Acute PNP vs. Primary Care PNP

[onconurse34]

Hi! Im a BSN-RN with two years of experience in inpatient peds oncology/bmt. I am interested in applying to NP programs for next fall and am torn between acute and primary care routes. I think initially I would love to stay in inpatient onco or onco clinic. However, I could see myself in a few years wanting a change of pace and switching to primary care. Is there flexibility for Acute PNPs to switch to a primary care setting? Would love any advice I've been so stressed out about this!! Thanks

[RN4Shizzle, BSN]

I called UF (a school I'm interested in) and the director of the ACPNP program set up a zoom call for me and answered this question. I totally recommend calling the school you're interested in and letting them help you with it. It's super helpful! I was very much in the same boat as you (and still kinda am, sometimes). 

He recommended starting acute care, then when you're burnt out with the hospital, take a certificate program in primary care then switch to primary care. 

I'm kind of in a situation where I just want to pick the path I ultimately want to end up at. I'm done with call. I'm done with the hospital shenanigans. I think I'm going to go primary care and teach which is my ultimate end game. 

[adventure_rn, MSN, NP]

If you're interested in oncology at all, I would absolutely start with acute care peds.

The thing I've come to find in my acute care peds program is that the role is extremely flexible--you can work in all sorts of specialty roles and clinics, many of which have great hours. I would argue that it's actually a lot easier to find a 'cushy' outpatient acute care role than in primary care. In 'true' primary care, you're seeing dozens of patients per day while trying to squeeze a ton of screenings and teaching into a very short period of time. In my acute care rotations in outpatient clinics and consulting services, many of the NPs had lighter patient loads where they could spend a lot of time on each case (for instance, seeing around 8-10 patients per day).

Beyond that, you might come to find (as I did) that primary care is extremely different from acute. Primary care is heavily focused on developmental screenings, minor infections/injuries, immunizations, skin rashes, and figuring out when to refer. I found it kind of tedious and dull compared to learning the complex patho in acute care.

When I first started looking at schools, I was certain that I wanted to do a combined dual-specialty program for AC and PC in order to have the greatest flexibility--after I actually started learning primary care, I was so glad that I didn't.

[GunnyNurse, BSN, RN]

Both are great specialties. I have chosen AGACNP myself as this specialty only represents a small amount of practicing NPs. There is a large number of graduating FNPs and the job market may be a bit more competitive. You also are trained to perform skills such as endotracheal intubation, central line insertion, chest tube insertion, etc which is really great. As you said, you can always bridge to primary care. The curriculum of many acute care programs cover care across the lifespan which allows a seamless transition to primary care if interested in the future.