NP or Perfusionist?

I am an acute care adult NP in a SICU and care for various surgical patients but mostly cardiothoracic surgical postop. Obviously I work in the hospital but I do 3 x12s, no weekend or holidays (which is rare) because it is a large teaching hospital and we have a physician intensivist in-house in our unit 24/7.

The demand for acute care NPs is very large in my area (Pittsburgh, PA) and I can't hire enough in either our medical or surgical cardiac ICUs. [I get tons of new grad FNPs with ICU nursing experience who apply, but I don't consider FNP training suitable to work in ICU as an NP.]

At the other major health system in our city, there is a very large critical care NP group, in all the ICUs except CT surgical (surgical ICU, neuro ICU, trauma ICU, neurosurg ICU, medical ICU, transplant ICU etc) and a lot of opportunity to move around between specialties. There are also a lot of locum tenens critical care NP jobs but you need to be basically OK with being solo in the ICU and doing all the bedside procedures before I'd recommend going locums.

The only thing I would caution is that you can over-specialize yourself and that makes it harder on a personal level to switch specialties and go back to scratch in terms of learning. Critical care management can be VERY different depending on the specialty. If you want the most marketable and transferable skills, surgical or medical ICU is probably best.

So look at what your interests are, what your market/employment opportunities are like in your area, and what kind of flexibility you may need in the future - but be aware that MOST ACNP jobs are 24/7 rotating in the hospital. Some adult outpatient specialty clinics also use ACNPs. ACNP is not the best choice for ER unless you also do a pediatric ACNP post-masters.

EDIT: So I re-read your post and concerns. I would add that I have a lot of autonomy. I basically split my ICU with the doc, and he takes the residents on that side of the unit and I take my patients. I pre-round, write down patient data, check out the patients, speak to the night nurses, decide on my plan. Then, when doc is done rounding with the other side of the unit/teaching trainees, he comes over and rounds with me, which usually means walking around, I present and tell him (my attendings happen to be male) my plan, then if there is anything I want to run by them or have them look at on the patient (like a wound or something new I want them to be aware of) we do that. After rounds, I write (and bill) my own progress notes, perform (and bill) my own procedures, supervise residents/fellows doing procedures, update families, answer patient/nurse questions etc. If I get a fresh postop, I take report from Anesthesia and write the note, then usually just stuck my head in and tell my doc what it is, any drips or notable issues in the OR etc; they go by and look at the patient at some point. At the end of my shift, I send them a written signout/handover and then walk around with the night intensivist for signout.

I know several ICU nurses who became perfusionists and like it. I don't know any who regretted the change. I know in my area there are lots of jobs for perfusionists and salary is good compared to COL (more than most ACNPs). There is a 24/7 requirement including being on-call for perfusionists. They do also have opportunities to move to industry roles (education/sales reps with medical device companies etc). I think I prefer the variety of my tasks though - they seem to do their own things, but ultimately they are on the surgeon's time schedule. With the explosion of ECMO utilization, there is some job security although several hospitals have moved to nurse ECMO specialists as they are cheaper than perfusionists.