Finding Myself as an NP

Specialties NP

Published

I am graduating from an AGPCNP program in December 2017. However, I've realized in my clinical rotations that I don't think primary care is for me. It requires a lot of administrative work in addition to the practice of healthcare. One of my clinicals right now is with an inpatient patient management service at an acute-care community hospital and I love it! I love going around to the different units... general medicine, psych, telemetry, etc and helping people with their pain. Sadly, as a future AGPCNP I don't think they would hire me in that setting since I'm primary care. My other clinical is in a primary care HIV clinic and I find it rather monotonous. Most patients are taking their medication as prescribed and are stable with their viral load, but have several other co-morbidities which can get complicated, yet I find it boring because there's not a lot of hands-on stuff. I imagine though not all primary care is like that. I realized this week that I'm someone that likes to do more focused care on individual problems such as pain, neuro, etc. rather than focus on general care. I'm better at seeing "the trees" but not "the forest" if that makes sense.

I have current experience working as a volunteer EMT-IV (EMT-B who also does IV skills). I like dealing with acute illnesses and focusing on what's going on right now with the patient. Working in an ED might be overwhelming especially for someone who's new, but I really like the idea of working in urgent care. You get everything from fractures to mild/moderate asthma attacks. You have the opportunity to work days and evenings and you're treating acute illness. It may be tough adjusting to the urgent care pace at first, but I can definitely do my best. But, urgent care typically hires FNPs because they work with patients of all ages.

Here's what I want to do. I'm doing well in school (GPA is 3.52), so I figure why stop if you're doing so well? However, I'm now considering applying to an FNP post-master's certificate after I graduate from the AGPCNP program. It's specifically designed for NP's in other specialties who want to go for FNP. There's only 1 program in the USA that is accredited in my state. It's online and you get placed with a preceptor. It's 17 credits, I'm guessing that's a max of 2 semesters part-time, so I can work part-time as an AGPCNP while in school.

Do urgent care centers typically hire new NPs? I imagine they'd be a great place to learn. I would need help learning things like suturing because I haven't learned that skill yet.

Is It normal for people to be in NP school and want to change their direction? I feel like sometimes you don't realize where you fit in until after you start school.

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I've seen new grads in ED as long as they have ED experience as an RN.

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Specializes in Nephrology, Cardiology, ER, ICU.

Please be mindful of the consensus model and many states are now relegating FNPs to outpt areas only - some are allowed in urgent care/ED settings but the number seems to be getting fewer by the day

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Specializes in Hospital medicine; NP precepting; staff education.

If your state allows it, hospital medicine might intrigue you.

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Please be mindful of the consensus model and many states are now relegating FNPs to outpt areas only - some are allowed in urgent care/ED settings but the number seems to be getting fewer by the day

Would you mind providing information on where I can read more of this? I see a lot of talk about it here on AN, but I still work with FNP's in the ER, etc. Curious if it really is a national trend or more of a spook.

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Would you mind providing information on where I can read more of this? I see a lot of talk about it here on AN, but I still work with FNP's in the ER, etc. Curious if it really is a national trend or more of a spook.

I'd love to know more about this as well. I'm ACNP for multiple reasons but, admittedly, this was a small reason (working outpatient primary care sounds horrific to me). I've heard it thrown around a lot but never found anything substantial or concrete.

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Specializes in NP, ICU, ED, Pre-op.
Would you mind providing information on where I can read more of this? I see a lot of talk about it here on AN, but I still work with FNP's in the ER, etc. Curious if it really is a national trend or more of a spook.

You just need to google the Consensus statement and this type of info will come up. I live in Georgia and currently they have not adopted this, but many see it as inevitable. Time will tell..... I have read the consensus statement many times and I think that it leaves many things up to interpretation.....

just my thoughts.

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Specializes in Nephrology, Cardiology, ER, ICU.

Not a spook at all - I work in central IL at a large nephrology practice and we rec'd a recent mass email that from now on FNPs will not be credentialed to see pts in the hospital. The ones currently credentialed will be "grandfathered". And, if an APRN changes specialties say from nephrology to cardiology, you must have 30 days of preceptorship by one of the docs or APRN in that practice, and then must have a completed checklist if you are going to perform procedures.

Here are some links to maps:

APRN Roles

Consensus Model Implementation Map

Hope this helps...

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I had to be signed off on every procedure I perform in the hospitals I hold privileges. I had paperwork singed by my supervising MD and the medical director to have on record that I was competent to perform those procedures (I was a new NP at the time). I assumed this was common practice by all facilities. Even when I was a nurse I was required to be signed off on skills I practiced for years.

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Specializes in Nephrology, Cardiology, ER, ICU.

Exactly TicToc - I worked level one ER as an RN for 10 years and yet every year we had to be signed off on equipment and procedures.

Now, the hospitals are following suit with medical staff. This is important to pt safety and provider competence

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I live in PA and the hospital is full of FNPs but ACNPs are starting to take over this area to some degree. I've read the consensus model and it seems to be vague on this. I tend to agree that FNPs should focus on outpatient work and ACNPs on inpatient. The ICU I work in currently has two new FNPs and it took them a LONG time to get up to speed - a year or more. And it was rough. Neither were RNs in the unit and I, as a critical care nurse was teaching them too much. But ACNPs I worked with in the previous ICUs I've worked in were great. If you're not trained in it how can you justify working in that area?

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