ED NP/NP job saturation

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Hi Everyone,

I will be graduating with my BSN in about a year, and have been considering going back to school after that to become a NP. I'm new here, so I apologize in advance if some threads have already addressed my questions!

First, I've been hearing that NP jobs are becoming fairly hard to find. Has this been true or false in any of your experiences? The NP school I am looking at offers a FNP track that I'd like to take, so I know that will make me more marketable, but still, I'd hate to go through all that work and not be able to find a job. I have quite a few family members and friends who are CRNA's and at least in my area, the job market for them is very good.

Second, my dream NP job would be to work in the ED. I'd love to work with level 1 or 2 trauma cases, and not just the fast track. I realize that to do this I will most likely need at least a post-masters in acute care. Is this type of job realistic? Do you all see many NP's working in this sort of atmosphere, or are they mostly in ED fast tracks?

Thanks!!

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A new grad in nursing who wishes to speed ahead into the MSN, NP program without clinical experience is unsafe. At the school I taught and the one I attended for my BSN, the theory was basically we will instruct the student in the basics. You will learn everything else once you get a job. In grad school it was the same. I learned the book stuff and experimented on patients in the clinical but it was not until I got my first job as a NP that my learning curve went into orbit. My friends who did what you wish to do did okay in the classroom setting but in clinical they were average or plain mediocre. The RN's with critical care nursing did the best. I think this has to do with the numbers of stable and critical patients they took care of on the floor. Med-surg floors don't often get patients with a trach or dopamine drips. If you choose to go the route of the ER, do not get the FNP. They are no longer being grandfathered in to critical care. Attend a critical care NP program. Georgetown University developed one of the first. However, I don't think that is where I would go. You need to look at schools. It does makes a difference in how you perform on the floor. I would suspect not one school teaches nurses like the next. Many schools are okay. Find how your nursing school is rated next to others country wide and grad schools. I preferred my MSN for NP to be affiliated with a medical school. I learned a lot more in class with doctors teaching who were in research than my PhD nursing teachers. Please think twice before enter graduate. You are too green for what happens in the ER as clinician.

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The problem with only getting the ACNP is that you will only be trained to care for adults... so I liked your idea with the combined FNP-ACNP... FNPs are still being used at the hospital I work in... but check what the trends are in your state because some states are requiring that hospital nurses have ACNP (which you will have if you do the duel). I really think that the ACNP is most beneficial for ER and ICU because of the acuity of the patients. There are even some programs out there that offer programs specifically for Emergency Medicine... not sure if this would something you would be interested in, but worth researching.

FNP is more marketable. I have done searches for jobs (not yet an NP but still seeing what is out there) and they are plentiful in the SE. I don't recall seeing many ER NP positions though, but that does not mean that they don't exist. I also assumed that I wanted to work in ICU, so I was wanting my ACNP... but once I realized that I would limiting myself, I decided on the FNP, then once I get some experience as a NP in a clinic setting, I can go on and get a post masters in ACNP if I still want hospital....not that it would be required of me in my state but I would want the education.

As far as nursing experience and direct entry programs, I tend to lean more towards at least having a year of experience as a nurse, which you can do while you are going thru your master's program. I think its important to learn the nursing role. My first year as an RN was a huge learning curve. Its where I learned my time management, my drugs, mastering lung sounds, heart sounds, etc. I think you would benefit from it, and cause yourself less stress coming out of NP school with no nursing experience. Not only will you be learning how to be a new NP, but a new nurse too. I am scared to death being novice again. I am comfortable now as an RN and feel like I know my stuff in the ICU... I couldn't imagine doing it without that experience.

BUT people have done it and have exceeded doing it direct entry so I suppose it's preference.

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Oh and as far as CRNA (I wanted to do that too), they do make really good money and there are jobs everywhere, but it is more expensive from what I found and I personally would not be able to work during the program, so there is the lost income as well. I have 2 kids and a husband so it would be extremely hard with just his income. And it is very competetive. But if you think that is the route you want to go, that is a viable option. You will not being seeing too much trauma as one tho... you may put something to sleep that may have been a trauma, but they would have already been stablized by then, etc... just a thought.

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Thanks for the replies! They were helpful. And yes I most certainly agree that a graduate BSN student should have at least a year of clinical experience before going on to graduate school. Sorry for not making that more clear.

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Specializes in medical surgical.

I actually would like to have post NP as well. I already know that I do not want to work with children so I am thinking ACNP or PMHNP. I am finishing up a ANP. My med-surg experience has been an extraordinary help during my clinicals. I would want to work in the ICU while getting ACNP, but that is just me. I learn better this way.

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First, how "green" you are or are not does not make you good now or later. It is your personality. I have worked with nurses straight out of school who are awesome and I have worked with some with experience and their NP and they are so so. It is your determination and the way you handle situations. I work in a trauma center. When I get a trauma, my main goal is to stay calm so there is at least one person in the room who is. I am fortunate to work with some awesome trauma docs and a couple of awesome trauma NP's. All my friends who have gotten or are in the process of getting their NP degree have told me, clinicals are what you make them and they are what makes you. So, keep that in mind regardless of where you go and what route you take.

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Specializes in Emergency,.

I would recommend the track i have gone on.

I went right from a RN to an FNP. i worked as an ED RN during my NP schooling.

Also during my didactic time i took PA classes in EM and Critical Care.

then right after i graduated i started an emergency fellowship/residency.

I work along side the EM residents, i am learning amazing amounts of information on

caring for critical patients.

Sure, I could have gone back for a post masters ACNP and worked as a hospitalist or in the ICU. But for working in the ED, I truly believe this is the best way.

If working in the ED is what you want, the Go for it. and don't let ANYONE tell you that you need years of full time nursing experience. you DON'T, the work you do as an RN is quite different than what you will be doing as an NP.

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@SkiBumNP: Thanks for your input-it was very helpful!! If you don't mind my asking, what is your scope of practice in the ED? I've heard that some NP's do more primary care in the ED, but are you able to frequently work with critical cases? You mentioned that you do work with EM residents on some critical patients--do you get to have some patients of your own, or do you work more collaboratively with the residents?

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Specializes in Emergency,.

Well. I am able to see any pt I want. And the docs I work with are always willing to lend an ear and a brain. Today I was primary on two code threes that I lead the RSI and the ACLS. I also saw little babbies who all they needed was a well mother check up. So I see them all. Some other mlp's like the fast tracks. But I rather the more acute cases.

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What you described sounds just like what I would love to be doing in the next few years! Thanks for the info.

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@SkiBumNP...it sounds like you are doing exactly what I would like to be doing and so far I am following the track you have recommended. I graduated with my BSN, went right into an FNP program and I am working as an ED RN while going to school. I have not taken any PA classes in EM or Critical Care. What classes did you take? Where did you find the time on top of working and your NP classes? :confused: Also, can you give more information about how you went about getting an emergency fellowship/residency? Was there one already established for NPs at the facility? My first job as an RN was a new graduate BSN residency and I learned a ton, so the idea of an NP residency is very appealing to me. I was planning to do a post-masters ACNP. What made you decided not to get one?

Any information you could provide would be helpful. Thanks for your time!

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