FNP vs ACNP...brain vs heart.

Advanced Practice Columnist / Guide · Jan 25, 2011

Unfortunately, the tough decision for most NP's is to achieve balance between your dream job and the reality of the NP job market. I've been a critical care NP trained as an ACNP since 2004 and I love the field. You are never autonomous in the sense that you work with attendings but how much input and involvement you bring to the table is really up to you. Physicians will generally listen to what you have to say if you can show competence and the plans of care you recommend make a lot of sense. It is also a very team-oriented specialty so the care is driven by many disciplines. With that said, critical care is only one of many jobs ACNP's can have and although it is gaining ground as a field for NP's, not all parts of the country are as receptive to the NP role in the ICU so I would caution you against pegging yourself in this field and then getting disappointed that you couldn't find a job in it. Add to that the fact that you already noticed that there are a lot of NP jobs out there where the role seems too focused on writing notes and doing scut work.

APNgonnabe · Jan 26, 2011

Thank you so much for posting this question. Mmcmarsh I am in what I feel is the exact same position as you are. The only advise...comfort that I've some up with is in Illinois(where I live) I do not believe there is anything stopping me from practicing in a clinic. I know we have some Illinois mods here so please correct me if Im wrong. I have thought about getting a post certificate in FNP or I think PNP would be really amazing. Anyways good luck and I'm here with you..

Trauma Columnist · Jan 26, 2011

Yep, no restrictions on ACNPs in IL as to working in clinic or outpt settings.

However, the age restriction, 13 and up only can be tough to break.

I'm an adult health CNS in IL who went back and did a second post-MSN peds CNS in order to be able to see everyone.

If I had to do it over, I would have done FNP.

Christen, ANP · Jan 26, 2011

I chose the ANP over the FNP out of convenience, to be honest about it. I would have chosen the FNP over the ANP as it is more marketable. The problem with the ACNP as already mentioned is that the role doesn't transition to some markets well. IE, here in Southern Georgia, ACNPs aren't used, like, at all. I know one ACNP who looked for a year for a job. She got one locally, but eventually moved up to a bigger city with a bigger market for that role. ANPs and FNPs are used more, but that probably has to do with the fact that there are two local schools who offer that program.

I'd say pick whichever role is the most marketable for where you live, and go with that. Just realize that having an FNP doesn't entirely exclude you from the acute care setting if you have a strong acute care nursing background to fall upon.

linearthinker, DNP, RN · Jan 27, 2011

I could have written the OP. I decided on FNP for marketability and may return for ACNP someday if opportunities expand.

TradHunterRN · Feb 1, 2014

The OP's question is exactly what I was looking for on here as I am applying to FNP programs but am worried that I will miss my ICU once I leave the bedside. To add to the question though, are the ACNPs out there able to practice their skills a lot? I just know that at my institution (one of the top 5 hospitals in the U.S.) the ICU has ACNPs but they hardly ever get to do skills because their are constantly residents training there.

Advanced Practice Columnist / Guide · Feb 1, 2014

To add to the question though, are the ACNPs out there able to practice their skills a lot? I just know that at my institution (one of the top 5 hospitals in the U.S.) the ICU has ACNPs but they hardly ever get to do skills because their are constantly residents training there.

I've never experienced what you've referred to actually. I have been an ICU NP/ACNP for 10 years and worked in two different states in three different hospitals (I worked in 2 different hospitals at one time dividing my time between 2 ICU's). 2 of the hospitals, current one included, are major teaching hospitals with a large teaching mission (translation: all kinds of residencies and fellowships).

I think the difference I've seen in my experience and others who claim they don't get to do anything in their role is the fact that 1) the physician leadership is unaware of how to fully incorporate the NP role in the ICU or 2) I'm going to say this not to try to offend but as an opinion -- have NP's who are weak at asserting their skills.

In both places I've worked for, the physician leadership has been the champion in making sure the ACNP's hired are trained adequately and whatever we lacked in skills as a new employee are remedied during orientation. They also are quite selective with the ACNP's they hire. Not only do the candidates come with extensive ICU experience, they also have strong and assertive personalities.

In the settings I've worked in, NP's are sometimes working by themselves managing the patients in the entire unit. Residents have strict restrictions in work hours and they are not a constant and consistent presence in the ICU. Just by that fact, it would be very foolish to have NP's around and not train them to perform everything that is required to manage an ICU.

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