Acute Care NP

Advanced Practice Columnist / Guide · Aug 9, 2010

i graduated from an acnp program in dec 03 and was initially certified as an acnp in apr 04. i had a job offer in jan 04 but opted to start my new job in may 04 because i wanted to devote time for board review and make sure all my certifications are in place before starting np work.

as acnp’s, we’re trained in the management of hospitalized adults in a hospitalist-like role or in specialty care of patients in acute or critical care settings. that’s the strict sense of what we are trained to do but i would be lying if i say that you’ll never find acnp’s practicing outside of that realm.

knowing how bad the economy is right now and taking that into consideration, i still feel that in major cities and larger metro areas, acnp’s will continue to have favorable job prospects. hospital medicine has become so advanced and complicated that the traditional team of attending physicians and residents caring for a patient in a hospital setting has become inadequate. add to that the fact that resident hours are being limited by acgme and the current hours may continue to be cut back.

this is the age where 24/7 coverage of patients with a team of highly-trained providers who can manage patients with advanced disease and on advanced therapeutic modalities (mechanical circulatory device patients, transplant patients for example) any time of the day or night. of course, i’m not saying that np’s have replaced physicians in this setting but rather, np’s have become adjuncts to physician services and have received specialized training in specific population-based care especially in these kinds of complicated diagnoses.

most of the openings i’ve seen for acnp’s appear to be in high-tech care (lvad coordinators, transplant services, icu’s) although majority of my classmates have been hired in general cardiology, surgical specialties, hospitalist roles, trauma services, and other high acuity roles. however, be aware that while there is definitely a demand in these areas, pa’s are also just as capable and trainable in these settings and can be in competition with np’s in a few job markets.

i definitely like being an acnp and love being in the icu as an np. the tradeoff is that the hours are out of whack (day/night rotations, holidays and weekends) but the fact that i only work 3 12-hr shifts a week is a plus for me. with that said, there are acnp’s who only work during the days and do not have to work weekends and holidays either. i just think the acnp role is definitely not for those who want to do only office work or be autonomous as a primary care provider. the complexity of our patient population does not allow that and no less than a multidisciplinary team of professional are required in our work settings.

MBARN · Aug 10, 2010

Thank you so much Juan. Have you known any ACNP that also have received their CRNA? I work in a busy, well known cardiac intermediate care facility so I am getting good training. Would like to start NP next summer do full time and full time work!

Advanced Practice Columnist / Guide · Aug 10, 2010

I used to work with an NP (not trained as an ACNP) who worked with us in the ICU who later took time off from being an NP (or a practicing nurse for that matter) to attend CRNA school. I have not spoken to this person since school started so I have no updates on how things are going.

MBARN · Aug 10, 2010

Thank you Juan, would be interesting to hear. I am older but will be continuing to go to school for quite some time. Will get that PhD in nursing and research after I can no longer teach. I don't plan to retire. I also have an MBA so I do think I am in a very good position to further my nursing career. What I love about it is the patient interaction and the CRITICAL SKILLS!

hrodgers · Nov 9, 2010

Anyone have recommendations for the top 5 or 10 Acute Care NP programs??

Advanced Practice Columnist / Guide · Nov 9, 2010

There's really no official rankings of top ACNP programs. Many people refer to US News and World Reports annual ranking of graduate degree programs in nursing but if you look at their rankings, there is nothing for Acute Care NP programs. This is probably due to the fact that ACNP programs, both adult and peds, are relatively new (if not the newest NP tracks to be recognized from a regulatory and reimbursement standpoint). There are universities that have earned a distinction as well-respected nursing programs but the designation tends to be based on peer review (as is the rankings from US News...) or the strength of their nursing research capabilities (amount of NIH-NINR funding). No rankings really address the strength of clinical training, well-rounded curricula, expertise of clinical faculty, extent and reach of student clinical resources and placements, and quality of graduates. With that said, you're probably best making a list of what you would like to see in an ACNP program and asking around from various ACNP graduates from different schools and figuring out which school matches the criteria you set for yourself.

hrodgers · Nov 9, 2010

All very good points, thank you! Just from looking online, my top three programs so far are: University of California at San Francisco, University of Pennsylvania, and University of Virginia. I work at a VA hospital right now in the MICU for the past 2 years, and I would really like to continue a career with them so my search has been somewhat limited to programs near VA's.

Like other posts I've read on this topic, I too was interested in becoming a CRNA for the longest time but after starting to devlope as a nurse, now I'm leaning more towards ACNP. I've read a lot of your posts, so I know your description of the job and it sounds really awesome and very much up my alley! I love the ICU, the procedures, the drugs, the codes, the patients, the families and can't even remember why I was so drawn to the OR and CRNA...

I have heard horror stories though of nurses getting this degree and then not being able to find a job utilizing it, man that would suck! I would really love to go to an awesome program and know a job was waiting for me in the same area (moving is a pain) when I graduated. Is that just asking for too much? Comments/advice? Thanks again!

Advanced Practice Columnist / Guide · Nov 10, 2010

hollyw22, are you still in Gainesville, FL? I ask because I've met an ACNP who works for Shands in the ICU and it sounds like they have a team of ICU NP's there. I'm sure you'll find VA hospitals that have NP's in the ICU. You mentioned some excellent school choices but don't rule out the universities in your area. It will cost you less money and you may be pleasantly surprised that they are just as good.

hrodgers · Nov 10, 2010

Yes I am still here in Gainesville and I'm wondering if we know the same people. I have been put in contact with a few ACNP's at Shands and I've already began communicating with them, hoping to set up a time to shadow them and see what the real day to day activities can include. I know UF offers the program and I do plan to apply, I just kind of wanted to branch out and see what other opportunites were available in this big country of ours. And I heard a lot of UF's program is online, which I don't love the sound of. BUT I do hear you about the cost, so maybe I should just suck it up, get the degree, and then explore for jobs in a few years....thanks again!

allnurses Guide · Nov 13, 2010

If you're interested in Pittsburgh, U Pitt has a good ACNP program and lots of jobs at local hospitals for NPs.

hrodgers · Dec 19, 2010

U Pitt sounds good too, I visited Pittsburgh a few years ago and had an awesome time there! ghillbert - did you get an ACNP degree from there or how is your opinion of the program based?

Lately, I have been really leaning towards UPENN's program and I'm wondering if there is anyone out there that can comment on it? The good/bad/ugly/anything! Also, how much $ am I looking at for the ACNP program? THANKS!