New consensus model for Adult-Gero NP - job limiting?

[ChristineAdrianaRN, BSN, RN]

I'm having major stresses over choosing which NP track to take.

This isn't so much the typical "Adult or FNP?" question. It comes down to the fact that if I know my preferred population is the elderly, I should go for gerontology, period. I don't like the idea of trying to cram knowledge about every lifespan into my brain - I'd rather really specialize and get really good at what I truly want to do.

And thanks to reading archives on here and my internet surfing, I know all about the changes to the adult-gero certification that are coming up.

I don't like that it's been split into primary and acute care, now.

My knee-jerk reaction is to go for primary care because that's ultimately what I want to do. But my fear is that there aren't going to be any jobs. It seems like most of the jobs out there are in hospital settings. Before I knew of the changes, I figured I'd look for that primary care dream job, but likely work in a hospital in the interim.

Am I going to be unable to do that with the new certifications? Do you think this is going to limit career options? Depending on which you choose, you can work in an inpatient setting or a primary care office, but not both?

Also, which track do you think hospice/palliative care would fall under? Primary care or acute?

I wasn't sure where else to go for these answers. Thank you in advance.

[GWTWFabToya]

Hi

When i enrolled into the MSN FNP option i directly wanted to only do adult. i am a great nurse with kids but i prefer not to because i become too emotional and want to refrain from that type of nursing. i spoke to an enrollment counselor and she stressed that the FNP is more marketable in the future of nurse practitioners which is true. for example, my personal nurse practitioner was only certified in womens health and had to go back to school for the FNP certification. i rather just get it all done at one time so i can have many avenues to go down when the time arises. i still see myself with geriatrics and adult but at least with the FNP i also see myself working with womens helath and low income individuals. in the end it is your decision and do what is best for you as well as for the market and availability of jobs within your area.

[mammac5]

The new changes to the Adult speciality are meant to give clear focus to whether a NP is suited for inpatient or outpatient care - and I think it makes sense because the two are vastly different.

I am an ANP (certified prior to these new changes, obviously) and I currently work inpatient. These are different patients than the folks I saw in the outpatient world - both in my previous jobs as well as while I was in training. The meds are different, the acuity is different, helping make plans for discharge are different, working with the families is different. Etc., etc.

My personal choice was NOT to do FNP because I already knew I didn't want to treat children or deal with their family members. I knew that to treat the many chronic diseases of adulthood, I needed the time to really study those processes and to see those types of patients in my clinical rotations. Spending time on immunization schedules, physical/emotional stages of the lifespan for infants to adolescents, and such would've been a waste for me.

Although it may seem most of the jobs are in hospitals (from what you say in your post) dig a little further. You may find that the jobs are in outpatient settings BUT are in clinicals/practices owned and operated by hospitals. This is becoming very common since government regulations and limits to personal time make it very difficult for physicians to own and operate their own practices today.

I would suggest spending time in both inpatient and outpatient settings - find someone who will let you follow them for a few days - and just see what your interests are and what makes you feel enthusiastic. You may discover a strong pull toward one or the other and get some direction that way.

As for limiting yourself, I think it's going to be pretty easy to move between the roles and that many NPs will certify in one area and then do a short course to add the 2nd certification if/when they want to change settings. I don't think that will be a lengthy (or expensive) process.

[traumaRUs, MSN, APRN]

I think the focus is heading towards keeping folks out of the hospital. In IL, many of my medicaid pts are now case managed. I get calls now from case managers saying Mr A or Mrs B is out of xyz med, do they still need it, can I eprescribe it for them. Other times I get called by the CM that Mr A is not feeling well. I call Mr A, find out what is going on, either agree to see him in next 24 hours or turf to ER, Urgent care. So, I think that primary care jobs will be rising not declining.

[esjones4]

Unfortunately, in Delaware, one most repeat the entire program to add FNP to a prexisting ANP license. I found that corrections, which I worked for 13 years and geriatrics are the only options for an ANP, even in one who doesn't want to deal with children.