Once I earn FNP... should I go for ACNP, too? Pros vs. Cons?

[yellow finch, BSN, RN]

I've been thinking about the future lately. Although I don't graduate from my FNP program until next December, I know that the time will fly and it doesn't hurt to think of the next step.

From my interactions with a Pulmonary group that comes to the hospital, I think I'd like to join them as an NP. I can provide primary care services along with Pulmonary care. I've already spoken with the mid-level liason and it looks promising.

The ACNP part comes in because I would like to spend more time in the hospital, especially in the ICUs since that's my background as a RN. This Pulmonary group only sends the MDs into the ICU while the PAs service the floors (I'd be the first NP to join the group). In other hospitals where I've worked, the ACNP visits the ICUs, so it doesn't seem to be outside the scope of practice (unless someone here can explain it better).

So would it be worth earning the ACNP certification after becoming an FNP? Would it give me a broader practice range? More earning power? How would I go about learning more about the ACNP scope of practice? (Yes, I'll go look on their website) :) Are there any reasons why it would be a waste of time?

Thanks in advance. All comments appreciated.

[yellow finch, BSN, RN]

Ok... I feel really silly now that I've seen the other post. :imbar How embarrassing.

Remind myself to do a search or at the very least read recent posts.

Mods can delete or lock this since I'm just repeating what others have asked.

[Corey Narry, MSN, RN, NP]

Actually, yellow finch your questions are valid and are a little bit different than the one posted in another thread. I think what you need to find out, especially if you are interested in joining the Pulmonary group to work in the ICU, is that whether your state advanced practice laws allow you to do that as an FNP. Some states have no set rules on what different NP specialties can do. In those states an NP is an NP.

The other step is to find out if the Pulmonary group is comfortable hiring you despite your training as an FNP. I would bet that if they are similar to the groups based in my geographical area, the docs wouldn't know the difference and it actually ends up being the NP who educates the docs on what the difference in the training is. I also find that many physicians prefer NP's who have ICU background as an RN to work in an intensivist mid-level role and many times, this trumps the fact that the NP was not trained in an acute or critical care track.

Having said these, I still think that you run the risk of being unqualified to round in the ICU should the rules change in your state practice act or the hospital credentialing board gets infiltrated by ACNP's who review applicants and are not friendly towards non-ACNP's working in acute care specialties. This is somewhat of a worse-case scenario and I personally have not heard this happen at least anecdotally. But this is where a post-master's ACNP certificate would come in handy.

You also asked about earning power. I think getting an ACNP may not necessarily grant you a higher salary at first but your value as a team member may increase with the fact that you may get credentialed to do procedures you otherwise won't do as an FNP. For instance, inserting lines, performing BAL's, and other similar procedures can be revenue-generating for a medical practice. In the long run you may get a raise if you offer skills such as these.

But looking at the brighter side I do know of a primary care trained NP who works with a Pulmonary group at a VA System who only sees patients in the clinic. This person also assists in out-patient bronchs in addition to his role in managing a wide range of patients with lung problems, sleep apnea, malignancies involving the lungs and other similar stuff. Needless to say, the job is busy enough as it is.

And finally, just a short soapbox on my part about the different NP specializations. This is a general comment and is not directed at anyone in particular. If physicians have to choose a residency program and have to stick to the specialty they choose to train in, I think it's not too hard to ask us NP's to do the same. Physicians have to start a new residency or fellowship program in order to jump into another specialty so I think a post-master's certificate is not asking for too much.

[yellow finch, BSN, RN]

Thanks for your comment, pinoy. You've just confirmed what I was thinking. My interests lie in not only working out of the office but also performing in patient procedures as you outlined. I want the excitement of working in the ICU balanced out with a stable patient base in the out patient environment.

If nothing else, I can barter my abilities with this group (or wherever I end up working) against other hospitals and groups in the area that utilize the ACNP in the ICUs in order to achieve the responsibilities I seek.

[Jengirl18]

Yellow Finch,

That sounds like a pretty logical plan. It would be great if your degree allowed for you to enter into that particular ICU and provide the procedures. I do have one question though...in this particular group, why is it that the PAs are only on the floor? Legally, their scope of practice is the physician's (so the PAs should already be able to perform the ICU procedures....unless there is hospital policy against all midlevels performing procedures (as there are in some hospitals)??

[yellow finch, BSN, RN]

Yellow Finch,

That sounds like a pretty logical plan. It would be great if your degree allowed for you to enter into that particular ICU and provide the procedures. I do have one question though...in this particular group, why is it that the PAs are only on the floor? Legally, their scope of practice is the physician's (so the PAs should already be able to perform the ICU procedures....unless there is hospital policy against all midlevels performing procedures (as there are in some hospitals)??

You're asking the same question I've been wondering. As far as I can see, other groups with midlevels allow their NPs and PAs to enter the ICU to assess, chart, and order for the patient. Afterwards, the MD comes behind them and co-signs. The Pulmonary group I'm looking at just doesn't do it. Even when we call the service they ask if I'm calling from the floor or the unit. That might be a good interview question down the road. I'd hate to spend their time and mine as a new grad only to find out that after ACNP certification I won't have any more ability to enter the ICU than as an FNP.