eastsideRN

I work in ER and there is always attending physician oversight. As such most of the more critical procedures are done by the physician. As an ACNP my scope of practice and what I was taught in school includes intubation, central line, art line, and LP. I frequently intubate and place lines, I have never done an LP. The the procedures I do frequently in ED include: I&D, lac repair, reduction/splinting of fracture and FB removal. I do not work in primary care, but I imagine common procedures include IUD insertion/removal, Nexplanon insertion/removal, suture, I&D, cryotherapy for mole/wart/seborrheic keratosis removal and toe nail removal? I'm sure I am missing something that is frequently done in primary care! I think procedures are dependent on the state you practice, the type of practice and your supervising physician. I imagine if an NP worked in specialties like interventional radiology, general surgery, dermatology, pulmonology or cardiology there would be opportunity for specialized procedures specific to that practice and/or specialty. I'm sure any procedures done in a specialty practice would come with a high level of oversight until proficiency can be established. I know that trauma teams/trauma centers have ACNP's on service but I cannot speak for what their specific role/duties on the team consists of. Also ACNP working in ICU manage vents/lines/drips. It seems to me from reading on Allnurses and networking with other NPs that NP practicing on the east coast have more procedural opportunities/responsibilities than their west coast counterparts, but this may not be entirely accurate. I assume there are dual programs for ACNP/FNP and/or ACNP/PNP available. As far as what certification I recommend? you need to decide what population you'd like to work with and what patient acuity you'd prefer.

If you are working in a community ER for all ages then dual certification with ACNP- Adult/Gero and a Post Masters FNP or Post Masters PNP to cover you for the Acute Care component and from Womb to Tomb. If the ER is designated Adult or Peds only then obviously one could be credentialed only in either ACNP-Adult/Gero or PNP-Acute Care. Being credentialed to work with only adults or peds in the ER setting could be limiting if you are interested in working outside large metro areas as most community hospitals are one size fits all. YMMV state to state and hospital to hospital. I have read that FNP are no longer being credentialed to work in the Acute Care setting but this is not true where I am in Central California.

I am an ACNP in CA. My clinical preceptors were a MD- hospitalist/internal med, a DO- pulm/critical care, a FNP- in ER and a ANP- outpatient cardiology. I had no problems with the California BRN or AACN to test for ACNPC-AG. I suggest that you get the hours wherever you can (as long as they are clinically relevant) and good luck!

This answer to this questions is certainly one where your mileage my vary. Where do you want to work? Adult ICU? ACNP. Hospitalist? ACNP. Specialty outpatient services such as adult cardiology, neurology or pulmonology? ACNP. Family Practice? FNP. Rural clinic? FNP. ER or Urgent Care? then you will likely need both, or perhaps just FNP (womb to tomb) unless you live in a state that adheres to the consensus model, then you need AG-ACNP and/or P-ACNP. I work ER in California and we provide care to all ages. A NP who has age restrictions on their license would be less desirable than a PA. I am in central California in a town of nearly 500,000 we have one Peds ER and it is on the same campus as the Main ER (they share a wall). When the census is low or provider staffing is low they will have one physician and one midlevel to cover both by constantly going back and forth between adults and pediatrics.

If you passed your boards, then obviously you should indicate you are board certified. As far as your state licence or DEA, if you have applied and are waiting, then I would state the date applied so your prospective employer is aware that you are on track to becoming licensed.

Why not apply for your Post Masters Certification program and work part time in Acute Care?

I am located in Central California and most people I talk to (including physicians, nurses and NP's) do not know the difference between FNP and ACNP. The consensus model is driving the NP specialty change and I suspect it will take years to be applied to practice. Check with your local or prospective employer Human Resources personal to find out which degree is preferred. Here the FNP is still the front runner NP degree to have based only on the "womb to tomb" patient demographic. However your mileage may vary...