I, like many others in the forum, have been recently struggling with which NP program to pursue - FNP or ACNP. I've read so many threads and talked with so many people (RNs, NPs, nurse recruiters, professors, deans) and this is the summary that I've compiled.
Does anyone have any thing to add?? Please let me know!
FNP
Pros:
Care for patients of all ages
Flexible career options (Primary care, ambulatory care, urgent care (?))
Increased need for FNP/PCNP in future of US healthcare
Increased need in underserved populations
Increased opportunity to work abroad
Will learn more about US healthcare system
Increased opportunity to develop meaningful relationships with patients
Often working with healthy patients
Opportunity to open own practice
Cons:
Ineligible to work as NP in hospital setting
Sacrifice in-depth knowledge in one population for more basic knowledge across lifespan
Often working with healthy patients
Mellow work atmosphere
Most likely working 5 days/wk, less $ than ACNP
ACNP
Pros:
In-depth knowledge in adult population
Can work anywhere in hospital (ED, ICU, Floor)
Can follow pt throughout hospital stay (trauma NP)
More fun work atmosphere
Most likely working 3-4 days/wk, more $ than FNP
Cons:
Education limited to adults
Career options limited to hospital setting
Limited ability to develop relationships with patient (?)
Interesting what the NC board of nursing says about NP scope:
"The population-focused Nurse Practitioner scope of practice is defined by the Nurse Practitioners formal academic, graduate educational preparation, national certification, and maintained competence. The scope of practice is operationalized by the Collaborative Practice Agreement (CPA)."
FnP has 1 OB 2 adult rotations 1 peds 1 adult gerontology rotation. I did all my rotations inpatient. Both adult clinical were in medicial ICU and CT ICU, Peds was done on a pediatric ICU, OB i did inpatient . My training was ICU inpatient focused.
You did all your FNP rotations inpatient which tells me your school clinical program is garbage and imo didn't train you at all to be an FNP.
Thats an inaccurate statement. When i did FNP i knew my end game was Critical care or ED . And i know FNP's work ED cause we can care for pediatric patients. My education was very adequate.... i passed my boards and i am a very good NP. Just saying. THis peofession is abt experience. Just like nursing school didnt prepare me to be a critical care nurse..... but i learned it came way other FNP's who work critical care learn and get good at it. I challenge how anyone can say FNP are qualified for critical care when so many so it and do it well. Please explain that. Speaking of inpatient , look at a internal medicine physician. They are basically a primary care physician certified internal medicine that works in inpatient. All primary care docs are internal med certified so i suppose this physicians shouldnt be in a hospital. Saying my school is garbage is way off base just saying
edit --Speaking of inpatient , look at a internal medicine physician. They are basically a primary care physician certified internal medicine that works in inpatient. All primary care docs are internal med certified so i suppose this physicians shouldnt be in a hospital. Saying my school is garbage is way off base just saying
Apparently you don't work with internal medicine residents. While there are primary care focused IM residencies, most IM residencies are heavily concentrated on inpatient services. What this does point out is that primary care specialties are not generally qualified for inpatient services. You can see this born out in the use of Family Practice Physicians in hospital medicine. At one point there was a significant FP presence in hospital medicine. However as FP residencies emphasized outpatient ambulatory care it became harder and harder to show training and expertise in inpatient medicine. In most healthcare systems FP cannot be credentialed for inpatient services without a hospital medicine fellowship. The same split occurred in emergency medicine which was largely the domain of FP. With the establishment of EM residencies there are fewer and fewer FP physicians in the ER.
Does that mean that FP doesn't do ER or inpatient, of course not. On the other hand the more standardized an organization becomes the less likely they are to credential FP for inpatient or EM. It doesn't matter how long they have been doing something or talented they are, from a liability standpoint the system would assume tremendous liability if they credential them. You wouldn't credential a family practice physician for critical care. They don't have the education, training or credentials to perform critical care just like you wouldn't credential a infectious disease physician to do spine surgery. Are there family practice docs rounding in ICUs and performing surgery in the hinterlands. Absolutely. Is it dependable if something goes wrong. Absolutely not.
As far as scope I defer to Carolyn Buppert: "What is the level of care required for my patients? If primary care, hire an adult-gerontologic, pediatric, or family NP, or a PA. If practicing psychiatry, hire a mental health NP or a PA who has specialized in mental health. If the practice is gynecology, hire a women's healthcare NP or PA who has specialized. If the practice is hospitalist, hire an NP certified in acute care or a PA."
Thats an inaccurate statement. When i did FNP i knew my end game was Critical care or ED . And i know FNP's work ED cause we can care for pediatric patients. My education was very adequate.... i passed my boards and i am a very good NP. Just saying. THis peofession is abt experience. Just like nursing school didnt prepare me to be a critical care nurse..... but i learned it came way other FNP's who work critical care learn and get good at it. I challenge how anyone can say FNP are qualified for critical care when so many so it and do it well. Please explain that. Speaking of inpatient , look at a internal medicine physician. They are basically a primary care physician certified internal medicine that works in inpatient. All primary care docs are internal med certified so i suppose this physicians shouldnt be in a hospital. Saying my school is garbage is way off base just saying
I'll say any school that authorizes inpatient for FNP clinical is garbage all day till sunday. Some get away with a 20% marker in ED or other, but not requiring outpatient for the majority of training brings up serious concerns about how that school remains accredited. IDGAF what you *wanted* in the endgame. And it's understandable that you are defensive as we push for people to actually work in their actually trained fields because it may in the long run affect your livelihood. But it doesn't make your choices any less inappropriate. ENP exists now as a rider for FNP because AANP recognized the shortcomings that FNP presented. If you were actually serious about your role in critical care, you should take the time to own the role and get that certification. But give us 5-10 years and we will see where our roles lie. Because as more states start to recognize the real legal and safety implications, more people will be forced to make a choice. If states don't, malpractice insurance and hospitals will. Better to encourage that earlier on. FNP is NOT a catch all that can do anything. It's about time people start realizing that and actually going for a degree in a clinical area they want. Not what they think will cover the most bases. Want the flexibility you desire, go for a PA program.
Apparently you don't work with internal medicine residents. While there are primary care focused IM residencies, most IM residencies are heavily concentrated on inpatient services. What this does point out is that primary care specialties are not generally qualified for inpatient services. You can see this born out in the use of Family Practice Physicians in hospital medicine. At one point there was a significant FP presence in hospital medicine. However as FP residencies emphasized outpatient ambulatory care it became harder and harder to show training and expertise in inpatient medicine. In most healthcare systems FP cannot be credentialed for inpatient services without a hospital medicine fellowship. The same split occurred in emergency medicine which was largely the domain of FP. With the establishment of EM residencies there are fewer and fewer FP physicians in the ER. Does that mean that FP doesn't do ER or inpatient, of course not. On the other hand the more standardized an organization becomes the less likely they are to credential FP for inpatient or EM. It doesn't matter how long they have been doing something or talented they are, from a liability standpoint the system would assume tremendous liability if they credential them. You wouldn't credential a family practice physician for critical care. They don't have the education, training or credentials to perform critical care just like you wouldn't credential a infectious disease physician to do spine surgery. Are there family practice docs rounding in ICUs and performing surgery in the hinterlands. Absolutely. Is it dependable if something goes wrong. Absolutely not.
As far as scope I defer to Carolyn Buppert: "What is the level of care required for my patients? If primary care, hire an adult-gerontologic, pediatric, or family NP, or a PA. If practicing psychiatry, hire a mental health NP or a PA who has specialized in mental health. If the practice is gynecology, hire a women's healthcare NP or PA who has specialized. If the practice is hospitalist, hire an NP certified in acute care or a PA."
Truth. And most IM docs I've come across are adult only. In our clinic, all of the FNPs have to use the same collaborator who's FP because all the rest of the docs are adult only IM docs. These docs work in the hospitals as well and often try to encourage the NPs to do hospital rotations, but we know our role and discourage this. The reality is things are changing. It will get harder for FNPs to work out of their scope. You're an idiot if you choose to ignore it and just presume your job will always be safe.
I understand you wanna defend ur ACNP, ACNP's like to think or make others think they are somehow brighter than an FNP. I dont see or buy that bologna. You know as i do that school education doesnt make the NP, experience does. Like I said im very good at my job and i would put my acute care knowledge up against most with the same experience as me that has an ACNP. Anyday. My education and knowledge of what i do will not be discounted. Sorry but my education and clinicals prepared me what what i do.
I understand you wanna defend ur ACNP, ACNP's like to think or make others think they are somehow brighter than an FNP. I dont see or buy that bologna. You know as i do that school education doesnt make the NP, experience does. Like I said im very good at my job and i would put my acute care knowledge up against most with the same experience as me that has an ACNP. Anyday. My education and knowledge of what i do will not be discounted. Sorry but my education and clinicals prepared me what what i do.
This isn't about being "brighter" or even making anyone feel a certain way. It's about understanding your training and the scope of your role. It's about patient safety and protecting our profession. You may be good at what you do, but you're relying on a degree that isn't made for what you do. So that by default can discount your knowledge. As stated, you can tell me your are the best np in the whole hospital and the minute you say you're an FNP I will discount your abilities. You not only refuse to admit that your actual training isn't adequate, but you're getting defensive as you now have to back yourself up with a laundry list of why you"deserve" your role.
I bet some of my IM docs could see a pediatric patient in a pinch, but they don't because they recognize despite their vast medical training there are legal and malpractice risks for them seeing other populations. But give someone an FNP and who cares about what your degree is in. If I want to do surgery procedures then I'm gonna do it because I can care for the whole lifespan and that time I did as an or/prep nurse is good enough! Heck maybe I can convince a hospital that they don't need to pay CRNAs all that money because I've given my fair share of sedation and everyone takes an advance patho and pharmacology course. All I need to know is ojt anyway!
Your certification is inadequate. Just because your joke of a program let you train wherever you wanted doesn't change that. The test you took had nothing to do with the job you do. You are certified to do primary care. Not acute or critical care. Take and pass that test and then you have nothing to worry about. No role to defend. And no need down the road to talk your way into a job when that acnp cert speaks for itself. Let's be real. Few nurses work in the same place forever. There will likely come a point where someone's gonna be more concerned about the legalities of your certification over your experience.
Dude. How is my training inadequate when i did comparable clinical training to an ACNP???????????? I was in clinical with ACNP students??♂️??♂️
Your school did you a great disservice if this is the case. FNP does NOT equal ACNP. And per the NCSBN it truly no longer does.
FNP is OUTPT ONLY!
Per the NCSBN site:
If programs prepare graduates across both sets of roles, the graduate must be prepared with the consensus-based competencies for both roles and must successfully obtain certification in both the acute and the primary care CNP roles. CNP certification in the acute care or primary care roles must match the educational preparation for CNPs in these roles.
As to FNPs in the ED, here is what the Advanced Emergency Nursing Journal states:
Nurse practitioners prepared as primary care providers have competencies different from those prepared for acute care roles. These unique educational differences govern an NP's scope of practice (American Academy of Emergency Nurse Practitioners, 2015). Recently, several FNP programs have revised their curricula to incorporate didactic and clinical content in emergent and urgent care. Nurse practitioners educated as acute care providers are prepared with didactic and clinical practice in acute care settings; they do not have the academic preparation to care for pediatric patients in emergency care settings.
Your best bet is to look toward your state's board of nursing. In Illinois, where I live, FNPs are no longer being credentialed in the inpt role. As an FNP, you do not have the EDUCATIONAL background nor the CERTIFICATION to see hospitalized patients.
7 hours ago, djmatte said:
Your certification is inadequate. Just because your joke of a program let you train wherever you wanted doesn't change that. The test you took had nothing to do with the job you do. You are certified to do primary care. Not acute or critical care. Take and pass that test and then you have nothing to worry about. No role to defend. And no need down the road to talk your way into a job when that acnp cert speaks for itself. Let's be real. Few nurses work in the same place forever. There will likely come a point where someone's gonna be more concerned about the legalities of your certification over your experience.
This - can not like this enough. Believe me, your hospital won't stand behind you if the BON comes knocking at your door wanting to see your ACNP certification. And the lawyers will be licking their chops awaiting that big settlement for their clients....
I feel like maybe we should just say "cool story bro" at this point, lol. It will probably take a couple of decades, but the battle of trained as primary but work as acute as a non-starter is decided. It will just take time to be enforced.
core0
1,831 Posts
Interesting what the NC board of nursing says about NP scope:
"The population-focused Nurse Practitioner scope of practice is defined by the Nurse Practitioners formal academic, graduate educational preparation, national certification, and maintained competence. The scope of practice is operationalized by the Collaborative Practice Agreement (CPA)."