ACNP or FNP???

DaisyRN, ACNP · Nov 15, 2007

i'm on my way to the hospital, but i will post a lengthier message later. i will tell you that there has been a great deal of discussion about this in other threads and while you're waiting on responses, you might consider going through some of those threads to see if you can find some helpful information.

be back later...

mvanz9999, RN · Dec 17, 2007

Hey Daisy?

Are you going to make that post now? I would be interested in reading your thoughts. LOL!

amberfnp · Dec 17, 2007

Daisy RN...

I second mvanzz999. I am getting ready to start an FNP program in May and enjoy reading your posts. Sometimes I wonder if ACNP might be the better fit for me based on my experience.

How did you last week of school go?

mvanz9999, RN · Dec 17, 2007

I'm not 100% sure that question gets answered until it's too late. LOL!

I'm ACNP starting January 08. And terrified, naturally.

amberfnp · Dec 17, 2007

I chose FNP because I feel my experience is 'limited' so to speak. I work FT for a plastic surgeon and prn in the ED (non-trauma), both for the last 5.5 years. I guess I'm hoping an FNP program will best prepare me for care of all age groups but still allow me to focus on adults if that's what I choose to do. Also, my long term goal is to teach nursing and I felt FNP would give me a better background to draw from.

vanz999, where will you be going to school? I will be at the University of South Alabama. I was accepted to begin in Jan but chose to wait until May.

Advanced Practice Columnist / Guide · Dec 17, 2007

It must be getting really hectic for Daisy RN these days as she is about to graduate.

Anyway, there are a lot of factors to consider when you choose an NP track. I think the most important of all is whether you will find a job in the NP specialty you choose. Some rural areas tend to have more job opportunities for FNP's. However, in most urban settings, the choices tend to be more varied. In the urban setting where I live, I find that not many family practice physicians hire mid-level providers. However, FNP's do find their way being employed in ED's and urgent care centers. Because my state is not very specific on which type of NP's can work in hospital settings, I also find FNP's working alongside ACNP's and ANP's in purely adult specialties and even in the ICU setting. As an ACNP, I found that my training is favorable for the type of job openings available in my geographical area.

Going back to the OP's questions:

1. performing advanced skills - I am not sure what you mean by this. FNP's are trained to do office procedures which can include suturing of lacerations, gynecological exams, and things of that sort. On the other hand, as an ACNP I am trained to insert invasive lines from arterial lines to triple lumen catheters as well as introducers and Swan-Ganz catheters. I also insert chest tubes and perform thoracentesis. I guess the difference here is that FNP's are trained to learn out-patient skills whereas we are more trained to do acute care skills.

2. Don't want to be in the hospital the rest of my career - you will need to have some hospital duties if you want to stay as an ACNP. But it does not mean that you can only work in the hospital exclusively. Typically, ACNP's who work in specialty services such as Cardiology and Neurology work in both the out-patient clinic and the hospital. However, it's rare to see an ACNP work exclusively in the office even in my area where NP's tend to cross barriers in terms of educational preparation.

3. A sense of autonomy as a healthcare professional - this is highly subjective. I feel that I am autonomous in my role. For instance, I can order vasoactive medications, start lines, transfer a patient to the ICU without asking for a physician to approve it. However, I answer to an intensivist and I better make sure that whatever decision I made, I can back it up with sound rationale. There are times when I am stumped and couldn't figure out what's wrong with the patient - these are times when I know my limitations and have to approach the intensivists for their opinion. Some NP's feel that true autonomy is establishing your own clinic and running your own practice. This is not possible in acute care in my opinion.

3. Can I go into a specialty as an ACNP? - most definitely, as long as it is an adult specialty.

DaisyRN, ACNP · Dec 18, 2007

hi. i'm a rn who works in icu (trauma, neuro, surgical, medical, ect). currently i'm traveling. i enjoy the icu setting but am ready to go back to school for a higher degree. i am debating on which track to take acnp or fnp? i would like to perform advanced skills but don't want to be in the hospital the rest of my career. i also want a sense of autonomy as a healthcare professional . as a acnp could i go into a specialty such as neurology or surgery in a outpatient setting? i want to be able to get a job out of school too. everyone says go with fnp....what do you think?

i feel so loved around here!! *hehe* 92mxmom, the last week went great, thank you for asking! actually sqeaked out 2 a's!! woohoo!!! started my new job last week, but thats a whole other story in itself... :)

mvanz... *lol* sorry i kept ya waiting for so long! :) these credentialing applications for the hospitals are um... witches! hehe (and i have 3 to do!).. and congratulations, by the way!

and pinoy, you were right on! it's been crazy the last couple of weeks... but its over! (until boards...)...

okay, so... nursecutie... i really think that pinoy did a great job at breaking the differences down. it truly does have to be a personal decision. i chose to do acnp because i did not want to get suckered into just working in a doctor's office. granted, i know an fnp working for a hospitalist group right now... (out of scope??? ) but its not the wave of the future according to the bon pres.

i do like the hospital and i like the higher level of acuity of my patient population. i enjoy consults in the icu, etc. the job i took is with a cardiology group and i will be doing both outpatient follow ups and inpatient consults/new admits (whenever i get the stupid credentialing apps done!). eventually, i will be supervising stress tests and interrogating devices as well. i do not mind the overlap between outpt/inpatient.

as an acnp, i had to do an internal medicine rotation... thus, i am qualified and "legal" to go to work for an im office, granted there are no preggos or children. that would be an option for you, if you only wanted outpt. you will also, as you said earlier, be able to find specialty work as an np. i would suggest looking into the job market of your area and calling around... keep in mind that just because an ad says, "family nurse practitioner wanted for neurology group" doesn't mean they won't hire an acnp or vice versa. also, call about pa positions. some employers simply dont think about alternatives. i have found this to be the case a lot around my neck of the woods. :)

as for skills, you get more "critical care" skills as an acnp, like pinoy described. just because you are capable doesn't really mean you'll get to do them though... i wouldn't get your heart set on being able to do so unless you know without a doubt that your area is progressive enough to allow it. my hospitals are quite antequated (sp?) when it comes to what i can do vs. what they'll let me do; it's geographically specific.

best wishes to you cutie!!

yellow finch, BSN, RN · Dec 18, 2007

Wish I'd bothered to read the forum before posting my thread asking almost the exact same question.

There are some excellent responses here that we can take into consideration.

mvanz9999, RN · Dec 18, 2007

I chose FNP because I feel my experience is 'limited' so to speak. I work FT for a plastic surgeon and prn in the ED (non-trauma), both for the last 5.5 years. I guess I'm hoping an FNP program will best prepare me for care of all age groups but still allow me to focus on adults if that's what I choose to do. Also, my long term goal is to teach nursing and I felt FNP would give me a better background to draw from.
vanz999, where will you be going to school? I will be at the University of South Alabama. I was accepted to begin in Jan but chose to wait until May.

University of Illinois at Chicago. I chose ACNP for many of the reasons the others have posted. Whether that's truly the right choice...only time will tell. I think it is, though!