AGNP vs FNP

[NP2BeNY]

I'm currently enrolled in an ANP program that has a primary care focus, and have several coworkers enrolled in FNP programs. We were discussing the pros and cons of each, and several people felt that FNP was more marketable. Conversely, I've heard that ANP is more marketable for the adult population and for hospital-based positions in particular.

Along the same vein, is it worth it to go on for one of these ACNP programs that grant a DNP upon graduation? While I understand that they are different "tracks" It seems like a PhD offers more options for future career growth.

As always, thank you all for your feedback.

[Dranger]

It's not "nitpicking" it; its is explaining to a perspective APN that in-fact a FNP is not a "master of none" and in fact many work in speciality settings. FNPs make up nearly 50% of practicing NPs and function highly effectively in a diverse set of roles.

To answer your questions, I would rather an experienced FNP in any of those roles over a less experienced NNP/ACNP/WHNP. Starting out in practice a ACNP/NNP/WHNP would (likely) have more clinical experience in a provider role in their respective speciality settings, but any novice is a novice, and has a lot of learning in front of them.

Sent from my iPhone.

Honestly that's a strawman argument response, of course a novice is a novice with any specialty.

There wouldn't be a consensus model nor a variety of NP specialties if the nursing powers at be didn't see a difference or preference in certain education pathways.

[guest538567]

The OP asked about marketability of FNP vs ANP. As an ANP/AGNP I think that the FNP has the current edge on marketability as the scope of practice is broader (ie. can see pediatrics). However there are many variables that affect employment such as employer preference, regional variances, etc. There are many FNPs employed in areas that are suitable to ANP practice. I view the ANP/AGNP as the NP specialty that most closely resembles the internal medicine specialty and you can look at all of the many roles and specialties that fall under that category to help guide where you can obtain employment.

I have seen jobs clearly appropriate for an ANP that ask for FNP certification. This does not necessarily exclude the ANP just speaks to the hiring managers familiarity with NP specialties. As with anything, getting a job is about how you can market yourself.

I think the ANP/AGNP is a good choice for someone that knows they don't want to work with pediatrics or has very clearly defined practice goals. I think NP training hours in grad school are far too low already and so there is some benefit in spending all of them focused on a particular specialty or population.

[guest538567]

Also, to Follow up on ACNP vs FNP vs ANP -- As NP's, do many of you feel that your RN experience shaped where you ended up for your first NP job? I'm an ED RN and was told that Critical Care and ED RN's generally have an easier time finding a job in a hospital based on that experience, and they weigh the FNP vs ANP less heavily unless you need to see pediatric patients.

Yes, I think your RN experience can be very helpful in obtaining an NP position. Having critical care or hospital based experience at the RN level would likely give you preference over a new grad NP that is applying for an inpatient job and only worked outpatient as an RN.

[BostonFNP, APRN]

Honestly that's a strawman argument response, of course a novice is a novice with any specialty.

There wouldn't be a consensus model nor a variety of NP specialties if the nursing powers at be didn't see a difference or preference in certain education pathways.

The OP isn't asking about the "nursing powers" preference; the OP is asking about real world experience as an APN, at least to my read. Care to share what your experience in the APN role and APN job search is?

There are many APNs that do not agree with the consensus model, but more importantly, it is distant from current APN practice.

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[Dranger]

The OP isn't asking about the "nursing powers" preference; the OP is asking about real world experience as an APN, at least to my read. Care to share what your experience in the APN role and APN job search is?

There are many APNs that do not agree with the consensus model, but more importantly, it is distant from current APN practice.

Sent from my iPhone.

I work with enough NPs to know who knows their stuff and who doesn't. Last time I checked physicians don't feel the need to be experts on everything (as you deem FNPs do) and willingly consult on a variety of matters for a patient. They know their limit. But hey don't worry FNPs got it all covered and come out of school knowing more about the ICU than a ACNP and more about gynecological health more than a Women's NP. Makes total sense. By your notion, ACNP should do well in primary care too, I mean if there is no real difference from an FNP going from primary to acute then the other way should work as well. Actually ACNPs should treat kids too, I mean since consensus models don't matter right? OJT?

Who cares if they diasgree with the consensus model, its logical. Specializing APN makes them more viable just as physicians do.

You want to work in a hospital? Get your ACNP. That's logical. You want to work broad primary care (with hospital rounding or whatever ) get your FNP.

I work ICU and we have had FNPs drift in here on occasion to treat stable ICU patients and they do not succeed like the intensivists or ACNPs. It's obvious.

[guest538567]

Who cares if they diasgree with the consensus model, its logical. Specializing APN makes them more viable just as physicians do.

You want to work in a hospital? Get your ACNP. That's logical. You want to work broad primary care (with hospital rounding or whatever ) get your FNP.

I work ICU and we have had FNPs drift in here on occasion to treat stable ICU patients and they do not succeed like the intensivists or ACNPs. It's obvious.

I am assuming you are in an ACNP program? I think you are speaking to a broader problem with NP education and the reality of actual practice. I would agree that an ACNP should have more acute care exposure than an NP program that is designed to offer only outpatient or primary care. However, like anything this does not globally speak to who would be the best candidate for a job. My experience has been that grad school really establishes only a foundation for practice but you learn all the essentials after school. A good FNP or ANP can certainly learn critical care and excel at this role as many have already done for years. The consensus model is changing the acceptance of this practice. I personally would rather have a PA model where NPs are trained as generalists (even more so than FNPs) with a significant increase in didactic and clinical training and then specialize after school using residency programs or clinical orientations but that is just my wishful thinking :)

However given the current system, if one wants to practice in the acute care arena it makes since to pursue ACNP and spend all of your educational clinical hours in this realm.

EDIT:

I will add that specialization has really worked in the favor of NNP and PMHNP which seem to dominate their respective fields. I think the difference between those specialties and the ACNP vs FNP/ANP debate is that there is much less clinical overlap.

[BostonFNP, APRN]

I work with enough NPs to know who knows their stuff and who doesn't.

Working in the provider role is far different than it looks from the outside.

Last time I checked physicians don't feel the need to be experts on everything (as you deem FNPs do) and willingly consult on a variety of matters for a patient. They know their limit.

Speaking of strawman arguments: where did any one say that FNPs are "experts on everything"? The original point was that your statement saying FNPs are "jack of all trades and master of none" was incorrect because there are many FNPs that are "masters" of the respective practice areas/specialty. There is a big difference there; and NPs are often much better at knowing their limits than physicians, but that is another matter.

But hey don't worry FNPs got it all covered and come out of school knowing more about the ICU than a ACNP and more about gynecological health more than a Women's NP. Makes total sense. By your notion, ACNP should do well in primary care too, I mean if there is no real difference from an FNP going from primary to acute then the other way should work as well. Actually ACNPs should treat kids too, I mean since consensus models don't matter right? OJT?

Again, see the above fallacy. FNP clinical training includes primary care, pediatric and WH rotations; it also may include tertiary care and specialty rotations. FNPs may graduate with a considerable amount of WH focus, pediatric focus, specialty focus: this is the clinical and educational overlap a previous poster referred to. Conversely (and a ACNP/WHNP/PMHNP/NNP can correct me if I am wrong), there is not much overlap the other way in clinical experience.

Who cares if they diasgree with the consensus model, its logical. Specializing APN makes them more viable just as physicians do.

Viable? Based on what, clinical outcomes? Please share your citation. PAs don't specialize, so I assume that you view a ACNP as more viable than a PA?

You want to work in a hospital? Get your ACNP. That's logical. You want to work broad primary care (with hospital rounding or whatever ) get your FNP.

If you ONLY want to work in a hospital, by all means, its a waste of time to get and FNP over a ACNP.

I work ICU and we have had FNPs drift in here on occasion to treat stable ICU patients and they do not succeed like the intensivists or ACNPs. It's obvious.

I wouldn't think the hospital would continue to credential FNPs if their outcomes were significantly worse than the outcomes of ANCPs.

[Dranger]

Working in the provider role is far different than it looks from the outside.

Speaking of strawman arguments: where did any one say that FNPs are "experts on everything"? The original point was that your statement saying FNPs are "jack of all trades and master of none" was incorrect because there are many FNPs that are "masters" of the respective practice areas/specialty. There is a big difference there; and NPs are often much better at knowing their limits than physicians, but that is another matter.

Again, see the above fallacy. FNP clinical training includes primary care, pediatric and WH rotations; it also may include tertiary care and specialty rotations. FNPs may graduate with a considerable amount of WH focus, pediatric focus, specialty focus: this is the clinical and educational overlap a previous poster referred to. Conversely (and a ACNP/WHNP/PMHNP/NNP can correct me if I am wrong), there is not much overlap the other way in clinical experience.

Viable? Based on what, clinical outcomes? Please share your citation. PAs don't specialize, so I assume that you view a ACNP as more viable than a PA?

If you ONLY want to work in a hospital, by all means, its a waste of time to get and FNP over a ACNP.

I wouldn't think the hospital would continue to credential FNPs if their outcomes were significantly worse than the outcomes of ANCPs.

So let me get this straight, with an average of 600-800 clinical hours in most NP programs you still believe a FNP is just as viable as a specialty NP. With 600-800 hours spread out in a myriad of different areas (100 acute, 200, adult primary, 200 pediatric etc for FNP) you still believe that they are suitable for specialty roles already covered by NPs who do ALL of their clinical hours in ONE area. Really? Really? I mean ACNPs should work in primary too as well ANNP/APNP, I mean whats the big difference between primary and acute care right?

You already know my views on PA vs NP.

[BostonFNP, APRN]

So let me get this straight, with an average of 600-800 clinical hours in most NP programs you still believe a FNP is just as viable as a specialty NP. With 600-800 hours spread out in a myriad of different areas (100 acute, 200, adult primary, 200 pediatric etc for FNP) you still believe that they are suitable for specialty roles already covered by NPs who do ALL of their clinical hours in ONE area. Really? Really? I mean ACNPs should work in primary too as well ANNP/APNP, I mean whats the big difference between primary and acute care right?

You already know my views on PA vs NP.

Again, you are trying to generalize, which is not the point that I made. To answer your question, yes, I do believe that there are FNPs that are every bit as viable in providing care in a specialty setting as other types of NPs.

Is every FNP viable in providing ICU care or OB/GYN care? Probably not, and FNPs (or any other NP specialty) should not practice outside the scope of their education and training (which is the scope of practice in my state).

I never formally trained in the ICU and I don't cover patients there for more than 2 hours before another member of my service takes over; I cover patients in the hospital without any difficulty and my quality measures are in the top 10% of the medical staff. I do almost no WH in my practice so I am probably not a viable NP there either but I don't try to be, I initiate a workup on my differential and refer them to our WH specialist (who is a PA).

On the other hand I have a close colleague that was a CICU RN for fifteen years prior to returning to an FNP program; he did over 500 clinical hours in the ICU alone during his training and he has worked for the past 6 years as a well-respected intensivist at one of the most prestigious academic hospitals in the world, teaches for one of the nations top medical schools as well as several local APN programs. I have no doubt he is every bit as viable as an ACNP. He is not viable as a primary care provider at this time without a refersher, as he would admit. He is (likely) not a viable WH NP either unless there is more than I know.

I am sure there are ACNPs with enough experience to work in primary care, but most don't receive much formal training in it.