FNP/Adult vs. ACNP for cardiology office

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I'm mostly been lurking over the last couple years, but now I need some advice from you wonderful knowledgeable folks.

I'm now a few years into nursing (Bachelors plus RN) and ready to start thinking about advancing my degree. I've worked tele and CTICU, and am considering a program that would allow me to work in a cardiology office as an NP.

Looking around at the offices near me (northeast), I see cardiac NPs listed as both FNP and ACNP. I originally wanted to be the one in the unit managing the patients, but having worked with these NPs I have developed both an admiration for the work they do and a fear of having that immediate responsibility myself. I don't want to spend the rest of my life working shifts, rotating to nights, having people go south in an instant, etc. Hence I had kind of discarded the idea of ACNP and was looking toward FNP/Adult.

In my area both seem to be accepted, but how about in the rest of the country? How likely are you to get an office job as FNP/adult that either doesn't require you to round on hospital patients or allows you to do so without an ACNP? Am I shooting myself in the foot without the ACNP preparation?

I'm trying to get in touch with some local cardiac NPs to get their perspective, but figured it would be good to get a spread of responses from different geographic areas. Thanks for any input!

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Specializes in Family NP, OB Nursing.

I'm an FNP in Ohio and work in primary care. My brother in law is in the same state, is an ACNP and works in CCU. I have friends who are FNPs working in hospital ICUs, or other units, but this is starting to change since the BON issued a vague statement about how FNP study focuses on primary care not acute care.

Now that being said, I can round on hospitalized patients in hospitals that grant me priviledges, if I so choose. I know FNPs who work with cardiologists in the office and never go to the hospital and I know FNPs who work in cardio offices and round with the cardiologist. I also know of ACNPs who do both.

So, you can round on patients as an FNP or ACNP, order tests, meds, organize discharge, and things along that line and not be the one running a code, placing chest tubes or initiating external pacing...it depends on the BON and how your collaborative agreement with your supervising doc looks.

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It is hard to predict what the future will hold. Nurse practice is regulated by the states, and several states in the US have recently instituted changes prohibiting FNPs from working in specialty clinics or inpatient settings. While my state of Virginia has not mandated this yet, it will likely occur in the next few years. I have been contacted by dozens of FNPs who work either on inpatient units or in outpatient clinics (cardiology, urology, oncology, etc) who have been told to get post-masters ACNP certification to keep their jobs.

I would encourage you to also check with your state's Board of Nursing and inquire about the prospects for change in NP practice over the next decade in your state. It might make better sense to aim for the ACNP now rather than have to go back for a second certification later. Getting financial aid for a non-degree (ie, post-masters) program is become more and more difficult.

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Good point about the financial aid. And it's as I feared - gray area but doable now, yet liable to change. I'm not sure what part of the country I'll be in 5 or 10 years from now, so I'd like to stay on the safe side. I guess I need to do some more shadowing and really pin down which practice area would be best. Too bad there are so many interesting paths!

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Hi. I work in a large Cardiology group with 14 Nps who do mostly (80%) inpatient care. We have become more and more reticent to hire non-ACNPs because the learning curve is so great. ACNPs seem to learn the outpatient care readily while FNPs and ANPs have hard time learning inpatient care. However, if you are able to choose your own clinical sites, we have had some FNPs who have dne substantial inpatient rotations and have been great. Good luck

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Specializes in Emergency, MCCU, Surgical/ENT, Hep Trans.

ACNP. I'm an ANP in an ED and still wish I had gone the ACNP route. My ANP focus was cardiology, so I could have worked in a Cards office easily and have no trouble with cards in the ED. If you truly love cards, I'd go the ACNP route. I believe this will give you the credentials to do anything dealing with the heart, whether IP or OP.

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Hi. I work in a large Cardiology group with 14 Nps who do mostly (80%) inpatient care. We have become more and more reticent to hire non-ACNPs because the learning curve is so great. ACNPs seem to learn the outpatient care readily while FNPs and ANPs have hard time learning inpatient care. However, if you are able to choose your own clinical sites, we have had some FNPs who have dne substantial inpatient rotations and have been great. Good luck

I would agree with this. Most FNPs have minimal inpatient rotations and are lacking in school based preparation. I know you can arrange for a lot of your sites to be inpatient, but it is questionable as to whether inpatient care really reflects the true scope of FNP. I think a good ACNP prepares an NP wonderfully for the challenges of inpatient management.

I am an FNP and have always loved cardiology. I was offered two office based cardiology jobs before graduation. One required rounding, one did not. I turned them both down because I felt I was lacking in inpatient experience AND because I realized my heart wasn't really into that kind of care. I have a passion for working with the 30 year old PRE-hypertensive and coaching them along so they don't even need a cardiologist !

Good luck to you in whatever you choose!

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