ACNP or CRNA for Extremely Driven?!

Advanced Practice Columnist / Guide · Oct 30, 2008

In terms of salary, it is well established that CRNA's consistently fare much better than NP's including ACNP's in most areas of the country.

Geographically, there are probably locations that are more favorable for autonomous practice for both a CRNA and an ACNP. In terms of ACNP's, ICU setting vary across the US and across different metro areas. In the hospital where I work, ACNP's do a lot of ICU work with minimal intensivist involvement ranging from managing unstable hemodynamics to performing invasive procedures. Since you mentioned Pennsylvania, ICU's across the University of Pennsylvania Hospitals usually recruit ACNP's in a similar fashion. This I know because I belong to a yahoo group for ACNP's and one of their Lead ACNP's at Penn posts job openings on that site from time to time. Having attended a few conferences here and there, I've met other ACNP's in Florida and Virginia who perform a similar role as we do in Detroit.

Sorry, can't give you a CRNA perspective cause I am not in that profession. However, I've not heard of states that give CRNA's a NP license as well. That does not mean that it's not happening, I just am not aware of it. I am aware of advanced practice nurses who carry both ACNP and CRNA credentials. There is a program somewhere in the south (I forgot exactly which one) where ACNP students are guaranteed admission to the school's CRNA program after completing their ACNP.

NP prescriptive authority varies considerably among states. Although all states allow NP's to write prescriptions, only a few states allow no physician involvement in the act of prescription writing. Laws vary among states from requiring a collaborative agreement with a physician, establishing prescription protocols on which meds the NP is allowed to prescribe, and requirement for additional pharmacology continuing education credits to maintain the authority to prescribe. Check with the CRNA forum so you can get this information from their perspective.

The path to CRNA and ACNP are entirely different. CRNA usually requires a year of ICU experience and full time commitment while in the program. There is one program in my state that allows part-time courseload for the first year's worth of coursework and then full time for the final year. This allows the student to complete the program in 3 years. CRNA programs are competitive in my state. Of the 5 university programs, only about 30 students among hundreds of applicants are accepted for each program in the fall term when the programs start.

ACNP programs also require experience for the most part. However, ICU experience is usually not mandated. Part-time coursework is allowed throughout the program and the ability to work at the same time can be accomplished although not without difficulty. ACNP programs are a combination of Internal Medicine with some Intensivist training. Clinical rotations are mostly done in in-patient settings ranging from ED's, general patient care units, to ICU's. Subspecialty clinical rotations in fields such as Cardiology, Neurosurgery, Oncology, or Trauma are common. Typically, students express an interest in a subspecialty field to the program director and arrangements are made by either the student or the school for a clinical rotation in the student's field of interest.

I believe CRNA programs only allow students to train in the peri-operative areas with the exception of bedside intubations. Again, CRNA's are welcome to correct me if I'm wrong.

Since your interest is in the ICU, be aware that ICU NP's typically rotate or do shift work. ICU's are 24-hour operations. Patients are sick throughout the day and a watchful eye is needed no matter what time of day or night. Our NP's rotate days and nights and do three 12-hour shifts each week. I met an ACNP who works 36 hours straight each week and practically lives in the hospital during the entire 36 hours! but then there's a lot of free time after that. Ask the CRNA what their typical schedule is like 'cause I don't know what it is. We have minimal interaction with CRNA's. Needless to say, our hospital seems to be unfriendly towards them and this is more of an exception than the rule so don't be alarmed.

MissBehavin · Mar 27, 2009

"""Sorry, can't give you a CRNA perspective cause I am not in that profession. However, I've not heard of states that give CRNA's a NP license as well. That does not mean that it's not happening, I just am not aware of it. I am aware of advanced practice nurses who carry both ACNP and CRNA credentials. There is a program somewhere in the south (I forgot exactly which one) where ACNP students are guaranteed admission to the school's CRNA program after completing their ACNP."""

The program in the south is Vanderbilt. They work with MTSA (middle tennessee school of anesthesia), however it is NOT guaranteed admission. 2 of the ACNP classes ( I believe they are Patho classes) are taught by a prof. who teaches at MTSA. (His classes are supposed to be very intense, but very worth it). If you graduate from Vandy with your ACNP AND do well in his class, you can get a priority interview at MTSA.