FNP vs AGACNP? Need help deciding.

[jwirth.rn, BSN, RN]

I'm currently a critical care nurse and I love it - I love codes and vents and really sick patients. I am trying to decide between AGACNP vs FNP - I feel like as an AGACNP I may be more superfluous in the critical care environment, and I cannot work nights again and don't want to be a nocturnist/hospitalist.

As an FNP I could work in the ER, and still have that critical care experience while also seeing more urgent care/primary care needs. However, I have *no* ER experience as an RN.

Autonomy is high on my list of priorities.

My mother passed away last November. I had planned to become a nurse practitioner to help take care of her because she was terrified to go to the doctor and refused to go. She was only 59. Her passing is my main impetus for doing this now - time is so short!

I would like to be the kind of health care provider she would not have been afraid of. She had Asperger's syndrome and agoraphobia, and severe COPD and heart disease.

I would love input from anyone currently working in these fields. Thank you very much in advance!

Jamie RN, CCRN

[ArrowRN, BSN, RN]

I was also wanting an answer to this exact question. Nursing graduate degrees are so poorly define its difficult to determine what to do. From what I read FNPs can work in ER but some things could be out of their scope of work and require the AGACNP certificate as well...its so confusing.

[Nimrodel, BSN, RN]

Just wondering - have you thought at all about becoming a CRNA, given your background in critical care?

[jwirth.rn, BSN, RN]

I am the sole breadwinner for our family of 5 - my 2 stepchildren and our daughter. My husband is a stay-at-home dad. I can't take off the time even for the didactic portion of the program. I have thought about it. :) FNP or AGACNP both would let me work while completing the degree.

I am leaning towards the AGACNP, that's where my passion lies - I can always be a nocturnist for a year to get NP experience, and then relocate to be a hospitalist on days in a critical access hospital. And maybe get an FNP post-grad certificate for more versatility.

Thank you for your reply!

[ghillbert, MSN, NP]

Sounds like you should be a good fit for AG-ACNP all the way! I am an ACNP who works in critical care - I am not sure what you mean about being superfluous. I prepare for rounds, present my patients on rounds to the attending, liaise with my patient's nurses, communicate with other teams and families of my patient, and write notes/bill. I would not say it's an independent role, particularly as I have been in this unit for only 6 months, and I certainly would not want to be alone in our very high acuity unit, but I feel I have a lot of autonomy. My attending physicians provide as much "supervision" as I ask for. I have them around for intubations still, but I am comfortable placing chest tubes, central or arterial lines etc by myself.

I would hate being an FNP. I have thought about doing it as a post masters certificate, but the thought of doing primary care or peds clinical make me want to strangle myself, so I'll stick with ACNP for now :)

[Riburn3, BSN, MSN, APRN, NP]

I was exactly like you in terms of experience before I became an NP, and I think you already answered your own question when you say you don't want to be a hospitalist/nocturnist, and listed the things you would actually like to do like ER, urgent, or primary care.

I have my FNP (and am currently almost done with my AGACNP), and am glad I got the FNP initially because the program is so much more broad and I feel like it teaches internal medicine better than an acute program does. The flexibility in job role is a lot better too (which can vary wildly depending on where you live). Now that I am getting my AGACNP, I feel like this degree is just building on my FNP, where as had I gotten this degree first, I would likely be more lost in an FNP program had I done it second.

Despite what people say, there is also overlap in the two degrees in terms of what jobs you actually end up doing. My current job entails me rounding in the hospital on cardiac patients, which is more acute, but I also spend a good chunk of my day in an outpatient CV clinic seeing patients and managing their chronic issues, which is much more in line with being an FNP. Similarly, my first job was working in a primary care IM clinic managing things like diabetes and hypertension, but I was also required to do some hospital rounding, which again is more acute. Even AGACNP friends that work with pulmonary/intensivist groups have to spend some of their time in the clinic managing/maintaining more chronic issues, not in line with what the AGACNP really teaches.

If I were you, I would look up what openings are available in your market that you would be interested in, and what role better fits the opening. I know in my area, for every one or two hospital openings that would call for an AGACNP, there are 15 outpatient/primary/urgent care openings better suited to an FNP. This is why I got my FNP first, even though I like acute care and am better suited for an AGACNP, the openings at the time I went to school weren't there for an AGACNP and I wanted to more broadly scoped degree. You call always go back and grab a quick post masters cert like I'm doing.