family NP or Acute/crital care NP

allnurses Guide · Aug 22, 2008

Best to call the hospitals you are interested in and find out what type of providers they employ.

MOMINMA · Aug 22, 2008

I actually do not have a specific hospital that I am set on working with. Maybe I am crazy but I didn't want to base my career choice on what is available now at a certain place because that can change, I might not end up liking the place, etc. I want to have a broad range of opportunities available to me. For example, I want to work in a fast paced, hospital environment now but in ten years I will most likely not want to keep up with that pace and want to work in a practice setting. I also want to volunteer my services in my "free time" in clinics and with those less fortunate.

I am hoping to get some input from other NP or those who work with NP's to hear the range of opportunities available in both specialties, drawback/perks of each, etc.

I see what you are saying though about contacting employers. I have looked at several hospitals job postings although I have not contacted them to ask questions. Several positions were in say med/surg, NICU, neurosergery yet said the position was for an NP that graduated and is certified as a FNP with med privilages - so either the specialty(family or acute care) is not a factor or the person posting the ad didn't get it right.

Thanks though!

DaisyRN, ACNP · Aug 23, 2008

hi there,

not to sound completely like i do not care, because i do. :) but there are exhaustive posts on this site, this this forum, regarding this issue. the most recent is the following:

https://allnurses.com/forums/f34/tell-me-again-why-i-should-choose-fnp-over-anp-324095.html

basically, it boils down to your location (state, mostly)... and also what your ultimate goals are. i am not going to repeat all that we have said in the other posts, but as a general rule, fnps are not trained in hospital medicine, therefore, should not be practicing in the hospital. however, some states are not as strict on this (i do not know about ma), and only use fnps in the hospital setting because acnps are not as prevalent, or whatever. as an acnp, i was trained in adult internal med outpt and hospital medicine. i could work in an internal med clinic as an acnp and i can also work in the hospital. currently, i work for a cardiology clinic and do both. all within my scope.

MOMINMA · Aug 23, 2008

hi there,
not to sound completely like i do not care, because i do. :) but there are exhaustive posts on this site, this this forum, regarding this issue. the most recent is the following:
https://allnurses.com/forums/f34/tell-me-again-why-i-should-choose-fnp-over-anp-324095.html
basically, it boils down to your location (state, mostly)... and also what your ultimate goals are. i am not going to repeat all that we have said in the other posts, but as a general rule, fnps are not trained in hospital medicine, therefore, should not be practicing in the hospital. however, some states are not as strict on this (i do not know about ma), and only use fnps in the hospital setting because acnps are not as prevalent, or whatever. as an acnp, i was trained in adult internal med outpt and hospital medicine. i could work in an internal med clinic as an acnp and i can also work in the hospital. currently, i work for a cardiology clinic and do both. all within my scope.

thanks for your honesty. i did read through the posts, i didn't find exactly what i was looking for so i figured if someone wanted to answer my post even thought here might be others they would - if not no big deal.

DaisyRN, ACNP · Aug 23, 2008

what is it that you are looking for exactly and i will try to help. there is no site that i know of to tell you where each type of specialties flourish. the classifieds are a good source... but you need to take them with a grain of salt. just because it says "fnp wanted," but its a hospital setting, theres an opportunity for you to contact that employer and offer yourself as an acnp or ask them if they would consider it.

as for the perks/drawbacks of each, i'll try to get back to you later today. do you have any specific questions?

good luck with your decision making!

Advanced Practice Columnist / Guide · Aug 24, 2008

In theory, there is no such thing as a generalist NP who is trained to do everything and can work in every single specialization. The fact is, each NP track has a specific focus and this goes beyond the simple assumption that specific NP's can see a pre-determined age group of patients. You are torn between FNP and ACNP. Simply said, FNP's are trained in the primary care of patients of all age groups. Majority, if not all, of the clinical rotations in FNP programs are in out-patient settings. I've heard of some that allow for an elective rotation that can involve in-patient settings. On the other hand, the acronym ACNP usually refers to Adult ACNP's who are trained in the care of adults with chronic as well as acute and critical illness. Part of ACNP training involves clinical rotation in hospital settings including critical care units in many instances. There is a health promotion component in the ACNP program in addition to managment of chronic illnesses commonly encountered in the out-patient setting.

NP-related organizations that either certify or address standards of NP education do not do a good job explaining differences among NP specializations and actually contribute to the confusion. For instance, the NONPF document on Acute Care Nurse Practitioner Competencies state that ACNP's can provide care across all settings and provide care to adults, children, and neonates (http://www.nonpf.org/ACNPcompsfinal20041.pdf). But there are three different NP tracks that are considered acute care - Adult ACNP, Pediatric NP-Acute Care, and Neonatal NP. Each track obviously are very age-specific. Similarly, the NONPF document that describes competencies for Nurse Practitioners in Primary Care Specialties (Adult, Family, Gerontological, Pediatric, and Women's Health) are just as vague and written in very general terms (http://www.nonpf.org/finalaug2002.pdf). However, not only are these tracks age-specific, they are also population-type specific.

Now that I've got you even more confused with my rant on how there's so much hodge-podge in the different NP specializations, you probably are even more lost and unable to decide which track you should pick. Your state-specific nurse practice act should help you clarify what track is best for you. There are states out there that clearly distinguish where specific NP's should work and what type of patients they are allowed to see. It is pretty easy to find this information. Look at your state BON website and see if this issue is already answered in your state. If not, call someone at the BON and ask an actual person. Obviously in states where there are no specific rules on what specific NP's can do, then FNP's seem to be the most flexible choice because of the ability to care for patients of any age group.

However, just because one's state may not be restrictive about what specific NP specialties are allowed to do and in what setting does it mean that any NP can safely cross settings, turfs, specializations or whatever you may want to call it. Many posters have alluded to a higher risk of liability if a nurse practitioner practices in a setting where they received very little training on. While I have not known any actual NP's who were litigated, I agree that the risk is real. In the event of an unfortunate clinical error in judgement and harm resulted, any smart prosecutor will plan an attack on the clinicians qualifications. It would be hard to defend practicing in a field where a nurse practitioner practically had no advanced practice training in not to mention failing to have the validation of competency via the appropriate NP certification.

This is why DaisyRN, ACNP was advising you to look at the previous posts on this matter. This issue has been a recurring topic here and in other forums and internet groups addressing advanced practice nursing. You basically can do whatever yor state practice act tells you but that in itself may not protect you in worst case scenarios. And I think she may be right too when she said that there is not a website out there that accurately tells which geographical areas are better for specific NP's

Would it help if I tell you why I chose adult ACNP over the others? https://allnurses.com/forums/f8/np-program-acute-primary-325342.html#post3039656

manursing · Aug 24, 2008

Thanks so much Daisy RN for offering to help. :nurse: :wink2: (sorry I am new to the smiles and thought they were cute) I am a planner and like to understand all of my options. I have two lovely kids and a great husband who has supported me in focusing on school and not working. I want to be able to complete my schooling as efficiently as possible, therefore, having clearly defined goals will help. I am going to be in my mid 30's when I become an NP and want to work in a fast paced challenging hospital environment - preferrably with children. So I was thinking that ACNP would be the way to go. But at the same time after working for 10+ years I might want to slow down and have the opportunity to work for a practice. Can you do that as a ACNP?

Below is a copy of a current job listing. When I read it it seems like it would be a position for a ACNP but them it states that emergency medicine OR primary care???? So this is why I am so confused as to if the specialty route I chose is really that important.

"The Nurse Practitioner functions under the Neonatologist. Attends high risk deliveries and prepares for potentially compromised newborns. Provides daily care and medical management of high risk infants in the Neonatal Intensive Care Unit. Assesses patient condition, performs physical examinations and develops appropriate diagnostic and therapeutic plans. Identifies needs for and interprets diagnostic lab reports and or radiologic studies. Manages respiratory interventions and identifies need for and performs medical procedures. Discusses medical problems and therapeutic interventions with attending physicians. Assumes clinical management for neonatal transports from referring hospitals. Participates in data collections and interpretation of clinical research. Develops, coordinates, implements and evaluates educational activities for designated are(s) of responsibility. Maintains and updates clinical knowledge and actively seeks opportunities to broaden clinical expertise. Participates as member of health care team to develop policies, clinical protocols and evaluation tools. Adheres to system and department compliance policies, and any applicable laws and regulations."

Emergency medicine or Primary Care experience preferred. Must be able to work independently in a fast paced environment. Certification as NP required"

Several other listings say similar - "experience in adult internal medicine and/or critical care medicine".

My gut is telling me to go the ACNP route, I am looking to hear others experiences as to job opportunities (in MA or nearby) Some of the posts I have read scare me a bit, hearing NP's are working as RN's because they can't find a job or they do not like the job. I have heard many say that they are NP's working as RN's because the minimal extra pay is not enough to cover the added responsibility.

- Money is not everything but is the pay really that bad compared to RN's?

- What types of incentive plans/bonuses are area NP's getting?

- Some RN's are saying that they can make more than an NP because they get OT pay. What is a typical NP work week FCN and/or ACNP? If an RN works 60 hrs and makes more than an NP but that NP is only working 40 hours - well for me I'd like to spend those extra 20 hours with my family or volunteering.

Also as far as perks/drawbacks - I want to be able to offer personal care to my patients and show them that I care and listen to them. Am I kidding myself in thinking that I can do that in a hospital setting? Are there going to be quotas and higher ups telling me to move faster?

manursing · Aug 24, 2008

In theory, there is no such thing as a generalist NP who is trained to do everything and can work in every single specialization. The fact is, each NP track has a specific focus and this goes beyond the simple assumption that specific NP's can see a pre-determined age group of patients. You are torn between FNP and ACNP. Simply said, FNP's are trained in the primary care of patients of all age groups. Majority, if not all, of the clinical rotations in FNP programs are in out-patient settings. I've heard of some that allow for an elective rotation that can involve in-patient settings. On the other hand, the acronym ACNP usually refers to Adult ACNP's who are trained in the care of adults with chronic as well as acute and critical illness. Part of ACNP training involves clinical rotation in hospital settings including critical care units in many instances. There is a health promotion component in the ACNP program in addition to managment of chronic illnesses commonly encountered in the out-patient setting.
NP-related organizations that either certify or address standards of NP education do not do a good job explaining differences among NP specializations and actually contribute to the confusion. For instance, the NONPF document on Acute Care Nurse Practitioner Competencies state that ACNP's can provide care across all settings and provide care to adults, children, and neonates (http://www.nonpf.org/ACNPcompsfinal20041.pdf). But there are three different NP tracks that are considered acute care - Adult ACNP, Pediatric NP-Acute Care, and Neonatal NP. Each track obviously are very age-specific. Similarly, the NONPF document that describes competencies for Nurse Practitioners in Primary Care Specialties (Adult, Family, Gerontological, Pediatric, and Women's Health) are just as vague and written in very general terms (http://www.nonpf.org/finalaug2002.pdf). However, not only are these tracks age-specific, they are also population-type specific.
Now that I've got you even more confused with my rant on how there's so much hodge-podge in the different NP specializations, you probably are even more lost and unable to decide which track you should pick. Your state-specific nurse practice act should help you clarify what track is best for you. There are states out there that clearly distinguish where specific NP's should work and what type of patients they are allowed to see. It is pretty easy to find this information. Look at your state BON website and see if this issue is already answered in your state. If not, call someone at the BON and ask an actual person. Obviously in states where there are no specific rules on what specific NP's can do, then FNP's seem to be the most flexible choice because of the ability to care for patients of any age group.
However, just because one's state may not be restrictive about what specific NP specialties are allowed to do and in what setting does it mean that any NP can safely cross settings, turfs, specializations or whatever you may want to call it. Many posters have alluded to a higher risk of liability if a nurse practitioner practices in a setting where they received very little training on. While I have not known any actual NP's who were litigated, I agree that the risk is real. In the event of an unfortunate clinical error in judgement and harm resulted, any smart prosecutor will plan an attack on the clinicians qualifications. It would be hard to defend practicing in a field where a nurse practitioner practically had no advanced practice training in not to mention failing to have the validation of competency via the appropriate NP certification.
This is why DaisyRN, ACNP was advising you to look at the previous posts on this matter. This issue has been a recurring topic here and in other forums and internet groups addressing advanced practice nursing. You basically can do whatever yor state practice act tells you but that in itself may not protect you in worst case scenarios. And I think she may be right too when she said that there is not a website out there that accurately tells which geographical areas are better for specific NP's
Would it help if I tell you why I chose adult ACNP over the others? https://allnurses.com/forums/f8/np-program-acute-primary-325342.html#post3039656

thaks pinoyNP hearing why you chose your career route was very helpful. The past few moths have really confused me, for many reasons you stated. I have gone to the sites you mentioned about and like you said became really confused. They make it difficult to understand and I feel like I knew that I wanted to go the ACNP route before looking into it more but now I feel like I will be limiting myself because FNP's seem to get all the jobs. What you said makes sense and it is what I felt (although I questioned myself because I do not work in the field) why would an NP trained in primary medicine be suited for the ER, med/surg, or NICU. I guess i thought an FNP would work at a clinic/private practice/doctor's office - seeing people for their well visits, sick visits, surgery follow-up, etc and that ACNP would work in the ER, NICU, various hospital setting dealing with (as the title suggests) critical care patients. Maybe I am just looking in the wrong places for my information. Med school grads seem like they have it much easier - if your specialty is cardiac, neurosurgery, etc that is where you work. They wouldn't post a job for the cardiac floor asking for an MD specializing in dermatology.

Maybe I am just looking in to it too much, I am just scarred that I am going to choose my path and not be able to find a job after investing a whole lot of time and money into it. It helps to hear from others already in the field too because sometimes you hear perspectives and ideas that you never considered so thanks so much!!!

manursing · Aug 24, 2008

:banghead:

So I went to the MA BON and this is what they say:

My certification is in a specialty different than the job I am working in, is that okay?

The Board does not grant you authority to practice in a specific specialty. The Board grants you authorization to practice in a specific domain of Advanced Practice Registered Nursing. Those domains include Nurse Practitioner (NP), Nurse Midwife (NM), Nurse Anesthetist (NA), and Psychiatric Mental Health Clinical Nurse Specialist (PC). Your specialty certification is a measurement of your competency to provide services to a certain population. The decision to work with a population different than what you are certified in should be based on whether you are competent to provide services to a population different than your certification, whether you are willing to assume accountability for the outcomes, and whether you are in collaborative relationship with a supervising physician who holds the proper credentials to care for that population.

Editorial Team / Admin · Aug 24, 2008

sounds as if they answered your question, manursing

the board grants you authorization to practice in a specific domain of advanced practice registered nursing. those domains include nurse practitioner (np), nurse midwife (nm), nurse anesthetist (na), and psychiatric mental health clinical nurse specialist (pc).

they do not address sub-specialties of the np.

to further quote the bon:

the decision to work with a population different than what you are certified in should be based on:

whether you are competent to provide services to a population different than your certification
whether you are willing to assume accountability for the outcomes
whether you are in collaborative relationship with a supervising physician who holds the proper credentials to care for that population

so, if you can answer, 'yes', to the above 3 points, you have your answer.

manursing · Aug 25, 2008

sounds as if they answered your question, manursing
they do not address sub-specialties of the np.
to further quote the bon:
the decision to work with a population different than what you are certified in should be based on:
whether you are competent to provide services to a population different than your certification
whether you are willing to assume accountability for the outcomes
whether you are in collaborative relationship with a supervising physician who holds the proper credentials to care for that population
see i took it as them saying an aprn is broken down into domains not subspecialties so if say you are an np and want to work as a na you have to be able to answer yes to the questions they list. i just think it should be more specific and direct so people can easily understand. if i were to believe my interpretation of their statement was the only way it could be perceived then i did answer my own question. i just don't think it is.
i am sure the board was trying to make the explaination simple and easy to understand-cut and dry i suppose, but i think it leaves too much out there.
say i am a fnp that works in geriatrics. i decide i want to work in pediatrics. 1. i feel competent to work with kids - i had coursework and clinical work in school with kids. 2. i am willing to assume accountability for the outcomes because i am smart and think it will be fine. 3. my collaberating physician has work in pediatrics his entire career so even though he is swamped i am sure it will work out.
now mind you i probably could have come up with a better scenario (i am a little tired) but i think it falls alot onto the judgement of the individual. i know that i have good judgement and i would not take the job but some people might. it would be a challenge and they can do anything that they set their mind to - but at what cost?
i am getting way off track here and i am so sorry if i am coming across insensitive (i am so not trying to do that) i think it just goes on my list of things i wish were different in america. people might be able to point the blame a little less if there was clearly defined expectations out there that did not rely on a persons opinion that they are competent. like maybe yet another test (ugh) you want to work in a different area, take a competency test of some kind. prove to your self as well as the employer. protect yourself from litigation and from possibly having to live with a costly mistake that could have been prevented for the rest of your life.
i am glad that i have been able to get my brain going again, start school next week - needed a workout. this summer was the first time i have had off since my son was born in june of 2006. i have been in classes (on campus or on-line) since then. while i loved every minute of the time i had in school it was so wonderful to be with my two little men all summer, i am never going to get this time back and it was great. but i am so ready to go back, my family is great but it doesn't complete me, at least not in the way it does my homemaker friends. i give them and anyone who stays at home and tends to the house and family a lot of credit cause i could never do it. i can't wait for my first day home from school next week, my kids will actually of missed me(i hope???) their smiles will make it all worth while.:heartbeat