Did you know what specialty you wanted

Trauma Columnist · Aug 26, 2006

Hi and welcome. I did an adult health clinical nurse specialist and so far haven't regretted it. Some other APNs that have specialized have found it too limiting in that they either find that it doesn't keep their interest or there are few jobs in that particular specialty.

Spacklehead, MSN, NP · Aug 26, 2006

I'm going to be honest with you - I didn't know what kind of nursing I wanted to do after I graduated and took the NCLEX! When I graduated, new grads weren't in high demand like they are now, and they definitely were not allowed to start in the critical care, OB, ER, OR areas. I was lucky enough to find a telemetry unit that would hire me, so I started there. I did that for about a year, did urgent care, relocated to a new state and did telem/open heart - and then FINALLY found my true calling in the ER. It took three years from the time I graduated to figure out that I belonged in the ER, and from there I decided to go the FNP route so that I can work in a fast track area of the ER or an urgent care center.

I'm sure some people know right from the start of their nursing programs what they *think* would be the perfect clinical area for them; but until they actually start doing clinicals and experience it first-hand, it can be difficult to make that decision.

Hopefully, when you start clinicals, you'll get a feel for what type of nursing you like. Also, at the beginning of your NP education, all of the different specialties usually share the same "core courses," so you should still have time up until you are almost ready to start your NP clinicals to decide what fits with you. Would your school allow you to switch specialties? :)

morganvibes · Aug 26, 2006

Actually I talked to someone yesterday at the school and they told me that exact thing. the first year is the same no matter what specialty you choose, so you could easily change the specialty before the second year of the program. Since I will be going part time, that would give me about 2 years of working as an RN.

I heard that FNP was more work because you have to learn everything instead of a specialty in one area. I guess it's a good choice because of that as well. did you need extra education for ER? I'm thinking a FNP would be at a Family clinic.

thanks

Spacklehead, MSN, NP · Aug 27, 2006

I'm actually still in my FNP program currently. I know several FNP's in the area who work in the ER who were all ER RN's prior to becoming NP's. They mostly do only fast-track - which is what I am interested in. They did not need any extra education for that.

I believe that Siri, our mod, works in an ER at times. She could probably answer the education question better than I.

As far as FNP being more work - I wouldn't say that - but it is actually a longer program (at least at my school it is - is that what you meant?). I imagine the PNP's learn a heck of a lot more about peds than FNP's do, but we also have to learn about adult health, elder health, and women's health. So in a sense, we are more generalists where we know a little about a lot, not a lot about a little. :)

Editorial Team / Admin · Aug 27, 2006

I actually worked for several years as RN before seeking NP role. Made up my mind that way. Out of RN school, I HATED OB, but that later proved to be not hate, just lack of knowledge and experience. Yes, did clinicals in RN program, but the experience in the OB unit is what prepared me for my future role as OB/GYN NP.

Later, I discovered that this role was too narrow and sought out and secured the FNP. A much better fit.

Yes, I do ED call weekly as sole HCP. In my area, there isn't a specification for Acute Care NP in the ED.

Cyndee, MSN, NP · Aug 27, 2006

I'm actually still in my FNP program currently. I know several FNP's in the area who work in the ER who were all ER RN's prior to becoming NP's. They mostly do only fast-track - which is what I am interested in. They did not need any extra education for that.
I believe that Siri, our mod, works in an ER at times. She could probably answer the education question better than I.
As far as FNP being more work - I wouldn't say that - but it is actually a longer program (at least at my school it is - is that what you meant?). I imagine the PNP's learn a heck of a lot more about peds than FNP's do, but we also have to learn about adult health, elder health, and women's health. So in a sense, we are more generalists where we know a little about a lot, not a lot about a little. :)

The FNP program at my school had the exact same clinical hours and didactic hours as the specialty programs. We were taught that FNP's worked at Family Practice Clinics, Acute Care NP's worked in the hospital, Geriatric NP's worked in nursing homes/assisted living centers, Adult NP's in internal medicine, Trauma NP's in the ER, etc. I completed a dual Adult/Geriatric NP program and I'm working in pain management. I see FNP's working in internal medicine, geriatrics and everything else, so I'm not sure why our professors were so adament that everyone have a specialty (?). Also, if you're certified by the ANCC, then remember that you will have to have a certain number of practice hours (1000?) IN YOUR SPECIALTY when you re-certify. So, if you're audited you will have to prove that you practiced those hours in your specialty. I'm not sure what all of this means, since I've only been a NP for a year. I'm seeing both adult and geriatric patients, so I'm assuming that I'm meeting the requirement. However, we did have a FNP quit because she wasn't able to see kids (we only see ages 18 and over). It is my understanding that if you don't meet the minimum practice requirements, then you will have to retake the certification test when you try to re-certify. Does anyone know if that's ever happened to someone they know?

Cyndee, MSN, NP · Aug 27, 2006

Hi and welcome. I did an adult health clinical nurse specialist and so far haven't regretted it. Some other APNs that have specialized have found it too limiting in that they either find that it doesn't keep their interest or there are few jobs in that particular specialty.

The school I attended offered every APN specialty available (forensics, palliative care, Trauma/ER, Acute Care in Cardiac/Pulmonology, FNP, ANP, GNP, NNP, etc... We were told that we HAD to practice in our specialty in order to remain certified. In Texas we have to be nationally certified in order to practice, but I know a FNP who has worked in geriatrics for at least 7 years. She told me that she wouldn't have a clue as how to take care of a baby/child, so I don't understand how she is maintaining her license/certification. I'm certified by the ANCC as an Adult NP and a Gerontological NP, but I'm not working in internal medicine or at a nursing home. I'm employed by a pain management doctor, but I see adult and geriatric patients. We had a FNP quit specifically because we don't see children. So, it appears to me that even NP's in those specialty areas are really practicing outside of their specialty. I used to work with children when I was a nurse, and that was something that I wasn't interested in doing as a NP (no way), so that's why I chose the Adult/Geriatric route. I didn't have any trouble getting a job and I don't know anyone who had trouble getting work as a NP (I'm in South Texas).

ERNP · Aug 29, 2006

Yes, I knew exactly where I wanted to work when I started my FNP program. Several years nursing experience placed me in the ER, after a few years run through critical care. I knew then where I was going. It was just a matter of getting there.

At this time, I don't believe there is a specialty certification for ER or trauma. The trauma programs, for the most part seem to be preparing students to sit for the ACNP exam. However, looking into the limited number of ER NP programs, it appears there are some preparing students for ACNP and others preparing students for the FNP exam.

Recently, the staffing company I work for has placed a ACNP in our ER. A good NP, but without further courses, his adult acute care program places peds out of his scope of practice. This is proving to be a problem since we turn a relatively high volume of peds.

morganvibes · Aug 29, 2006

Informatiojn on maintainng certification seems like an important thing to find out before picking a specialty, unless you are really sure what you want.

the FNP program is not longer, just has a little of everything as opposed to specializing. Sections on young, old, adults. Maybe some people would find that harder?

Siri, what is HCP?

thanks

Trauma Columnist · Aug 29, 2006

HCP - health care provider.

I did the adult health CNS certification by the ANCC. My background however is ER. However, (sadlly), the ER's in my area are not interested in mid-level providers in the ER since there is a huge ER MD residency program.

For the adult health CNS, my hours for recertifying have to be caring for adults. For now, I do dialysis management of two chronic hemodialysis units.

One of the better known ER/trauma NP programs is in Chicago at Loyola. I would have considered this but knew that jobs would be very limited so that is why I went the adult health CNS route.

ERNP · Sep 2, 2006

One of the better known ER/trauma NP programs is in Chicago at Loyola. I would have considered this but knew that jobs would be very limited so that is why I went the adult health CNS route.

Jobs were pretty limited where I lived too... so I moved. There are many where I live now. Not enough people to fill them all.

Relocation is not an option for everyone though.