justhink

Wrong. I clearly state that my experience is just that and that others may have had a different experience. And my personal experience, is, by definition, anecdote. I was then replied to by NYCguy that stated that Juan might have have a different experience - an anecdote to counter mine. That's fine, except the implication was that Juan does things that I know he/she doesn't do. There is no need to exagerate one's duties simply to counter my original point. Follow?

Really? They are managing ICU patients??? They are diagnosing coronary artery disease/occlusions based on their caths, and their own readings/interpretations with no MD present in the cath lab??? You do realize that driving a cath and diagnosing CAD are entirely different, right?

I do not "realize the irony," and hope you will comment further. Where I work (anecdotal), we have nothing but Intensivists (4 year MD + 3 year IM residency + 1-2 years pulmonology + 1-2 years intensive care) in the 120-bed ICU. Despite that extensive training, they generally limit themselves to vents/relevant pulmonology, basic electrolytes (K+, mag), basic empiric antibiotics, and simple ICU patient management (foley's, CT's, x-ray, 500 cc boluses, AM labs, nutrition, etc.). If there is any comorbidity (cardiac, neuro, ID, renal, etc.), most is referred/consulted to the relevant specialists (cardiologists, neurologists, urologists, etc.). So maybe there is an APN on this board that handles it all, and is far more prepared to manage patients in the ICU than the Intensivists (with 8-10 years of formal training) that I work with, who is so bright that he/she doesn't need to lean on specialists like the Intensivists (with 8-10 years of formal training) that I work with. If that were true (God help us), then it is an anomaly (I hope).

Yes, me too. Anecdotes, however, mean nothing. Perhaps Juan's area fully uses ACNP's to their fullest capacity. Or perhaps only he is. In my area, they do as I described - glorified RN's. And some may be happy with that. What matters is not what Juan says, and not what I say, but how ACNP's are used in the OP's area. If you have actual evidence (not you or Juan's personal experience that may or may not describe reality) that describes how most ACNP's are used nationwide, please post it and spare us the anecdotal opinions and smiley faces.

Yes, I will read images. There is a second clinic not far away where there will always a physician I can call, and he can also access the x-rays that I shoot. Nonetheless, I share the same concerns you mention.

Several things. First, they are entirely different specialities. FNP does not prepare you for hospital based work, though I see some FNP's in my area working for specialists in the hospital or with the hospitalist service. However, the IOM Future of Nursing report calls for NP's to ONLY work in the speciality area for which they are trained. States have already implemented some of the IOM recommendations, so in the future, I think you will see fewer FNP's working in hospitals. Secondly, if you like problem solving, you get plenty of that in family practice. I can't speak for everywhere, but every ACNP I have ever met does very little problem solving with regard to patient care. Instead, they write very basic admissions orders on behalf of the physician/service for which they work, take call for minor things, round, and write discharge orders. Some work on the floors overnight to handle basic issues that arise when the docs aren't around. They are not heavily involved in developing or adjusting medical treatment plans, so diagnostic reasoning skills are not heavily utilized by the ACNP's that I've seen. If you like diagnosis, family practice/urgent care/ED fast track is the place to be. If you simply like being in the hospital doing physical assessments, taking histories, and writing basic, initial admissions orders and discharging, and don't care too much about using diagnostic skills, then ACNP is a better fit. And, as another noted above, ACNP is rare in the outpatient setting, except maybe for some specialty clinics. The ACNP is not trained to provide primary care, and the FNP is not trained to do inpatient care.

Did you have any NP experience when you started in UC? How long did you train in the clinic before going it alone?

Thanks for the input. Yes, the "sister" clinic is where my preceptor is at and it's about 10 minutes away, and will always have someone there I could reach out too. I like urgent care, and like the group that runs the clinic, and like the idea of 3 12-hour days per week. But, I know how I perform at my first job out of school is extremely important for my career.

I'm about to graduate (FNP) and I think I'm about to get in a job offer in urgent care. Ultimately, they'll want me able to work certain days as the sole provider for the clinic (with a physician always available for call). While they have promised not to leave me alone until I'm ready, neither the physicians nor I know how long this will be. I have about 1,000 hours of experience as an RN in the ER and will have about 2,500 hours of experience in the ICU by graduation. My GPA has been very strong both in undergrad and grad, and I have always had very positive reviews from my FNP preceptors (most of which have been physicians). In fact, one of my preceptors recommended me for this job and he is part of the same practice (but two different clinics). While neither I nor the physician know how long it will take me to get ready to be solo, I don't think they'd hire me if they thought it would take a year, certainly not more than that. If I were to guess, I think they have somewhere between 3-6 months in mind. Anyone here gone solo in urgent care in that time frame after graduation? Is it completely unreasonable to think it could be done?