NP's in specialty fields?

[nfdfiremedic, BSN, RN]

Greetings,

I am a veteran ED nurse leader. I am an assistant manager in my department, a CEN, a former paramedic, (prior to becoming an RN) and have extensive specialty training in trauma, etc. I am an instructor.educator for all the "normal" critical care stuff, like ACLS, PALS, TNCC, and so forth. I am 28 years old, and have decided that I will never get any further than my current level without going back to school. I have been contemplating pursuing training as an NP.

I realize that the answer to this question may vary from state to state, and thus answers to it here may not be entirely accurate to my specific situation. Still, I am interested in hearing what people have to share. From my experience, most nurse practitioner training declares that the candidate will be trained as an FNP, or "family" nurse practitioner. As you can probably assume from the above paragraph, the last thing I ever want to be is somebody's primary care provider. I have looked up the PA programs in my area, and some of them offer a specialty in Emergency Medicine. The only NP programs in this area are so called "FNP" programs. Will these programs limit me to practice in primary care settings?

I have also had in the back of my mind the notion that I may want to get involved in some sort of surgical field. Ortho, plastics, trauma surg, general surg, etc all hold a certain appeal to me as well. If this is a field I were looking to enter, would that be possible for me as an NP? Are there some things that are "PA only?" I have read in lots of places that "an NP can do more" but I'm not entirely sure what that actually means with regards to scope of practice and career path. I have many PA friends who have explained the versatility of the PA role to me but, sadly, I have no NP friends to ask for the other side of the story.

Any help would be much appreciated.

Thanks very much!

Andy

[abass211]

I am in the exact same boat as you - even down to ER/trauma center. I can't give you many specifics. but this is what i have heard so far.

pa vs. np - pa school is more medical based and more clinical hours. almost impossible to attend and work because it can't be done part time. pa and nps vary per area/hospital/groups. in my ER our doctors are outsourced and the group only hires PAs. plus it is a teaching hospital so we have all the residents as well. as for other specialties, i think it varies per hospital/group. my hospital we have nps in all those fields however the residents do all the fun stuff and the np/pas follow-up or are there for back up. some are present primarily in ortho, trauma, cards - but i don't think either pa/nps are doing big surgeries.

as for fnp. acnp - can't treat adults because you have to choice adult or pediatric acnp. fnp is the only np that can treat everyone. i've been told fnp give you the most broad certification. if you know you never want to work with kids then consider anp or acnp. however if you are thinking ER/Clinic/doc in a box, think twice because they see kids. and if you only have acnp you will not be able to see them.

i am leaning toward a fnp program. just talked to an anp today with cards and she said you can get a "critical care." certification after and its no additional classes, just an exam. i still have to research this, but something else to consider as a possibility.

hope this helps some. its so confusing (to me atleast)

[CCRNDiva, BSN, RN]

There are a few NP programs that prepare for the NP for trauma or ER work. University of Maryland, Loyola University Chicago, Vanderbilt, University of South Alabama to name a few. I think the time of "a FNP can do anything" is ending. A number of the admission counselors I spoke with were very specific when ascertaining career goals and pairing them with prospective programs. They are not allowing FNPs to take inpatient clinicals and they are not provided training in acute care unless they are enrolled in a dual program. I know that one of my former coworkers approached our intensivists about a NP job when she completed her FNP but they would not hire her because they felt she did not have the appropriate training although she had years of ICU nursing experience.

I don't think it is as easy to get certified as a critical care NP as was implied. An ANP may be able to get a CCRN certification but must be able to provide proof of current critical care nursing experience. I'm pretty sure one must complete an ACNP program (either MSN, post-masters, DNP) to obtain an ACNP certification.

I work in a level II trauma center and trauma services just hired an ACNP who is a Rush grad. She has a couple of yrs experience and has definitely hit the ground running. I know she was hired over FNPs with critical care nursing experience (even one who had worked in our unit) because of her training in acute care. She rounds on all of our trauma pts. Most of our involved peds trauma cases are transferred out since were are certified in peds trauma as we don't have a peds surgeon so her lack of peds training is not an issue. One of my friends is a NP and works with an ortho group in the OR as 1st assist. He worked with them prior to his FNP program so they were willing to hire him as their NP/1st assist. Our cardiothoracic surgeons all have PAs that round on pts and 1st assist in OR (I'm not sure if they are open to using a NP, I'll have to check). I also know of another recent FNP who did clinicals with an ortho doc. He used her clinical time train her as 1st assist and post op evaluation with the intent of hiring her as his NP/1st assist after graduation. Most of the recent FNP grads in our area have been offered outpatient positions.

I chose an ACNP program because like you, I don't have any desire to provide primary care and I don't want bust my butt completing a master's to learn primary care either (no offense to those who have chosen to do so). I want to work in critical care or trauma services after graduation. I think the ACNP will better prepare me for those roles. I wish there were combined adult/peds ACNP programs out there because I definitely would've signed up for it! Maybe I will complete a post masters in Peds acute care later on. My advice would be to seek the education that will best prepare you for your career goals. I don't see how a FNP would do that.

[TJFRN]

In my area FNP's work in acute care. However, it's all about experience as an NP (your RN experience does not count). I know FNP's who work first in an office setting (like cardiology, or another speciality) after 1 or 2 years experience then apply to the jobs working with intensivist, surgeons as first assists, etc but at the same time in the same hospital they will only hire PA's in trauma. At a few ER's I've worked at we had FNP's because of the client base (children and adults). ACNP is a great route also if you know for sure that's what you want because it is limited... 30 years from now you may decide that acute care setting is to much on you, and you want that 9-5 job seeing patient's in an office setting and at times you may see kids (never know). Schools do discourage FNP students working in acute care because of your clinical training but, think how many of you learned what you know today from your clinicals in nursing school? Didn't most of it come from on the job training? As you said not everything you read on here is 100% and my info is just through my own experience and research in my specific work area. I choose FNP because I'm one of those that is all over the place.... today I may want to work acute care, tomorrow I may want to work in a family practice, and yesterday... oh well yesterday already passed....

Good luck to what ever you do choose and do it for yourself! Being an NP or a PA is a proud profession and it sounds like you are a go getter that have a love for learning so I'm sure you will do great... plus you're young why not think medical school if I was your age I would go for it! Again, best wishes!:)

[bsnanat2]

The proposed Consensus Model really addresses this issue by saying that the level of acuity of the patient is what determines who can treat them. The goal and probability is that NCSBN members (virtually all state boards of nursing) will adopt the Consensus Model which limits who you can treat, including their level of acuity, based on your education. It specifically states that if your training allows for primary and acute care you must be certified in both in order to treat both. Under the model, FNP's would be allowed to work inpatient (the model does not limit setting), but cannot do things like critical care. Everyone that continues to play fast and loose with their training and who they treat will become fodder for lawyers and will potentially set back advancements NP's have made. If you want to do it, get the formal training and certification. There are enough online programs so that this can be done.

[meandragonbrett]

To the OP,

Based on what you've mentioned in your post it seems as though you'd be easily adapted to either PA or NP school. Just keep in mind that NP school results in an MSN and will result in some nursing theory during your program. NP programs are not all created equal and should be taken into consideration when choose a program to attend.

Primary Care is going to be Family NP, Adult NP, Gero NP.

Acute Care is going to be ACNP and PACNP (Which is a relatively new course of study and certification).

Different parts of the country utilize different providers based on state laws and on hospital bylaws. My local trauma group uses ACNPs over PAs for one main reason and that involves the hospital's rules of chart reviews/cosignatures for the PAs vs. practically non-existent for the NPs. I'm not saying this is right or wrong either way.

I know of ACNPs who practice Neuro critical care and place EVDs and I know of other ACNPs who place chest tubes, PA caths, central lines, intubate, etc. It's VERY region, facility, and employing group related.

[traumaRUs, MSN, APRN]

My vote for prospective ER/trauma APNs: dual certs: either ACNP and PACNP or ACNP, PNP or some combo.

I did both an adult CNS and a pads CNS and did most of my clinicals in the ER where I had worked as an RN.