GNP or FNP?

Published

I need some advice from experienced NP's of all specialities. I am enrolled at the University of South Alabama NP on-line program and torn between the GNP and FNP tracks. I work for the Dept of Veterans Affairs in MICU and generally take care of pt's 55 yrs old and older with some very complex health problems. Therefore the GNP program would fit perfectly in with the VA setting, especially when the program has the GNP with a special focus in diabetes management that will allow you to sit for the CDE. The veterans and our general American population is getting older and requiring professionals with specialty training to meet their complex healthcare needs. However, I really don't care to deal with children and pregnant women, but I know that the FNP will make me more marketable. I'm a young nurse with 6 yrs of professional nursing practice under my belt and I don't plan on leaving the VA until I am eligible to retire, which is about 30yrs. If you had this decision to make which would you choose? Keep in mind that the VA is paying off my BSN student loan, paying for my MSN/NP, providing excellent benefits/retirement plan and pay comparable to the private sector from my research. Also did I mention that you can transfer to any VA and practice under your home state's NP license and you are covered under the VA's policy. There are many areas within the VA for both FNP's/GNP's to work autonomously (Geriatric clinic, Diabetes clinic, TCU-TRANSITIONAL CARE UNIT, ECU-EXTENDED CARE UNITS, etc... Catch my drift!! What I'm getting to is that I'm really leaning more towards the GNP track, but I'm open to any suggestions, professional advice and words of wisdom.

Wow, so how on earth does one go about figuring out what's the best specialty in their state? I'm just beginning school (direct-entry program) in the fall, and the FNP vs. ACNP debate has been heavily on my mind. . . . I plan to work in California when I finish, and want to be sure that I can get a job!

Thanks,

Kens

The FNP is the way to go, because it has the broadest scope of practice, no matter which state you live in. We can see patients of any age and we can "specialize" in some areas (geriatrics, OB/GYN, pedes, etc) without getting additional certifications. As an ANP/GNP, I couldn't see children under the age of 12 nor could I treat pregnant women. I'm glad I had all the additional training, but it would have been much easier for me to have gotten the FNP the FIRST time around!

Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

Totally agree with above poster - get the widest scope possible the FIRST time around. Then...if you really really need a specialty you will have less to complete.

Up Vote Up Vote ×
Specializes in Acute Care - Cardiology.

preface: the following message reflects my own personal beliefs and statutory requirements. :)

i, too... had the same inner debate regarding acnp vs fnp. i chose acnp... and have yet to be disappointed with my choice (i graduated in december). i knew that i did not want to be restricted to primary care. i wanted a more in-depth, acute and critical care focus. i also wanted the ability to go in the hospital... and figured i would specialize at some point (cardiology, hospitalist, etc.).

for me... the fnp would not have been a good choice. i would not have been satisfied with it... so i just went right for the gusto and set my mind up to deal with it later if i needed to see pediatrics or ob patients.

i am very happy... you have to do what is right for your goals and local needs. what is right for me, or trauma, or anp, or whoever may not be right for you.

Up Vote Up Vote ×

preface: the following message reflects my own personal beliefs and statutory requirements. :)

i, too... had the same inner debate regarding acnp vs fnp. i chose acnp... and have yet to be disappointed with my choice (i graduated in december). i knew that i did not want to be restricted to primary care. i wanted a more in-depth, acute and critical care focus. i also wanted the ability to go in the hospital... and figured i would specialize at some point (cardiology, hospitalist, etc.).

for me... the fnp would not have been a good choice. i would not have been satisfied with it... so i just went right for the gusto and set my mind up to deal with it later if i needed to see pediatrics or ob patients.

i am very happy... you have to do what is right for your goals and local needs. what is right for me, or trauma, or anp, or whoever may not be right for you.

i'm glad to see there are acnp's practicing in the hospital. if someone wants to practice strictly in a hospital setting, then acnp is the only way to go!

Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

However, that too is specific to an area. In my area, FNPs are in the hospital too.

Up Vote Up Vote ×
However, that too is specific to an area. In my area, FNPs are in the hospital too.

Right, and I think that's the big question for me in California. If I can be in the hospital with FNP, then it seems like a really good way to go, because I can also be in primary care down the road, and pretty much have doors wide open for me. HOWEVER, if SOP laws are going to change my ability to be in the hospital as an FNP, then that changes things for me, too.

Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.

preface: the following message reflects my own personal beliefs and statutory requirements. :)

i, too... had the same inner debate regarding acnp vs fnp. i chose acnp... and have yet to be disappointed with my choice (i graduated in december). i knew that i did not want to be restricted to primary care. i wanted a more in-depth, acute and critical care focus. i also wanted the ability to go in the hospital... and figured i would specialize at some point (cardiology, hospitalist, etc.).

for me... the fnp would not have been a good choice. i would not have been satisfied with it... so i just went right for the gusto and set my mind up to deal with it later if i needed to see pediatrics or ob patients.

i am very happy... you have to do what is right for your goals and local needs. what is right for me, or trauma, or anp, or whoever may not be right for you.

i actually felt the same way as you did. before i registered for an msn program, i really looked around to figure out what the different np programs have to offer as far as their curriculum and preparation for clinical practice. i looked at anp, acnp, and fnp. of all three, i really liked the way the acnp program was organized into body systems and that it is quite similar to an internal medicine training with a focus on hospitalized patients. since np training is only two years full time, i wanted to utilize that small amount of time to the fullest in studying and training for stuff that is interesting to me and not have to go through other classes that i know i don't care for. i have no interest in peds, women's health, or psych.

as a nurse, i enjoy acute care and of all the settings i've worked in, icu and adult er were my favorites. i was also interested in cardiology, pulmonary medicine, and endocrine disorders as a prospective np student and i thought that the acnp program would give me adequate exposure to competently work in these areas. i know that there are fnp's in hospitals in some states including here in michigan where i live. however, i felt that i am not going to get the focused adult acute care training in that program and i would be depending solely on my nursing experience and on-the-job orientation if i do that in school and end up working in an acute care specialty. that too me defeats the purpose of going through an np program to advance my knowledge base.

finally, my acnp training has helped me a great deal in my current intensivist practice in a surgical icu setting. i've precepted acnp students and some of them wonder why we remember so much of the internal medicine stuff despite working in a strictly cardiothoracic surgery patient population. i tell them once you start working as an np, all the adult medicine stuff you learned you'll always need to fall back on because you need to treat your patient's medical issues from head to toe and not just focus on their primary diagnosis.

Up Vote Up Vote ×
Specializes in Acute Care - Cardiology.

excellent post pinoynp... you reflected on my thoughts exactly... just went more in depth than i did. :) glad to know i'm not in this boat alone...

Up Vote Up Vote ×
Specializes in CTICU.

As a potential NP student, what is the best way to find out about the local market and what's the best choice? I can't find much info online about the scope of practice of the various specialties. Should I just ask the NPs at my hospital?

Up Vote Up Vote ×
As a potential NP student, what is the best way to find out about the local market and what's the best choice? I can't find much info online about the scope of practice of the various specialties. Should I just ask the NPs at my hospital?

You can look up the various scopes of practice on the ANCC (American Nurses Credentialing Center) website.

I went to school with people from across the U.S. and the vast majority of them were in the FNP program. I could have kicked myself for not doing the FNP program from the beginning. There were several NP students from various specialties in that program and we ALL wished we had done it the first time around.

Up Vote Up Vote ×
I actually felt the same way as you did. Before I registered for an MSN program, I really looked around to figure out what the different NP programs have to offer as far as their curriculum and preparation for clinical practice. I looked at ANP, ACNP, and FNP. Of all three, I really liked the way the ACNP program was organized into body systems and that it is quite similar to an internal medicine training with a focus on hospitalized patients. Since NP training is only two years full time, I wanted to utilize that small amount of time to the fullest in studying and training for stuff that is interesting to me and not have to go through other classes that I know I don't care for. I have no interest in peds, women's health, or psych.

As a nurse, I enjoy acute care and of all the settings I've worked in, ICU and adult ER were my favorites. I was also interested in cardiology, pulmonary medicine, and endocrine disorders as a prospective NP student and I thought that the ACNP program would give me adequate exposure to competently work in these areas. I know that there are FNP's in hospitals in some states including here in Michigan where I live. However, I felt that I am not going to get the focused adult acute care training in that program and I would be depending solely on my nursing experience and on-the-job orientation if I do that in school and end up working in an acute care specialty. That too me defeats the purpose of going through an NP program to advance my knowledge base.

Finally, my ACNP training has helped me a great deal in my current intensivist practice in a Surgical ICU setting. I've precepted ACNP students and some of them wonder why we remember so much of the internal medicine stuff despite working in a strictly cardiothoracic surgery patient population. I tell them once you start working as an NP, all the adult medicine stuff you learned you'll always need to fall back on because you need to treat your patient's medical issues from head to toe and not just focus on their primary diagnosis.

Are there Adult NP's in your hospital? When I went through the Adult NP program, I trained with internists and also in the hospital. The program I attended trained us to see patients over the age of 12. What age group do you see? If you're working in the ER and a child comes in, what do you do?

Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Are there Adult NP's in your hospital? When I went through the Adult NP program, I trained with internists and also in the hospital. The program I attended trained us to see patients over the age of 12. What age group do you see? If you're working in the ER and a child comes in, what do you do?

There are ANP's working in our hospital. But like I've said before, there are FNP's working in in-patient positions here too. The state has no specific rules on what specific NP's can do and the hospitals are uneducated on what the different scopes of practice entail. I agree that there is a risk being taken by the hospitals if FNP's continue to be hired in in-patient positions here. So far, nobody has addressed that in my hospital and no one wants to bring it up in our Mid-Level Council as folks are probably afraid to cause people to lose their jobs.

In an urban area like the one I reside in, many NP positions are in hospital settings. There are primary care positions too but the majority of NP programs available are FNP so there is a large number of NP's trained in the FNP track and not all are able to work in primary care. That's the reason why many seek employment in acute care so they can work as NP's. Again, what is happening here does not necessarily mean that it is the most appropriate thing as far as scope. The state BON has advanced practice nurse representation by an ANP. So far, I have not seen possible changes in the near future about scope of practice issues.

As far as your last question, I trained in a strictly adult specialty (18 and above). I do not work as an NP in the ER. In fact, the ER at our hospital do not hire NP's, only PA's. I work in adult critical care medicine with a cardiothoracic surgery population. Our hospital do not perform cardiothoracic surgery on pediatric patients. That subset of patients are admitted to the nearby children's hospital. I do cross-coverage of the cardiothoracic service and do ER and floor consults with that service but again, there are no kids seen in that service.

Up Vote Up Vote ×
+ Join the Discussion