ACNP vs FNP for ER


Hello NPs!

I am currently a RN in the ER and am interested in starting a NP program next fall. My ultimate goal is to work in trauma and continue working in the ER. I am asking for some clarification as I have heard different opinions as to whether I should pursue the Acute Care NP route or Family NP. Also, I have heard of the option to do a post master's emergency/ trauma certification after receiving my MSN, but if I take this option I would still be unsure if FNP or ACNP is better!

What I have heard so far:

FNPs currently work in the ER because they can take care of all ages while ACNP are only certified to take care of 18+

ACNPs are becoming more popular in the ER and FNPs will be phased out in the future due to the specialty critical care training ACNPs receive

ACNPs work in ER and critical care stabilizing critical patients while FNP work in clinics, urgent care and focus more on education and prevention of disease

Certified emergency NPs (beginning in January 2017) are only eligible for the exam as a FNP not ACNP

Any information about FNPs and ACNPs is greatly appreciated as I am seeking advice on what is best for me!

Thanks in advance :)

Advanced Practice Columnist / Guide

juan de la cruz, MSN, RN, NP

9 Articles; 4,338 Posts

Specializes in APRN, Adult Critical Care, General Cardiology. Has 31 years experience.

Well, let's start with what does the ER you work at hire? or what kinds of NP's get hired in ER's where you live?

ER has been quite an outlier in the FNP vs ACNP debate. It's been a complex area of practice that was never really addressed by the current crop of NP tracks until more recently.

I've recently been involved with an ACNP-based national task force where the issue of the new AANP sponsored ENP-C exam was discussed. I think this exam is still quite new to determine its impact. The consensus among the group (of ACNP's of course) was that the exam totally ignored those with both adult and peds ACNP backgrounds. The feeling was AANP did not think globally and was just protecting the interest of its own certification programs which include FNP and not ACNP. If you come to think of it, that pretty much sums up the issues in NP education in general - we never really come to a consensus and whatever consensus we have doesn't take into account the real issues faced by our NP's on the field.

From a legal standpoint and with the consensus model in mind, the rule is your education as an NP and whatever post-NP training you get is the leg you stand on when you defend our scope and areas of practice we get into. Nursing experience prior to NP training is not based on advanced practice and is not defensible. There is certainly variation in NP training even across similar certification tracks. In the end, NP programs should be honest to students and not sell a product as "you can do anything with this degree" just to boost enrollment.

That said, what should you do? at this time, very few states have specific language that mirrors the consensus model though that model should have been implemented across the board in 2015. Look into what kinds of NP's work in the ER's in the area and waht kind of jobs they do. If it's FNP, then I would suggest you go for that but be prepared that if your role would involve more high acuity roles that your program didn't expose you to, seek additional training (even to a point of doing a post-master's ACNP). That is a more proactive approach in case things change in the future. Things do change on a state and national level quite a bit - you can ask many of us "old-timers" who've seen our certification programs retired at some point.

Of note, I work in an urban medical center with an adult only ER - the ER for kids is based in the Children's Hospital. We have an ideal situation for ACNP's in the ED for both adult and peds. We also have trauma NP's that are only ACNP's in many area hospitals that are Level 1 certified. They do have a variety of roles from just ward follow-up in one place to some actually assisting in the OR. But then our situation is not found in majority of metro areas and smaller communities where hospital ED's and trauma programs are more community-based and expect a well rounded NP who can take of patients of all ages.

Specializes in Hospitalist Medicine. Has 8 years experience.

I think juan de la cruz summed it up well. Definitely find out what your local ER's hiring policies are for NPs and what certifications they prefer. Where I'm at, if you want to be in the Level 1 trauma in ER, you have to be dual certified (FNP & ACNP). While they prefer the ACNP for high acuity care, they really want you to have the FNP so you can see patients under the age of 13, if necessary. Our ER has a separate Peds ward, but they still prefer the dual cert. You most definitely have to get a feel for your ER and what they really want. I'm an ICU nurse and picked up some shifts in the ER and talked to the NPs there. I like the idea of being in the ER versus solely being in ICU, so I want to keep my options open. I'm going for dual certification.