Critical care NP programs vs. regular NP programs...

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I've been contemplating going back and getting my NP (peds). For a long time I was only interested in the critical care programs (Duke, Vanderbilt, Rush and Penn) because that's my interest (currently a PICU RN). I've talked with a number of MDs recently and everyone of them said that of the NPs that they worked with who graduated from a critical care program, none of them were able to hit the ground running; they all needed a lengthy preceptorship with training in how to put in lines, intubate, vent management etc.

When I talked with them further, they all said that they would be just as happy with a basic NP degree and that they would train as long as the NP had ICU experience.

Couple that with the fact that from what I've heard, only Penn is a true critical care program, the rest are "acute care" with most of the focus being chronically hospitalized children I'm wondering what the point of doing the specialized programs. They are expensive and not close to where we live (although Vandie and Rush have a significant on line component).

If you've made it this far, my thanks. I'd love your thoughts.

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Specializes in Nephrology, Cardiology, ER, ICU.

Hi there and welcome. My thoughts for APNs to be are that you investigate the market in your area for APNs BEFORE you commit to a program. I think you are going at it the right way. Personally, in my area, there are few APN jobs period, so you consider yourself lucky if you are able to get even close to what you want to do. It sounds like you have done your homework. So, I gather now you are considering an FNP or Adult Health NP?

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Hello Climberrn! I am currently working in an adult critical care environment. My training is in adult ACNP. There is truth to what the physicians you talked to are saying, at least I know this for sure in the adult ACNP area. I am saying this because the adult ACNP program I attended has a critical care NP option. However, there is really nothing different in terms of the didactic portion of the training between the traditional ACNP and the critical ACNP in the school where I graduated from. The difference lies in the clinical rotations - the critical care NP track students have strictly critical care clinical rotations.

I actually chose the traditional ACNP route because I wanted to have a broader scope of training. I did internal medicine, cardiology, ER, and adult MICU rotations as a student. I ended up being employed in critical care and did have a lengthy orientation period of six months! Learning technical skills was my biggest challenge (putting in triple lumens and introducers, chest tubes, and bronchoscopy). I thought arterial lines were a piece of cake because we have been doing ABG draws as an RN but I found that it can be challenging too when there are no radial sites to use and I had to go with the femoral and axillary sites.

The intensivists in our group do prefer NP's with critical care background as an RN but are not very particular about whether the NP underwent critical care training in their NP program. If the docs where you work seem interested in hiring you as an NP after you graduate, I would just follow their advice and continue being a good critical care nurse that they know you to be.

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Trauma RUs: actually I'm looking at a pediatric critical care NP. It limits my options school wise but peds is all I've done and I love it.

PinoyNP: Thanks for your thoughts. It's good to hear that I"m not totally off base. I think that as long as I could make my rotations more CC oriented I could be okay. Much to think about...

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Trauma RUs: actually I'm looking at a pediatric critical care NP. It limits my options school wise but peds is all I've done and I love it.

PinoyNP: Thanks for your thoughts. It's good to hear that I"m not totally off base. I think that as long as I could make my rotations more CC oriented I could be okay. Much to think about...

Consider one of the DNP programs. I'm not sure if they have one yet for peds, but in theory you could do the base PNP program and then do your extra work in Peds critical care. The 1000 hours should give you enough practice in the techical skills.

David Carpenter, PA-C

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David, I'm sure I'll kick myself but, what does the D in DNP stand for?

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Specializes in Maternal - Child Health.

Doctorate of Nursing Practice. A clinically-oriented doctoral program.

I believe Rush offers this degree. I used to work there, and know that their NNP and PNP programs are well-regarded. I wasn't aware that they offered a pediatric critical care NP program.

PNPs are pretty widely used in the Chicago area in pediatric offices, hospital units and health departments. It also seems that just about any hospital that offers maternity services employs NNPs. I don't know about the demand for peds critical care NPs.

Best of luck in your future education and practice!

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David, I'm sure I'll kick myself but, what does the D in DNP stand for?

Doctorate of Nurse Practitioner. This is an extension of the NP role with extra classes in pathophysiology and pharmacology. There is also a requirement for 1000 hours of clinicals specific to a dedicated nursing practice. This is the theory, I'm not sure how this works in reality. In theory if you entered a DNP peds programs you would do a basic PNP then expand the role or make a more defined role. In this case, 1000 hours of peds critical care would be a pretty good start on this. This would still let you have the basic PNP to fall back on if the job market does not materialize.

In the adult world the common tactic was to do an FNP which would allow you to see essentially any patient. With the advent of the ACNP some hospital credentialling committees are looking at the training of the FNP's and the scope of practice for the FNP and finding that the scope of practice does not cover critically ill patients. In our area they are still allowing FNP's to continue to practice but refusing new FNP's credentialling (they are allowing individuals that can document inpatient experience if their physician goes to bat). We don't have any PNP's doing inpatient medicine in our area so I am not sure how this is going to play out. PNP actually has a similar problem with ACNP. There are now two different ACNP exams with different scope of practice. Similarly there are two PNP exams with different scope of practice. The ANCC is a general certification while the PCNB exam is in either critical care or primary care and it looks like you have to choose. This is an ongoing problem and does not recognize how most private practices operate.

The presence of multiple credentials is very confusing to hospital credentialling committees and there is substantial pressure to use one credential or the other. I would guess they would go with the more restrictive credential. It is also interesting that the FNP requires 1000 hours of clinical practice for recertification. While one could argue that cardiology or rheumatology is an outgrowth of family practice, it is hard to see how an NP working in surgery or critical care can document 1000 hours of clinical practice as an FNP. There are some NP's that argue that these NP's should not be allowed to recertify if they are not practicing in family practice.

Overall it is a very confusing situation and I'm not sure how it is going to play out. While the NP educational programs seem to turing out NP's for academic environments, they seem ill suited to specialty practice which demands both inpatient and outpatient skills (just my opinion).

David Carpenter, PA-C

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Specializes in Education, FP, LNC, Forensics, ED, OB.
Doctorate of Nurse Practitioner.

David Carpenter, PA-C

You almost have that right, David.;) It is Doctorate of Nursing Practice.

To climberrn, here is a link regarding this degree:

https://allnurses.com/forums/f34/doctoral-degree-become-np-160044.html

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
It is also interesting that the FNP requires 1000 hours of clinical practice for recertification. While one could argue that cardiology or rheumatology is an outgrowth of family practice, it is hard to see how an NP working in surgery or critical care can document 1000 hours of clinical practice as an FNP. There are some NP's that argue that these NP's should not be allowed to recertify if they are not practicing in family practice.

This can actually be a tough issue for NP's not practicing in their specialty. During school, our faculty members cautioned us against seeking employment in strictly primary care roles because we may end up having difficulty re-certifying with ANCC. Looking though the ANCC website for requirements for re-certification, it appears that the practice requirement is very minimal - just "1000 hours in an NP role during the five-year certification period". However, it adds that "practice must be in the area of specialty certification".

On a positive note, a loophole does exist in this system because the requirements further add that "practice may occur in a variety of settings, and may be for compensation or volunteer". A few NP's I know who are certified as FNP but are working in acute care have offered volunteer work in inner-city free clinics providing primary care in order to meet the practice requirement for re-certification.

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PNP actually has a similar problem with ACNP. There are now two different ACNP exams with different scope of practice. Similarly there are two PNP exams with different scope of practice. The ANCC is a general certification while the PCNB exam is in either critical care or primary care and it looks like you have to choose. This is an ongoing problem and does not recognize how most private practices operate.

I had heard that was the reason more PNP programs were going away from Critical care, per se and moving towards the "acute care" model. This way both worlds were encompassed and the NP could qualify for both exams and both practitioner worlds.

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Specializes in ICU, ER, HH, NICU, now FNP.

No wonder the states and medical boards feel the need to try to step in and mandate things - This multiple standards thing is just plain nuts. We are sometimes our own worst enemy.

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