Looking to start in sub-specialty

Specialties NP

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Since I have a decent amount of emergency experience as an RN (and actually started out in ED - I've never worked a day in Med-Surg in my life), I want to start out working an NP in the Emergency Dept. However, everyone seems to want NPs but not to train us - they all insist on a year of experience. How can I best find an "in" where someone is actually willing to train?

Specializes in Psychiatric and Mental Health NP (PMHNP).

How long do you want to be unemployed? As a new grad, you are not in a position to be super picky. Go get some solid FNP experience for one year, then apply to EDs.

I'm quite done with school at this point...

However, everyone seems to want NPs but not to train us - they all insist on a year of experience...

Beggars can't be choosers my friend. The reason they want a year of experience is because FNPs are not trained in emergency medicine and it is a significant time/energy/monetary commitment for employers to bring an FNP up to speed in the ER. If there was only some other way for you to show it might be worth their time to hire you because you have training and/or education in emergency medicine...

Oh wait:

There are a variety of options to gain emergency specific education. First, there are 8 graduate academic MSN programs and 10 post-graduate fellowship programs in the U.S. (See American Academy of Emergency Nurse Practitioners - Home Page )

Most academic ENP programs also offer post-master certification options for FNPs to obtain additional didactic knowledge, procedural skill training and clinical experiences in emergency care. Finally, there are excellent procedural skill courses and emergency medicine conferences and boot camps that offer continuing emergency medicine education for NPs. (See American Academy of Emergency Nurse Practitioners - Ongoing Education)

Additionally, the AANPCB has a list of FAQs which provides additional information on opportunities for acquiring emergency education. This can be found at Frequently Asked Questions - ENP - AANPCP

Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.
How long do you want to be unemployed? As a new grad, you are not in a position to be super picky. Go get some solid FNP experience for one year, then apply to EDs.

They specifically want Emergent/Urgent experience; a year in primary care is not going to help.

Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.
Beggars can't be choosers my friend. The reason they want a year of experience is because FNPs are not trained in emergency medicine and it is a significant time/energy/monetary commitment for employers to bring an FNP up to speed in the ER. If there was only some other way for you to show it might be worth their time to hire you because you have training and/or education in emergency medicine...

Oh wait:

There are a variety of options to gain emergency specific education. First, there are 8 graduate academic MSN programs and 10 post-graduate fellowship programs in the U.S. (See American Academy of Emergency Nurse Practitioners - Home Page )

Most academic ENP programs also offer post-master certification options for FNPs to obtain additional didactic knowledge, procedural skill training and clinical experiences in emergency care. Finally, there are excellent procedural skill courses and emergency medicine conferences and boot camps that offer continuing emergency medicine education for NPs. (See American Academy of Emergency Nurse Practitioners - Ongoing Education)

Additionally, the AANPCB has a list of FAQs which provides additional information on opportunities for acquiring emergency education. This can be found at Frequently Asked Questions - ENP - AANPCP

First, the sarcasm isn't helpful.

Second, why do you think I'm not aware of these options? The academic program near me specifically does not have a post-degree certification, and the post-grad fellowship near me has a prerequisite of current experience in an ED with sign-off from a current manager...which is putting the cart before the horse, to be honest. In any case, the supply for these programs and their graduates far outstrips demand...yet hardly anyone is willing to hire new grads and train themselves.

Third, procedural skill courses, conferences, and boot camps are things I expect an employer to put me through on their dime, emergency or otherwise, either directly or through a CME allowance. An FNP is definitely qualified to work a fast track/urgent care area with minimal extra training, and I'm more than willing to work in such a setting as I prove that I can manage case loads and get fully trained up to handle cases of higher acuity.

Specializes in Hospitalist Medicine.

Well, since you're so insistent on not obtaining additional certification, then your only option is to work at an Urgent Care for a year or two to obtain some experience and then roll the dice on an ER wanting to hire you. Were you a critical care nurse while working on your FNP? We're not trying to be snarky, just realistic.

Specializes in Psychiatric and Mental Health NP (PMHNP).

Based on previous posts on this forum, there are FNPs who get hired by EDs. So if you can't find an employer in your area, then move to an area where you can get an ED job.

I don't understand what is so horrible about working as an FNP in primary care for one or two years, then getting an Urgent Care job. There are some Urgent Care facilities that will hire a new grad FNP.

It is not incumbent upon employers to finance education that is not relevant to the job you are performing. As an NP, you will be making enough money to afford some additional training.

Reading this thread, it appears you have a lot of excuses. As a new grad, you are not in a position to be picky. Get a good FNP job now, and worry about this stuff later. Or relocate.

Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.
Well, since you're so insistent on not obtaining additional certification, then your only option is to work at an Urgent Care for a year or two to obtain some experience and then roll the dice on an ER wanting to hire you. Were you a critical care nurse while working on your FNP? We're not trying to be snarky, just realistic.

I've been an Emergency RN for 7 years, and recently re-upped my CEN.

As I've stated earlier, Urgent Cares (if they even are that, and not mis-named immediate care locations) are even worse about not wanting to train - they want someone with at least a year of experience they can hire and put to work immediately.

I've been an Emergency RN for 7 years, and recently re-upped my CEN.

As I've stated earlier, Urgent Cares (if they even are that, and not mis-named immediate care locations) are even worse about not wanting to train - they want someone with at least a year of experience they can hire and put to work immediately.

So you know the answer to your question. Suck up working as an np in primary care, go to urgent care.... Then to ed. Why is this so hard? Nobody wants your emergency experience and they all think it isn't enough for what they expect.

Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.
Based on previous posts on this forum, there are FNPs who get hired by EDs. So if you can't find an employer in your area, then move to an area where you can get an ED job.

I don't understand what is so horrible about working as an FNP in primary care for one or two years, then getting an Urgent Care job. There are some Urgent Care facilities that will hire a new grad FNP.

It's not horrible, it's just irrelevant. I can work twenty years in primary care, and I won't have the year of emergency/urgent care experience they want. And while there may be Urgent Care facilities that hire new grads, I'm having problems finding one, which was the original point of this thread.

It is not incumbent upon employers to finance education that is not relevant to the job you are performing. As an NP, you will be making enough money to afford some additional training.

I'm not asking them to - I expect an employer who hires me to an ED/Urgent care position to send me to relevant training, or provide it themselves. And while I might be able to afford such as an NP, I need a job first.

Reading this thread, it appears you have a lot of excuses. As a new grad, you are not in a position to be picky. Get a good FNP job now, and worry about this stuff later. Or relocate.

I'm not making excuses. However, I'm getting quite annoyed at people who didn't actually read my initial question, or my subsequent responses.

I didn't show up here with the very tired question of "How do I make myself look better for employers?" I know that I am a decent candidate for an employer willing to hire new grads. Having talked to many ENPs and emergency physicians - including a past president of ACEP - I already know the difference between "sick" and "not sick," and that's apparently half the battle. My frustration comes in finding an employer willing to hire new grads, when everyone seems to want someone fully trained and next-to-no one-wants to do that training. I am looking for such needles in a haystack, and wanted help in that. I never said I wasn't willing to relocate, but I still need to know where to look first.

Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.
So you know the answer to your question. Suck up working as an np in primary care, go to urgent care.... Then to ed. Why is this so hard? Nobody wants your emergency experience and they all think it isn't enough for what they expect.

Again with the not reading...

It's "so hard" because the urgent cares are just as bad. They don't care about primary care experience. I could get 20 years of primary care experience and they wouldn't care - I don't have the 1+ years of emergency/urgent care experience, and my application still would hit the trash before anyone saw it.

It's also "so hard" because the chorus of "Why don't you start in primary care first?" is suspiciously familiar to the much older nurses who told my nursing student/new grad RN self, "Oh, you can't start in Emergency, you need to start in Med-Surg first," when nothing was further from the truth.

I know the trajectory I need to be on. I just need to find a first employer willing to train. And it appears that most of the readers of this sub-forum have reading comprehension issues...

It's not horrible, it's just irrelevant. I can work twenty years in primary care, and I won't have the year of emergency/urgent care experience they want. And while there may be Urgent Care facilities that hire new grads, I'm having problems finding one, which was the original point of this thread.

I'm not asking them to - I expect an employer who hires me to an ED/Urgent care position to send me to relevant training, or provide it themselves. And while I might be able to afford such as an NP, I need a job first.

I'm not making excuses. However, I'm getting quite annoyed at people who didn't actually read my initial question, or my subsequent responses.

I didn't show up here with the very tired question of "How do I make myself look better for employers?" I know that I am a decent candidate for an employer willing to hire new grads. Having talked to many ENPs and emergency physicians - including a past president of ACEP - I already know the difference between "sick" and "not sick," and that's apparently half the battle. My frustration comes in finding an employer willing to hire new grads, when everyone seems to want someone fully trained and next-to-no one-wants to do that training. I am looking for such needles in a haystack, and wanted help in that. I never said I wasn't willing to relocate, but I still need to know where to look first.

So you are unwilling to pursue acute care education/training via a post-master's certificate.

You are unwilling to pursue EM education/training via a residency/fellowship.

You are unwilling to spend some of your own money on EM workshops and/or bootcamps.

You are unwilling to relocate and broaden your search radius.

You are unwilling to gain any other work experience in primary care (which you were trained to do) or urgent care to attempt to offset the experience requirement.

Not much more insight we can offer you with this. You've got to pick your poison.

Again with the not reading...

It's "so hard" because the urgent cares are just as bad. They don't care about primary care experience. I could get 20 years of primary care experience and they wouldn't care - I don't have the 1+ years of emergency/urgent care experience, and my application still would hit the trash before anyone saw it.

It's also "so hard" because the chorus of "Why don't you start in primary care first?" is suspiciously familiar to the much older nurses who told my nursing student/new grad RN self, "Oh, you can't start in Emergency, you need to start in Med-Surg first," when nothing was further from the truth.

I know the trajectory I need to be on. I just need to find a first employer willing to train. And it appears that most of the readers of this sub-forum have reading comprehension issues...

They're saying to start in primary care because that's what you were trained to do and it is applicable experience, like it or not. The majority of ER patients are outpatients. And of course they have to hire people, at some point, without ER experience. Otherwise there would never be any new ER providers and eventually the well would run dry. But they're going to choose someone with SOME type of experience over a new grad who's holding out.

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