FNP vs ACNP

ryguyRN · Aug 27, 2014

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.

allnurses Guide · Aug 27, 2014

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 · Aug 28, 2014

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!

justhink · Aug 29, 2014

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.

MurseJJ · Aug 30, 2014

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

littlepeopleRNICU · Aug 30, 2014

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!

justhink · Aug 31, 2014

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 · Aug 31, 2014

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 · Aug 31, 2014

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.

justhink · Aug 31, 2014

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).

justhink · Aug 31, 2014

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?