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Discussion

Is the specialization of NP training.....

Hurting us????

I am merely posing this as a hypothetical question. I have pored through every posting on the pros and cons of Acute Care NP vs. Family or Emergency NP (which results in the same license). I still haven't come to a conclusion as to which one would best suit what I want to do, although I think that the ENP route would be the most versatile.

I will preface my statement...I know that NPs have historically been specialized in their training and on the other hand I know that some NPs on this board that have worked through these issues and have been able to function in multiple roles. My issue with the specialization of NPs, is the fact that there is no straight answer or absolute when it comes to where and what NPs can or can't do. It all DEPENDS.

At first, I was looking and strongly leaning towards doing the ACNP program. My interest is ER and Trauma and wouldn't mind working in an ER with the freedom to move towards more ICU type work. ACNP seemed like a perfect fit, BUT many of the ER jobs want a person to be able to see patients of all ages, which ACNP doesn't necessarily fit.

So, I looked into ENP programs that result in a FNP license. This is all fine and dandy but from reading different threads on this post, there are moves to prohibit FNPs from doing hospitalist type roles because they aren't trained as acute care providers.

The positives about NP training is that you can do it full or part time and in some instances via distance education. This is great for the working professionals among others (moms, etc etc) The flexibility is fantastic and I think it's a plus and a good avenue to bring more providers to the field.

Here is my beef. I have quite a few friends from college that are currently practicing PAs. One of my friends, in particular, has worked primary care moved to ER, then onto the floor doing Int. Medicine. They have the flexibility to move like this with no restrictions on practice and area of care.

So here's my question, why if I as an NP want to work in a primary care (all ages) setting with the ability to do rounds on my clinic's patients at the hospital, and assist my MD/DO with surgery if needed, have to get training as an FNP, ACNP, and get my RNFA.

I am not trying to fuel the NP vs. PA debate, but wouldn't it be easier for me to become a PA and have the flexibility to move as opposed to doing all of this training mentioned above?

I am posing this more as a hypothetical question for the purpose of sparking some PRODUCTIVE responses on how we can improve the marketability, etc of NPs.

Please fire away.....

Thanks for listening (or reading)

Jack

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This dillemma of yours have been addressed in this forum before and many have posted links to programs around the country that offer combined ACNP, FNP, and ENP tracks. Graduates of these programs are able to sit for certification in both ACNP and FNP (since there really is no formal ENP certification exam available).

One such program is offered at Vanderbilt combining a dual specialty track in ACNP and FNP with an emergency care focus. See website: http://www.mc.vanderbilt.edu/nursing/msn/fnpacnpec.html

Unfortunately, these programs are not as prevalent as traditional NP tracks we all know but for someone like you whose goal is to practice across the continuum of ER to acute care to primary care, it's worth a shot to travel distances to obtain that specialty training you want for yourself.

That really doesnt solve the problem though. You still wouldn't have acute care pediatric training and could be really hairy when it comes to treating acute pediatric problems. Also, just to be fair, although PAs can move from specialty to specialty right now, it may not be that way in the future as specialty "recognition" is being pursued by the NCCPA and the post-grad PA residencies are being accredited by the ARC-PA. I think you should make the choice of going to PA school because you want an intensive, science rich program, that will challenge you and not allow you to work much. If you don't want to deal with that, you can always get the FNP and go from there adding post masters certs along the way. For now, though, PAs do have much more flexibility in jobs especially with the required surgical training. Sometimes NPs have better laws though, but this is changing pretty quick since the last 2 states to limit PA prescribing privelages have now allowed prescriptive athority in the past year. Also consider that by the time you end up in NP school you might be needing to get the DNP to be marketable.

With regards to emergency medicine, I was an EMT before coming back to school and I have always noticed that PAs tend to be used much more than NPs in the ED. Good luck to you whatever you choose.

This dillemma of yours have been addressed in this forum before and many have posted links to programs around the country that offer combined ACNP, FNP, and ENP tracks. Graduates of these programs are able to sit for certification in both ACNP and FNP (since there really is no formal ENP certification exam available).

One such program is offered at Vanderbilt combining a dual specialty track in ACNP and FNP with an emergency care focus. See website: http://www.mc.vanderbilt.edu/nursing/msn/fnpacnpec.html

Unfortunately, these programs are not as prevalent as traditional NP tracks we all know but for someone like you whose goal is to practice across the continuum of ER to acute care to primary care, it's worth a shot to travel distances to obtain that specialty training you want for yourself.

Another thing to consider is that in some states, NP's have independent practice, where PAs work under the physician's license.

Locally, ED's use FNP's & PA's for the fast-track situations. It just depends on the need & state regs.

Sorry but there is just so much to learn I think NP's should specialize. If you'd rather be a PA-go for it but I don't think their philosophy of treatment is the same as NP's . There's no turf issues for me-there are plenty of patients around.

In my primary nursing specialty (NICU), NP's seem to have the lock on midlevel care in most institutions - and I think it's for good reason. Some of the procedures and tasks that our NNP's perform are extremely tricky. I just can't imagine any midlevel provider with generalist training who would be safe in that role. It's an interesting question though.

  • Expert
In my primary nursing specialty (NICU), NP's seem to have the lock on midlevel care in most institutions - and I think it's for good reason. Some of the procedures and tasks that our NNP's perform are extremely tricky. I just can't imagine any midlevel provider with generalist training who would be safe in that role. It's an interesting question though.

Very regional. In our city two of the NICU's are staffed only by PA's and the rest by NP's (all one company). In other cities you see similar things. PA's are frequently trained in that role and there are several fellowships that will train you for this as well as one pediatric oriented PA program where you get a fair amount of NICU time. It's all about working with the MD's and getting the proper training. You have to remember that we all get at least 2-300 hours of peds didactic and 4-5 weeks of general peds. If you wanted to do another 3-4 months in the NICU it would be pretty easy in a lot of programs. That would give you a pretty good head start.

David Carpenter, PA-C

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