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FNP vs ACNP

Posted

Specializes in NICU, telemetry. Has 7 years experience.

Hello,

I know there are already a few threads on FNP vs ACNP, but most of what I'm seeing is dated from a few years ago, so I just wanted to see if there is any update from those of you currently practicing or in school. I am in the process of researching programs to start applying to, and the question of ACNP vs FNP has come into place. When I first graduated nursing school, I had planned on doing ACNP. This was prior to transferring from the adult world into the NICU. I have been told by some that FNP allows you to take care of all ages in a variety of settings, which gives the flexiblity I would love. However, reading, I am seeing some things saying it's hard to find hospital work for an FNP, as the education really is centered around family primary care. I don't see myself working outside of a hospital initially. It may be something that I decide to do in the future, but I love acute care. I love the fast pace, I love the challenge, the puzzle of solving this problem with this problem. Not saying that there will not be challenges in primary care, but they are just different types. I have hands-on experience in telemetry and a level III NICU. I think as far as NP goes, I can envision myself working in the (primarily adult, but I like having a peds option too)units, EDs, etc., at least to start.

I have found a couple of dual ACNP/FNP programs, but they all go by the title of "emergency NP" and require at least a year or two of bedside ER experience, which I do not have. I just know I do want to have the option to work in the hospital without struggling to find a job that allows my position.

While we're on the topic, did any of you/are you complete(ing) online programs for your degree? I'd love to hear any insight on how you like the program, if so!

Thanks!

Edited by littlepeopleRNICU

It sounds as though you have already decided ACNP. Once you decide to get out of the hospital you can go to the clinic setting. I have seen ACNPs working in primary care. It is more of a question of whether you want to work with kids or not. Whichever way you decide you can go back and get a post-masters or the DNP in whatever you want.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

It sounds as though you have already decided ACNP. Once you decide to get out of the hospital you can go to the clinic setting. I have seen ACNPs working in primary care. It is more of a question of whether you want to work with kids or not. Whichever way you decide you can go back and get a post-masters or the DNP in whatever you want.

ACNP work in clinic is almost always speciality-based and is borderline outside scope, you'd have to be very careful there.

It is easier for FNPs to get inpt jobs than ACNPs to get primary care jobs. Speciality clinic is about even though I would suspect FNPs have an edge there.

littlepeopleRNICU

Specializes in NICU, telemetry. Has 7 years experience.

Thank you both for your responses! I talked to a few people at work last night who are in NP programs, and based off what they're told in their programs, FNP would probably be better for me. I just worry that I won't be able to work in a critical care setting in the hospital if I choose to. I have a lot to think about!

Several things. First, they are entirely different specialities. FNP does not prepare you for hospital based work, though I see some FNP's in my area working for specialists in the hospital or with the hospitalist service. However, the IOM Future of Nursing report calls for NP's to ONLY work in the speciality area for which they are trained. States have already implemented some of the IOM recommendations, so in the future, I think you will see fewer FNP's working in hospitals.

Secondly, if you like problem solving, you get plenty of that in family practice. I can't speak for everywhere, but every ACNP I have ever met does very little problem solving with regard to patient care. Instead, they write very basic admissions orders on behalf of the physician/service for which they work, take call for minor things, round, and write discharge orders. Some work on the floors overnight to handle basic issues that arise when the docs aren't around. They are not heavily involved in developing or adjusting medical treatment plans, so diagnostic reasoning skills are not heavily utilized by the ACNP's that I've seen. If you like diagnosis, family practice/urgent care/ED fast track is the place to be. If you simply like being in the hospital doing physical assessments, taking histories, and writing basic, initial admissions orders and discharging, and don't care too much about using diagnostic skills, then ACNP is a better fit.

And, as another noted above, ACNP is rare in the outpatient setting, except maybe for some specialty clinics. The ACNP is not trained to provide primary care, and the FNP is not trained to do inpatient care.

Edited by justhink

MurseJJ

Specializes in Neurosurgery, Neurology.

I'll just wait for our critical care ACNP, juan de la cruz, to comment on the above ^. :)

littlepeopleRNICU

Specializes in NICU, telemetry. Has 7 years experience.

The ACNPs I have met also do more than basic admission orders and discharges. I know a lot of this will depend on your region, and the institution itself. I wish this decision was more clear cut!

I'll just wait for our critical care ACNP, juan de la cruz, to comment on the above ^. :)

Yes, me too.

Anecdotes, however, mean nothing. Perhaps Juan's area fully uses ACNP's to their fullest capacity. Or perhaps only he is. In my area, they do as I described - glorified RN's. And some may be happy with that.

What matters is not what Juan says, and not what I say, but how ACNP's are used in the OP's area.

If you have actual evidence (not you or Juan's personal experience that may or may not describe reality) that describes how most ACNP's are used nationwide, please post it and spare us the anecdotal opinions and smiley faces.

MurseJJ

Specializes in Neurosurgery, Neurology.

Yes, me too.

Anecdotes, however, mean nothing. Perhaps Juan's area fully uses ACNP's to their fullest capacity. Or perhaps only he is. In my area, they do as I described - glorified RN's. And some may be happy with that.

What matters is not what Juan says, and not what I say, but how ACNP's are used in the OP's area.

If you have actual evidence (not you or Juan's personal experience that may or may not describe reality) that describes how most ACNP's are used nationwide, please post it and spare us the anecdotal opinions and smiley faces.

I do hope you realize the irony in your comment above, in light of what you posted previously.

Perhaps I'll comment further later when I'm at my computer (and not using my phone), perhaps not, as your ironic attempt at condescension is off-putting.

MurseJJ

Specializes in Neurosurgery, Neurology.

The ACNPs I have met also do more than basic admission orders and discharges. I know a lot of this will depend on your region, and the institution itself. I wish this decision was more clear cut!

Yes, it's definitely dependent on region, institution, etc. In my area, ACNPs function in a variety of settings, managing ICU patients, performing diagnostic cardiac caths, NP cardiology units, etc. Perhaps in states more restrictive, they do less, but that would also be true for all other types of NPs.

I do think you have a lot to think about since you're interested in caring for both adults and children in acute care.

I do hope you realize the irony in your comment above, in light of what you posted previously.

Perhaps I'll comment further later when I'm at my computer (and not using my phone), perhaps not, as your ironic attempt at condescension is off-putting.

I do not "realize the irony," and hope you will comment further.

Where I work (anecdotal), we have nothing but Intensivists (4 year MD + 3 year IM residency + 1-2 years pulmonology + 1-2 years intensive care) in the 120-bed ICU. Despite that extensive training, they generally limit themselves to vents/relevant pulmonology, basic electrolytes (K+, mag), basic empiric antibiotics, and simple ICU patient management (foley's, CT's, x-ray, 500 cc boluses, AM labs, nutrition, etc.). If there is any comorbidity (cardiac, neuro, ID, renal, etc.), most is referred/consulted to the relevant specialists (cardiologists, neurologists, urologists, etc.). So maybe there is an APN on this board that handles it all, and is far more prepared to manage patients in the ICU than the Intensivists (with 8-10 years of formal training) that I work with, who is so bright that he/she doesn't need to lean on specialists like the Intensivists (with 8-10 years of formal training) that I work with. If that were true (God help us), then it is an anomaly (I hope).

Edited by justhink

Yes, it's definitely dependent on region, institution, etc. In my area, ACNPs function in a variety of settings, managing ICU patients, performing diagnostic cardiac caths,

Really? They are managing ICU patients??? They are diagnosing coronary artery disease/occlusions based on their caths, and their own readings/interpretations with no MD present in the cath lab??? You do realize that driving a cath and diagnosing CAD are entirely different, right?

ixchel

Specializes in critical care.

I do not "realize the irony," and hope you will comment further.

The irony is that you laid out a ton of anecdotal information, said you do not want someone else to contribute their own anecdotal information, and basically said that rather than find valid proof for your statements, you expect someone else to provide proof of their own point of view. So essentially, you're the only one allowed to throw out anecdote without proof just because you say so.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

I think, by irony, they meant that you gave your opinion based on a bunch of anecdotal experience, then said that the OP shouldn't rely on anecdotal experiences.

I think, by irony, they meant that you gave your opinion based on a bunch of anecdotal experience, then said that the OP shouldn't rely on anecdotal experiences.

Wrong. I clearly state that my experience is just that and that others may have had a different experience. And my personal experience, is, by definition, anecdote. I was then replied to by NYCguy that stated that Juan might have have a different experience - an anecdote to counter mine. That's fine, except the implication was that Juan does things that I know he/she doesn't do. There is no need to exagerate one's duties simply to counter my original point. Follow?

ixchel

Specializes in critical care.

That's fine, except the implication was that Juan does things that I know he/she doesn't do.

I'm curious to know how you could possibly know this.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

Let me provide my own anecdotal evidence.

I am not an ACNP. Three days a week I am responsible for managing my office's patients in the hospital. On these days I am considered the attending and I am solely 100% responsible for those patients. This is the real world not House MD: I don't take them down to the lab and do my own cath or wheel them to the OR and personally do their exploratory lap. I order specialist consults as needed; many of the specialist teams are also largely made up of NPs and PAs.

littlepeopleRNICU

Specializes in NICU, telemetry. Has 7 years experience.

Let me provide my own anecdotal evidence.

I am not an ACNP. Three days a week I am responsible for managing my office's patients in the hospital. On these days I am considered the attending and I am solely 100% responsible for those patients. This is the real world not House MD: I don't take them down to the lab and do my own cath or wheel them to the OR and personally do their exploratory lap. I order specialist consults as needed; many of the specialist teams are also largely made up of NPs and PAs.

BostonFNP, if I am wanting to work in the hospital primarily, working in an ER, ICU, or as a hospitalist role, do you feel an FNP program would suit that?