What NP Specialty Should I Choose?

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    There is this notion that the Family Nurse Practitioner (FNP) specialty program should be the default, and this should not be the case.

    What NP Specialty Should I Choose?

    First off, I believe that we need to stop this push to have anyone and everyone come into nursing just to become a Nurse Practitioner. We need to stop the "I just want to be a NP, but I'm not sure where I want to work," mentality. This article is not about this particular topic directly, but I believe it ties into the true purpose of this article. I feel many whom have no researched the NP profession thoroughly end up just settling on FNP. I also would love someone to write another article expanding on the Clinical Nurse Specialist (CNS- multiple subspecialties much like the NP discipline) and Certified Nurse Midwife (CNM) facets of APRNs, as many individuals don't consider these specialties either as they are less popular.

    I have seen many posts over the years about the correct specialty certification that one should have when pursuing Nurse Practitioner education. There is this notion that the Family Nurse Practitioner (FNP) specialty program should be the default, and this should not be the case. Many individuals have a notion that they do want to transition from the bedside to the provider realm. Some individuals know exactly what area of advanced nursing they want to work in, others haven't the slightest clue, which is perfectly fine.

    The problem that I have seen is that everyone and their brother wants to go to FNP school, instead of any of the other specialties. Now, FNP programs do have a wide scope of practice, but remember, the number of clinical hours may only be slightly more than other specialities, therefore, the clinical hours that one will have is spread very thin to all areas of clinical practice.

    Is this a problem? Well, that depends on your end goal.

    If your goal is to work in family practice, retail, or urgent care; the FNP specialty is right on for you due to the actual philosophy of the program. It is called Family NP for a reason, it gives to a broad, but somewhat superficial understanding of all of the systems across the lifespan (disclaimer- not saying that all FNPs have only a superficial understanding, but rather the focus of the typical/average FNP programs). This specialty is also great for those whom have not identified a particular area to practice. This would give that individual what they would need to be able to trial and error specialties.

    When jumping to FNP is a problem- I have seen many posts and discussed with many aspiring NPs, "I'll just get a FNP cert, just because it gives me the most options." Honestly, the 'most options' is still being debated on. What isn't debated on is that if you know you want to go into a specialty, FNP is not likely going to be your best choice. I knew that I didn't want to work with kids or OB patients, I wanted to do either general internal medicine (adult medicine) or a specialty before I started school. I settled on Adult-Gero Primary Care NP (AGPCNP), with the intent to work in the area(s) that I had desire in.

    "But wouldn't a physician want to hire someone who can see everyone?" One of the questions I hear a lot. The thing is, consider where I wanted to work: either adult health (IM) or adult specialty. Why would I need to know peds or OB if I didn't see peds or OB? One of the biggest motivating factors as to why I was able to get my job was the clinical area(s) that I completed my hours in. I completed all of my hours in adult health, internal medicine (with some basic OB primary care issues), urgent care, and cardio/nephro. I got my job over FNP candidates because my now boss saw that I had far more in-depth knowledge of adult disease, diagnostic, management etc, than my FNP counterparts. My certification and education fit far better into most of the jobs I was offered. We do nephrology in my practice- adult only. Remember, most specialty areas will do either adult or peds, not both.

    I have met numerous NPs whom are FNPs, working in adult heath or a specialty with adults who wasted extra semesters trying to find Peds/OB clinical sites, extra semesters off because they couldn't find clinical sites, etc. Many of these FNPs knew they wanted to work in adult health, but wanted to ‘keep their options as numerous as possible.' I have found FNPs wanting to work in women's health, whom are passed over for Women's Health NPs (WHNPs) due to the depth of knowledge discrepancy for the specialty.

    In conclusion, the FNP certification/specialty should not always be a fall back, the go-to certification, or considered the best way to find a job. My thought is that if you want a NP job for the sake of a NP job, go for it. I wouldn't recommend just settling for a NP job unless you really are content with anything. No matter what, most of the learning as a NP does happen post-graduation, but remember, you still have to get a job and maintain the job long enough to learn.
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  3. by   Ipfeiffe21
    This part really rang true to me: "The problem that I have seen is that everyone and their brother wants to go to FNP school, instead of any of the other specialties." Anytime I bring up in conversation that I am in nursing school, the conversation always jumps to "...so are you thinking about becoming an NP?" My response: "well no, not yet... I need to figure out which direction I would like to go...which area(s)/population(s) I enjoy working with, etc. before I even think about future schooling. I am glad the author included this bit.

    A lot of my peers seem to have the mentality that becoming an NP is for them, before they have even practiced as an RN. Experience trumps all other bells an whistles in an interview. How else would you answer questions better than all other candidates to secure a position in a specialty? Hint: you can't. Knowledge is great, but if two people have the same exact knowledge... and the position is between one person or the other, I would bet all of my money that the man or woman applying with focused training in THAT PARTICULAR FIELD would get the job. I like that the article encourages others to think a little bit about why it is they want to head straight to NP, so that the reader can come to this conclusion and realize ahead of time what it is they are getting into and where it is they are going.

    If you know where you want to go, you don't need all of that experience in other areas you won't be using primarily (or ever), and could then instead get more valuable hours and experience in the area that you would like to work in, thus becoming a better, more qualified candidate and provider... As my dad always asked me when I was a child, "How are you supposed to get to your destination (hopefully a meaningful and enjoyable career in this instance), if you don't know where you're going?" I think a key ingredient in figuring out the "How" in "how to get there" is understanding who you are as a human and why it is you are doing what you are doing. If you aren't doing something that gives your life meaning, then why the hell are you doing (or practicing) in the first place? If you want that range in population because you enjoy helping multiple age groups or want some flexibility with your future, that's GREAT! But I do agree with the author that you should, at the bare minimum, ask yourself first "why this direction and not THAT direction?" If you can't answer that but know that you want to do more on the provider end, then maybe FNP school IS the route to take in order to find that meaning in your life.
  4. by   babychickens
    I'm always surprised at the automatic FNP goal too. When someone says that I hear, "I have someone financially supporting me into eternity and they expect me, as soon as I'm off their dime, to make the absolute most money possible". In other words, it's programmed into them. There's no passion, no WHY. Sure, some have a great reason. In fact I know a great psych NP whom I have a ton of respect for. She's always inspired me. Maybe if I want to ever get close to psychiatry I'll pursue that route. Or perhaps if I feel called to obstetrics in the future I could go there. I had a fabulous NP at a Planned Parenthood a million years ago who made an impact. My point is, this job can be so draining that I know I'll give the best care over time to my patients if I have a passion for the specialty. I've been in the trenches of the ED for awhile now. I've been in other trenches too. I don't love them as much. If I see fit to add letters to my name so I can advance once I have more experience under my belt then I'll do that. In the meantime, I'm not looking to be called a "master" or "practitioner" of anything until my horn is less green. That's my take.
  5. by   LadyT618
    Excellent article! Well articulated, well put! This has been nagging me in the back of my mind....oh hell, in the front of my mind as well lol. It grates my ears to hear folks (or read) that say they'll have more options by going the FNP route. Forget options, what is it that YOU want to do? Most of the time, they really don't know. (And now I'm gonna bring up a little bit of that dead horse) Direct Entry programs aren't helping. Like Ipfeiffe21 said, how are you supposed to know what you truly want to do as a Nurse Practitioner without actually exploring as a Registered Nurse? The first specialty you work in as an RN may not work out and you may have to move on. The same may (or may not) occur for a DE NP grad who goes into their first specialty (without first practicing as an RN) and then realizes, "Hey, this ain't for me. Now I must return for a Post Master's Certificate for another specialty." While the DE debate argues whether or not RN practice is REQUIRED to practice as an NP, I think the real debate shouldn't really be practicing as an RN itself making a difference in future NP success, but RN practice/experience HELPING the future NP student to REALIZE WHAT it is exactly they want to do.

    I've been wondering if anyone else out there was thinking the same as me regarding this "fallback on FNP" attitude that has been rearing its ugly head lately. Again, thank you for this article.
    Last edit by LadyT618 on Jan 6 : Reason: spelling
  6. by   Dodongo
    It really irritates me when people become a FNP because they think they can do whatever they want with it. Go be trained to do what you want to do. Being trained in primary care won't help you get a job in peds, acute care, psych, etc. Being trained in those specialties will help you get a job in those specialties. More FNPs, in my experience, end up disappointed in their jobs than do specialty NPs who follow what they are actually interested in.

    Not to mention practicing outside of your training and scope is a terrible idea AND it ends up making NPs in general look I'll prepared for advanced practice.
  7. by   noon1004
    I agree that people should work as a nurse for a year or two at least before going back to school. Once you start working as a RN, you get a different perspective than working as a student nurse for 8-16hr/wk. Also, I want to add that this isn't a recent topic/issue. I remember some of my nursing school friends saying the same thing during nursing school and that was 10 years ago! Even now, when I brought up the idea of advancing my education, many people assumed it was for NP school. I don't hate it but NP for my masters/doctorate was never my first choice when I was in school nor now. Partially because I had learned in nursing school NP almost always meant FNP when someone was taking about NP programs. Now that I know more about the field, I am considering specializing in surgical NP but as a 2nd choice. I believe many people who don'tknow what they want or don't really know the field of NPs or nursing in general go for FNP program because its usually the easiest specialty to quickly find information on and the programs are offered by several great universities. Also, as mentioned before, a lot of direct entry programs are mostly tied with FNP specialty. Nursing is a big field with many subspecialties. If there was a list of all the jobs a RN or APRN could apply for and their job description, this would help spark a more generalized interest especially in nursing students.
  8. by   5150rn2
    The NP trend that I find most concerning is not only the lack of specialization, it's the lack of experience and practical knowledge. Apparently there are now programs that go from 0 to NP with your RN obtained during the process. It's called an entry level masters. ((ELMSN) it takes 11 semesters.
    i worked with a graduate of this program , one thing I vividly remember is having to prove that insulin comes in other size vials than 2ml Very very concrete... Granted this is one person and PA programs start without medical background. But to me, I think it's too fast. you do need to have a sense of the profession..and I do fully support the idea of a year or 2 of basic med-surg nursing prior to specializing to sort of "cement" general all around practice and skills. Then start trying out specialties. Not everyone is cut out for each specialty or love their initial dream specialty as much as they thought.. so a little self awareness and insight are helpful.
    Last edit by 5150rn2 on Jan 7
  9. by   SopranoKris
    Quote from Dodongo
    It really irritates me when people become a FNP because they think they can do whatever they want with it. Go be trained to do what you want to do. Being trained in primary care won't help you get a job in peds, acute care, psych, etc. Being trained in those specialties will help you get a job in those specialties. More FNPs, in my experience, end up disappointed in their jobs than do specialty NPs who follow what they are actually interested in.

    Not to mention practicing outside of your training and scope is a terrible idea AND it ends up making NPs in general look I'll prepared for advanced practice.
    The issue I'm facing in my area is that the ERs want you to have the FNP so you can see pts of all ages. So, I'm basically forced to get the dual FNP/ACNP so I can still work with critical pts. I would have loved to just get the ACNP, but I won't get hired unless I have that FNP. It was a quicker route to get the FNP first and then do the ACNP post-master's certificate after, so that's what I'm currently doing. Many of the ER docs have said "as long as you have prior critical care or ER experience, the FNP is OK". I still want to have that ACNP specialty certification as it will make me a better practitioner to have the in-depth training and extra clinical hours.

    This is why I really wish we could have standardized training similar to PAs. They do clinical rotations in every area (including surgery). I would much rather have more clinical training and less B.S. courses (like health care policy, informatics, etc.). The fluff courses do nothing to make you a better clinician.

    However, there is still the perception by many who hire NPs that FNP is more "well-rounded" because you can see pts of all ages. We have so many "flavors" of NP (FNP, ACNP, AGNP, NNNP, PMHNP, etc.). There is only one "flavor" of PA. Why can't we have a standardized education and then go in to our specialties hitting the ground running? I constantly hear "I don't want to study specialties I don't like". Well, MDs have to get a well-rounded education. So do PAs. They finish their education and then select a specialty. Why do we, as NPs, have to select one upfront? I am all for enhancing our clinical education.
  10. by   djmatte
    Quote from SopranoKris
    The issue I'm facing in my area is that the ERs want you to have the FNP so you can see pts of all ages. So, I'm basically forced to get the dual FNP/ACNP so I can still work with critical pts. I would have loved to just get the ACNP, but I won't get hired unless I have that FNP. It was a quicker route to get the FNP first and then do the ACNP post-master's certificate after, so that's what I'm currently doing. Many of the ER docs have said "as long as you have prior critical care or ER experience, the FNP is OK". I still want to have that ACNP specialty certification as it will make me a better practitioner to have the in-depth training and extra clinical hours.

    This is why I really wish we could have standardized training similar to PAs. They do clinical rotations in every area (including surgery). I would much rather have more clinical training and less B.S. courses (like health care policy, informatics, etc.). The fluff courses do nothing to make you a better clinician.

    However, there is still the perception by many who hire NPs that FNP is more "well-rounded" because you can see pts of all ages. We have so many "flavors" of NP (FNP, ACNP, AGNP, NNNP, PMHNP, etc.). There is only one "flavor" of PA. Why can't we have a standardized education and then go in to our specialties hitting the ground running? I constantly hear "I don't want to study specialties I don't like". Well, MDs have to get a well-rounded education. So do PAs. They finish their education and then select a specialty. Why do we, as NPs, have to select one upfront? I am all for enhancing our clinical education.
    Perhaps it's because advance practice wasn't conceived around the notion of going so far as a doctorate where there would be turf wars with other medical professionals. Nursing school is something I consider well rounded in nursing education. You're expected to learn to care for a range of conditions and have clinical rotations in everything from psych to OB. Coupled with some real world experience, that master's degree was the opportunity to expand your knowledge in a given area and add more authority/responsibility.

    I guess if they wanted to make the master's degree the entry nurse practitioner with the doctorate specialty focused it would make some sense. But to date, the DNP isn't even considered entry level yet despite the suggestion it was going to be by 2-3 years ago.
  11. by   JL1982
    Great Article! I am about to start school at University of Cincinnati for AGPCNP tomorrow ! Reading your article made me feel even more confident about my decision for adult-ger focus. I have numerous friends who have completed there FNP and am constantly hearing them tell me I have more options with FNP. I have 100% no desire to work on peds or OB, so I always felt the adult-ger was the best route for me. Thanks for sharing!
  12. by   BostonFNP
    Quote from noon1004
    I agree that people should work as a nurse for a year or two at least before going back to school.
    Based on what? A nurse in what setting, or any setting?

    Quote from 5150rn2
    The NP trend that I find most concerning is not only the lack of specialization, it's the lack of experience and practical knowledge. Apparently there are now programs that go from 0 to NP with your RN obtained during the process. It's called an entry level masters. ((ELMSN) it takes 11 semesters.
    i worked with a graduate of this program , one thing I vividly remember is having to prove that insulin comes in other size vials than 2ml Very very concrete... Granted this is one person and PA programs start without medical background.
    Based on what? One experience with the size of insulin vials? First off, it is one experience. Second off, it might be the most ludicrous reason I have ever heard for thinking an novice NP isn't competent.
    Last edit by BostonFNP on Jan 10 : Reason: typos as always

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