FNP seeking acute care / hospital training and job

allnurses Guide · Aug 10, 2014

Find a post-masters ACNP program or a local post-grad residency/fellowship if you are looking for an Intensivist job.

If you are looking to work in an ED that shouldn't be a problem with and FNP, especially if you get some precepted experience in that area.

ExpensiveBSN · Aug 12, 2014

Are there any alternatives to going back to school for an additional 2 semesters? The only post-mastes ACNP i see requires classes that are redundant to my current classes.

allnurses Guide · Aug 12, 2014

The classes won't be redundant. There may be some overlap but the focus will be different. And the clinical experience will be different.

chouxpastry · Aug 13, 2014

hi expensiveBSN :) i am also a FNP student with a strong preference for inpatient (or combined outpatient and inpatient) experience upon graduation. as bostonfnp has answered, a post-certification in acute cute medicine would be the most direct way to gain both academic and clinical experience in inpatient medicine (p.s., ucla offers exactly this - albeit a two-year program). and as bostonfnp has mentioned, these classes will not be redundant. your clinical focus will be on acute care disease management. if there is redundancy, it will be because the nature of medicine is continuous vs. repetitive curriculum. in the meantime, i might suggest getting hands-on experience with an appropriate acute care provider. acute care medicine is a big field and further exploration may help sort out your specific speciality of interest. with regards to supplemental learning material, i snooped a bit on med student/physician forums to find recommendations in the fields i was interested in. you will find an abundance of classic paperweights, board review books, podcasts, etc with just a quick search. for example, there are several well-crafted podcasts devoted entirely to the subject of emergency medicine (e.g., smart em, em basic). a good resource to have on hand is a copy of either cecil's or harrison's. an icu job may be difficult to get without a formal acute care certification - so minimally get some student experience before you graduate. these have just been my meager experiences as a student, but i hope they help. i'm in the same boat!

ExpensiveBSN · Aug 13, 2014

Thanks for the reply Boston FNP, i'm not sure if going back to school for an additional 2 years is beneficial in my current situation but it seems thats the best/ only? option

chouxpastry, what are your plan?

IBSavn · Aug 15, 2014

I think it really depends on where you are looking to practice. I live in VA and FNP/ANP/ACNPs all work in the hospital setting, however, ACNPs are given preference. Most hospitals are like this, they will hire ANPs or FNPs and provide on job training. There are states (Maryland) who have state laws governing the practice of NPS and their specialties. In MD, you must be a ACNP in order to practice in an inpatient setting. I am finishing a ACNP program and my fiance is finishing a FNP program. I can tell you from experience the training is as different as night and day. The ACNP program is focused on acutely ill patients--think ICU and trauma. We have very little training and education in preventative health, health education, women's health, and OB. From what I've seen in his program (FNP), they cover all of those areas but don't cover critically ill patients as in depth as ACNP does. Additionally, ACNP school teaches ventilator management, central line insertion, chest tubes, thoracentesis, paracentesis, surgical airways, and a bunch more of critical procedures. Honestly, I've thought of going back for a post masters FNP certification to better round myself. I hope that gives you some insight.

chouxpastry · Aug 15, 2014

ExpensiveBSN: there are one-year post-cert programs as well :) i just mentioned ucla b/c you mentioned being from southern california. and i will be taking the exact advice i provided in a previous post - make connections, get experience, study, and likely complete a post-certification program in the future :)

IBSavn: thank you so much for your insight! i hail from california, and from the job listings i've seen...true inpatient jobs appear to come from within - the exception being more rurally-located institutions willing to train. it's good to know about MD as well. are there many states in the east coast that allow only acute-trained NPs to work inpatient? which ones are they (if you don't mind naming a few)?

the two programs are definitely night and day like you stated. i am absolutely clueless as to what goes on when a patient is admitted (unfortunately no RN experience under my belt either), much less how to interpret x-rays, perform skilled procedures, etc. having only primary care training is imo even disadvantageous in the primary care/outpatient setting (e.g. ordering the appropriate follow-up testing in a post-hospital visit). however, self-study of acute care med is a daunting hill to climb with only a primary care background. i am definitely considering post-certification!

IBSavn · Aug 15, 2014

I only know for sure about MD because i was looking to move there. I know you can contact each states BON and they will inform you about requirementa. Keep in mind that the NCSBN is working on creating a national NP system. You will chose an age group (Neonatal, pediatric, adult/Gerontology) and then a specialty (primary, acute care)--much like physicians. The goal is to gain national recognition so that regardless of where you live all laws governing NPs will be the same. Granted, I foresee this taking forever. If it does happen, you will see laws like MD move across the U.S. FNPs are being asked to pull out of the inpatient setting and into the clinic setting due to a shortage of primary care physicians. The goal is to have FNPs provide the majority of prehospital care and physicians provide specialty care. You'll also see more and more hospitals start to seek out ACNPs in place of FNPs. As I stated earlier, it's because the training is vastly different. Keep in mind, ACNP has only been around since 1995, FNP goes way back. It will take time for ACNPs to train. Additionally, there are only about 20 schools who offer the ACNP education at this time.

allnurses Guide · Aug 15, 2014

i am absolutely clueless as to what goes on when a patient is admitted (unfortunately no RN experience under my belt either), much less how to interpret x-rays, perform skilled procedures, etc. having only primary care training is imo even disadvantageous in the primary care/outpatient setting (e.g. ordering the appropriate follow-up testing in a post-hospital visit).

Make sure you communicate to your NP program that your training in these areas was deficient. Most programs do 1-year and 5-year surveys regarding your transition to practice. You should have been exposed to much of this in school.

Most state BONs limit NP practice to that which they have education and experience in. Some PC-NP program do little to no AC and those graduates shouldn't practice in the AC environment.

I did have AC management in my FNP program and I did two in-patient rotations. I work both in-patient and out-patient now without any problems.

You could also ask to shadow a few in-patient providers in your area to help you feel a little more confident about the AC side from the PC side.

chouxpastry · Aug 15, 2014

bostonFNP, with all due respect, unfortunately many NP programs do not have adequate resources to provide structured rotations or specific skills training to their students. the state i will certify in also does not bar primary-care trained NPs to work in an inpatient setting. that being said, it would be criminal for a NP to perform unsupervised care in an area he/she is inadequately prepared for.

allnurses Guide · Aug 16, 2014

many NP programs do not have adequate resources to provide structured rotations or specific skills training to their students.

This is exactly why it is important for graduates of those programs to identify the lack of resources/training; those post-graduation surveys are used for re-accreditation. Those programs need to either remediate those issues or not be re-accredited.

The last thing the NP profession needs is continued NP education lacking resources and training.