FNP or Acute Care NP or PA?

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  • Columnist
    Specializes in Tele, ICU, Staff Development, Freelance Writer. Has 30 years experience.

Hi Nurse Beth,

My name is Jean, RN. I've considered to go to a NP school next year. I have so many questions but don't know whom I ask.

1. I don't know which specialty I need to choose, either FNP, or Critical Care. I'd like to work in the hospital (I'm interested in working in Adult Cardiac area). However, I don't have any ICU experience but have only over two year tele experiences. However, I don't want to limit my work area in the hospital, either. I maybe want to work a clinic. People say with FNP I'll have a limit to work in the hospital and with Acute care NP I'll have a difficult time finding a job in a urgent care clinic. Someone even suggested to go to a PA school because PAs can work in any areas.

2. I'd like to know how I can be a Cardiac nurse (or a cardiac NP). I started nursing career in tele unit but found difficult to work in a cardiac ICU because of no experiences.

I have only over two year nursing experiences but am old because this is my second career. I wish I had switched to nursing sooner.:) But I'm grateful that I found something that I'm passionate about. Working a hospital to help sick people is a privilege.
Thanks for reading my questions and for helping me.

Dear Jean,

Choosing to become an NP is a big step in your career, and part of that decision is narrowing your focus of practice/population. When studying towards a nurse practitioner degree, it's important to consider which area of nursing you are most interested in. You have the option of many different specializations, and all areas are in demand.

The U.S. Bureau of Labor Statistics expects a growth of around 19% for NPs by 2020, well above the national average. There is an increasing demand for NPs as primary care practitioners.

Certified Nurse Practitioners are prepared to practice as:

  • Primary Care NPs (FNP)
  • Acute Care NPs (AG-ACNP)

Family Nurse Practitioners (FNP) practice in primary care settings, such as clinics and offices. Adult Gerontology-Acute Care Nurse Practitioners (AG-ACNP) typically practice in hospital settings, although an AG-ACNP could also practice outside of the hospital setting.

You do not necessarily need a background in ICU to become an Acute Care NP, but it would be very helpful in terms of exposure, familiarity, and helping to determine if you really are attracted to this population. Some realities of ICU include managing patients who remain on life support for very (overly?) long periods of time.

RN to PA

You mentioned PA, which is yet another career choice for you. It may or not be easy to find an RN to PA bridge program, but being an RN would most likely improve your chances of acceptance. As a PA, you do not have the autonomy of an NP. You are just what it says- a (highly skilled) physician's assistant. Your focus so far has been nursing, and a PA focus is medicine.

PA programs are intense, and you would probably not be able to work while in a PA program. The required clinical hours for a PA are about 2X those of an NP.

I'd say that, looking at everything, it would be hard to go wrong as an FNP. You will always be able to find a job, you will not have to work weekends and nights, and with the sheer selection of jobs and settings, you can find your niche.

Best wished on your decision,

Nurse Beth

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