critical care NP question

CrufflerJJ, BSN, RN, EMT-P · Oct 30, 2012

Melissa -

Yes, it's quite possible to go straight into grad school after you graduate (depending on the school & grad program). You'll probably get a variety of viewpoints from your post as to what's the best approach to achieve ACNP.

My perspective is that it would be good for you (and for your patients) to get a year or two of direct bedside experience in an ICU before going for ACNP.

I felt this same way when I went to EMT-Basic school twenty-mumble years ago. While it was possible to go straight from EMT-B school to EMT-Paramedic school, I felt that it would result in what I call a "shake & bake" paramedic. You'd end up with the spiffy neato-keen NREMT-P certification, but would have almost ZERO real world experience upon which to base your scene safety/pt care decisions. How would it be possible for a "shake & bake" whatever-level-of-practitioner to step back & see the big picture if you're still at the skill level of having to focus on each & every little teensy tiny baby step of the process? I ran as a basic EMT for 2 years before going through paramedic school, and always felt that this time was well spent.

Having worked for a year or two as an ICU RN would also give you the "street creds" with the nurses coming to you with patient concerns. Rather than basing your actions/replies on "well, the textbook approach is such & such", you'd be able to respond with confidence, basing your decision not only on "book smarts", but what you've seen & done as an ICU RN before going on to ACNP.

The ICU can definitely be a fast paced, demanding, stressful environment. Is it fair to your critically ill patients for you to be learning the basics of critical care nursing WHILE trying to stabilize/heal them? I don't think so.

That being said, I think I've seen posts on allnurses taking the opposite approach, saying that there's no need to work as a RN before going on to a NP role.

Sorry, but that approach is not for me.

You might want to shadow a few shifts in a busy ICU before deciding if ICU-RN or ICU-ACNP is a good goal for you.

Good Luck!

SycamoreGuy · Oct 30, 2012

I have been looking into FNP and ACNP programs as well. All the ones I have seen require a minimum of one year of experience and some want two or more. I'd start looking at where you want to go and meet the requirements from that.

myelin · Oct 31, 2012

even in my direct entry program, they require that the ACNP students step out and work as a RN before earning the MSN. It's one of the only specialties where that's a requirement.

Advanced Practice Columnist / Guide · Oct 31, 2012

Most if not all ACNP programs require some form of experience as an RN in the acute care setting. Even direct entry programs require students to take a break after the RN portion in order to allow students to find employment at the bedside as an RN. ACNP programs do not require critical care experience to get admitted. Critical care is only one area that ACNP programs train students on.

Since you're still an undergraduate student in a nursing program, allow yourself some time to really understand critical care as an area of nursing practice. Ask for a preceptorship in critical care in your senior year. The field can be busy for a nurse if that's what you mean by "fast pace environment" and "constantly on my toes". However, a lot of critical care is really about sitting back, looking at the patient as a whole, and tying together the multi-organ physiology that is happening to the patient in order to find ways to manage critical illness and assist in recovery. Codes happen and fast decisions have to be made in those instances but more often than not, the field requires a more "cerebral" approach to patient management rather than a quick fix.

If your goal is to become a critical care NP, it is highly recommended that you also have experience as a critical care nurse. I've been a critical care NP since 2004 and whenever there is an open position in the places I've worked, applicants considered for interviews typically have experience in high acuity ICU's, have CCRN certification, or have worked as a critical care NP somewhere else.

Aymese · Nov 2, 2012

Melissa -
The ICU can definitely be a fast paced, demanding, stressful environment. Is it fair to your critically ill patients for you to be learning the basics of critical care nursing WHILE trying to stabilize/heal them? I don't think so.
That being said, I think I've seen posts on allnurses taking the opposite approach, saying that there's no need to work as a RN before going on to a NP role.
Sorry, but that approach is not for me.

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Ditto to above. I encourage you to reach your goal of ACNP if that is what you desire. However I really think you should get some ICU nursing experience for 1-2 years before entering grad school. I don't think it's really necessary to have floor experience beforehand. Others have different opinions about that too, I'm sure you will fid.

In ICU, you will find it very fast paced, challenging, and sometimes even scary as you first start. Just food for thought...Do you know how to troubleshoot or analyze PA catheter waveform? Do you know the differences between assist control, pressure control, pressure support ventilation and when a patient should begin weaning trials? Have you been involved in codes? These are just a small example of valuable experiences that you will gain as an ICU nurse. To have a basic foundation in critical care before becoming an ACNP will be very valuable to you. I believe you will feel much more confident as a new ACNP.

LaurieCRNP2002, MSN, RN, APRN · Jan 19, 2013

I'm with the other posters who say that you should get some experience as a bedside nurse, particularly if you want to work as an NP in critical care. Having a foundation as a bedside ICU nurse will help you tremendously

Just because you CAN go straight to grad school after finishing your BSN doesn't mean you SHOULD do so. There is a thread elsewhere which talks about the changes needed to NP curriculums and i think one of them should be "a minimum of 2 years experience as an RN".

Just my $.02. Good luck in reaching your goal!

dah doh, BSN, RN · Jan 20, 2013

Yes it is possible and I see new grads who could get jobs going this route but its not a good idea. Example: np student asked me "what's tlc? (Paused) tender loving care? Don't you do that already?" Seriously! I had a hard time keeping a straight face!

Annaiya, NP · Jan 21, 2013

I agree that you need ICU experience before you can work there as an NP. Keep in mind that the ICU nurses are going to expect you to know more than they do and that can be a challenge for a new grad with experience. And if you don't, they will not respect you, which means they will not support you and you need to be able to work well with your bedside nurses. My ICU recently hired a new NP without ICU experience and the buzz among the bedside nurses is not very favorable. Personally, I would not want to be the one walking into that situation.