Best path for more work options post MSN?

Jules A, MSN · Sep 1, 2015

No clue about the costs or time but in my area PAs are utilized more than NPs in hospitals. If I understand you are not an Acute Care NP?Imo PAs get a better, more practical education if you are focused on acute care. I would not get a FNP if you want to work in a hospital as the trend is now heading toward specialty certs like ACNP

allnurses Guide · Sep 1, 2015

Sorry I wasn't clear. I am an ACNP and work in acute inpatient setting. I am talking about getting post-masters FNP vs PA to give me the option of caring for all ages in more settings.

Jules A, MSN · Sep 1, 2015

Sorry I wasn't clear. I am an ACNP and work in acute inpatient setting. I am talking about getting post-masters FNP vs PA to give me the option of caring for all ages in more settings.

Got it. Are you thinking about changing to outpatient? Their schedules can be more flexible but just personally I can't imagine wanting to leave my hospital gigs. Although they might not be abundant I would bet if you did some digging among your contacts you could find someone who would create a part-time job for you or perhaps even a job share with a PA?

I'm all for education if it moves us forward but imo if you have a specialty cert the FNP is lukewarm, unless you want to do OP stuff with peds. My guess is a ACNP could do most everything a FNP can and definitely anything a PA can, right?

PG2018 · Sep 1, 2015

I think PA school hung the moon. I really like it from the outside looking in. My wife's little sister will soon start PA school, and she used my discussion of NPs versus PAs in her interviews. However, unless you're wanting to become inimately involved in surgery, then I'd say you're wasting money, time, and time you could be making money by going to PA school as a NP. Depending on the part of the country, FNP can be obtained without any undue outlay of time and resources.

I think the problem with being a NP is that it's too niche. Look at psychiatrists, for example. That's a pretty niche field in medicine, but they are totally unrestrained, licensed physicians who happened to be specially (board) certified in psychiatry. It's entirely personal preference or operating procedures that dictate what they do. I see them frequently diagnosing and prescribing things totally unrelated to mental health, but they can because they're physicians. Then again, there are others who won't discuss anything related to non-behavioral or behavior-induced somatic stuff.

For us NPs, we're too compartmentalized, and I think we should follow a more generalized PA model (exposure to all the organ systems and their typical pathologies) before we specialize. That's just my $0.02. So for what it's worth, keep the change.

With respect to acute care NPs, well, I worked with them some when I was a RN in the ER. They'd come down and do their hospitalist crap, and then of course a hospitalist physician would come down and do it all over again. No clue how that's cost saving. It's totally log jamming for the ER, however. They had no idea how to treat OM but they could handle an old person with syncope and fall well. (If the reader isn't aware, most ERs throw a very comprehensive, and costly, battery of tests at an old person with syncope.) When the ER would be full and the UC side would be lighter the FNPs would come over and so some of the more, typically obvious stuff like some syncopes, GI bleeds, etc. Most often, they'd leave something out, skip over something, not foresee something, etc. However, they were really great with OM. Personally, I'd rather be great with OM myself as I don't happen to keep handy vasoactive drips, EKGs, etc., but I do have a darn good otoscope at home and a wide array of antibiotics stockpiled. Anyhow, this reiterates the compartmentalization of advanced practice nursing. In this state, the adult ACNP can't work with kids obviously, but the FNP can do kids in critical care settings as well as adults, lol. I really have no idea if ACNPs can operate in a primary care type of clinic, but they're routinely found in cardiology, pulmonology, etc. Go figure. It's ridiculous and advanced practice nursing is over regulated and politicized.

sailornurse · Sep 2, 2015

Well to add to the confusion, the 2 local hospitals use both Acute CareNP/Acute Care Gero NPs/ & FNPs as hospitalists. They are IT when they are on schedule. No physician in house for backup. They can call someone else for consults, but they do all the admits, rounds etc. Both hospitals use FNPs in the ER. BUT NP's here have independent practice so that probably has something to do with this. I think it depends on what part of the country you're in and what the practice environment is. IMO-FNP is most marketable, I know one FNP who works in a cardiology practice along with a ACNP. FNP working dermatology also. I agree with Jules that inpatient is now going to Acute Care/Gero NPs and that is why the school I attended for FNP now has ACGNP plus FNP & Pediatric NP. They got rid of midwifery & women's health NP a while back.

Dranger · Sep 3, 2015

PA school is too much of a time sink in my opinion especially if you want to have another kid. It's a full time gig and I have no PA friends who worked really while in school.

I would go post-masters. PA school is a ton of time commitment and you are reinventing the wheel for no reason to get a generalist education.

Dranger · Sep 3, 2015

I think PA school hung the moon. I really like it from the outside looking in. My wife's little sister will soon start PA school, and she used my discussion of NPs versus PAs in her interviews. However, unless you're wanting to become inimately involved in surgery, then I'd say you're wasting money, time, and time you could be making money by going to PA school as a NP. Depending on the part of the country, FNP can be obtained without any undue outlay of time and resources.
I think the problem with being a NP is that it's too niche. Look at psychiatrists, for example. That's a pretty niche field in medicine, but they are totally unrestrained, licensed physicians who happened to be specially (board) certified in psychiatry. It's entirely personal preference or operating procedures that dictate what they do. I see them frequently diagnosing and prescribing things totally unrelated to mental health, but they can because they're physicians. Then again, there are others who won't discuss anything related to non-behavioral or behavior-induced somatic stuff.
For us NPs, we're too compartmentalized, and I think we should follow a more generalized PA model (exposure to all the organ systems and their typical pathologies) before we specialize. That's just my $0.02. So for what it's worth, keep the change.
With respect to acute care NPs, well, I worked with them some when I was a RN in the ER. They'd come down and do their hospitalist crap, and then of course a hospitalist physician would come down and do it all over again. No clue how that's cost saving. It's totally log jamming for the ER, however. They had no idea how to treat OM but they could handle an old person with syncope and fall well. (If the reader isn't aware, most ERs throw a very comprehensive, and costly, battery of tests at an old person with syncope.) When the ER would be full and the UC side would be lighter the FNPs would come over and so some of the more, typically obvious stuff like some syncopes, GI bleeds, etc. Most often, they'd leave something out, skip over something, not foresee something, etc. However, they were really great with OM. Personally, I'd rather be great with OM myself as I don't happen to keep handy vasoactive drips, EKGs, etc., but I do have a darn good otoscope at home and a wide array of antibiotics stockpiled. Anyhow, this reiterates the compartmentalization of advanced practice nursing. In this state, the adult ACNP can't work with kids obviously, but the FNP can do kids in critical care settings as well as adults, lol. I really have no idea if ACNPs can operate in a primary care type of clinic, but they're routinely found in cardiology, pulmonology, etc. Go figure. It's ridiculous and advanced practice nursing is over regulated and politicized.

I have never seen an FNP in adult ICU and would be very leery of a place that staffed with them (akin to staffing a psych practice with FNPs as psych providers). The ACNPs around here round and do the procedures not taught in FNP programs and are solely inpatient for a reason. However, I have seen ACNPs in specialty clinics. ACNPs are not trained for primary care so they would not be found there. My school's primary hours for rotations are almost all inpatient IM and specialty services only.

I agree that FNP provides the broadest scope and that FNPs can stretch over to inpatient but asserting they have a staple place in most critical care settings is not likely (not saying you are). Maybe in a small rural hospital but the majority of ICUs will not have them.

core0 · Sep 3, 2015

Sorry I wasn't clear. I am an ACNP and work in acute inpatient setting. I am talking about getting post-masters FNP vs PA to give me the option of caring for all ages in more settings.

I'll say as a PA it doesn't make sense. If you look at the time you are looking at 24-29 months full time (ie little to no outside work). In addition its unlikely you have all the pre-reqs so factor in that time. Around here post masters FNP is three classes + clinicals (750 hours to less depending on what credit they give you). That would give you adult inpatient + adult specialty + primary care. For what its worth you could add Peds ACNP and then do peds inpatient. The only time it would make remote sense is if you wanted a surgical job in places that only hire PAs for surgery. Even then that would hardly be congruous with your goal of cutting back time.

allnurses Guide · Sep 5, 2015

Thanks all - interesting points and I agree with you all.

I think Jules is right - the best path for me is probably sticking with ACNP/inpatient acute setting and just twisting my boss' arm into creating a part time or job share position. I am not hugely confident as they refused to do so for one of my staff who had a kid last year (and she left for a PT job). We'll see. Thanks again.

PG2018 · Sep 5, 2015

I have never seen an FNP in adult ICU and would be very leery of a place that staffed with them (akin to staffing a psych practice with FNPs as psych providers). The ACNPs around here round and do the procedures not taught in FNP programs and are solely inpatient for a reason. However, I have seen ACNPs in specialty clinics. ACNPs are not trained for primary care so they would not be found there. My school's primary hours for rotations are almost all inpatient IM and specialty services only.
I agree that FNP provides the broadest scope and that FNPs can stretch over to inpatient but asserting they have a staple place in most critical care settings is not likely (not saying you are). Maybe in a small rural hospital but the majority of ICUs will not have them.

I'm merely reporting not condoning.

Nursetonp · Sep 9, 2015

I see you are from PGH. I have a friend that works for Upmc and she was able to talk them into working one day a week after working full time (although she has worked for the same doc for the past 5 years) I think it all depends on who is in charge and what they are willing to do. But I say try try try! It can't hurt to go after what you really want.