SFNP127

Nervous is a good thing - it will keep you honest, humble, and on your toes. Use your preceptors, that's what they're there for. They know you're nervous so tell them what you need - ask them to come do your first couple of H&Ps with you, and give you pointers to improve. Then gradually work your way up to the point where you're doing the exams on your own and presenting to them, etc. You'll need their support, validation, and expertise a lot in the beginning and will find a way that works for both of you (or all of you) to wean that down gradually as you gain confidence in yourself and they in you. In all honesty, you're not gonna suddenly not be nervous after you graduate. I've interviewed for 2 jobs so far and I'm scared out of my wits about the prospect of actually getting one... while I'm no longer a student, I AM a brand new NP, and my first year to two years on the job (per what I've heard from many other NPs) will be very much like being a student or like my first couple of years as a RN were... full of nerves, uncertainty, and feelings of inadequacy. That, too, will pass...

1. Your best bet as someone already having an undergraduate degree is likely to be either A. as the other reply said, apply for an accelerated BSN program, get your experience, then apply for your masters separately, or B. apply to direct entry programs (those for which you're accepted to the BS and MS nursing degree programs together. They are usually somewhere in the 3 year long range. Once you get your BS/BSN (or pass the NCLEX as not all programs will actually award you the BS degree, some may simply give you the MS/MSN when you're done with the entire program but once you finish all the appropriate elements of the program you can sit for the NCLEX) you can start working as a nurse while you complete the rest of the program. 2. The above being said, some masters specialties (particularly the acute care programs) will require you to 'step out' for a year, or do a 'residency' lasting anywhere from several months to a year before you're allowed to continue in the program. With that plus whatever work you do while in the masters you'll likely rack up about 2+ years of RN experience by the time you graduate. This will be enough for some people and not enough for others.... I can't speak specifically about primary care oriented programs, but I do know that you can often do those programs part time (many acute care programs won't allow this) so may be able to rack up even more RN experience prior to graduation. Good luck!

ANP and ACNP are not interchangeable in the educational or certification senses. As someone above mentioned, different educational programs, different exams. My understanding is that technically speaking, ACNPs "shouldn't" be doing primary care, nor should ANPs be doing acute care. As an ACNP you are not trained as a primary care provider, and vice versa (or so I understand of ANP programs; my institution titles its ANP clinicals 'Primary Care Residency'). However, as others have mentioned there will be positions that either 'require' or 'prefer' one type of NP or the other who will train the opposite type for their position. I asked this question of the program director of an ACNP program with regard to ACNP vs FNP, ACNP vs ANP, etc. and his answer was simple... one word - liability. Just another angle to consider.

I graduated in June, passed the ACNP boards last Tuesday (!). My class was about 20 people. 8-10 of them I know for sure either already have or have been offered at least 1 position already. The rest of the class I don't have any direct information about. Personally, I have applied and interviewed at 2 jobs, one of which chose another candidate, and one of which will be letting me know after they interview a final candidate this week. There are many (on the order of 5-8) other jobs I could have easily applied for but I'm interested in relatively specific positions so haven't applied to all the ones that have been available. For reference, I live in the Bay Area.

I've been on both sides of this. I chew gum at work regardless of whether I'm allowed to or not. I don't chew with my mouth open or pop it in my patients' faces, come on. I work in an ICU where we RARELY have time for some semblance of a normal break to eat, sit, hydrate, perhaps brush my teeth or swish a little mouthwash, etc. The air is dry in the hospital, anyone who works in one knows that. It's gum, people. If some manager can prove that me chewing gum makes me a worse nurse, I'll stop immediately. Enough said.

I am a NP, graduated in June and will soon be taking (and passing!) the ACNP boards. From my own personal searches, I can tell you the market is pretty slim right now. However, I will say that being in a program in and of itself opens you up to inside information regarding positions (i.e. my program director gets information directly from recruiters or former students working at Bay area hospitals regarding positions that are opening up, sometimes before they're even posted on the hospitals' websites). I will also say that about 1/2 of my classmates have already accepted positions (most in the bay area and slightly beyond). Personally, I am currently in the middle of the interview process for one position about an hour outside the city, have an application into one of the major SF medical centers, and have rec'd an email within the last week from my program director regarding a temporary position that isn't even posted on the hospital's website yet, but for which I have emailed directly with the MD running the department. My point is that even when the market is slim, there are jobs out there. You just have to be patient, search/stalk the hospital websites, network with classmates who may know people working around area hospitals, and get your applications in! I'd caution anyone choosing a specialty based upon the job market today. Unfortunately we can't predict what the market will be 2 years from now when you graduate (assuming you're just getting ready to start since you haven't yet chosen a specialty). ACNP is still a relatively young specialty, and many centers are just learning the ways they can be utilized.

I've taken 2 adv. assessment classes, and I can tell you plain and simply what will get you through - practice. Find a friend (or make one!) with whom you're comfortable and who will get half naked for you on as many occasions as you can convince them to and let you practice on them. I also make myself a bullet pointed format according to exactly how my program required things to be done and using Bates' Assessment book. I took it most places I went and studied it often, went through it in my head before bed every night, etc. etc. Practice makes perfect!

I haven't read every single response to this post, so I may be reiterating others' ideas or not. In any case, I believe it will be extremely difficult to make the DNP/DrNP (clinical doctorate) required for all NPs. Nursing as an entity is confused enough about getting people into registered nursing, for which we still cannot find a way to ensure that every RN has a bachelors degree, let alone that every NP will need to have a doctorate. As it stands, many (if not most) of the 'clinical' doctorate programs still focus largely on epidemiology, research, and policy rather than on clinical residencies/fellowships or actual enhancement of diagnostic, treatment, or procedural skills - another testament to the unclear purpose and goals of this type of program. If the DNP does somehow become a requirement and already licensed NPs are not exempt, I probably won't be a NP any more.

This may also be somewhat dependent upon your school and its variety of programs. Here at UCSF there are ACNP (adult), pediatric acute care, and neonatal (which is pretty much acute care by default) NP programs. Straight-up ACNP is, I believe in most cases an adult specific specialty. I've seen peds as either up to or including 18 and adult accordingly as 18 or 19 and up.

Hi all, I just graduated from ACNP school in June, so I have VIVID memories of school and all things related. These are the things that were most important for me during school: 1. coffee. 2. highlighters. lots of highlighters. 3. the ability to recognize when (time of day, days of week, etc.) when I could get the most and the best studying done and learning to take FULL advantage of those times. 4. coffee. 5. calendar - you will need one to keep track of when your millions of assignments are due. 6. love for your classmates. PLEASE don't compete - help each other and recognize that you can ALL learn something from one another. 7. coffee. 8. equipment-wise, the school will tell you what they "require." Go with the flow on this in general; it's probably safe to wait until your first adv. assessment class/lab and talk to the profs about big ticket items like oto/opthalmoscopes. 9. A good physical assessment partner or a very good friend who will frequently strip half naked for you and let you examine them. PRACTICE over and over and over was the best way for me to avoid getting flustered and forgetting steps on the physical exam checkout. 10. COFFEE. :)

I graduated from UCSF's ACNP program in June. I would highly recommend the program. The instructors and director are wonderful and they care about us and our education. However, they program has high expectations of its students and I would caution you against applying for a program that you think can "make" you a very strong NP. The NP program is designed to put the information at your fingertips and get you into a clinical position to make the best of that information with the help of your preceptors at some amazing institutions. You get out of your education only what you're willing to put in, and only YOU can make/develop yourself into a strong and amazing NP!

How much autonomy you're going to have in practice will be heavily dependent upon the unit and hospital themselves in part, with the influence of your legal rights and responsibilities... In terms of whether you're legally allowed to practice without the supervision of a physician, the state boards of nursing determine those guidelines individually I believe.

I agree with the 2 NPs who worry about you already having started your NP program with no ICU (well, very little) experience. If you're not even confident in your abilities to do a basic assessment and be able to think through the reasons why you're doing interventions, you're probably not ready to start thinking like a NP. Frankly, I'm surprised your NP program didn't require a minimum 1 year ICU or critical care experience before you could start the program, as many of them do. Personally, I was in an entry to practice program (combined BS to MS program) and withdrew to work for a few years first, because I felt the same stress and fear as you do and knew it was a bad idea to try putting NP school on top of all that. I have friends who went straight through the program with only the minimum required ICU experience who had a really rough time of it. When you can walk through the doors at work (in an ICU) and be confident that you can handle whatever patient they're gonna throw at you (or at least that you're at a place where you're comfortable using your knowledge and resources to give the best care possible even if you're put in a situation where you don't know the disease, the medication, or the intervention well), then you're probably more ready to think about ACNP school.

PS - I ended up doing ACNP...just finished my first quarter!

I asked a similar question of the director of the acute care program where I got my undergrad, and he explained it in the way that made the most sense to me... An ANP may technically be able to practice in acute care settings (e.g. the cath lab or CTICU), and an ACNP may technically be able to work in primary care (e.g. outside the hospital in a clinic), however, it all comes down to the fact that if you're an ANP working in a critical or acute care position meant for an ACNP, you are a liability. You are NOT trained to work in critical care if trained as an ANP, FNP, etc., and should something happen and any legal proceedings be brought forth, that could mean trouble...