Beng told not to become an NP!

Trauma Columnist · Sep 20, 2007

Hi and congrats on being accepted everywhere. That's wonderful. Your job opportunities are usually area-specific. For instance, in my area (rural central IL), NPs are seen more often outside the hospital in offices while PAs are in the hospital. However, the hospitals like the APNs. Look into the geographic area where you want to live and make your decision based on that.

caldje · Sep 21, 2007

some people will argue against what I am about to say, and that is ok.. but this is what I have seen.

FNPs schooling, in GENERAL, is for care of well family practice patients. The differences I see in PA and NP practice is that FNPs tend to be put in clinics where their "collaborating" physicians see the more acute, serious cases and NPs do a lot of "well" exams and med checks/refills.

PAs often see more ill patients. I have been in clinic where there are NPs and docs and no PAs. The PA students are taught by the docs, the NP students are taught by the NPs. I think the experience of being trained by docs lends PAs to be a little more attractive to docs because they have been exposed to the "doc only" cases which seem to be diverted away from the NPs.

This has been MY EXPERIENCE. And is not true everywhere.

core0 · Sep 21, 2007

I need some feedback from the NP's out there. I am a BSN with an extensive critical care background. I have been accepted to FNP, PA, and CRNA programs. I am leaning toward PA or NP. I have had more than a few PA's and RN's tell me not to do FNP. They tell me that there are no jobs and PA's are more respected and readily hired. Please help. I know the difference between a PA and an FNP, but I want to make a good choice. Can I get some feedback from the NP's out there??
Thanks

You have an interesting dilemma. Unsolicited advice (as a non NP) is that first you have to make a decision whether or not to do CRNA. This is sufficiently different than your other choices that this is your first decision point. Essentially do you want to practice medicine or anesthesia. While you could go back and get your ACNP for example after getting a CRNA, the skill set means that you would have a hard time being good at both.

I would echo TraumaRUs on the second point. It is really about the market. If the market is dominated by one type of provider then you will have a hard time getting a job no matter how talented you are. The other thing you have to decide is what type of practice do you want and what are the prospects of the various options. As I stated above CRNA limits you to one type of practice. Depending on your local situation and state FNP may limit you to primary care. Ask yourself if that is what you want to do and look at the community to see if there are primary care jobs.

The third part is money. As an experienced critical care nurse you will probably take a pay cut to work in primary care. Depending on the local market you may take a pay cut to work in specialty care. You have to decide if this is OK to get where you want to go. Virtually the only area that will guarantee you more money is CRNA.

The fourth part is time commitment. Of the three areas that you are looking at two will involve at least two years of full time commitment without a chance to work during school. FNP depending on the program may allow you to work full or part time.

This leads into cost. Part of deciding on an educational program is to look at the cost-benefit analysis. Is the cost of the extra schooling and missed income from nursing worth the the final product (graduating). That said there are many NPs, PAs and CRNAs that attended school when the cost-benefit analysis is not favorable because that is what they want to do.

The final point is what do you want to do? I am somewhat puzzled on how you would get to a point where you are accepted in all three programs. When I interview PA students they have to demonstrate an understanding of the profession and an enthusiasm for the profession. While people can fool me, I have a hard time understanding why you applied for all three if you did not know what you wanted to do (especially the CRNA vs others). Ultimately you have to decide what you want to do. If you are looking for affirmation that you should do the FNP then it seems that you know what you want to do. I would caution you to do that in the setting of TraumaRUs' advice.

David Carpenter, PA-C

core0 · Sep 21, 2007

some people will argue against what I am about to say, and that is ok.. but this is what I have seen.
FNPs schooling, in GENERAL, is for care of well family practice patients. The differences I see in PA and NP practice is that FNPs tend to be put in clinics where their "collaborating" physicians see the more acute, serious cases and NPs do a lot of "well" exams and med checks/refills.
PAs often see more ill patients. I have been in clinic where there are NPs and docs and no PAs. The PA students are taught by the docs, the NP students are taught by the NPs. I think the experience of being trained by docs lends PAs to be a little more attractive to docs because they have been exposed to the "doc only" cases which seem to be diverted away from the NPs.
This has been MY EXPERIENCE. And is not true everywhere.

I'll respectfully disagree. The PAs in our clinic precept NP and PA students and they get the same clinical experience. The only issue is that NPs do not go to the OR and since we precept ACNPs they do not see peds. In general if an organization uses both NPs and PAs in the same role they are used identically. When we are in clinic there is no separation by acuity. Everyone grabs the next up. Of course I work in a very high acuity environment. Your experience may vary of course.

David Carpenter, PA-C

Trauma Columnist · Sep 21, 2007

David - the same is true in my current practice: we have FNPs, PAs, one ACNP and one CNS and we all do the same exact job.

rnsrgr8t · Sep 21, 2007

Congrats PreppyRN on your acceptance to several grad schools!!! I am a pediatric nurse practitioner for the past 3 years.

David had some excellant advice on things to consider when you are making your decision.

I would like to add my 2 cents. It will really depend on what you want to do. My background was always in pediatrics so there was really only one grad school way to go unless I wanted to be a CRNA (which I didn't) so that made my decision easier for me. The market in the area that you are will make a difference too. I work in a hospital and we are used interchangeably with the PA's. The only difference is that the surgical specialities that do not have fellows or residents will use the PA's to assist in the OR and we are not used that way (which is fine with me b/c I do not want to be in the OR). The pay is going to vary widely too. You also need to consider how much independance you would like in your practice. That can vary widely. In the role that I am in, I see/treat patients independantly using my docs as a resource if needed. However, this varys widely from specialty to specialty in my hospital. There are some areas where I do not feel that the APN's are used to their full potential. I worked in primary care prior to this job and made diddley squat for salary so the job I have now doubled my salary. As an acute care nurse with your experiance, that is not going to be the case for you. I did not really care about the increased salary when I decided to go back to school. I was bored in what I was doing and needed a more advanced role which is where I am now and it fits me to a T. I did have to move to a different state for a job after I graduated because the market for PNP's where I went to school was completely saturated and there were no jobs. I knew this though going into school and was prepared to have to move to get what I wanted.

Good Luck!!!

HudsonValleyRN, BSN · Sep 22, 2007

core0 · Sep 22, 2007

Thanks for the feedback. I initially thought I wanted to do CRNA. However I like the idea of seeing and treating patients. I basically already passed on the CRNA. As far as the PA vs NP. I actually do have a very good idea of the difference. While I realize it essentially yields the same product, I would prefer to be trained under the medical model as opposed to the nursing model. The draw of the FNP program is I can do it part-time. However, I don't want to get out and regret my choice. Basically I would like to work in a fast-track ER or an urgent care...that is the ultimate goal. The draw of the NP is working independently. Although that is not my goal, the option would be nice if the desire ever arose. I'm going to be honest, I typically see more PA's out there working than NP's, so I wanted the feedback from other practitioners.
Thanks

The issue with working fast track or urgent care is what do you do if you get bored with it? Are you willing to make that your career. If you choose FNP you are (depending on your state) limited to primary care (not dissing primary care just not my particular cup of coolaid). ACNP or PA offers more career choices in acute care. As for more PAs working in the ER, you are probably correct. The data on NP employment is incredibly sketchy. The best data probably comes from Advance for NP which shows that 3% of NPs work in the ER. Another 16% work in hospital settings and some of those may work in emergency medicine. The survey does not break out urgent care. The full survey can be found here:

http://www.advancefornp.com/resources/NP010106_p34table12.pdf

Contrast that with PA where 10% of PAs work in emergency medicine and another 10% work in FP with urgent care. There are also a number of other areas that would be closed to you with an FNP such as inpatient critical care medicine and trauma services.

The issue with emergency medicine in particular is that this is a case where there is no particular nursing domain that aligns well with it. ACNP limits you to adults which will limit your job opportunities in smaller ERs where you would be most likely to have more independence. Probably the best NP training would be a combined ACNP/PNP(acute) certification which would let you see any patient in that setting. There is an ERNP program at Emory. However, it is an FNP program with additional EM content and the certification is an FNP certification. Optionally there has been discussion about a separate ERNP certification but I am not sure where that is (and I have not seen proposed curriculum for that).

Good luck with your decision

David Carpenter, PA-C

RNCENCCRNNREMTP · Sep 23, 2007

some people will argue against what I am about to say, and that is ok.. but this is what I have seen.
FNPs schooling, in GENERAL, is for care of well family practice patients. The differences I see in PA and NP practice is that FNPs tend to be put in clinics where their "collaborating" physicians see the more acute, serious cases and NPs do a lot of "well" exams and med checks/refills.
PAs often see more ill patients. I have been in clinic where there are NPs and docs and no PAs. The PA students are taught by the docs, the NP students are taught by the NPs. I think the experience of being trained by docs lends PAs to be a little more attractive to docs because they have been exposed to the "doc only" cases which seem to be diverted away from the NPs.
This has been MY EXPERIENCE. And is not true everywhere.

I am an acute care NP and all of my preceptors ere physicians. My choice. I have never fully subscribed to the nursing model and nursing Dx, even as an RN. Do what you want to do, there will be a job.