Percentage of various NP specialties in acute care?

Trauma Columnist · May 5, 2015

Well, I think you do need to decide what area you would like to work in.

Yes, its true that CURRENTLY as an FNP you can work in a hospital. I live in central IL and here, in all hospitals FNPs are employed. We have a large CNS population here too and adult health CNS have education in acute, chronic and geriatric care so they are also utilized in hospitals.

In more rural areas, FNPs are in the hospitals.

I made a mistake in my education by obtaining a post-MSN adult health CNS as well as a peds CNS with the idea I could see everyone. That is true FOR NOW. However, at my current practice, I don't see children so I need to retest the peds CNS and ANCC is retiring that test in Dec 2016.

So, for me, I have an adult health CNS (which I plan to keep current) and then I am also doing the FNP which is my third post-MSN.

(And yes, I have a very stinky attitude in class! - lol) Very frustrated as ANCC and NCSBN keep messing with all our certs.

Dranger · May 5, 2015

It comes down to the simple question, do you DEFINITELY want to work in acute care or not?

If you KNOW you want to work acute care, then by all means get your ACNP. It will prepare you for that role. If you would like possibility of being able to do some acute care but prefer the marketability of FNP then go for that.

Regardless of how people analyze the consensus model, I live in the MOST NP friendly state and there is a preference to hiring ACNP per the HR dept at my hospital as well as the positions posted. Trends across the country from my own anecdotal research and reading others posts leads me to believe this as well.

Look at it this way. You can't know everything. Gone are the days where family med docs (FNP equivalent) round on patients in the hospital. Hospitalists do that now because patients are becoming more and more complex. Sure there a few outliers but at my MAJOR hospital we might have 1-2 primary care docs with rounding privileges and every knows that having them round makes the process WAY more cumbersome and frankly ineffective. No one physician specialty can do everything nor can one NP do and know everything. You want to see kids but you also want to intubate and place CVCs in adults. Honestly at the end of the day this isn't possible. Sure you can get both certs, but to stay up to date on every age group from primary to acute with EBP is daunting.

You have to choose.

MallysMama · May 7, 2015

I totally agree with Dranger. It depends on where you can see yourself spending the majority of your career. I am also in a state now that uses mainly ACNPs in the hospital setting. Though I think this varies greatly depending on location and hospital. I chose to do the AG-ACNP route because I don't care to work with children (caring for my own 3 is enough for me!) and I love critical care. It just made sense for me to pursue acute care. But if you aren't that positive - time to decide what you want to do, and go from there.

KG MSN RN CCRN CEN, MSN, RN · May 7, 2015

I totally agree with Dranger. It depends on where you can see yourself spending the majority of your career. I am also in a state now that uses mainly ACNPs in the hospital setting. Though I think this varies greatly depending on location and hospital. I chose to do the AG-ACNP route because I don't care to work with children (caring for my own 3 is enough for me!) and I love critical care. It just made sense for me to pursue acute care. But if you aren't that positive - time to decide what you want to do, and go from there.

But what is the job market for ACNP's? I've heard it sucks. I would rather become a FNP with a better job security and work inpatient with that degree than waste time on an ACNP degree that won't get me a job anytime soon.

KG MSN RN CCRN CEN, MSN, RN · May 7, 2015

It comes down to the simple question, do you DEFINITELY want to work in acute care or not?
If you KNOW you want to work acute care, then by all means get your ACNP. It will prepare you for that role. If you would like possibility of being able to do some acute care but prefer the marketability of FNP then go for that.
Regardless of how people analyze the consensus model, I live in the MOST NP friendly state and there is a preference to hiring ACNP per the HR dept at my hospital as well as the positions posted. Trends across the country from my own anecdotal research and reading others posts leads me to believe this as well.
Look at it this way. You can't know everything. Gone are the days where family med docs (FNP equivalent) round on patients in the hospital. Hospitalists do that now because patients are becoming more and more complex. Sure there a few outliers but at my MAJOR hospital we might have 1-2 primary care docs with rounding privileges and every knows that having them round makes the process WAY more cumbersome and frankly ineffective. No one physician specialty can do everything nor can one NP do and know everything. You want to see kids but you also want to intubate and place CVCs in adults. Honestly at the end of the day this isn't possible. Sure you can get both certs, but to stay up to date on every age group from primary to acute with EBP is daunting.
You have to choose.

I do want to work in acute care...but possibly not for my entire career, I may want to end up retiring as a primary care NP. But if I can get the best of both worlds with just a FNP degree, why not go for it? Then if it is required to have an ACNP degree to work in a hospital in the future, then just do the post master's certificate to fulfill that requirement. But at the moment seeing MOST FNP working in a hospital ER or ICU setting instead of ACNP,and still being able to work on an outpatient basis for a family practice, I feel FNP is the way to go...

Dranger · May 7, 2015

You want validation that you are making the right choice. We can't give you that. If you already know you want FNP, why bother asking the question?

ACNP are groomed for inpatient and specialty care. None around me have had trouble getting jobs.

Take that for what it is. After traveling around FNPs in a real ICU are not the norm

HikingNinja, BSN, MSN, DNP, RN, APRN, NP · May 7, 2015

USA has a dual FNP/ACNP you could consider. Two birds one stone.

guest769224 · May 7, 2015

USA has a dual FNP/ACNP you could consider. Two birds one stone.

Isn't it like 3 or more years to complete, though?

HikingNinja, BSN, MSN, DNP, RN, APRN, NP · May 7, 2015

Isn't it like 3 or more years to complete, though?

Honestly not sure. Haven't looked at the program since they came up with it.

MallysMama · May 7, 2015

Vanderbilt also has an FNP/ACNP route.

I've heard many, many times that with the new Consensus model they are really pushing for people to stay in the area they are trained. FNP is trained as primary care- not acute care. And vice versa for ACNP.

I think that your route of doing FNP to start and then later going back for a post-masters ACNP is a great idea. I know of 4 FNPs at my school doing that now. But to hear them talk- it's been incredibly challenging for them. The two programs are very different. I think they thought that having already been NPs for years- that it would be easy. But they have told us it wasn't! So- just recognize that each program teaches different things and that they really are not interchangeable. I like the exaggerated example of: you can't become a PMHNP and expect to work as a CNM. I don't think an FNP has a place in critical care, and an ACNP has no place in a primary care clinic. (But obviously- in some areas you'll see one here and there. That doesn't mean it's the norm.)

Dranger · May 7, 2015

I know about USA's ACNP/FNP program, it is 3 years. However, I think to be proficient in both areas it is more than getting both certs. It highly unrealistic to think you can be titrating vents and managing ARDs one day to be treating a kid with impetigo and new onset asthma the next.