FNP vs ACNP

[littlepeopleRNICU]

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!

[ixchel]

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]

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.

[justhink]

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]

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]

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]

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?

[BostonFNP, APRN]

If all you want to do is work inpt (and make sure you shadow some inpt and outpt so you know that you absolutely only want to do that), than ACNP is a better speciality for you.

FNPs shouldn't be working in the ICU without a lot of supplemental training or a post-masters. I will cover the unit but I transfer them off my service ASAP.

[veterannurse]

I see everyone has attempted to breakdown the fnp vs acnp debate..my question is where does the Agnp and the AG-ACNP play into this. So an AG- ACNP. I have been told by my hospital education department can do in patients or outpatient over the age of 13. How do you guys see them occupying this role?

[ryguyRN]

The gerontological NP was combined with the ACNP and ANP, there is no longer the GNP training. They still function as the ACNP and ANP did before just with some geri training.

[IBSavn]

I will weigh in on this conversation...

I am currently in the AGACNP program at Georgetown University. From everything I've been told by professor's and peers this is what I've concluded.

FNPs should be utilized in the outpatient primary care setting. This is what their education is focused on. ACNPs should be used in the hospitals and outpatient clinic settings that are not primary care. The education of an ACNP is based on here and now (acute>chronic). We learn extensive diagnostic information about radiology, ultrasound, laboratory, and many other diagnostic tests. Additionally, we receive hands on training regarding critical care procedures that few, if any, FNP programs receive (intubation, central line placement, arterial line placement, surgical airways, chest tube insertion, PEG insertion). As a soon-to-be-graduate ACNP I would NEVER trust myself to be the primary provider for a patient. We do not learn preventative medicine nor primary care medicine. My partner is in his final semester of FNP school and our programs are as different as night and day. While he learns about vaccinations, rashes, obstetrics, health promotion and so on, I learn about vasopressors, ventilator settings, critical-care procedures and so forth.

My recommendation, if you want to work inpatient become an ACNP if you want outpatient/primary care go FNP. As for the Emergency NP, I highly recommend you do a dual ACNP/FNP program. There is a program like this at Vanderbilt and South Alabama University. Both FNPs and ACNPs can get hired in an ED; however, most hospitals desire dual certified providers. ACNPs are not educated in pediatrics, obstetrics, and gynecology. This makes it exceedingly complicated for ACNPs to staff a quickcare or fast track section of an emergency department. Most fast track patients have complaints that can be dealt with in a primary care setting. While FNPs are trained in obstetrics, gynecology, and primary care, they lack the education in acute and critical care. While a FNP may have been an ER or ICU nurse prior to NP certification this does not make it OK to practice in an acute and or critical care area.

As stated before by another poster, may boards of nursing are mandating that NPs practice in the areas which they were educated. I know for sure that Maryland does not allow FNPs to practice in inpatient settings that are deemed acute/critical care. With that said, they also specify that they seek FNPs and/or ANPs for settings such as primary care or outpatient clinics.

Hope this helps.

Also, please excuse any grammatical errors. It's 0427 and I'm on my 6th twelve-hour shift.

[Corey Narry, MSN, RN, NP]

Sorry, late for the conversation as I didn't realize I was mentioned in the thread. To be honest, I feel disinterested with these FNP vs ACNP threads. It's so redundant. There are so many resources out there to help with this decision and to be honest, nobody here really knows what's good for you but your own self.

ACNP or AGACNP as it's now called does not limit you to just working in the in-patient setting. There is no state mandate anywhere that says that. Sure, you are to stick to the age group that you are trained on. That does not mean that jobs are not as abundant just because of that.

I happen to love critical care and have been working in this field for 10 years. I have a lot of autonomy and our ACNP group is well respected at the institution we work for. It is a well known fact there that attendings would rather have one of us stick a coagulopathic pre-transplant end-stage liver disease patient in the ICU for a central line than a resident being supervised by a fellow. That's how skilled our group is.

And I won't repeat what I already said in this other thread so I'll just post a link to it: https://allnurses.com/nurse-practitioners-np/acnp-job-opportunities-923749.html#post7912258

Another accolade: Seminal Program Has Changed, Improved Acute Care in Northern California | UCSF Science of Caring

[globalRN]

FNPs were likely grandfathered in before the ACNP specialty.

In Canada, we don't have ACNPs, just pediatric, adult and family NPs.