I need your wisdom regarding NP specialty

cgfnp · May 13, 2004

Greetings all:
I'm new to the forum as of last night. I must say, there are a lot of very interesting conversations going on and I believe this forum will prove quite informative. Having said that, I really need some input regarding a couple of NP specialty tracks I'm considering and what I can anticipate from them.
I will be matriculating into a graduate ACNP program this fall at Vanderbilt. Vanderbilt offers a couple of specialized tracks through its ACNP program that interest me--emergency medicine and cardiothoracic first assist. I've been vacillating back and forth trying to make a decision regarding which one to pursue. I guess I could really benefit from some of you giving me some feedback.
Here's what I've been tossing around in my male-pattern balding little head:
Pros of CV first assistant: Best of both worlds--extensive patient interaction and the ability to participate in highly technical procedures. Perhaps more opportunities to work in private practice vs. for hospital? Probably better earnings potential?
Cons of CV first assitant: Probably fewer job opportunities. Long hours and extensive call. Probably not as much diversity of disease/populace.
Pros of ER: Probably more available positions. Probably more opportunities in hospitals, but still opportunties in private practice. Could easily re-direct into other sub-specialties if interest comes along. Probably better hours? Lots of diversity in patient care--never know what's coming through the door next.
Cons of ER: Probably more patient interaction at the cost of less involvement in technical procedures. Probably less earning potential?
I would really appreciate any feedback offered. Are my pros/cons realistic expectations, or are there things I'm missing? This is all I've been able to come up with so far and I feel like there's something I'm overlooking, but I just can't pinpoint what it is.
Brian

Brian:

This is coming from a ER RN; soon to be NP:

Remember what you'll have to be dealing with on a daily basis. Ya, you'll get diverse patients and whatever walks through the door, but keep in mind that 90% of what walks through the doors is a load of crap or a friggin drug seeker. Because (at least in MO) the legislators have created a horrific health care system and left it to grow out of control, anyone that doesn't work gets a "gold card" to walk in the ER whenever they want for whatever they want. At least when you are dealing with a CV patient, you know by that time they're really needing some help. On the other hand, you get to do shift work, which means you get to go home and stay home until you're on again. Depends on what's important to you. I imagine the CV surgeon will give you whatever chores he doesn't want.

I'm sure this clarification really muddied up the waters for you. Good luck...

suzanne4, RN · May 13, 2004

It also depends on you physically. Are you able to stand for long periods at a time. you will be taking night call if you go the CV route.....

You have more possibilities of private work with CV then you would with ER.

One is a surgical specialty. My preference would be CV, but have you actually ever spent time in an OR? I would highly recommend that you do it for a day or two, and see if you can tolerate the mask for long periods at a time. Some people are unable to do so.

Sure your cardiac patients all will have heart problems, but you may find some that also have kidney problems and are on dialysis, are diabetics, have severe hypertension. Congenital heart problems in infants and kids. So you will also see a little of everything and it never gets dull.

Hope that this helps you.....And a big welcome to Allnurses.com....

Good luck with whatever you select..............

bbear · May 13, 2004

Oh yes, I definitely have OR experience--including CV experience. I was a Navy Corpsman and later worked as a civilian surgical tech and OB tech. Masks never bothered me. It's the standing in one place for hours on end that got to me at times. But it had to do more with boredome than discomfort. I honestly don't think it would bother me nearly as much if I were doing something instead of standing there waiting for someone to ask me for a retractor or a needle driver. Let me in there coach! I can do it! hehehe Errrr, gauze please, I think I just dissected the patient's aorta.

suzanne4, RN · May 13, 2004

Definitely go the CV route then.......................

I think that you will find it more rewarding, plus the nurses in the room will appreciate that you have experience in that area.

Good luck................. :balloons:

bbear · May 13, 2004

Okay, but here's my question. Am I going to have trouble finding a position as a CV RNFA after I graduate? Or would you think that perhaps I might make decent connections through my training at Vandy? And what would you guess the pay would be like? Would you think I could have decent earnings potential if I was also handling patient workups in the office and doing rounds at the hospital?

suzanne4, RN · May 14, 2004

There is absolutely no problem finding work as a CV-RNFA but you would also have an NP so that even improves your work outlook. You would be better situated than many others becasue you also won't be the new kid on the block in terms of CV. And that can make quite a difference in the person that is going to hire you.

:balloons:

bbear · May 14, 2004

Thank you, Suzanne, for taking the time to answer my questions.

bwt02 · May 16, 2004

I dont think you could ever hurt from having ER/Primary care training. As a trauma ICU nurse moving into an Urgent care setting as a new NP I was overwhelmed with the complexity of the patients. It is a totally different role than being a bedside RN. I look at it this way... Do you want to be someones assistant for the next 20 years, or would you rather work more autonomously via ER/Primary care.

TMnurse · May 19, 2004

Sounds like everyone gave you great advice. My only thought was... Can you get a few classes under your belt before you decide? When I was getting my BSN I was PSY all the way... until I did a rotation. Perhaps, your program needs you to sign off on one track or the otherif not "take it as it comes". Good Luck!

MaleAPRN · May 19, 2004

Greetings all:
I'm new to the forum as of last night. I must say, there are a lot of very interesting conversations going on and I believe this forum will prove quite informative. Having said that, I really need some input regarding a couple of NP specialty tracks I'm considering and what I can anticipate from them.
I will be matriculating into a graduate ACNP program this fall at Vanderbilt. Vanderbilt offers a couple of specialized tracks through its ACNP program that interest me--emergency medicine and cardiothoracic first assist. I've been vacillating back and forth trying to make a decision regarding which one to pursue. I guess I could really benefit from some of you giving me some feedback.
Here's what I've been tossing around in my male-pattern balding little head:
Pros of CV first assistant: Best of both worlds--extensive patient interaction and the ability to participate in highly technical procedures. Perhaps more opportunities to work in private practice vs. for hospital? Probably better earnings potential?
Cons of CV first assitant: Probably fewer job opportunities. Long hours and extensive call. Probably not as much diversity of disease/populace.
Pros of ER: Probably more available positions. Probably more opportunities in hospitals, but still opportunties in private practice. Could easily re-direct into other sub-specialties if interest comes along. Probably better hours? Lots of diversity in patient care--never know what's coming through the door next.
Cons of ER: Probably more patient interaction at the cost of less involvement in technical procedures. Probably less earning potential?
I would really appreciate any feedback offered. Are my pros/cons realistic expectations, or are there things I'm missing? This is all I've been able to come up with so far and I feel like there's something I'm overlooking, but I just can't pinpoint what it is.
Brian

Here's my 0.002 cents...

It depends on the MEDICAL demographics of where you live...that will help you get the most out of your training and career. If there are lots of CV practices there where you live...lots of (this may sound cold ) people that frequent MacDonald's and may soon need bypass, etc....then, becoming an ACNP-FA is for you! If on the other hand...if there are more ER's there that hire NPs and if you like the adrenaline rush of this setting...and surely, ER's won't run out of patients coming in...especially in these times of unaffordable health care insurance...which prompts people to make the ER their "doctor's clinics"...then, being and ACNP in the ER is for you!

But, the question that you need to ask yourself is this: WHY DO I REALLY WANT TO BE AN APRN (Advance Practice RN)? And, WHAT SETTING DO I SEE MYSELF BEING THE MOST COMFORTABLE IN and HAPPY IN?

I too, am an NP. I also debated between becoming an ACNP or FNP (ACNP would be more attractive if I decided to become a CRNA later on). I chose to become the latter (It didn't matter if I were an ACNP...since I got accepted to CRNA school recently).

I practice in a level 1 trauma ER as an NP. I function as an ACNP. Trained by the docs and practice under their protocols. I enjoy this kind of stuff...hands-on...etc. But, I also can practice in the private clinic setting (which I have done)...since I have FAMILY PRACTICE TRAINING. I chose this area of advance practice, so that I can pretty much have the flexibility of practicing in different settings. Especially, after finishing CRNA school...I can practice in rural areas both, as a FNP and CRNA (have the best of both!).

So, the point of my 0.002 cent advice is...take the time to sit down and focus on what area of advance practice are you really turned on by. Where do you see yourself 10 yrs from now...and will you get fullfilment out of it?

Good luck with what you decide.

V.