Advice on where to start as a new grad FNP

[ivory21]

Hi all, 

I'm new to this community. I'm currently in a FNP program and am aiming to complete by December 2027. I've been a RN for about 9 years now with mostly a cardiac background. I decided to go back to school largely because I don't think I can physically keep up with it when I'm in my 50's-60's and I enjoy learning/desire some more autonomy. 

Some of my colleagues are also training to be FNP's and some have expressed the desire to start off in PCP or urgent care in the beginning to get a develop a good foundation. A colleague who is my unit's APP said she started off in a primary care office and learned a lot before transitioning into other specialities. My friends who are FNPs, however, advised that it's better to wisely pick a speciality instead. 

This conversation reminds me a whole lot of when I became a new grad RN - many people said it was better to start off in Med-Surg, while others pursued their desired specialities off the get-go. I was one who chose a specialty and have not regretted doing so. Unfortunately, I'm not so sure that I want to be a provider in cardiology as I can see that requiring frequent call (although I am glad to have a foundation in cardiology). I'm not against some call, but I can imagine cardiology being called a ton. Also, this does give me a chance to learn more about other specialities in general. I'm assuming specialities pay more as well? 

For the experienced FNPs, looking back, do you think it's better to try PCP/urgent care first and then specialize or do you think it doesn't matter?

 

[traumaRUs, MSN, APRN]

Great conversation!

I can only speak for myself. I'm an adult and peds CNS but am in a full practice state where I have the same practice act as NP. I've been an APRN for 19 years now. My nursing background was 10 years level 1 trauma center ER, 1 year adult ICU plus some years in nursing home as an LPN. 

When I graduated, there were not a lot of jobs. I took a nephrology job which I really do like a lot. I had no nephrology experience when I started. I was hired because I could handle myself with sick vs not sick patients. 

I think going into a specialty right out of school is not an issue. Nephrology would fit perfectly with your cardiology background. (Hint hint). However, any specialty would welcome someone with your experience. 

 

As to call, work requirements, that can all be hashed out in your contract when you get an offer. Best wishes with school and new job and if you happen to live in Illinois, our very large nephrology practice is always looking for NPs

[FullGlass, BSN, MSN, NP]

My first NP Program was AGPCNP.  My first job was in a primary care facility and I am extremely grateful I had this experience.  Unless you are absolutely, 100% sure you want to specialize in a particular area, the primary care experience will be invaluable in providing a wide range of experience.  If you are not sure if you want to specialize, then this experience can help you determine what is of most interest to you.  You may end up being passionate about an area that would never have occurred to you otherwise.

I also don't understand the advice that an FNP should specialize and not do primary care.  In many parts of the country, thaere is a desperate shortage of primary care providers.  So FNP can be a great position for one's entire career.  Pay and benefits for FNPs have gone up a lot, at least where I live.  FNP would also give you the opportunity to be in a Residency or Fellowship after completing your program.  In addition, being an FNP in an underserved area will give you the best chance when applying for loan repayment or forgiveness programs.

Many patients have comorbidities and the primary care experience will help you to better understand the relationships between different diagnoses and conditions.

Most Urgent Cares will no hire new grad NPs.  You will need at least one year of FNP primary care experience.  I worked in an FQHC that had both primary care and urgent care, so we would take turns working in the urgent care.  You could look for a job like this.

I decided to become an PMHNP after working in primary care for a couple of years.  However, I am EXTREMELY grateful an MD mentor advised me to get the primary care experience first.  The majority of mental health care is actually provided by PCPs.  I also learned how comorbidities can contribute to mental health issues - like diabetes, chronic pain, etc.  

I also received job offers from specialists that I had sent a lot of referrals to while a PCP.

The easiest job to get is FNP, hands down.  

However, if all you can get is a specialist position, fine.  But don't feel that is your only option.

Good luck