.. just like some states require chart review for NPs.

    Also, in all 50 states, a PA can write and sign their own prescriptions, and can also writ eorders in hospitals.
  7. by   caldje
    I was just trying to be informative. I wasn't necessarily saying you were against PAs. Sorry.


    Quote from Atl_John
    caldje,
    I know, I have no problem with PA's, I wanted to be one before I went to nursing school even interviewed at a PA program for a masters. I love PA's, but I love nursing more. I would love nothing more than to be precepted by a PA, core0, for instance, which I have mentioned to him already. I have absolute respect for PA's and the roles that they play. I have worked with many PA's before I went to nursing school, and have a PA writing a letter of recommendation for me for NP school. I just believe my fit will be better as a NP.

    I am not sure why you mentioned all that you did below I never said PA's couldn't do any of those things. I know many on here are not friendly towards PA's which is unfortunate but I am not one of those folks. If and when I become a NP I will be one that sees PA's a colleagues not some inferior form of midlevel. There is no need to become defensive with me when it comes to PA's I admire you for you for your knowledge and skills and look forward to one day working with other PAs' and learning from them.
  8. by   Atl_John
    Its all good caldje, you are only trying to make sure things about your profession are said correctly on a forum which at times seems over whealming anti PA. No worries.

    John


    Quote from caldje
    I was just trying to be informative. I wasn't necessarily saying you were against PAs. Sorry.
  9. by   Sugah Britches
    This is a very informative thread. I have an odd question. As a ACNP, if you were unable to continue working in the Hosp.. what would your choices be? Could you work as an Adult NP in an office? I love working in CCU and want to pursue an advanced degree, however I have been dx with MS, not a problem now but I always have to consider my options.
  10. by   core0
    Quote from Sugah Britches
    This is a very informative thread. I have an odd question. As a ACNP, if you were unable to continue working in the Hosp.. what would your choices be? Could you work as an Adult NP in an office? I love working in CCU and want to pursue an advanced degree, however I have been dx with MS, not a problem now but I always have to consider my options.
    You couldn't do primary care like IM, but you could do outpatient cardiology, neurology or another specialty that involved clinic work.

    David Carpenter, PA-C
  11. by   mvanz9999
    I don't see why an ACNP COULDN'T legally do IM as long as there are no peds. In fact, there is no legal reason why an ACNP couldn't.

    Whether an actual job would present itself, I don't know....
  12. by   core0
    Quote from mvanz9999
    I don't see why an ACNP COULDN'T legally do IM as long as there are no peds. In fact, there is no legal reason why an ACNP couldn't.

    Whether an actual job would present itself, I don't know....
    Depends on your state. Most states scope of practice require the NP to have training in the specific area of nursing practice as NPs. From my understanding of ACNP training, ACNPs are trained in acute care, not primary care. So legally if you were doing primary care you would be outside your scope of practice. It would depend on your certification and state.

    David Carpenter, PA-C
  13. by   DaisyRN, ACNP
    Quote from core0
    depends on your state. most states scope of practice require the np to have training in the specific area of nursing practice as nps. from my understanding of acnp training, acnps are trained in acute care, not primary care. so legally if you were doing primary care you would be outside your scope of practice. it would depend on your certification and state.

    david carpenter, pa-c

    [font="comic sans ms"]
    hey david,
    just fyi: acnps are trained in im... in fact, its a required clinical rotation for us. but you're right... it has to be no peds/pregnancy. but no, we cannot do general primary care, i.e. family practice. from things i have read and people i have talked to (reputable, that is ), the acnp is the medical equivalency of adult internal medicine. granted, i know we are not going to know everything an im physician does, but if you had to equate acnp to something in medicine, it'd be im.


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