Choosing a NP focus: FNP, ANP, ACNP

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    Can some of you speak to the career opportunities that may be unique or specific to each? I am leaning toward an ANP program, but the school also offers ACNP. Am I wrong in assuming that I could probably have a wider range of options with the ANP? I don't know if I'll always live in this area, in fact I doubt it, but at this time, the hospital system here will not credential advanced practice nurses(the medical staff opposes it and the chief of staff says he will leave if they ever do, and he has the largest practice in the county and RULES the roost). Assume I move to a more civilzed part of the country. What would be different ANP vs. ACNP?

    As to FNP, I really have ZERO interest in caring for children under 12. I avoid those patients in the ED and CCU where I work (it is a general critical care unit, all diagnoses, all ages) at every turn as it is! Am I shooting myself in the foot by not considering a FNP program? We have 3 NPs in my area and each of them is an FNP. They run the coumadin clinic, work as back up in the doc offices (urgent care stuff). They do not have their own practices or patients.

    I am going to put serious strain on our budget to get the MSN, and I want the most bang for my buck. Not the highest salary, but the widest range of options. I don't want to fnish one and wish I'd not pigeonholed myself.

    Advice, suggestions, general thoughts? Thanks.
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  3. 23 Comments so far...

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    i choose FNP to have the broadest scope. I am the opposite of you and didn't really want to work with adults, but the area I am in is saturated with PNPs and I just wanted to be more marketable. I am glad i did it. I still don't enjoy some things but you do get to do a lot more, and i doubt i will ever get bored.
    I think you need to think of the setting you want to work in.
    Many hosp. are really wanting ACNP now versus FNP. but it also depends on where you work. Here no ACNP program (i think only one in pueblo that's fairly new) so they do hire FNPs to work in hosp. setting.
    But I did talk to some HR people about some ER jobs and they wanted ANCP.
    But if you think you would rather do outpatient then ANP or FNP would be the way to go.

    If you just don't like working with kids then I wouldn't do FNP. Although if you did get a opportunity where you needed to see an occ. peds pt. you wouldn't be able to as an ANP.
    I think ANP is just fine esp. for many speciality clinics.
    meg2465 and Iconoclast like this.
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    Thank you for your response. There are not enough words in my lexicon to describe just how much I despise caring for pedi pts (and their parents). I do it all the time, and no one knows how much I hate it, I'd never let it show. So I could do it if I had to, and I don't want to find myself marginalized careerwise by closing that door.

    My dream job would be NP in a University health clinic. Second to that my preference would be to see adults in hospital, but in my area neither is a likely option in the next ten years. I'd like to move to a more urban area, but my husband likes the rural south, so unless I get divorced, I don't know that I could find employment as an ACNP within 2 hours of here. Or can an ACNP see pts in a clinic/office setting?

    I guess what I really need to understand is how much crossover there is between them. Who has the most flexibility? Physicians cross over all the time. My ED is staffed with emergency med guys, family practice, and an internal medicine doc (who does see the kids who come in). Does AP nursing offer that flexibility, or is it far more specific? If I do ANP, no doc is going to hire me into his/her family practice, and that is pretty much all we have around here. There are no specialists in town (except a urologist one day a week and a neurologist that sees chronic headaches -oh joy- in a rented trailer office twice a month).

    If I do FNP, I'm broader, but only to include a subset of patients I can't stand and it will require going to a different program that will take, in effect, two years longer due to it's set up and my schedule, etc.

    I have to make a choice by this fall so as to get applications in on time and other than ruling out psych, lol, I'm nowhere.

    ALL comments are appreciated!
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    Iconoclast-
    You sound identical to me! I DO NOT want to take care of peds, but I also want a job after I graduate. I am starting FNP in the fall only to have the greatest marketability-but I seriously considered the ANP. Every NP that I have talked to has told me to pursue FNP, and some are going back for better job options.

    The FNP provides the broadest scope and I see them working in a variety of settings-not dealing with children. So as much as I dread the pediatrics portion of the FNP, I am going to go ahead for job security reasons. I feel that if I only have to deal with peds periodically at most-it won't be too bad.
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    I work in a large nephrology practice and we have 3 FNPs, 2 PAs, and me (adult health CNS). Personally, I wish I had done the FNP program because it would be more marketable.
    CrazyPremed likes this.
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    Depending on your program you may not have to do much peds clinicals. But you do have to know the stuff for the cert.exam.
    My clinicals for example, i had several speciality clinics with no peds, as well as i was in a internal medicine clinic. They said that you should be expected to do 25% peds clinicals but really you arrange it, I picked up more hours because i like peds, but probably did not see more than 30% peds and maybe less. You might be able to get away with working in adolescent clinics but remember you will have to know milestones/developmental for exam.
    One NP i worked with in a Cardio clinic said she did the FNP program but ended up just taking the Adult cert exam because she didn't feel like our program had enough peds experience. (go figure its #1 in US for PNP)

    neelia
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    Quote from iconoclast
    thank you for your response. there are not enough words in my lexicon to describe just how much i despise caring for pedi pts (and their parents). i do it all the time, and no one knows how much i hate it, i'd never let it show. so i could do it if i had to, and i don't want to find myself marginalized careerwise by closing that door.

    my dream job would be np in a university health clinic. second to that my preference would be to see adults in hospital, but in my area neither is a likely option in the next ten years. i'd like to move to a more urban area, but my husband likes the rural south, so unless i get divorced, i don't know that i could find employment as an acnp within 2 hours of here. or can an acnp see pts in a clinic/office setting?


    yes, acnps are trained to treat acute and chronic complex illnesses. think: diabetes, heart failure, not sore throats and conjunctivitis. however, in my acnp program and many others, we were required to do an outpatient internal medicine rotation, so im is within scope of acnp, as long as no pedi or preggo patients.


    i guess what i really need to understand is how much crossover there is between them. who has the most flexibility? physicians cross over all the time. my ed is staffed with emergency med guys, family practice, and an internal medicine doc (who does see the kids who come in). does ap nursing offer that flexibility, or is it far more specific? if i do anp, no doc is going to hire me into his/her family practice, and that is pretty much all we have around here. there are no specialists in town (except a urologist one day a week and a neurologist that sees chronic headaches -oh joy- in a rented trailer office twice a month).


    no, the problem with apns is that we do have to choose a specialty (acute care, family, adult, pediatric, geriatric, etc.) and do not have much crossover. in the future, according to linda rounds texas bon president, they are trying to figure out a plan for apns that is more like that of a pa program: generalized training for all, so there is no question of scope... with specialized training afterwards, kind of like residencies for medical students.

    for me, i am an acnp and work for a cardiology group. i see patients in the clinic for hospital follow ups (status post pacemaker insertions, cabgs, ptca, etc.), outpatient consults, chest pain/heart failure follow ups, etc. plus, i go to the hospital and help with seeing consults/writing orders/discharging pts, supervising stress testing, etc. so, i get it all with my acnp degree... and i love it. (for those of you that have read my dramatic posts regarding my job may not believe that i love my job... but i do truly love what i do... i just don't love my supervising doc/her situation.)

    you will be broader with fnp... just think about what kind of patients you want to see (how sick, how old, what setting)... and that will help you decide.


    if i do fnp, i'm broader, but only to include a subset of patients i can't stand and it will require going to a different program that will take, in effect, two years longer due to it's set up and my schedule, etc.

    i have to make a choice by this fall so as to get applications in on time and other than ruling out psych, lol, i'm nowhere.

    all comments are appreciated!
    good luck!!
    celclt, MissBehavin, Gingilly, and 2 others like this.
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    Another thought. Is there an avenue to expand education and practice i a post masters program? For instance, if I did ANP and later decided it was too limiting, is there a way to get additional education and test for the pedi part later? Or would I have to begin again?

    The crux of the issue for me is that here in Western NC, the best option for me is Vandy's distance program and FNP is not an option. To do FNP I'd have to go to ETSU and their distance program is through Regents, which is a big turn off to me. It is also 3x as long as Vandy's. Western NC Univ does not have a set up that would mesh well with my family at this time. I can make ETSU work, but it is unappealing for some practical reasons. The school is 90 minutes away and I'd be going 3-4 days a week for three years. With gas at $4 a gallon here, Vandy would be cheaper, lol.

    Can I do an ANP through Vandy and expand practice through further Ed later, is the short version. What about DNP after ANP? Or is the DNP only for FNP?
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    DaisyRN,

    I am currently enrolled in an ANP program and my plans are to be employed within a Cardiology group doing the same things you are in your group. The only difference is that I am not really set on the idea of having hospital round responsibilites. Do you think I will be okay with the ANP, or would I need ACNP certification in order to make hospital rounds, if the position called for such?

    Thanks in advance!!

    P.S.- I know your having a hard time, but thanks for posting the deatils of your dilemma with your new job, it have given me a lot to think about post graduation in December.
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    Quote from rn4u2c
    daisyrn,

    i am currently enrolled in an anp program and my plans are to be employed within a cardiology group doing the same things you are in your group. the only difference is that i am not really set on the idea of having hospital round responsibilites. do you think i will be okay with the anp, or would i need acnp certification in order to make hospital rounds, if the position called for such?

    thanks in advance!!

    p.s.- i know your having a hard time, but thanks for posting the deatils of your dilemma with your new job, it have given me a lot to think about post graduation in december.


    rn,
    that was my hope when i posted all that about my job dilemma... so that others could be aware of issues you probably don't think about running into with a new job. also, i posted so i could get some advice. *hehe* as for your question, i do think (keyword: think) that anps are okay in the hospital. to be honest, i really don't know a lot about anp programs. and as for working for a cardiology group, sure... anp is very appropriate. in fact the other np working for our associate cardiology group is an anp.

    good luck with everything!


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