Fnp Or Acnp????

hey there,

i am in an acnp program and i will do the best to answer the questions i have input on.

1. what is more marketable (i.e. which offers more job opportunities)?

more overall job opportunities? fnp. why? fnps can see pedi and ob/gyn patients where acnps cannot (which is part of the reason you see fnps in the er). also, more people (at least in my part of texas - 2 hrs east of you), are not as familiar with the acnps. in all honesty, i have done a lot of teaching the last several weeks because when people hear "nurse practitioner" they automatically assume you are "fnp." they dont realize that there are 6 (or maybe 7?) different recognized specialties. i think that with a little word of mouth/education, people will be jumping at the idea of having an acnp working for them - if their practice is specialty/inpatient/critical care focused. in my current clinical rotation with a hospitalist group, there are so many people that after asking me about my program, etc. that have been very impressed and interested in my potential, including cardiologists, gi, and the hospitalists.

as for a specific market you are looking at (icu, cardiology, er, etc.), if dfw is familiar with acnps (which i would think they would be since you actually have programs there), and you are interested in staying inpatient, do acnp. there is a great deal of controversy over fnps being in the hospital setting. linda rounds, president of the bne, told me that they are working to refine the scope of practice saying that fnps aren't qualified to work in "acute care" settings, but i don't know that is something that will change very soon. it is a difficult area to address because there is overlap... what i mean is that there are fnps working for say, cardiologists (which is within their scope) that see patients in the clinic (which is known to be within the scope), and then go see the patients in the hospital and make rounds on them, do discharge planning, etc. (which is where they are questioning whether or not they are "trained" to handle the acute illness). i can see both perspectives.

comparatively, there is a fnp working with the hospitalist group i'm doing clinicals with right now (she's been there a year and a half) and my preceptor (md) and i can tell she has a completely different background than the acnp. it's not that she is dumb or incompetent, its that she just simply did not get the in-depth, critical/acute care focus pertaining to the disease processes and acute management like i am getting in the acnp program. she has a lot of questions pertaining to the a/p part of the soap note which is the assessment and plan, where you are diagnosing and planning the management of the patient. in my acnp program, we are trained to think about the differentials and how to "critically" manage them in an inpatient type of setting. this is where she has the most trouble (per my preceptor). now, this is only one person, but it is an applicable example of the differences...

2. what is the difference in the hours? do acnp generally work in shifts or do they work out of the office or both? fnps?

part of this is answered in the previous question. but, i think this is completely based on where you work. the hospitalist group fnp works m-f, 8-5 (ish), no call, every other weekend. but she is not required to come in on the weekends, she just does to help out. another hospitalist acnp in waco works m-f, sees patients 8-1 or 2, and then does administrative duties until 5. no call/no weekends. i know that some acnps do 7 on and 7 off, 12 hr shifts. most of the acnps in the hospital setting, that i have talked to (i just got back from the society of hospital medicine conference) do not take call... and i think this is namely because by texas law, apns cannot "admit" a patient. they can write the admit orders and get the patient upstairs, but the md has to sign behind ya on the admit orders. also, alot of mds have problems calling and admitting a patient to an "np." however, some may take call for the nursing staff/established patients, just not new admits. it just depends upon your facility... and your comfort level.

since a lot of fnps are in the clinics, they are generally 8-5 m-f. again, it depends on what your job is.

3. is there a large difference in pay between the two? what can i expect to make as either?

since i'm in texas, i can give you some good numbers. for the hospitalist group in longview, they would pay an acnp $75-95k initially, dependent upon experience. in houston, acnps at methodist (i think - it might be memorial) are starting at $110k. i believe you can make more if you work with a specialist. as for fnps, i'm not sure. look around online, there are some salary surveys by the american academy of nurse practitioners that have been done recently. i heard from someone last week that dallas does not pay that well, but i'm not sure what that was based upon. what everybody is telling me is that you have to not only consider the salary, but you have to look at benefits/cme imbursement/vacation/etc.

also, if they are offering a lower salary, they may be offering productivity bonuses or incentives (this is what i would like). my preceptor working in an internal medicine clinic last semester was salary only and hated it. she said "why should i work any harder to see 30 patients in a day when i can make the same amount of money if i only see 5?" productivity pay is a very good thing. but... at the same time, you dont only want to be productivity based or you run the risk of low census/etc. and may not get paid unless you have a salary guarantee. (i may be telling you more than you asked for, but these are all things i just recently learned and found important!)

4. if i wanted to work in a fno environment but had acnp education would i need additional education and vice versa?

yes. see the previous responses r/t scope/general areas of practice. if you get fnp, you will have the whole population of patients covered. a lot of people do the fnp first and then get the acnp post-masters cert which takes about a year. some programs do a combined program, but i dont think any around here do. check uta. you have to do what's best depending on what your plans are. like i said, if you want to be in the hospital (i.e. icu), do acnp. also, if you are thinking of getting out of the icu, talk to people... that is how i have learned a great deal. talk to the people that are in the enviornments you are considering... ask them what they think.

best of luck to you!!!! pm me if you wanna talk about it some more... :)

My program in Colorado requires that, if you want to go the FNP route, you MUST ALSO obtain the ACNP. In other words, when I graduate and am licensed and all, I will be able to put "ACNP/FNP" after my name. That way, I demonstrate that I have the training in both acute care and family care. I could do just straight ACNP without the FNP, but I cannot do just FNP without the ACNP. Makes for a little longer program, but I think in the end I'll be grateful.

(At least, that's what I tell myself...)