Opportunities for an ACNP with RNFA certification?

HenryH · Jun 22, 2012

Quick bump...

Advanced Practice Columnist / Guide · Jun 22, 2012

You may have to ask the programs directly about your question and hopefully the directors are honest enough to tell you how their graduates fare in terms of employment. I've only heard of UAB offering this kind of training (and that institution is also known for their Surgical PA program).

Anecdotally, I know of two ACNP's who are also RNFA's but didn't attend a program that is a combined ACNP/RNFA. They were RNFA'S before starting the ACNP program. They currently work in Adult Cardiothoracic Surgery and do assist in the OR as well as manage patients in the ICU, surgical floors, and clinic.

It is a good gig and they are compensated well. One was a former ACNP student I precepted during his ICU rotation. He tells me he moonlights as a per diem NP/RNFA in addition to his full time job.

HenryH · Jun 22, 2012

Thank you for responding with that information, Juan. Yeah, I was actually looking at UAB's program in particular. Do you know if ACNP's who also hold RNFA certification usually take "standard" ACNP jobs, or is it more common for them to work in surgery? My fear is to graduate from an ACNP/RNFA certification program (such as that offered by UAB) and end up being relegated to working in doc-in-the-box clinics, etc. I did ask a faculty member at UAB's program about graduates' hiring prospects and was told that they didn't have specific figures/numbers regarding hiring trends, stating instead that the general consensus is that empoyment for NP's in various surgical sub-specialties is on the rise.

Additionally, is there any way you could provide a ballpark salary figure/range that an ACNP w/ RNFA cert. could expect to be offered by a surgical group as a new graduate? I already have undergraduate student loans to pay off, and attending any ACNP program would mean having to move and take out loans not only for the graduate degree itself, but also for living expenses, so I just want to be sure that taking on the additional debt would be a realistic endeavor (although it sounds like it most definitely is).

Advanced Practice Columnist / Guide · Jun 22, 2012

It would be tough to answer your first question because ACNP's with RNFA certification probably represent a small number of the total population of ACNP's. In addition, ACNP's represent a smaller fraction of the total number of NP's (there are states that do not even have a single ACNP program). Lastly, not all NP's who are also RNFA's are ACNP's, there are some who are trained as FNP's or ANP's.

I think the ACNP track attracts nurses who are interested in hospital-based roles particularly ICU's and other high acuity specialties such as Cardiology. Surgical specialties are constantly present in the hospital, thus, this is also a favorite practice setting for ACNP's. When you say Doctor-in-a-box, are you referring to retail clinics? That's not an appropriate setting for ACNP's.

The general rule of thumb is that NP's find jobs in fields that match their experience, NP training, and other special skills they may have (ie, RNFA). Having the ACNP/RNFA combo is attractive to employers in surgical specialties in job markets that have a need. It is possible that UAB us not able to give figures because their graduates do not stay to practice in the Birmingham are after graduation.

Surgical specialties typically generate better revenues than medicine-based practices that are not heavy with procedures. The colleagues I knew were making six figure salaries in the Midwest as new grads. However, six figures are not unusual for any ACNP where I'm at now even for those who don't have RNFA like myself. I'm sorry I can't really give you concrete answers. Just like in anything else, there isn't a crystal ball that tells us how our careers would go in the future.

HenryH · Jun 22, 2012

Thanks again for the information; I know what you mean about not having a crystal ball to predict the outcome of our career choices.

One other thing -- have you heard of physician groups/hospitals preferring not to hire NP's who graduate from direct-entry programs? The program at UAB I'm looking at is a direct-entry program for applicants who don't have nursing backgrounds, and I'm just a bit nervous because I have heard (through mostly internet-forum conjecture) that many employers have policies in place that more-or-less prohibit the hiring of graduates of direct-entry programs.

Advanced Practice Columnist / Guide · Jun 22, 2012

I've never heard of physicians refusing to hire NP's who are direct entry grads. I've heard of nurses and NP's who feel that direct entry programs undermine the concept of advanced practice nursing. I am an ACNP working in the ICU and I can tell you that 4 out of the 12 on our team are direct entry grads (2 out of 4 went straight to an NP job the other 2 worked as bedside RN's for a while). To me, there are so much what ifs with the direct entry programs that if I was in a situation where I'm forced to pick between NP or PA coming in without a nursing background, I would probably pick PA.

HenryH · Jun 22, 2012

Thanks; when you say that there are many "what-ifs" with direct-entry NP programs, would you mind expanding on what you are referring to (aside from contention amongst fellow NP's and RN's regarding the veracity of the direct-entry concept)?

Advanced Practice Columnist / Guide · Jun 23, 2012

Sorry for being too vague. I've been using the iPhone app and it's harder to type with such a small screen. There are issues with direct entry programs and I'm limiting my thoughts on the direct entry ACNP alone (not FNP or the others)

There's always competition for jobs to worry about. I attended a traditional ACNP program with a class full of over-achieving experienced ICU and ED nurses. These guys bring years of working in trauma centers and high acuity ICU's in tertiary centers. This was intimidating for me even though I had similar experience myself. In a climate where the best candidate for a job is one whose relevant nursing experience counts (as in most in-patient/hospital positions advertised), I find it hard for direct entry grads to compete with very little nursing experience to prove. Incidentally, the 2 direct entry grads in our group graduated from well-known East Coast institutions and were hired by the institution's affiliated medical centers straight out of their DE programs. They came to us with NP experience already (though no bedside RN experience other than during school). I think they are more of an exception than the norm. They are smart and you couldn't tell the difference between them and the rest of us.

The other issue is my perceived inherent flaw in ACNP training that seems to expect pre-existing experience as an acute care bedside RN and builds up on the body of skills and knowledge acquired through that bedside experience. It felt like the didactics are presented to a subset of people who already have exposure to clinical scenarios in hospital settings and everyone is expected to already know how to respond to them. Maybe my opinion is colored by the fact that I attended a traditional ACNP program with a class full of experienced nurses. I certainly have no idea how DE programs are set-up but I think this is where PA programs can be advantageous to a non-RN because of the fact that even though students come with various forms of health care experience, the program is presented to every student consistently so that everyone starts from the bottom and works their way up to the top in terms of acquiring skills and knowledge.

If I'm still sounding too vague, it must be the 12-hour shift I just finished.

HenryH · Jun 23, 2012

No, your post wasn't vague at all; in fact, thanks for giving such an in-depth response. At this point, the primary advantages of going through a direct-entry NP program over a PA program are centered around me not having any healthcare work experience (a requirement for admission to most PA programs). If I decide to pursue PA school, I'd be at least one year away from being able to apply. On the other hand, the DE NP programs I'm looking at start in January, so I'd only be waiting a few months (relatively speaking) to matriculate. I have heard that several people in my area have, upon being accepted to NP/PA school, signed advance employment contracts with local groups stating that, upon graduating, they'd return to this area to work as an NP/PA for the group they signed the contract with. I guess that would be a definitive way to find out for sure whether I'd be employable as a DE program graduate...

HenryH · Jun 24, 2012

I have done a few job searches on the usual websites (e.g., Indeed.com, etc.) for open ACNP positions and was surprised to find that not many are posted for my area or the surrounding area. On the other hand, there are plenty of postings for FNP's. By chance, would you happen to know if there is currently some sort of job shortage/provider oversupply in the ACNP job market? Or are most ACNP's hired directly out of their programs upon graduating?

SMReichert · Jun 27, 2012

HI Henry,

If you are already a nurse, I wouldn't waste your time becoming a PA. Better to be an NP.

I am an ACNP with RNFA certification. I got both at the same time. I had many years in the OR and you need at least 600 hours of clinical for the RNFA.

I work in Orthopedic SUrgery. Presently I only work managing the patients from the moment they enter the hospital until they are discharged. I can assist in the OR, but there is too much work to do on the floor.

Orthopedic NPs are usually in the higher end of the payscale. Depends where you work and your experience, but you should expect starting in the high 90s without experience and closer to 150,000 with experience. Depends on volume also.

GOod luck!