Acute Care NP vs FNP--advice, experiences?

allnurses Guide · Jun 2, 2016

It sounds like your only interest lies in acute care so it's a pretty obvious choice for you (ACNP). The only place where a FNP might be benefit for you would be in ED position. Before you invest, spend some mor time as an RN in acute/intensive care and shade some NPs in different areas.

Editorial Team / Admin · Jun 2, 2016

Moved to Student NP forum.

evolvingrn, BSN, RN · Jun 2, 2016

Sounds like acute Care. I do not like codes! I am an fnp and it's perfect for me. I still see crazy stuff but I rarely get the adrenaline rush

Rocknurse, MSN, APRN, NP · Jun 2, 2016

I'm in an acute NP program and I spent most of my career in critical care and acute dialysis. I do not want to do primary care and I can see myself working inpatient with some possible office visits when I graduate. I chose the acute track because I've only ever worked inpatient and I have no interest in working with children. I would like to work with bioidentical hormones in the future but I plan on working in a hospital environment for a while. I recommend trying to get a position in the ICU and working there for a while to see how you like it and then pursuing the acute track. Most big hospital systems require acute NPs in the ICU these days.

pro-student · Jun 3, 2016

You really need ACNP to work inpatient. Some primary care NPs (which includes all FNP) get away with it but you really don't want to skimp on your education especially if you're sure you don't want to do outpatient/clinic. Also, ACNPs hold positions across the spectrum of acute care from ER, ICUs, step downs, and hospitalist giving you lots of options within the SOP.

soyoureanurse · Jun 5, 2016

Thanks!!

Aik0 · Jun 6, 2016

I'm here to follow this trend. Wanted to also add that when I was looking at programs, the coordinator for the NP program told me that a few weeks ago she went to a conference where insurance are now re-structuring the way they reimburse. She told me that they will no longer reimburse NPs that practice outside their "scope" (ie: a FNP in a hospital/acute care setting or an ACNP in a primary care setting). She said that it's because that's where the future is heading, it's more important to decide exactly where you want to practice because hospitals and doctors will no longer be hiring just any kind of NP to practice because hiring the "wrong" kind of NP can result in the office or hospital not getting reimbursed for their services...just FYI. So even though you know FNPs who work in acute care now, that will no longer be the case in the future.... I'm going for FNP (mainly 'cuz I already got into the program and it's too much work to reapply getting LORs and writing essays). I just found out after talking to the recruiter that ACNP can work in the OR as a second assist and round on patients in the hospital. I was initially told by the PA that NPs couldn't do first assist. I would much rather work with adults than kids...so after my FNP program, the local university has an acute care NP program that will just take another year...but now I can't really switch tracks. Whatever happens my main concern is finding a job after I graduate to pay off student loans!!!

DesertSky, BSN · Jun 12, 2016

Hello! I am planning to go back to school to get my nurse practitioner. However, I am having a hard time deciding which track to choose. Some background--I've been an RN for a short period of time (8 months) and do not currently work in critical care. I work in Med Surg. However, when we have a rapid response I am one of the first people in that room and I'm right at the head of the bed with respiratory where all the action's happening getting O2 set up, bagging, giving boluses, etc. I love it. I love the adrenaline rush. That's the kind of stuff I want to do. Recently I accepted a position on a step-down ICU floor and I'm like a little kid on Christmas morning--I'm so pumped. These patients will be higher acuity and so I'm hoping that will help me determine if I truly want to do acute care NP. Now, my question(s)--I've read on other forums people suggest going for FNP as it has more options on where to work, is that true? What places could I work as an FNP? I, personally, am not interested in working in a doctor's office or clinic. Now as an acute care NP I could join the hospitalist team, but do I need to have the acute care NP track for that? I read some people were recommending the FNP program so that when you decide to slow down you don't have to stay in the hospital. Can FNP's join the hospitalist team? Can acute care NP's work in other areas? Thank you for your advice, sorry, that's a lot of questions!

Sounds like your interest is geared more towards ACNP. Just a heads up - most programs I have seen require at least one year of ICU experience for acceptance to the ACNP track. :)

mcleanstrong · Jun 14, 2016

Hi there! Just putting my $0.02 in here....

I have just graduated from a FNP program. I've been a nurse for about 10 years with most of my experience being on a med-surg/telemetry/progressive care unit. I also liked the action of codes and the adrenaline that came with it, but I'd had my fill of being a hospital employee for now, so I knew that I wanted to practice as an NP in the outpatient setting.

Initially I chose the Adult-Gero Primary Care track, but after my first semester, someone mentioned to me that if I ever wanted to work in an ER or urgent care where there may be a pediatric patient, it would be wiser and more marketable to take the FNP route. So I switched. I'm glad I did, as I will likely end up in an urgent care to start.

It sounds like you know that you want to stay inpatient, so for that reason alone, I would definitely take the ACNP route. It seems the trend is that employers and the boards of nursing within the individual states are starting to regulate more closely that NPs practice within the scope in which they were trained. I went to a Barkley live review course a few months ago, and he spent a great deal of time discussing practicing within your scope. He basically stated that as an FNP, yes, a hospital might hire you without a problem, but it's your license on the line if something happens and you were found to be practicing outside of your scope.

For you, I would NOT take the FNP route just on the off chance that at sometime in the future, you *might* want to be outpatient. If you see yourself staying inpatient for the foreseeable future, I would start with acute care.

Worse case scenario? You go back in a decade and do a post-master's certificate program in whatever it is you're interested in. My program was full of nurse practitioners who had obtained one certification and wanted to switch areas or wanted to be dual certified. Keep in mind you're not bound to stay wherever you start. You might need to take a few extra classes and rotations to switch patient populations and foci, but it's doable, and many do.

MallysMama · Jun 20, 2016

Just wanted to add that an ACNP can do specialty outpatient care too (though most roles I've seen combine inpatient and outpatient into one job). You could round on patients in the hospital and then see the clinic patients for that service as well. So- just know there are more options than just being in the ICU or a hospitalist.

I think that even if you find a program that doesn't require ICU RN experience- it would greatly benefit you to have it anyway. Even if you don't want to do critical care as an NP, ACNP programs seem to focus heavily on it, and being familiar with the setting is helpful.