Nurse Practitioner- Job Outlook

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Specializes in FNP- Urgent Care.

Hi,

Assuming I get accepted, I will start FNP School in a few months. We all know how expensive it can be and I have a family...and well, a lot of questions that I'm having a hard time finding the answer to.

For one, I don't see myself as a primary care provider and I feel like this is the most common job for FNP graduates. I chose FNP to be more versatile than specializing... but I would rather work someone like a cardiology office/heart failure clinic/ in-patient cardiology/ derm NP/ trauma surgery NP... Like do these things even exist for an NP? I've tried searching for jobs but the market around here is a bit saturated at the moment and I see mostly primary care jobs.

Another thing I've been thinking about is how I would want to be part- time until my kids are a bit older. I kinda suspect this will be difficult but I'm not sure?

Insight, anyone?

I live in Colorado if that makes a difference.

Thanks!

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Too many new NPs, not enough jobs. It is an oversupply situation with stagnant demand. I would not go to school at this time. Jobs for seasoned NPs are even getting more difficult to procure. Sure, you can move to the middle of nowhere and find a crappy job at a FQHCC but I wouldn't recommend it. 2025 is when the government predicts national oversaturation of NPs. It's happening regionally all over the place.

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Hi!

As for as an NP working in inpatient setting such as cardiology units and trauma surgery, there are definitely NP's that work in those areas. Pretty much wherever Physician Assistant's work, NP's could do those same jobs as well. For instance, I live in the Trenton NJ area and one specific hospital (Capital Health) hires NP's for specialties like cardiology to trauma surgery and observation units; and even intensivists/hospitalists. The assumption, however, is that they carry the Adult Care Gerontology - NP specialty. With an FNP, there is some worry that if they were to work in a lot of those acute care specialties, they'd technically be working outside of their scope of practice and may run into some trouble with the board of nursing. (from outside research!) I'm sure you can try calling a few HR departments and ask questions concerning the type of NP specialty they are looking to hire and accept.

There are also a bunch of part-time positions available for this specific hospital too. It's definitely not difficult (at least in NJ) and I'm sure it can be done!

Best of luck to you and fingers crossed for your acceptance letter! God Bless!

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Specializes in Adult Primary Care.
On 1/14/2020 at 4:11 PM, Warrior4ChristNursing said:

Hi!

As for as an NP working in inpatient setting such as cardiology units and trauma surgery, there are definitely NP's that work in those areas. Pretty much wherever Physician Assistant's work, NP's could do those same jobs as well. For instance, I live in the Trenton NJ area and one specific hospital (Capital Health) hires NP's for specialties like cardiology to trauma surgery and observation units; and even intensivists/hospitalists. The assumption, however, is that they carry the Adult Care Gerontology - NP specialty. With an FNP, there is some worry that if they were to work in a lot of those acute care specialties, they'd technically be working outside of their scope of practice and may run into some trouble with the board of nursing. (from outside research!) I'm sure you can try calling a few HR departments and ask questions concerning the type of NP specialty they are looking to hire and accept.

There are also a bunch of part-time positions available for this specific hospital too. It's definitely not difficult (at least in NJ) and I'm sure it can be done!

Best of luck to you and fingers crossed for your acceptance letter! God Bless!

We are in the same neighborhood!

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Specializes in Psychiatric and Mental Health NP (PMHNP).

Demand for NPs varies by location. You need to research the situation in Colorado and in the city where you live or want to live. You will have more opportunities if you are willing to relocate.

NPs can definitely work in specialty clinics. However, you need to be clear on whether you want to work inpatient or outpatient If you want to work inpatient, then you need to attend an Acute Care NP program.

There is no predication of national oversupply of NPs "all over the place." The contrary is true.

I also greatly resent "crappy FQHC in a crappy location." There are FQHCs everywhere, including big cities. There are urban underserved populations. Most FQHCs are very nice facilities and they pay well. If you want to win a Nurse Corps Scholarship you will need to commit to public service for awhile. There are great providers who work at these clinics who truly want to help less fortunate patients, from MDs to NPs. Working at such faciltiies also makes one eligible for loan repayment programs.

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Specializes in ICU, LTACH, Internal Medicine.

1). Only one instance holding legal power in question "which NP can do what" is BON of the state through Scope of Practice. All others including AANP can continue to want whatever they want.

The second real player in the issue is local market/employers' policies. These guys couldn't care less about AANP and Co, although they are, at least in theory, supposed to follow the Scope of Practice.

Therefore, if an NP wants to work in acute care with FNP, there are only two things to look for: does Scope of Practice in the state allow it at all and if FNPs in the location/facility of choice are routinely practicing in that role. If both answers are "yes", FNP will be sufficient as long as moving out of the area is not considered.

2). FNPs routinely practice in specialty clinics all over the country. It is totally up to owner of the clinic to decide whom to hire, and the most important question in this situation is the NP past experience. Owners want someone who can do the job and doesn't require months-long "orientation", aka teaching from level zero. They cannot care less about what letters are after the person's last name.

3). As American Medical Association and all national physician professional societies continue to do absolutely whatever they can to restrict public access to physician - led health care services, they pretty much assure increasing need for "extenders". Local oversaturation happens and will continue, likely experiencing cycles like every other profession, but overall NPs and PAs are here to stay. The fact that, like right now, a good deal, if not majority, of jobs will be in segments they are needed most (read: that very stuff nobody wanna do). 90+% healthcare as per diagnostics/management is in "primary of the primary" segment: routine infections, maintenance management, minor traumas, chronic supportive/palliative care, minor mental health problems, preventive, etc. It is mundane, boring, thankless and pays very little. It is where real "making change" happens and where we are needed most.

Read Colorado Scope of Practice document for NPs, research local market and go for it! You won't stay without a job, although finding your "ideal" one will likely take time and some experience.

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Specializes in Emergency medicine.

Hi Kerleigh,

Just a few thoughts from a recent FNP grad- if you’re interested in inpatient care, most FNP programs will NOT prepare you for it. Many do not allow any in-hospital clinicals- for me to do an ED rotation it was a real fight (and even then I only got 50 hours approved).

If you have extensive experience in the speciality of interest, you might have a shot, but just know that it will be your RN experience that you’ll be leaning on, as your FNP education won’t address mgmt of hospitalized patients.

My recommendation: Look closely at your experience- where does it position you in regards to your goals? Start looking at job boards- what is available in your area and what qualifications are needed? Start networking NOW! It is likely a contact that will hook you up with your first job- and they are a valuable source of insight into the profession in your area.

Best of luck!

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Specializes in FNP- Urgent Care.

Thank you so much for your response. I will have to start networking for sure at the hospital I work out. I do agree it can be about the people you know.

My “problem” is I am a float pool nurse, have been since I graduated 5 years ago. So I don’t really have a specialty. I feel like this is great experience for the primary care role (you see everything), I’m just trying not to limit myself since I’m not exactly sure what I want to do.

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4 hours ago, FNP2019 said:

Just a few thoughts from a recent FNP grad- if you’re interested in inpatient care, most FNP programs will NOT prepare you for it. Many do not allow any in-hospital clinicals- for me to do an ED rotation it was a real fight (and even then I only got 50 hours approved).

Strongly agree. If you're wanting to do inpatient care, surgery, OR/trauma, etc. then FNP really isn't the right route. Under the Consensus Model, there's a push to move FNPs out of the hospital setting entirely, and some BONs are becoming more restrictive about inpatient care falling within the FNP scope of practice (since it isn't covered in the FNP curriculum). If you're really interested in those inpatient areas, it's possible that an adult acute care NP degree would be a better fit.

It seems to me like there's a frequent misunderstanding about the versatility of the FNP degree. Yes, it prepares you to work with many populations. However, it can be more restrictive in terms of practice setting than other NP degrees.

There are outpatient specialty clinic areas that are appropriate for FNPs, but...if your region is already really competitive and over-saturated, there may be very stiff competition for those jobs (and they may preferentially hire adult acute care or adult primary care NPs over FNPs, depending on the specialty and practice). It would be easier for you to get a specialty clinic job if you had several years of prior RN experience in that specialty. Unfortunately, that's not the case.

As a new grad, I'd prepare yourself for the possibility that you'll have to put in a couple of years in primary care to gain experience before you move to specialty care, especially if you're unable to relocate. It's still possible for you to end up where you want to be (i.e. a specialty clinic), but it may take a few years to get there.

Also, it's probably unrealistic for you to start out part-time (much in the same way that it's almost impossible to start as a new grad nurse part-time). There's a steep learning curve, and you really need to start out full-time in order to become proficient in your new role. Moreover, I doubt you'd be able to find someone to hire you part-time as a new grad. Training new grads is crazy expensive (i.e. $50,000+ expensive), and your employer won't get as good of a return on their investment if you're not working as many hours.

I mean this in the gentlest possible way: perhaps you should do some serious soul-searching before you start pouring time and money into (or going into debt over) this program. Many of the goals you've described don't align with your chosen path. It's better to sort through these big-picture discrepancies now than to wait until you're already heavily invested (for instance, in a full-time primary care job that you hate because you've got a bunch of student loans to pay off).

Just my 2 cents.

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Specializes in Emergency medicine.

@adventure_rn I second this 100%. @kerleigh722 Don’t hesitate to take the time you need to research your career path. If there are specialties you are interested in, it will be easier to get into as an RN. So the work you put in now will most definitely make your life easier later on as an NP (not to mention saving you the stress of a job you hate later on).

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Specializes in FNP- Urgent Care.

Thank you very much. It’s like I want to go to grad school and be an FNP just because that’s what’s expected at this point and the next step in my career. But you are totally right, I keep thinking my goals and ideas aren’t figured out yet completely. I’ve got 2 little ones and family time is the most important at this time in my life.
maybe one day I’ll figure out what I want to do, and maybe it would make more sense when my kids are older.

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Specializes in Advanced Practice Critical Care and Family Nursing.

Regardless of the litany of opinions you're getting here, ask yourself the most important question.

"When I'm in court or facing a complaint with the BON (because if you do this long enough it will happen) will my training back me up?"

What your employer feels comfortable with does not matter. What other APRN's in the area are doing holds no legal water and is just ignorant to cite. Even what your "supervising" or "collaborating" physician approves you to do will not protect you from liability. You are responsible for your license, and the word soup of nursing certs that can follow. The only thing is legal documentation of training, and state scope of practice.

My FNP training was 99% out patient, rural-community healthcare, mostly primary care, which is ironically what the FNP was intended for to begin with 60 years ago. The exam material covered the same.

My ACNP training was guess what? 99% hospital based inpatient care with focus in specialties. And need I say the exam questions covered acute care material, not pediatric vaccinations, annual exams, or pap smear due dates.

I attended a top ten program, keep , and an attorney on retainer. Protect yourself, trust no one unless you're paying them for advice, including my short rant here.

"If you can't feed one-hundred, feed just one." -Mother Teresa-

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