What do ER's hire more: PA-C, FNP or ACNP ?

Specialties NP

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Hi all. I am at the pinnacle of a very important decision that needs to be made by this upcoming Friday. I am hoping folks on here can help. I have been accepted to a great PA program and a great direct entry NP Program (accepted to FNP but could switch to ACNP if desired).

Currently, I have a strong interest in emergency medicine. I have worked only a little bit as an EMT and an ER Tech. I love the excitement of not knowing what's coming next and thinking on your feet. The pay is great, and I am very attracted to the flexibility in hours/shifts. But to be sure, there might be other specialties I'm interested in, I'm not sure yet. Primary care is also inviting, as is a hospitalist position, and perhaps international work.

So, first, I need to decide between PA and NP. I know this forum is loaded with discussions on this topic and I've probably read most of them. But it's still not an easy choice. Comparing PA school to direct-entry NP school, the education (in terms on clinical hours and breadth of didactic content) is stronger in PA school. I would come out and be better equipped to work my first ER job (not to mention that there are a number of 12-18 month residencies available for PA's [maybe there are a few for NP's, haven't seen them though]) On the other hand, I relate with the more holistic model of nursing, and also find the possibilities of independence and international opportunities (not to mention possibly more management and academic possibilities) very enticing. However, the fact is the MSN portion of the direct entry only has 700 clinical hours vs 2000+ for the PA program. The NP Program is only 3 days a week and they want you to work as an RN simultaneously.

I also have a hunch that more ER jobs are for PA's but am also aware that many NP's work in ER's too. I plan on living in Washington, Oregon, or California. So does anybody know if ED's on the west coast prefer PA's or NP's?

Secondly, for those that hire NP's, is FNP or ACNP more desirable? Clearly ACNP is better geared towards to ER and acute care in general, I understand that FNP's are sometimes preferred because their scope of practice includes peds and adults.

Any thoughts on my decision or as to who is preferred in the ED setting (especially on the west coast) are much appreciated!

in mississippi there are vastly more np's providing care in the er's than pa's. i think there is just one pa program in the whole state and it might have just started about 1 yr ago. though i have worked and continue to work with many pa's while i go active duty in the nat. guard, but those have went to school elsewhere.

This is because for a long time Mississippi has been one of the most restrictive states for PA practice (in particular prescriptive authority). Prescriptive ability is now in all 50 states but Miss. was one of the last holdouts.

Specializes in icu/er.

yep, thats typical of my home state. the only thing we are progressive in is teenage pregnancies and handing out wellfare checks. i think the pa program is at mississippi college and their clinicals are hosted by umc and baptist in jackson.

Specializes in ICU-MICU & SICU.

In Nursing more schools are including dual specializations. Such as Emergency NP with ACNP/FNP certification and training.

FNP- Allows you to see all populations

ACNP- Allows you to work with more ACUTE patients and are preferred in hospitals as an NP than FNP.

Many states are becoming more stringent on the specialty of NPs and some states are trying to makes laws that prevents FNPs from working in hospital ERs. The FNP curriculum was created for rural primary care but are used so broadly because they can see ALL populations from womb to geriatric.

Specializes in Emergency,.
In Nursing more schools are including dual specializations. Such as Emergency NP with ACNP/FNP certification and training.

FNP- Allows you to see all populations

ACNP- Allows you to work with more ACUTE patients and are preferred in hospitals as an NP than FNP.

Many states are becoming more stringent on the specialty of NPs and some states are trying to makes laws that prevents FNPs from working in hospital ERs. The FNP curriculum was created for rural primary care but are used so broadly because they can see ALL populations from womb to geriatric.

What state are doing this? how are they shaping legislation to make this happen?

Specializes in Anesthesia, Pain, Emergency Medicine.

They are not. Most are heading toward the consensus statement.

I find most states out west prefere the FNP as they can see all patients. Its not a hard jump to get some extra training if your program ONLY teaches you primary care.

Ron

What state are doing this? how are they shaping legislation to make this happen?

Texas is one of those states.

Specializes in Anesthesia, Pain, Emergency Medicine.

Texas is one of the most restrictive NP states, that is for sure. I am licensed in Texas although I refuse to practice there until we are independent. It seems as if that may be happening. If the bill before the legislature pass, it will be a huge step towards that independence.

Here is a study that was done recently. (Part of it, http://www.nonpf.com/associations/10789/files/ProjectFinalReport.pdf)

Major findings in the section, Regulation, were:

A total of 129 respondents (43.7%) indicated that state Boards of Nursing place

limitations on recognition of NP specialties in their states. Among these, 30 (23.3%)

indicated that the limits create problems.

Just over a third of the 295respondents (N=110; 37.3%) indicated the Board placed

limitations on how specialty NP credentials could be displayed in their title.

State regulatory limitations on the way subspecialty preparation is marketed were

identified by 28 (9.6%) of 295 participants; half of this group (n=14) indicated that NPs

were prohibited from openly marketing their subspecialty preparation.

Nearly half (N=131; 44.4%) of the 295 schools indicated a concern in their states about

NPs with initial broad preparation (e.g., FNP) being allowed to continue to practice in

narrowly-focused specialty areas (e.g., adult acute care, pediatric acute care) now that

national certification examinations exist for these specialties.

Major findings in the section, Marketability, were:

The majority of respondents (N=246; 83.4%) indicated that NPs with broad preparation

were more marketable than those with narrowly-focused preparation. The most

frequently given reason(s) were:

Graduates have greater employment flexibility (N=223).

Graduates can narrow their focus with additional subspecialty preparation if their

career coals or employment requires it (N=207).

Rural communities employ graduates and require NPs who can address health care

needs across the lifespan (N=192).

Just over half (N=166; 56.2%) of the participants indicated that subspecialty

preparation did not enhance marketability.

Among the 126 (42.7%) participants who indicated that subspecialty preparation

enhances marketability, the most frequently identified reason(s) were:

Graduates can market themselves in a specific area in which they want to practice

(N=115).

Employers in our area are looking for NP graduates with specific expertise (N=82).

Specializes in acute care.
Interesting that the rates of NP independent practice remain so low.

A political battle, it seems, to overcome the legislation in the majority of states which still require collaboration.

It is interesting how different the states are. I am about to start working in Maine, where NPs are required to have a supervising physician for their first 24 months of practice and then can be independent once they have that experience. I think that kind of system makes a lot of sense.

Specializes in Anesthesia, Pain, Emergency Medicine.

Why does it make sense? Why not prepare the NP to be independent right out of school just as the physicians are?

My CRNA school prepared me extremely well. I could do any case, anywhere with most any equipment and drugs. My FNP program though, another story. If I had not already had 20 years of INDEPENDENT experience as a CRNA, I would have needed a supervisor or at least a good mentor.

I say we bring up the NP programs education and training not dumb down our NP and make them be supervised.

Ron

It is interesting how different the states are. I am about to start working in Maine where NPs are required to have a supervising physician for their first 24 months of practice and then can be independent once they have that experience. I think that kind of system makes a lot of sense.[/quote']
Specializes in acute care.
Why does it make sense? Why not prepare the NP to be independent right out of school just as the physicians are?

My CRNA school prepared me extremely well. I could do any case, anywhere with most any equipment and drugs. My FNP program though, another story. If I had not already had 20 years of INDEPENDENT experience as a CRNA, I would have needed a supervisor or at least a good mentor.

I say we bring up the NP programs education and training not dumb down our NP and make them be supervised.

Ron

Physicians go through residency when they get out of school...they are under the supervision of the attendings during this time. The two years of supervised practice for NPs seems, to me, analogous. That's why I think it makes sense.

Specializes in Anesthesia, Pain, Emergency Medicine.

No, their residency is part of their school.

Our "residency" is our clinicals. We should be ready to go, as they are when we are done.

Physicians go through residency when they get out of school...they are under the supervision of the attendings during this time. The two years of supervised practice for NPs seems to me, analogous. That's why I think it makes sense.[/quote']
Specializes in Emergency,.

@ nomadcrna I agree with much of what you are saying, My FNP program was lacking in making me feel prepared, and I am glad i am taking a year of additional training, being supervised by docs in emergency medicine.

My understanding by talking with many MDs and DOs who are going through residency is that they are Drs, they have graduated, they are working under their own license.

I know that my clinicals were nowhere near as rigorous as a residency. the time spent alone is a joke, many schools only require 600 hours with no specific time in each rotation. I put in over 1000 hours and that is still less that my fellow PAs and WAY less than a MD residency.

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