Acute Care vs FNP, advice needed please

Specialties NP

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Hi all, I am looking for objective feedback from you all. I am at a crossroads. I have been an emergency RN for most of my career, and am now doing critical care education. It feel is time for me to pursue my NP. I love the ER, and am not sure if any of you are working as an NP in this setting. I am also in the midst of my career, and I want to be as marketable as I can be. I understand the differences in the two specialties; ACNP more for hospital setting, etc. I just wanted to know if I decided to pursue a job in the ER, which specialty will allow me to do so. I am having trouble figuring out which track to pursue, FNP or ACNP. I also reside in Florida, so if anyone has more specific feedback on their experiences this would be a bonus! I thank you all for your advice, in advance.

Respectfully,

Kim

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Specializes in Hospitalist Medicine.

It really depends on your state's BON and the hiring practices of the hospital. In my state, there's no distinction between ACNP and FNP with the BON, they consider all "APRN", but some hospitals prefer FNP so you can see patients of all ages (as long as you have a critical care/ER background). Then there are others that want dual ACNP/FNP, or just ACNP. You'll need to find out before deciding which avenue to pursue.

I am doing a dual ACNP/FNP program because I want to eventually work locum tenens in ER and don't want to worry about not having the proper credentials based on different locations.

Do what is going to work best for your local area.

Good luck with your decision :D

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It is highly variable on your state and your individual hospital. In Ohio, you can indeed work in the ED as an FNP. However, at some hospitals (like mine) if you only have an FNP you will find yourself working in the urgent care area. Others might let you on the acute side, but may be less likely to take a new grad FNP because of the learning curve. I have dual certification in ACNP/FNP. I have been working in the ED for some time. I work on the acute side. I intubate, put in central lines, put in art lines, suture, I and D, and put in chest tubes. At this facility, we will not allow FNP's to work on the acute side. End of story. Many nurses have tried to change this policy and have failed. You must be an ACNP to work in the main ED. No FNP will be allowed to do any of the advanced procedures I described above.

That being said, it is highly dependent on the state and the institution. My advice would be to check out the ED's in Florida. What kind of NP's are working there? Are they FNP or ACNP? Do some sleuthing to find out what education you need in your area.

Being faculty for an ACNP program I will tell you this, make sure your education prepares you to perform the job you want. I will always encourage the ACNP over the FNP for ED because the two programs are completely different. Many will disagree with me here, however I have been through both programs. I went back for my FNP to make myself more marketable.

There are some new ENP programs that are up and coming and very exciting for the future. However, some states are not recognizing them yet. Take your time and make an informed choice.

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8 minutes ago, ohiosam2 said:

It is highly variable on your state and your individual hospital. In Ohio, you can indeed work in the ED as an FNP. However, at some hospitals (like mine) if you only have an FNP you will find yourself working in the urgent care area. Others might let you on the acute side, but may be less likely to take a new grad FNP because of the learning curve. I have dual certification in ACNP/FNP. I have been working in the ED for some time. I work on the acute side. I intubate, put in central lines, put in art lines, suture, I and D, and put in chest tubes. At this facility, we will not allow FNP's to work on the acute side. End of story. Many nurses have tried to change this policy and have failed. You must be an ACNP to work in the main ED. No FNP will be allowed to do any of the advanced procedures I described above.

That being said, it is highly dependent on the state and the institution. My advice would be to check out the ED's in Florida. What kind of NP's are working there? Are they FNP or ACNP? Do some sleuthing to find out what education you need in your area.

Being faculty for an ACNP program I will tell you this, make sure your education prepares you to perform the job you want. I will always encourage the ACNP over the FNP for ED because the two programs are completely different. Many will disagree with me here, however I have been through both programs. I went back for my FNP to make myself more marketable.

There are some new ENP programs that are up and coming and very exciting for the future. However, some states are not recognizing them yet. Take your time and make an informed choice.

Didn't your state nursing organization in Ohio adopt the consensus model? Meaning only ACNPs can work in an inpatient hospital role and mandate inpatient FNPs add ACNP?

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On 4/21/2019 at 2:47 PM, djmatte said:

Didn't your state nursing organization in Ohio adopt the consensus model? Meaning only ACNPs can work in an inpatient hospital role and mandate inpatient FNPs add ACNP?

The Consensus Model does not specify setting but rather populations that APNs should be spending the majority of their time caring for. EDs are not considered inpatient either. An FNP can and do work in EDs especially when the majority of the patients they care for have primary care problems/ emergencies. There is also now board certification for ENPs which requires one to be an FNP (regardless of any other APN certification held). They must also have advanced preparation in the Emergency role through either an academic program, residency/fellowship, or work experience. Dual certification is a great option to cover all the bases but won’t necessarily prepare you for ENP certification if that is a goal.

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