How does becoming an APN work as far as picking a specialty?

elkpark · Feb 11, 2010

You choose a graduate program that offers the specialty you're interested in; i.e., you attend a CRNA program if you want to be a CRNA, an FNP program if you want to be an FNP, etc. The programs are all MSN (and now, increasingly, DNP) degrees, but they have different specializations/concentrations (like "majors" in undergrad programs). Advanced practice is not as flexible as generalist-level nursing -- if you want to change specialties later on, you have to return to school and complete the educational requirements for the new specialty (although you don't have to complete the "core" graduate-level nursing courses -- these programs are called "post-Master's certificates").

I believe there are some NP programs that focus on holistic/alternative/complementary modalities, although I don't have any specific info about that. There is a holistic nursing forum on this site (under the "specialty" tab at the top of the screen) that may have more information.

I'm not sure what you mean by your last question (what are your limits?) -- APNs' scope of practice is dictated by each state, and there are variations from state to state. Maybe you could get better answers if you could be more specific about what you're asking.

Best wishes!

Trauma Columnist · Feb 12, 2010

Your "specialty" is not necessary what you have experience in as a nurse either. For instance, my nursing exp was 10 years level one trauma center, 1 year adult ICU, 1 year med surg and 2 years LTC (LPN).

I'm currently in nephrology!

curioustwo · Feb 12, 2010

Okay, a little confused...

1. When looking at APN masters online, I did not see anything specifying which fields they have available to pick from. Are they all different?

2. Suppose you are interested in becoming a cardiac APN, do you apply for that program when it comes time to do so during your APN degree and hope to get in and if not get stuck with something less desirable (similar to how a residency works)?

3. Suppose you want to be a cardiac APN, but your only experience has been in L&D, is it possible to do that once you are already in an APN program or would you have to go back and get the experience first?

Trying to understand - sorry for all the questions.

Trauma Columnist · Feb 12, 2010

No problem. There is no specialty per se in an MSN program. There is a concentration; FNP, GNP, CNS, CRNA, CNM, etc..

Your specialty is what YOU make of it when you take clinicals. For instance, I was wanting to work ER when I graduated with my adult health CNS so I did approx 250hours in the ER.

Unfortunately, there were no jobs when I got out, so I'm in something else.

Cardiology EP NP · Feb 13, 2010

Yes your specialty is what you make of your education when you do clinicals. So most NP programs are pretty general and geared toward primary care. Now, if you want to specialize, that's fine. You would most likely want to do clinicals in your primary area of interest even though you would need to some hours in primary care since your board certification exam (either FNP or ANP) would focused on primary care.

I did a combination Adult NP/Cardiac CNS program, but really it was more like a cardiac NP program. Roughly 80% of my clinicals were in cardiology, mainly working with a cardiac NP preceptor. Aside from this, while I was in school, I chose to work on a telemetry unit that had mostly cardiology or CV surgery patients. So the two went hand in hand.

I guess you could work in a different field other that what you are specializing in school, but for me, it made the most sense to work in the same area I went to school for. It's what I really enjoyed doing and I really didn't want to work in any area of the hospital. Aside from this, when it came to interviewing and job hunting, having that work experience in cardiology really helped me to land my first job, working with an EP cardiology group. If I hadn't had the work experience that I did, I really don't think I couldn't have gotten this job.

What area are you interested in specializing in?

curioustwo · Feb 15, 2010

Thanks so much. I am not sure what I would specialize in just yet.

BabiesRUs23 · Mar 19, 2010

Cardiology EP NP, PLEASE PM me. I have questions for you. I don't know if I'm allowed to post my email address. I look forward to hearing from you!

BabiesRUs23 · Mar 22, 2010

Cardiology EP NP, I did get your PM but I don't think I'm allowed to reply. I will try this... Thanks!

cardio357 · Apr 3, 2010

Cardiology EP NP- Did you do an adult primary or adult acute program knowing you wanted to work in cardiology? My ideal job would be to see inpatient cardiac patients a few days a week and see patients in the clinic the rest of the time. Do you think ICU experience/adult acute care NP program is necessary to have a job like that? Or would a primary NP program be sufficient with cardiac focused clinicals, if possible?? Input much appreciated!

Cardiology EP NP · Apr 3, 2010

Hi cardio357,

I did an Adult NP program with CNS concentration in cardiac health and disease management. 90% of my clinical time was focused on caring for cardiac patients. I spent over 400 hours working with a cardiology NP in the outpatient setting. I did a shorter clinical in a CVICU hospital setting working with an NP there. I also did a primary care rotation (only because I had to). So my program was a little different. If you know for sure that you want to do inpatient, then you would be best off to do the acute care program. However, I know you said you wanted to divide your time between outpatient and inpatient. If you just focus on cardiology doing the acute care NP program, then you should be ok to do inpatient. However, if you ever decide you want to do primary care, work in retail health or change specialities, then you will run into some difficulty. Either the Adult NP route or the acute care NP route are very attractive. I don't think you go wrong as long as you focus your clinicals in cardiology. It really depends on what you are interested in doing long-term.

The bottom line with getting a job in cardiology really is dependent on how much experience you have working with cardiology patients. During my interview process, they were more concerned with what my work experience has been as opposed to what type of program I graduated from. The more experience you have, the better you will look. I had no real EP clinicals, but I worked inpatient on a CV unit where I cared for EP patients post procedure so at least I had that piece of it. That was enough along with my education to land me the job as a new grad. Aside from this, I was already working inpatient at the same hospital and knew the head doc of the EP department. So it helps to know people too.

Good luck in whatever you decide!

cardio357 · Apr 3, 2010

Thanks! I guess two more questions for ya...Is ICU experience really necessary for an acute care program? (I've heard mixed responses)...and would doing a primary care program be sufficient enough to do inpatient cardiology? I work on a progressive care cardiac unit with AMI, CHF, a-fib, pre/post cath/angioplasty/ablation/AICD placement, etc...have loved it so far, work with wonderful cardiac and EP PAs/NPs and really see myself doing what they do on the unit. A few of the NPs did acute care programs, others primary or just plain adult. It's kind of confusing as to what you're really getting yourself into when you apply for school...the school that is the most reasonable for me to go to only has primary care vs. a really expensive acute care program...so that's why I ask...Thanks for your input!