Advice from acute/critical care NP's

Specialties NP

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  • by CAPRN77
    Specializes in Anesthesia.

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Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Actually, surgery rotations can be incorporated in an ACNP program. It all depends on each school and the availability of NP preceptors who are able to provide the sort of clinical rotation you are looking for. In my area of the country, there are NP's who assist in surgery and I am quite familiar with one who works in neurosurgery assisting with stents and endovascular procedures in addition to the usual craniotomies. She is known to precept students who are intersted in her specialty. In addition, some ACNP programs can actually individualize the rotations based on the student's career goals. There are NP students who have a guaranteed position after graduation because they have established a relationship with a particular physician group. A few of the students in my class fall in this category and have decided to focus their rotations in the particular specialty they will be working with after they graduate and get certified. One such student did a strictly cardiology rotation throughout school and did get hired by the cardiology group. Also remember that in spite of this, ACNP didactic sessions are still the same for every student and we all still need to go over all the body systems in terms of diagnosing and treating patients. But the danger I see in setting your eyes on a particluar specialty is that you may end up realizing that the existing job market is not favorable for that particular specialty you set your eyes on. Then you're out of luck for a job and not marketable enough for the other specialties that have job openings.

Atl_John

216 Posts

Specializes in Pulmonology/Critical Care, Internal Med.

Hi Pino,

I actually wrote to UAB the school I was looking at for NP about taking extra classes in surgical procedures/disease, etc. I always wanted to do surgery and while I wanted to do things like long bone fixations, I wanted to be well rounded so that if I needed a change i could go to urological surgery or Cardiology, etc. For me it is not so much about specializing, but it is what will give me the best education so I can specialize later on, and two what will give me the best education so I can provide the best absolute care for my patient. My patients outcomes and my ability to help them is the most important in whatever I do. I just know I want to be involved with procedures not just office/hospital visits.

caldje

177 Posts

For me it is not so much about specializing, but it is what will give me the best education so I can specialize later on, and two what will give me the best education so I can provide the best absolute care for my patient.

I dont understand. Just a couple of posts ago you said you refuse to take more pre reqs but now you say you want the best education possible. I think you should consider taking those pre reqs to geta good foundation to build on to become a practitioner. Also consider, if you are choosing NP for the "autonomy" but what to go into surgery I am afraid you might be a little surprised. The only autonomous surgical providers are physicians.

Atl_John

216 Posts

Specializes in Pulmonology/Critical Care, Internal Med.

caldje,

Let me rephrase. I was going to have to take more Pre-reqs for PA school. I have everything that I need for NP school. I don't see how taking a second Bio course is going to make me a better practictioner.

I know that the surgeon is the only autonomous one in surgery, I have no problem following the lead of the doctor. I am talking about while in practice having more autonomy. (chart review,ability to sign alone on meds etc) I may be in for a surprise I realize with that but at least I have the choice as a NP if I don't like it I can move somewhere where I do.

DaisyRN, ACNP

383 Posts

Specializes in Acute Care - Cardiology.

hey there,

i thought about the same thing before i went to acnp school and decided against crna because i think i would not get enough patient interaction. what i have found (and been told by several) is that people that have been in nursing a long time, that have become "tired of dealing with people's crap," but want to pursue an apn role, choose crna because you put them to sleep, make sure they wake up, and then go about your way. you dont have to "deal with them" as some have told me. i, on the other hand, like to talk to my patients, teach them, monitor progress, and feel as though i am making an effort to improve their status quo. as a crna, you will be swimming in bucks, but its the same thing over and over, and i dont think i would feel like i would was "making a difference."

also, in my opinion, if a new rn wants to go right into crna school, then he or she probably went into nursing for the wrong reason... $$$.

well i'm not exactly looking for advice as much as looking to hear about your job. i am still up in the air as far as whether i'd like to become a crna or critical care np. i have looked into both professions quite extensively as well as the training involved. i have also shadowed a crna at my hospital. i know that crna salary is generally higher than that of an np but i would really hate for salary to be the deciding factor in which profession i choose since money doesn't mean squat if your miserable at work. what i'm looking for is any acute/critical care np's who are willing to share info about your job such as what responsibilities you have, what hours you work, where you work, what you would change if you could, and if your willing to share info about pay. maybe hearing from some more people who do the job for a living will help me out in making my decision. i am also putting a similar posting in the crna area. thank you.

DaisyRN, ACNP

383 Posts

Specializes in Acute Care - Cardiology.

hey there,

like pinoy was saying... in my acnp program, we have 4 clinical semesters where we have to acquire a minimum of 168 hours each (for my program's requirements). the first two are standardized, meaning 1st rotation, internal medicine - outpatient clinic, 2nd rotation - general/internal medicine - inpatient, and then for the last two, you can choose any thing you want.

for me, i am interested in a hospitalist role (which i am with right now for my 2nd rotation) and will probably do either an intensivist rotation next semester (so i get more exposure to icu mgmt), or a cardiology/pulmonary/nephrology rotation to get specialized training so i will be able to manage these more common disease processes in a hospitalist type role after graduation.

some others in my class want to work with surgical patients, so they are doing surgical rotations next semester. others want to learn the skills, i.e. central lines, a-lines, chest tubes, etc. so they are going to do a rotation in a neurotrauma icu that is known for being student-friendly when it comes time to do the procedures.

so, really... its all up to you. as much as i feel the acnp role is a good fit for me, you might need to consider talking with core0. he's a pa that can give you better insight into the pa program itself.

yes there is they do have one, only catch is you have to work or for minimum of 2 years before hand, pa schools you don't. i originally went to nursing school so i could go to pa school since i wanted to do surgery, to say that its complete gone would well be an over exaggeration, but i like the autonomy that np's seem to have, and i don't have to take anything extra to be a np.

its a real shame that np programs do not have a surgical component like pa programs do i'm not talking about rnfa you can have that without being a np. i'm talking real rotations in surgery etc just like pa's have to do. if i were to try to do uab's pa program which is a surgical program i would actually have to take more pre req classes honestly i'm not interested in taking more pre-reqs for anything. i've thought about emory''s i actually have all their pre-reqs. i'm just really curious as to why np programs don't incorporate surgery. i would love nothing more than to work for a ortho. surgeon as his midlevel being a fa and seeing patients in the hospital/er/or. love to do things like long bone reductions.

caldje

177 Posts

caldje,

Let me rephrase. I was going to have to take more Pre-reqs for PA school. I have everything that I need for NP school. I don't see how taking a second Bio course is going to make me a better practictioner.

I know that the surgeon is the only autonomous one in surgery, I have no problem following the lead of the doctor. I am talking about while in practice having more autonomy. (chart review,ability to sign alone on meds etc) I may be in for a surprise I realize with that but at least I have the choice as a NP if I don't like it I can move somewhere where I do.

a lot of states dont require chart review for PAs and the ones that do usually only require a small ammount of charts reviewed.. just like some states require chart review for NPs.

Also, in all 50 states, a PA can write and sign their own prescriptions, and can also writ eorders in hospitals.

Atl_John

216 Posts

Specializes in Pulmonology/Critical Care, Internal Med.

caldje,

I know, I have no problem with PA's, I wanted to be one before I went to nursing school even interviewed at a PA program for a masters. I love PA's, but I love nursing more. I would love nothing more than to be precepted by a PA, core0, for instance, which I have mentioned to him already. I have absolute respect for PA's and the roles that they play. I have worked with many PA's before I went to nursing school, and have a PA writing a letter of recommendation for me for NP school. I just believe my fit will be better as a NP.

I am not sure why you mentioned all that you did below I never said PA's couldn't do any of those things. I know many on here are not friendly towards PA's which is unfortunate but I am not one of those folks. If and when I become a NP I will be one that sees PA's a colleagues not some inferior form of midlevel. There is no need to become defensive with me when it comes to PA's I admire you for you for your knowledge and skills and look forward to one day working with other PAs' and learning from them.

a lot of states dont require chart review for PAs and the ones that do usually only require a small ammount of charts reviewed.. just like some states require chart review for NPs.

Also, in all 50 states, a PA can write and sign their own prescriptions, and can also writ eorders in hospitals.

caldje

177 Posts

I was just trying to be informative. I wasn't necessarily saying you were against PAs. Sorry.

caldje,

I know, I have no problem with PA's, I wanted to be one before I went to nursing school even interviewed at a PA program for a masters. I love PA's, but I love nursing more. I would love nothing more than to be precepted by a PA, core0, for instance, which I have mentioned to him already. I have absolute respect for PA's and the roles that they play. I have worked with many PA's before I went to nursing school, and have a PA writing a letter of recommendation for me for NP school. I just believe my fit will be better as a NP.

I am not sure why you mentioned all that you did below I never said PA's couldn't do any of those things. I know many on here are not friendly towards PA's which is unfortunate but I am not one of those folks. If and when I become a NP I will be one that sees PA's a colleagues not some inferior form of midlevel. There is no need to become defensive with me when it comes to PA's I admire you for you for your knowledge and skills and look forward to one day working with other PAs' and learning from them.

Atl_John

216 Posts

Specializes in Pulmonology/Critical Care, Internal Med.

Its all good caldje, you are only trying to make sure things about your profession are said correctly on a forum which at times seems over whealming anti PA. No worries.

John

I was just trying to be informative. I wasn't necessarily saying you were against PAs. Sorry.

Sugah Britches

76 Posts

Specializes in CCU,ED, Hospice.

This is a very informative thread. I have an odd question. As a ACNP, if you were unable to continue working in the Hosp.. what would your choices be? Could you work as an Adult NP in an office? I love working in CCU and want to pursue an advanced degree, however I have been dx with MS, not a problem now but I always have to consider my options.

core0

1,830 Posts

This is a very informative thread. I have an odd question. As a ACNP, if you were unable to continue working in the Hosp.. what would your choices be? Could you work as an Adult NP in an office? I love working in CCU and want to pursue an advanced degree, however I have been dx with MS, not a problem now but I always have to consider my options.

You couldn't do primary care like IM, but you could do outpatient cardiology, neurology or another specialty that involved clinic work.

David Carpenter, PA-C

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