FNP vs ACNP? Please help

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Hi, I am having difficulty deciding wether to start and FNP program or an acute care no program. I have been an RN for 5 years and have worked in acute care; telemetry and ICU. I want to become an NP and I see myself working in a doctor's office or urgent care faculty when I am done. I have never worked with children as an RN and don't have much of an interest to do so as an NP so that detours me from the FNP program. But, I love working with adults but would like a slower paced environment once I graduate. Can I do FNP and not work with children? Can I do ACNP and work outside of a hospital. Any informations will help.

My point is that ACNP's seems to be more concentrated near metropolitan and medical university hospitals. If you want my opinion on who would be hired for a hospitalist position, I would still say the FNP. I know you have a lot of people that think FNP is outpatient based and ACNP is inpatient, the reality is FNP's are used readily on the inpatient setting. Most specialist groups will not hire an ACNP for the lack of being able to see a child (which is also why you wont find them in the ER). I work in a community hospital and we do have ACNP's but our parent company does not look for them specifically due to restraints on whom they can see.

Like I said, FNPs are hired for hospitalist positions simply because there is no ACNP available. What is a rational reason to hire a FNP over an ACNP for an inpatient position? There is no reason and frankly with that rationale an ACNP should be be able to work in a primary care clinic. Hospitalist work is the bread and butter for the ACNP NOT FNP.

It makes no sense to claim, that FNPs can work seamlessly work anywhere but ACNPs can not. Many FNP programs have 0 inpatient clinical hours. There are plenty of specialty clinics or practices that only see adults. I believe ACNPS can see 13 or 15 and up.

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Specializes in Urology.
Like I said, FNPs are hired for hospitalist positions simply because there is no ACNP available. What is a rational reason to hire a FNP over an ACNP for an inpatient position? There is no reason and frankly with that rationale an ACNP should be be able to work in a primary care clinic. Hospitalist work is the bread and butter for the ACNP NOT FNP.

It makes no sense to claim, that FNPs can work seamlessly work anywhere but ACNPs can not. Many FNP programs have 0 inpatient clinical hours. There are plenty of specialty clinics or practices that only see adults. I believe ACNPS can see 13 or 15 and up.

I'm claiming this because it can and does happen everyday at my hospital. Again, ACNP's seem to concentrate more at academic facilities. FNP's can work seamlessly doing inpatient work just as well as an ACNP can. How many ICU NP's do you think you need at a community hospital, if any? No need to get defensive, its just how things are around here and its working just fine. What makes you think that an FNP should not do inpatient work? You think they have a hard time writing orders for the post op colon resection or the diabetic patient?

Don't get me wrong the ACNP we do have do a fabulous job. A lot of stuff can be learned on the job which is why it is filled with FNP's. If we were more of a progressive metro area, I'm sure the call for ACNP would be higher.

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Specializes in NICU, telemetry.
I'm claiming this because it can and does happen everyday at my hospital. Again, ACNP's seem to concentrate more at academic facilities. FNP's can work seamlessly doing inpatient work just as well as an ACNP can. How many ICU NP's do you think you need at a community hospital, if any? No need to get defensive, its just how things are around here and its working just fine. What makes you think that an FNP should not do inpatient work? You think they have a hard time writing orders for the post op colon resection or the diabetic patient?

Don't get me wrong the ACNP we do have do a fabulous job. A lot of stuff can be learned on the job which is why it is filled with FNP's. If we were more of a progressive metro area, I'm sure the call for ACNP would be higher.

Do you have any legitimate stats on this, other than just your own hospital/area? I'm just wondering because I know what it's like in my area(which, in my state, is similar to what Dranger said...even in non-metropolitan areas), but would like to know a general(proven) fact about this for other locations. Thanks!

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Specializes in Urology.
Do you have any legitimate stats on this, other than just your own hospital/area? I'm just wondering because I know what it's like in my area(which, in my state, is similar to what Dranger said...even in non-metropolitan areas), but would like to know a general(proven) fact about this for other locations. Thanks!

Good luck finding data on this outside of empirical. When speaking of this I was speaking of my health institution. If you want an answer you'll need others to chime in who have similar demographics to my own to see who they employ and for what. A woman I have worked with for the past 8 years tells me that her previous hospital she worked at used FNP's for inpatient. She worked at that hospital for 25+ years. It is a critical access hospital. I know BostonFNP has stated several times that he does inpatient. In Pennsylvania where I work, it is not outside the scope of a FNP to do inpatient medicine. I'm not saying that we dont hire ACNP's, im saying there isnt a huge need for them at my facility and several other community/rural areas.

For the purpose of the OP's orginal post, I was pointing out that they should check into what is the trend in their area and decide.

http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/imported/NPPrimaryCareAcuteCarePracticeFINAL.pdf

This is also a link to the consensus model which is just a guideline. It may or may not be followed. When im talking about FNP/AGNP doing inpatient, they are not seeing people in the ICU or any critical area. They can however round on patients from their specialty of practice or be hospitalists. For example, I plan on working for a Urology group as an FNP after I graduate. I will be seeing patients of that practice in the hospital and in the office. I will be writing orders while they are in the hospital and following up on them at the office after discharge. Should there be a need for anything outside of the services I can provide, I would be sure to bring the appropriate sources on board. This of course could be done by an ACNP as well but the primary reason I went FNP was due to children. Yes the ACNP can see patients down to 13? (15?) but that leaves a significant gap in patient age considering that we do several meatotomy, circ revisions, hypospadias, torsion, etc surgeries on patients well under the age of 13.

What I was trying to prove to the OP is his or her decision should be based on employment opportunity. I would hate to see them go to school only to find the job market for that specific cert is limited to none. They might have a huge market in their area for all I know. I'm just speaking from experience and again, this will vary on your coverage area/institution. Of course they always have the right to chose what they want to do but I was also showing that my facility uses FNP's in almost the same way as our ACNP's minus the ICU.

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I'm claiming this because it can and does happen everyday at my hospital. Again, ACNP's seem to concentrate more at academic facilities. FNP's can work seamlessly doing inpatient work just as well as an ACNP can. How many ICU NP's do you think you need at a community hospital, if any? No need to get defensive, its just how things are around here and its working just fine. What makes you think that an FNP should not do inpatient work? You think they have a hard time writing orders for the post op colon resection or the diabetic patient?

Don't get me wrong the ACNP we do have do a fabulous job. A lot of stuff can be learned on the job which is why it is filled with FNP's. If we were more of a progressive metro area, I'm sure the call for ACNP would be higher.

Who said anything about ICU? ACNPs are simply acute/inpatient care, period. I am not defensive, I am just trying to understand why you think if a hospitalist role would be better fit by an FNP.

I am just translating your logic over that a ACNPs should be allowed to work primary care with OJT. That is essentially what you are arguing. What makes ACNPs forbidden to do primary care?

Per hiring managers at my hospital, the ONLY reason we even have FNPs hospitalists is because of the lack of ACNP applicants. Working in a clinic and subsequently rounding in a hospital is a different story. The actual role of a hospitalist is better fit by an ACNP just like a primary care provider is better fit by a AGNP or FNP. Sorry, there is no way around this. To argue otherwise would make specialties pointless.

I never understood why people on here promote FNP like it is the catch all specialty. There are a million posts on here asking about being a psych provider as an FNP or wanting to working inpatient as an FNP. You want a specialty area? Then specialize. Most NP schools have 500-700 clinical hours, that's it. There is no way that one of the NP specialties can cover everything adequately from a purely didactic, simulation and clinical perspective. Last time I checked FNP programs don't teach you to place CVCs or chest tubes right?

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Specializes in Urology.
Who said anything about ICU? ACNPs are simply acute/inpatient care, period. I am not defensive, I am just trying to understand why you think if a hospitalist role would be better fit by an FNP.

I am just translating your logic over that a ACNPs should be allowed to work primary care with OJT. That is essentially what you are arguing. What makes ACNPs forbidden to do primary care?

Per hiring managers at my hospital, the ONLY reason we even have FNPs hospitalists is because of the lack of ACNP applicants. Working in a clinic and subsequently rounding in a hospital is a different story. The actual role of a hospitalist is better fit by an ACNP just like a primary care provider is better fit by a AGNP or FNP. Sorry, there is no way around this. To argue otherwise would make specialties pointless.

Right, that is how your facility operates. You know how mine does. There is no clear cut right or wrong answer. I think our FNP's do a fine job at inpatient work just as much as our ACNP's do. Could we hire more ACNP's? Sure. Why dont we? Because nobody is going to school for that around here as there isnt a need. Saying that ACNP's are better suited for inpatient is your opinion and I respect that. I reality its really down to the training of the NP, who you work for, and what your expectations are.

AGain, I'm not knocking ACNP's, just saying they arent in demand in my area and its not because we dont have any its because FNP has traditionally been more flexible.

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Right, that is how your facility operates. You know how mine does. There is no clear cut right or wrong answer. I think our FNP's do a fine job at inpatient work just as much as our ACNP's do. Could we hire more ACNP's? Sure. Why dont we? Because nobody is going to school for that around here as there isnt a need. Saying that ACNP's are better suited for inpatient is your opinion and I respect that. I reality its really down to the training of the NP, who you work for, and what your expectations are.

AGain, I'm not knocking ACNP's, just saying they arent in demand in my area and its not because we dont have any its because FNP has traditionally been more flexible.

Right, but with that train of thought you are going to have to concede that ACNPs could also function outside of the hospital. If an FNP has no clinical experiences in a hospital and is able to do it than surely a ACNP can work in a outpatient clinic.

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Specializes in Urology.
Right, but with that train of thought you are going to have to concede that ACNPs could also function outside of the hospital. If an FNP has no clinical experiences in a hospital and is able to do it than surely a ACNP can work in a outpatient clinic.

I never disagreed with you here, I absolutely think an ACNP could do outpatient work. As a matter of fact, I think we should get rid of these specialties anyway. To me, NP needs to adopt something like PA where the training is general but the scope is based on what you want to do after the fact. I feel like NP has an identity crisis on who works where and who can do what based on school yet the majority of the knowledge and skills comes after school and during practice.

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I never disagreed with you here, I absolutely think an ACNP could do outpatient work. As a matter of fact, I think we should get rid of these specialties anyway. To me, NP needs to adopt something like PA where the training is general but the scope is based on what you want to do after the fact. I feel like NP has an identity crisis on who works where and who can do what based on school yet the majority of the knowledge and skills comes after school and during practice.

The problem is many NP schools with online education are suspect at best. PA schools get the foundation and clinical practice to make them excellent generalists. The OJT comes afterwords, but the foundation needs to be there. As far as I know there are few if any online or part time PA schools.

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Specializes in Adult Internal Medicine.

This is a topic that is more hotly contested by students and prospective NPs than practicing NPs. The truth of the matter in practice is that everything is blurred. In an ideal world it would all be separated, but its not, and the truth of the matter is, regardless of training, after a year or two or four of experience it doesn't matter much. An ACNP with 4 years working in an internal med clinic will be a better provider than an FNP out of school. An FNP with similar hospital experience will be better than an ACNP out of school.

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