Help! Scope of practice FNP vs ACNP

littlepeopleRNICU · Feb 25, 2016

I am just a student, but from what I have seen in my own research or been told by program directors when I was contacting schools, or in conversation with practicing NPs, it is going to depend largely on two things: 1)region 2)individual facility.

It is true that a lot of programs are starting to base education more strongly off one role vs the other. I know that I could work acute care as an FNP, but I made my decision by realizing that the AC track's education is based more closely to managing the acute, in-house patient than FNP. To me, it isn't as much of "could I do it?" as it is, "am I as prepared as possible to do it?".

ACNP-Ray · Feb 25, 2016

I am just a student, but from what I have seen in my own research or been told by program directors when I was contacting schools, or in conversation with practicing NPs, it is going to depend largely on two things: 1)region 2)individual facility.
It is true that a lot of programs are starting to base education more strongly off one role vs the other. I know that I could work acute care as an FNP, but I made my decision by realizing that the AC track's education is based more closely to managing the acute, in-house patient than FNP. To me, it isn't as much of "could I do it?" as it is, "am I as prepared as possible to do it?".

I see no reason why as an ACNP I cannot manage somebodies DM, HTN, cholesterol, etc. If I can manage a pt in the hospital while in the hospital, then I can do it from my office as well and I frequently do. Sure I may not have a pt on an insulin drip but based on my education and training I'm able to prescribe the correct medications for my patients. The only reason I would go back for my FNP was if I wanted to take care of children. But having said that, here in Texas it was difficult finding a hospital job after I graduated unless I wanted to be paid less than what I was making as an RN with a few hours of overtime each paycheck. But FNP jobs are plentiful, I get tons of emails daily from headhunters looking for FNP's all over country and here in the Dallas/Ft Worth area...not so many looking for ACNP's

littlepeopleRNICU · Feb 25, 2016

I see no reason why as an ACNP I cannot manage somebodies DM, HTN, cholesterol, etc. If I can manage a pt in the hospital while in the hospital, then I can do it from my office as well and I frequently do. Sure I may not have a pt on an insulin drip but based on my education and training I'm able to prescribe the correct medications for my patients. The only reason I would go back for my FNP was if I wanted to take care of children. But having said that, here in Texas it was difficult finding a hospital job after I graduated unless I wanted to be paid less than what I was making as an RN with a few hours of overtime each paycheck. But FNP jobs are plentiful, I get tons of emails daily from headhunters looking for FNP's all over country and here in the Dallas/Ft Worth area...not so many looking for ACNP's

I did not say you couldn't...I actually said the opposite of that. And am well aware that many bases of patient management can cross over to either specialty. If I felt like you'd never see diabetes, hypertension, and many other chronics that a large portion of America possesses anywhere other than primary care, I probably have no place in healthcare...in any capacity.

I said the education is now being geared more towards primary care for FNP and inpatient for acute care, which is true for many schools. I said, for me personally, I feel like I thought the right choice for me was to choose acute care because I felt like I would be more prepared to handle an inpatient patient having gone through that program, than spending all of my time in outpatient settings for clinical. Every program I looked into, whether that meant calling the school or talking to students going there, stressed outpatient clinicals only(or at least mostly, I do know of one that allows around 20% of the time to be inpatient) for FNP and inpatient for acute.

Thanks for sharing your experience in your region. As I said in my initial post, it's something I have been told you have to consider. For me here, many hospitals no longer want to hire FNPs unless they have previous hospital experience...so as a new grad, my chances are more likely as an ACNP if I want to land an inpatient job.

INN_777, BSN, RN · Feb 25, 2016

Thank you both for responding. So based on your posts and my research it seems like where you want to work after each of these degrees is more a question of you preparedness and comfort level than scope of practice definition.

Advanced Practice Columnist / Guide · Feb 26, 2016

OP, you are in a situation where you can actually choose either one given your goal of working in Palliative Care. Neither of the two tracks teach Palliative Care as a specialty so it's not going to be a matter of would you be prepared better with one vs the other.

Acute Care NP programs will have the advantage of in-patient rotations that would expose you to clinical situations where Palliative Care as a specialty could be utilized. For instance, family meetings where goals of care are discussed in patients with prolonged and complicated hospital courses particularly in the ICU are common and you will see that as an ACNP student. These are great opportunities for honing skills in interacting with families in such a stressful and difficult situation as end of life decisions.

Family NP programs will give you the edge of a broad-based curriculum that cover the entire lifespan albeit in a primary care focus with little to no in-patient exposure. In the end, what you need to decide on is whether it would be easy to find a Palliative Care NP position where you currently live in or, as I would suspect, would you need to make sure you have completed an NP track that is flexible enough that the likelihood of finding a job in areas other than Palliative Care would be easy to accomplish. That question is going to be location dependent as another poster have pointed out. In some locations, you are best going for FNP because jobs are more easy to find and in others, the opposite apply.

Wolf at the Door, BSN · Feb 26, 2016

Hi all:
Need guidance or any input on scope of practice of FNP vs ACNP.
Context:
I am applying to NP programs. I currently work in inpatient Oncology and want to specialize in Palliative Care after I graduate from the Masters program. I was thinking I would start on Palliative Care service in an inpatient acute care setting and later work in Hospice in- or outpatient. I was not sure whether to pursue the ACNP or the FNP track, so I spoke with several APRNs who work in acute care setting Palliative Care (they all graduated from the FNP track) and looked up some discussions on the topic here (most seemed to suggest FNP as the right track). That considered, I applied for the FNP track.
I had an interview with one of the schools today. The FNP program director mentioned that the scope of practice for the various NP specializations is being "tightened". In that regard, it is out of scope for an FNP to work in an acute care setting and, similarly, out of scope for an ACNP to provide primary care or work in an outpatient setting. So, based on this discussion, ACNP seemed like the better track for me to pursue..

UAB - School of Nursing - Palliative Care Subspecialty

INN_777, BSN, RN · Feb 26, 2016

Juan de la cruz, thank you, very helpful to know this. I think the Acute track will give me the flexibility to work in or outpatient. It actually talks a lot about palliative care in the scope of practice. That said, only one school in the area has the Acute track, so it's good to know that if I end up in an FNP program, that's not the end of the world.