ACNP/RNFA or CRNA?

[uabrn06]

Hello all,

I have been accepted to an acute care NP/RNFA program at UAB, scheduled to begin classes this fall (a few weeks!). I chose this program because I've always wanted to work in an OR, and it sounds like fun to be able to assist during surgery and follow pts pre-/post-op. I know I'm way ahead of myself, but I've been doing job searches just to get an idea of what may be available to me upon graduating. I'm a little discouraged... partially because I don't see many listings describing what I should be capable of doing after completing this program (most are listed as PA jobs), and also I've been told by some former OR nurses in my unit that the RNFAs don't really get to do all that much--I do work in a teaching hospital with lots of residents, so this doesn't really surprise me.

I am considering applying to CRNA school, which is what I originally wanted to do, long ago, when I first thought of becoming a nurse. I do enjoy working with/titrating drips--other than this I'm not sure what being a CRNA entails (other than placing lines, intubating, etc). I think I had talked myself out of going for this because there are not any CRNA programs close to my home (I'm married and it is not possible for us to move due to my husband's job, other things)...I live about 1.5 hrs away from UAB, which I've always thought may be too far of a commute for the intensity of the program. Nevertheless, lately I've decided that I would be willing to attempt the commute, or move by myself to do this if it's what I really want to do.

So, after all that, my questions are these:

1. What could I expect to earn as a ACNP/RNFA? If I'm going to do this, I would like it to be financially worthwhile (meaning more that I am currently making working 4 nights/week)

2. Are there really that many surgeons who employ this type of APRN?

3. Do RNFAs go into private practice? How does that work?

4. Other that what I listed above, what do CRNAs do? Pre-post-op responsibilities?

I will greatly appreciate any and all advice offered!

[Corey Narry, MSN, RN, NP]

No responses eh? Maybe because your questions are probably best answered by members in the CRNA and OR specialty forum. I can take a shot at your first question though.

The idea of becoming a nurse practitioner is to gain advanced training to be able to do more for the patient than a registered nurse is allowed and also earn a higher salary because of the greater responsibility. However, some nurses realize that the latter does not always happen because of many factors. First, most senior registered nurses with many years of experience are at a higher salary range already so when they become NP's they realize that the NP salary is oftentimes calculated based on years of NP experience, thus, they end up being paid at the lower end of NP salary that is pretty close to what they were earning as an RN with high seniority. RN's with less than considerable experience who become NP's are those that end up making significant increase in salaries when their roles change.

Also, you mentioned that you work 4 nightshifts a week. Assuming that those are 12-hour shifts, then you have 16 hours of overtime pay each 2-week pay period, not to mention the shift differential from working nights. That adds up a lot so that if you do end up working in an ACNP position that is salaried, you may be disappointed to find that you make less than what you were making when you were at a non-advanced practice role.

So, maybe you should do the research yourself and find out what regular ACNP's (not ones who have the RNFA addition) make so you can make a ballpark figure of what your salary will be like in your geographical area. A physician group may offer to pay you more for assisting in the OR but I have personally not seen much difference in the pay of NP's who have OR responsibilities as opposed to those who do not as far as the acute care setting. Remember that being an RNFA is not an advanced practice nursing role.

Seriously consider the CRNA route if salary is one of the biggest factor in making your decision for advanced education.