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I have recently accepted a NP position in North Carlina for 77K. It is a federal job with 7 weeks leave, comfortable working hours, no call and excellent benefits. Still, I have one year of experience in neurology (the new position is in the same specialty) and three years as a RN. I can't help feeling I am being underpaid. The position is marginally more than I make now. Thoughts?

Hi, I'm a new grad FNP living in a smaller college town with few NP jobs. My best offer is a position in pain medicine where I would work one day per week in an outpatient clinic and the remaining work days doing consults to help med-surg patients manage their pain while admitted. The job sounds interesting and the pay/benefits are appealing. But honestly, in the long run I would prefer a wider scope of practice, primary care or IM and no hospital work. So, my question is, how easy is it for NP's to change specialties? Can I do this for a couple of years and eventually move into primary care, or will I be stuck in pain management forever? On a related note, is it better to take ANY NP job as a new grad in order to make that "cross" into NP-hood, or should I continue to work as a RN until that perfect job comes along, even if it takes a year or more? Relocating is not an option for me right now, although that possibility opens up in about 18 months. Thanks for your thoughts!

I know several FNP's who do not work with any peds. I also several NP's who have held jobs in many different outpatient settings during the course of the their career. FNP really is more marketable for this reason. The peds rotation is totally survivable and you may acquire skills that crossover into the adult population. Good luck with your decision.

Hi, I won't graduate from FNP school until Dec, but that's not stopping me from looking around for jobs. I happen to live in a college town that has a number of FNP openings in specialty outpt clinics, some of which are quite narrow in focus (sickle cell clinic, ENT). Jobs in straight up primary care are few, lower paying and tend to reside in outlying rural areas. My question is, as a new grad, is it a bad idea to start off in a specialty? It seems I may lose many primary care skills if I do. Or, is it more important to cross over into NP practice any way I can, and not worry so much about developing a broad base initially? Thanks

Thank you trauma, this is the kind of conversation I was looking for. I've been a RN for three years on a med-surg floor. The plan has always been to work full time for a year or two before hopefully working my way into a part time position. Though I feel a 4 day work week to start would be fine as well. My main concern would be the length of the workday. I can start any time in the morning but it will be tough to not get off work until 6pm every night. So I'm curious as to how late most NP's work, since this is not exactly a negotiation piece. I need to know ahead of time how many hours I'll be expected to put in.

i am in the middle of my first fnp clinical and so far, i love primary care! i do notice, however that my preceptor works m-f from about 8:15am to 6:30pm, and sometimes stays on later than that. she usually sees 25-30 pts a day. this concerns me because i have three young kids at home and i am nowhere near a place in my life where i can work those kinds of hours. so i wanted to survey some anp's that work in outpt settings about their hours. is it standard to work so late in the evening? also, do most anp's work full time? a part time position may be a better fit for me, but i'm not sure if that's possible as a new grad. thanks for replies.

Well, not two days since I made my "i'm doing the ANP track" declaration I'm having doubts again. I found some old theads on the subject and it seems to be a somewhat common problem that the ANP can't find a job, especially if in the case of an unexpected move to a different part of the country. So, since will likely be moving elsewhere in a few years I guess the best thing to do is stay with the FNP track, even though it doesn't align perfectly with my career goals (that include only adults). This is not the first nor last thing in nursing that doesn't make sense, I guess. JD- were you rounding/making decisions on inpatients while you were an RN? That I have not heard of..... You're right about how the nomenclature keeps changing- that makes it hard to chose a grad program that will endure for the long haul.

This thread has been very useful toward helping make the FNP vs ANP decision. I spoke with another faculty member and apparantly Florida is like some other states in that ACNP's work the inpatient side of things and ANP/FNP are more restricted to the outpatient setting. ANP/FNP's still work in specialties however, but only in an outpatient capacity. With this in mind, it seems like graduates of the FNP will have enhanced job opportunities because they can do everything the ANP does + peds. The difference lies in the educational preparation- with only 500 clincal hours, it makes a lot of sense to be focused on the population one plans to eventually work with. If you plan to work with only adults "why put yourself through that" in the words of one faculty member and learn all the peds stuff. So, for me, I'm going to go against popular advice and go for the ANP. I'm so busy right now with work/school/family the thought of learning the large knowledge base necessary to work in pediatrics when I plan to work with only adults is just exhausting. I know this means I'll be limited in some ways- I can't do retail clinics,true family practice or peds. But I've seen many jobs nationally where both ANP or FNP is ok, and some that prefer the ANP. I also feel I'll be at an advantage in terms of my clinical experiences and confidence by using all my clinical time on adults. I wish in a way NP's followed the generalist model (with attendant more clinical hours) that PA's have so we don't have to make these kinds of decision- sometimes it's hard to know where you want to end up before starting grad school.

What path are NP's taking that PA's chose not to 30 years ago? The history of a profession is always interesting. Also, are you saying that given my background/interests the ANP is a better way to go?

hey, thank you for your thoughtful reply. I had not considered the wider political ramifications behind FNP scope of practice. But I completely agree that is seems strange that the 500 hours clinical instruction would be enough to be competent when most other specialties have much more focused curriculum. Which is exactly why I'm questioning my current FNP path- it seems a much better use of my time to do the ANP if I expect to only work with adults. Yet the standard advice is to get the FNP if you want the most marketability. I live in Florida, where there are many ACNP programs. I was told about possible restrictions of FNP practice by faculty of an ANP program. My "gut" is telling me to switch to the ANP- if my knowledge base isn't improved by focusing just on adults I'm sure my confidence level will be. Yet lingering doubts remain- I don't plan to stay in Florida and I'm not sure how the ANP will affect marketability in other states. Perhaps this is less of an issue once I have some work experience?

So then, for someone interested in outpatient adult primary care but who would also like to have ability to work in an IM specialty is the ANP the better fit over FNP? Do do you see the profession moving to a place where FNP's do everything outpatient and ACNP's work the inpatient side, making the ANP obsolete?

Where I live (north florida), I've been warned that they are "cracking down" on FNP's working in hospitals- apparantly it's outside of the scope of practice. So, if that is true wouldn't the ANP give you the most versatility in that you could work both in hospital or outpatient? Maybe the rules are different in different states? I can see how the FNP/ACNP dichotomy makes sense however, maybe the ANP doesn't fit well with where most practitioners end up.

Hi, here's my scenario- tell me if you think FNP is the way to go: I am currently working as an RN on a general med-surg-oncology floor and I'll have about 3 years of experience when I graduate with the MSN next December. I would like to work in primary care for adults, a some type of specialty or women's health. While I fully expect to work full time for a year or two, I have three kids at home and definitely want to move into something part time while they are growing. I really can't see myself doing anything with peds though I have no particular aversion to it- I would just rather work with adults.. So, should I really bother with all the peds stuff required for the FNP? Isn't is better to focus on the ANP and have better job opps in hospitals? Or will I still find myself limited if I can't work with children? Thanks for the input..I'm currently in the FNP track and if this is my last chance to switch- clinicals start in Jan.

Yes, that's exactly right Pinoy- I'm concerned that I'll be expected to function on my own, doing everything the MD does and only consulting with questions when strange things arise. It's reassuring to hear that I won't be totally on my own and that it will be OK to ask questions.

Hi, I started my FNP program this year, part time and have not yet begun clinicals. But I'm already getting worried- it seems like NP's diagnose, treat and chart just like MD's do. They say NP's see mainly 'routine' illnesses but I'm quickly realizing it's not always that straightforward. The medical knowledge base is so vast, I'm not sure how we can be expected to function the way MD's do with only a fraction of the training. Can some practicing NP's out there tell me in what ways there job is like/unlike a full flegded MD?