Acute Care NP or FNP? What should I do?

aemarsh · Apr 24, 2016

Hey everyone,

**I posted this in the general nursing chat and I think it is better suited under this category. My apologies to anyone who has already read this in the general chat- this is my first time posting but not my first time visiting to read :yes: . Links are included at the bottom.

I need some help making a decision on whether or not to change my degree path. Currently I am enrolled in a FNP degree path completing the last two classes of my core course work. I live in Georgia, and last year the state passed legislature to implement the consensus model. I now have to choose where I want to work before I have even started practicing. The lovely thing about being an FNP before was the flexibility of being able to work in a doctors office right out of school and then bouncing to new positions until the "right fit" was discovered. I know a few FNPs that will come due for licensing renewal that have been practicing for 20+ years in the cardiology groups. The FNPs are having to go back to get their critical care degree or extra certifications because they will not be allowed a grandfather status. In my opinion this is crappy, but it is reality. Now I am second guessing my decision though; what do I want to do? How can I decide so early on either?

Here is what I do know:

I don't want to work in the hospital ICU or acute care settings, but I might want to work with a group that rounds on hospital patients. The consensus model language is written that if you work in the hospital at all an acute care degree is necessary and Georgia adopted it as strictly as that it seems. This has many NP's in my hospital scrambling to get the degree to meet their patient population before they are due for license renewal. From what I am reading, the Georgia BON licensing language is vague, but the consensus model stresses acute care nurses work in acute care settings only and family practice nurses work in outpatient facilities only. In getting their Acute care degree they forfeit their FNP degree... you cannot hold licenses in both unless you can work two full time jobs which is not going to happen often. Georgia is very regulated anyways, but this new law is actually causing severe rifts in the NP world since the cardiology NP's rounded on inpatients and saw outpatients at the clinics as well... they will no longer be able to do this. They will have to either work in the hospital or in the clinic, one or the other not both.

---on a side note- this is making PA's look more appetizing due to the hassle. A FNP I work with was saying her cardiologists were very upset all of their NP's are having to take time off to complete clinical time and may not want to hire any more in the future. I am not sure the consensus model is going to do what they intended for it to do, but that is not really related to my problem as much as I am concerned we may have limited job positions available after the dust settles, and I hope it does not affect me when I am looking for a job later.

Lastly, I might want to work in allergy and asthma/pulmonary, cardiac, or orthopedics one day based on my current interests. With an FNP degree can I work in an outpatient facility primarily or is that still considered acute care? Anyone currently working in one of these specialties or know what the best degree is for a specialty clinic with the new regulations?

Any insight personal or observed would be helpful.

Thanks!

Links:

Georgia BON website licensure page: Nursing - Authorization as an APRN (very vague)

APRN Consensus Model | NCSBN (this is the NCSBN consensus model webpage if you need to read up on the consensus model)

**IMPORTANT** changes to licensure for FNPs working in acute care | Gwinnett Forsyth Chapter United Advanced Practice Registered Nurses (this is a synopsis from an Emory University Professor that I found helpful)

https://s3.amazonaws.com/enp-network-assets/production/attachments/52431/original/FNPs_acute_BON.pdf?2015 (This is somewhat of a way to attain a grandfather status but still requires new certifications and clinical time for qualifying FNP's already working in a hospital setting- better than nothing for them but not helpful for future FNPs)