ACNP - Job Opportunities and Long Term Viability

LubbockNP · May 10, 2014

I did both ACNP and FNP back to back without any break in that order. I only work with adults in my job, I could use either one, b/c it is inpatient (mostly cancer pts). but if I had to do it over again. I would just get FNP. I had only worked as a RN in a SICU level I trauma unit, so I though ACNP would be a natural progression. But I found that I was drawn more to less ICU environment. What I see is FNP's getting credentialed to do things that ACNPs do. So in my town it does matter.

jessica.lanelle · May 10, 2014

With the ANCP, you will be able to do speciality clinics like ortho or cardio, ER/trauma, hospital inpatient, ICU, rehab units, or like my focus, urgent care. I do not want to have anything to do with any GYN stuff, and only peds when I have to, so it was a good fit for me. I know in urgent care I will encounter some peds, but hopefully things I have seen before or can confer with someone else about if I have questions.

I think you see more FNP positions because the ACNP has not been around as long, and as more people become aware of it, more positions will open up.

Also, it seems that the people in the FNP programs have a great deal of trouble finding clinical sites due the variety of places they have to seek out, but with the ANCP program, finding clinical sites has been pretty easy, since you don't have to find women's health sites, or IM sites. Just a place to practice physical exams and an acute site and a chronic site, basically.

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Advanced Practice Columnist / Guide · May 10, 2014

I'm an Adult ACNP working in Critical Care for almost 10 years now. While, I've been satisfied with the direction my career took me to, I'm going to avoid providing you with anecdotal data via my own personal experience.

There is some research data on ACNP practice that could hopefully guide you in understanding the role and where ACNP's work. The most recent research data was published in 2012 based on a 2009 survey by AANP. If you have Pubmed full text access at work, the link is: http://www.ncbi.nlm.nih.gov/pubmed/23190126

The sample size was relatively small: of 13,562 NP's who responded to the survey, 962 identified as ACNP's. I said small because there were about 7,020 ACNP's in practice in 2009.

The results showed that while majority of ACNP's work in the in-patient or hospital setting, less than 20% work in out-patient clinics or private practice arrangement with a physician. This debunks the thought that ACNP's only work in hospitals.

Surgical specialties are the biggest specialty practice for ACNP's, followed by Hospitalist, and Critical Care. Significant numbers work in Trauma, IR, Neurosurgery, Cardiology and ER. Smaller numbers work in Pulmonary, Neurology, Ortho, GI, Heme-Onc, etc.

So what does this mean to you? If you are interested in the ACNP role, there are many specialties that you can venture into as an ACNP depending on the job market where you live.

Nevada was not well represented in the survey - only 7 ACNP's were from Nevada. That could be a bad sign. For one, there might not be any ACNP programs there. Two, it might not be a state where ACNP's are recognized as a specialized group with unique skills and employers do not distinguish the difference between training in the various NP specialty tracks.

The ultimate decision should come from you on what track to pursue based on a few questions which I would propose:

does the job postings in your area predominantly ask for FNP's?
are you the type of NP that would like to do primary care at some point?

or

do you prefer specialty practices that separate adults from peds such as Critical Care, Cardiology, Pulmonary, Internal Medicine? I'd pick ACNP
does the job market allow you to be picky enough to get jobs in adult only specialties or would it be too risky to assume that because you really don't know where you will end up working in?

WitnessRN · May 10, 2014

I am currently in AG-ACNP school and had many of the same questions as you. I asked faculty members in my state many questions. ACNPs are well accepted here and are employed in cardiology, IR, ER, bone marrow transplant etc…. there are many options. It was explained to me that there are so many FNPs that the market is getting saturated. There are FNPs or PAs in almost every primary care office.

AG-ACNPs are newer to the NP realm and the anticipation is that the market can and will support many more ACNPs. The explanation was that with the cut in resident hours ACNPs are picking up those hours now. For me I just can't see myself in primary care.

Also according the the consensus model FNP and ACNPs are not suppose to be setting specific. However, here it pretty much is. Some FNPs that are working in speciality areas in the hospital are being required to attain their ACNP.

DavidRNNV · May 13, 2014

Thanks Juan, I did look up that Journal article and it was very helpful. I would prefer Internal Med and the job postings list ACNP here, because 90% of the locations here are organizations that are nationwide. The ACNP is a newer degree here and it looks like the overall consensus to have ACNP to be the primary NP in a hospital or specialist environments. Again thank you very much! I am much more confident that I picked the right NP program.

sasini01 · May 14, 2014

I'd say the "strength" of the degree depends on individual programs. I am in NYC and here there are a couple of ACNP programs, and there's definitely a reputation component attached.

ACNP means your clinical experiences will be in ICU/acute/ED settings.

There is also a trend (not sure how strong) for hospitals to hire ACNPs for inpatient settings and ANPs for clinics. The lines are somewhat blurred though because on many services the same NP cover both inpatient and outpatient settings.

I would look into job offerings for NPs in your area and see what their certification requirements are. However, it may very well change by the time you graduate. Best of luck!

FroNurse86 · Apr 16, 2017

I start AG-ACNP in sept at GCU and just wondering if you went through with it? How do you like your career path? Where are you working? Salary or Hourly?

Dodongo, APRN, NP · Apr 16, 2017

In my area it is starting to matter. The large, academic hospitals around me are using only ACNPs to staff their ICUs and there is definitely a preference for ACNPs on hospitalist and surgical teams.

I have zero interest in working in peds/OB/primary care and I enjoy critical care/surgery so it was an easy choice. Plus, I know I can work in an outpatient, specialty practice so I don't feel I'll be limited at all.

I think a lot of people play up the FNP degree as being so versatile, but if you never plan on working in peds/OB/primary care why do you care? From what I can tell FNPs can work in many areas, but they are probably not preferred. Peds prefers PNPs, OB prefers WHNPs, hospitals prefer ACNPs, etc. Primary Care prefers FNPs and that's about it. As for ER, the local ERs have FNPs, but they are encouraging them to go back to get an ACNP post master's certificate.

Just know your area. Many hospital systems are beginning to regulate the practice of NPs based on degree.

Trauma Columnist · Apr 17, 2017

I gotta say that in my area (and we have recently interviewed for three NP positions) we had several AGACNPs apply but we didn't consider them for our outpt positions because we felt they would not do well in a less acute environment.

Dodongo, APRN, NP · Apr 17, 2017

I gotta say that in my area (and we have recently interviewed for three NP positions) we had several AGACNPs apply but we didn't consider them for our outpt positions because we felt they would not do well in a less acute environment.

That's too bad. I can't speak to all programs, but, in mine we have hospitalist/ICU rotations, and we also have specialty rotations where I am expected to be in clinic with my preceptor and round on inpatients. So I get a mix of inpatient and outpatient experience (obviously focusing more heavily on inpatient).

I guess it's similar to the hospitals in my area not hiring FNPs anymore for inpatient positions. Anecdotally, I know an FNP that was hired into the ICU at one of the smaller community hospitals around here and she had a really rough first year, as she had no courses or rotations on acute care in school, let alone ICU.

SopranoKris, MSN, RN, NP · Apr 17, 2017

It really does vary by your area. The hospital where I work has ACNPs on the ICU & Trauma units. But to work in the ER, you have to be either dual certified (FNP/ACNP) or at least have FNP with ICU/ER experience as an RN, since the ER sees all ages. Since I'm an ICU nurse, I'm working on my FNP. I'll see once I finish the FNP if I need to get the ACNP certificate. I had a cardiologist in the ICU tell me that as long as I have more than 2 years experience as an RN in the ICU, he doesn't care whether I'm FNP or ACNP. Anecdotal evidence, but it certainly does show that it varies greatly.