FNP OR ACNP?

1. FNP vs ACNP- Trying to get a better understanding of the FNP/ primary care role. What I understand- it is more of an outpatient basis, better work lifestyle?

2. ACNP- Has anyone ever gotten into a program without having ICU and/or ED experience? What are the hours like as an ACNP? How do patients get assigned to you? How stressful is the work?

3. DNP vs MSN - is one superior to the other? DNP will be 4 years long, classes every other weekend. MSN is 2 years. Will a DNP give you more edge over someone with an MSN when it comes to jobs?

1. What do you want to do as far as practicing as an NP? Most ACNP programs require ICU or ER experience. Some will take you with acute care experience, but require extra courses in critical care. I would highly suggest getting experience in the ICU or ER if you want to pursue ACNP. There are things you do in critical care that you never get to do in acute care, such as CRRT, IABPs, titrating pressors, etc. You really need to have a thorough knowledge of critical care to be a successful ACNP. If you're looking for the M-F 8-5 type of job, then FNP is going to be what you want to pursue. Mostly office work. There are some hospitals who hire FNPs as hospitalists. It's really specific to your geographic area.

2. As I said above, there are a few ACNP programs that will accept you with no ICU or ER experience, but you must take some critical care courses and have extra clinical time in those units. It would be best if you get that ICU or ER experience first before pursuing ACNP. As far as hours, I only know what I see in my hospital. Not sure what it's like elsewhere. The ACNPs in our ICU work 7 days on/7 days off (12 hour shifts when "on"). The trauma NPs do three 12 hour shifts per week, 4 days off. The NPs in the ER also do three 12 hour shifts, but they have multiple start times, like 7-to-7, 11-to-11 or 3-to-3. As far as patient assignments, again this is specific to your hospital. In our ICU, our NPs are either contracted with the critical care team or the cardiovascular surgical team. They only see patients assigned to those practices. We are a teaching hospital, so the residents take care of the other patients. In trauma, they see all the patients on that unit. In the ER, the NPs are assigned by their level of expertise. A new NP is only going to get the fast-track urgent care patients (e.g. Cindy has the sniffles), you move up the chain to higher level trauma work as you gain experience. As far as stress, it depends on the patient load that week. Some weeks, it feels like every patient we have in the ICU is on death's door and we're running around like crazy. Other weeks, it feels like we only have people who really shouldn't be in the ICU, but there weren't beds available in the step-down units.

3. DNP gives you no advantage when trying to get a job. There is no extra clinical time involved in the DNP as a practitioner. The "clinical" time in the DNP portion of your degree is all leadership and research. If you have the desire to teach down the road, then by all means, get your DNP. But if you only want to be a practitioner, then you're wasting your time. The NPs where I work get the same pay, regardless if MSN or DNP. Might be different geographically. Again, I can only speak to what I see in my area.

Good luck with your decision!