New Grad FNP wanting to obtain critical care experience

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    Hello All!

    Thank you so very much for taking time to read this post. I am a new graduate FNP (haven't started worked as an NP yet- but have passed the ANCC national certification exam) and I am interested in doing critical/emergency care. My dream job would be to do some type of ER/Wilderness/Flight/ mobile intensive care nursing (a dream that I just realized at the tail end of my FNP program).
    The problem is that I only have 3 years of med/surg/tele RN experience. I know that if I want to make this dream a reality I have to obtain some critical care experience.
    So the other problem is figuring out how to go about obtaining critical care experience that I so desperately crave. Being an RN in ER/ED or FNP in ER/ED? What type of experience would be better in obtaining my goal, ICU or ER/ED? I would consider going back to school to become certified as an ACNP, but right now I think gaining more practical/work experience is more important.
    Some websites that I have read about wilderness/flight nursing, recommend paramedic training in addition to nursing experience, but is becoming a paramedic really necessary? For what it is worth, I would still like to continue working as an RN to gain critical care skills in addition to gaining NP experience. Am I asking for too much? Any feedback is greatly appreciated.
    Thanks for reading and for your time!

    Last edit by xOOx on Dec 7, '11 : Reason: too many spaces between paragraphs
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  3. 9 Comments so far...

  4. 0
    It sounds like you are more interested in working as an RN than as an NP. I'm not aware of an NP Flight/MICU type position. If you want to work as an RN, then probably the best route would be getting some solid trauma ER experience and pursuing paramedic certification followed by paramedic experience. NP roles in the ER tend to be more on the fast track side. What you seem to want to do is manage critical pts during transport. Paramedics gain skills in things like intubations which unfortunately you probably wouldn't be doing as an RN or NP. ICU experience is good but tends to be in a far more controlled environment.

    My 2 cents...
  5. 0
    Actually, Case Western Reserve University has a flight nurse ACNP program. Cleveland Clinic utilizes ACNPs for their critical care transports. Flight nursing usually requires many years of ED or ICU experience.

    It will be very hard for your you to get a job in one of those environments with a lack of critical care experience. I think your best bet would be to get a post-masters in Acute Care. Doing this would also allow you to treat all ages since you are a FNP. You could also look for a job in the ED while completing your post-masters.

    Good luck to you!!!
  6. 0
    I would agree that you'd need to specialize in acute care.
  7. 0
    I graduated from a FNP program, and went to work in an ER (the same ER where I worked as a ER nurse for 5 years). We have two ERs. There is the main ER, where we see everything, and a second ER where we try to see less acute patients, but will see the others if we have to. I work in both ERs, and I see all types of patients. Not just the clinic fast track stuff. The only things I can't do are intubate, central lines, and chest tubes. A doc has to review all of our patient's EKGs and x-rays. Still, we see some pretty sick patients at times, so I think it depends on where you work. Still, in some ERs working as an NP, you'll get to take care of the critical patients. I participate in the care of all kinds of patients, including patients requiring drips, patients having MIs, etc. So, if you want critical care experience as an NP, just look for a job that fits what you're looking for
  8. 1
    I agree with the other comments regarding getting your ACNP. In an FNP review certification review course that I recently took the lecturer pointed out that scope of care for an FNP does not cover the critical care environment even though many of us have had extensive RN experience in that setting. As an FNP, our training and scope does not cover management of patients in critical care. I am also a cardiovascular CNS but cannot step into an acute NP role I am told because of the scope of practice limitations of the FNP. You may want to investigate this issue before deciding on your next course of action. I am considering an ACNP post-masters program myself.
    MelanieAPN likes this.
  9. 0
    I currently work with an Intensivist Group/Critical Care doctors as their APN. I agree FNP training would not have been the ideal program for what it sounds like your passion has evolved towards. If in your situation, would consider the Acute Care Nurse Practitioner post-master program as more clinical is focused on critically ill inpatient environment. I did have 6 years ICU and a CCRN certification prior to becoming an APN as well. Most ACNP also have to become certified in Foundations of Critical Care, FCCS couse, and Advanced Trauma Life Support (ATLS) as well. Which ever road you chose, I wish you all the best in reaching your goals .
  10. 0
    The ACNP certification is apparently being retired, a fatality of the implementation of the Consensus Model (along with a number of current APN certifications); the ACNP exam as it exists now will no longer be offered to new applicants in a year or two.

    There are a number of scope of practice issues that you need to consider before even applying to jobs either as an RN or FNP.

    Can FNPs manage critically ill patients in your state? What does your Board say about that?

    What are the implications of being an NP but working in an RN role? You'll be held to the highest license you hold regardless of your job title, contract, and job description. I'd imagine this would be even moreso the case as an RN-FNP in ICU if you don't have 24/7 intensivist availability. I don't even want to think about the potential legal implications behind that... middle of the night, doctor wants to go back to bed and won't do xyz, pt decompensates, codes, dies... in the malpractice suit and/or Board hearing against you, why didn't you order abc, xyz, etc. like the prudent FNP would have done?
  11. 0
    any idea if the ACNP going to be changed to a AG ACNP (adult geriatric acute care np) and still exist? Basically is the Acute Care NP in the sense of the scope of practice still going to exist even after the current ACNP's demise? I hope not, the ACNP has been a part of my career goals for a while. I hope a new cert with a similar scope replaces it.
  12. 2
    The scope of practice is the same, they are just changing the name to AG-ACNP, supposedly the exam will start to be available in 2013 from both AACN and ANCC. The current ACNP curriculum already covers geriatric patients but I guess not to the satisfaction of someone in a tower somewhere who feels the need to change something that is perfectly fine...
    ivyleaf and apocatastasis like this.


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