IBSavn

I currently work as a intensivist NP in a MICU/NSICU. Our unit is 12 patients. I take 8, the physician takes 4--usually the most sick of the units. I am credentialed to insert central lines; however, our hospital has yet to provide education so that I can move forward in procedures. I'm an ACNP, so I'd like to be able to insert my own C-lines, A-lines, and intubate my own patients. For now, I have to rely on my attendings for lines and anesthesia for intubation.

I went to Georgetown University. Best decision ever. Hybrid program. Online course work, online live classes, then lab/Sim on campus once a semester.

What do you specialize in to make 200k?!

I would like to know what kind of NP you are, where you work, what procedures you do, and your job satisfaction.

I am a AGACNP student in my final semester of school. I am looking at applying to jobs soon, and the University of Maryland Medical Center is somewhere that I am interested in working. From what I can read on their website the medical center has a good NP program. However, they always have positions open for NPs. This is concerning to me. I worry that there is a lot of turnover amongst their APRNs. Has anyone worked their or know of anyone who has worked there. I need input.

You hit the nail on the head. Institutions like this give nurse practitioners a bad reputation. This is why we can't get respect and recognition from our healthcare provider peers. Your statements remind me of a comment a physician made once to a NP I worked with after she suggested an alternative treatment, "Really, that is what you think? Let me guess, you got your NP degree from Phoenix online?!" That just shows that they take our education and training as a joke because they know there really are low-ball programs out there.

I will weigh in on this conversation... I am currently in the AGACNP program at Georgetown University. From everything I've been told by professor's and peers this is what I've concluded. FNPs should be utilized in the outpatient primary care setting. This is what their education is focused on. ACNPs should be used in the hospitals and outpatient clinic settings that are not primary care. The education of an ACNP is based on here and now (acute>chronic). We learn extensive diagnostic information about radiology, ultrasound, laboratory, and many other diagnostic tests. Additionally, we receive hands on training regarding critical care procedures that few, if any, FNP programs receive (intubation, central line placement, arterial line placement, surgical airways, chest tube insertion, PEG insertion). As a soon-to-be-graduate ACNP I would NEVER trust myself to be the primary provider for a patient. We do not learn preventative medicine nor primary care medicine. My partner is in his final semester of FNP school and our programs are as different as night and day. While he learns about vaccinations, rashes, obstetrics, health promotion and so on, I learn about vasopressors, ventilator settings, critical-care procedures and so forth. My recommendation, if you want to work inpatient become an ACNP if you want outpatient/primary care go FNP. As for the Emergency NP, I highly recommend you do a dual ACNP/FNP program. There is a program like this at Vanderbilt and South Alabama University. Both FNPs and ACNPs can get hired in an ED; however, most hospitals desire dual certified providers. ACNPs are not educated in pediatrics, obstetrics, and gynecology. This makes it exceedingly complicated for ACNPs to staff a quickcare or fast track section of an emergency department. Most fast track patients have complaints that can be dealt with in a primary care setting. While FNPs are trained in obstetrics, gynecology, and primary care, they lack the education in acute and critical care. While a FNP may have been an ER or ICU nurse prior to NP certification this does not make it OK to practice in an acute and or critical care area. As stated before by another poster, may boards of nursing are mandating that NPs practice in the areas which they were educated. I know for sure that Maryland does not allow FNPs to practice in inpatient settings that are deemed acute/critical care. With that said, they also specify that they seek FNPs and/or ANPs for settings such as primary care or outpatient clinics. Hope this helps. Also, please excuse any grammatical errors. It's 0427 and I'm on my 6th twelve-hour shift.

I have worked in a facility that utilized NPs. Both as hospitalist and in specialties. First off, I hope you are ready for the long haul. It takes any facility or group of physicians a long time to accept NPs as providers and to adapt to the learning curve. They find it really hard to hand over the responsibility and a lot of them like the idea of, "you have to answer to me." Our NP hospitalist use to take turns with everyone else. Everyone rotated between covering the ER (admissions) and rounding on the floor. The NPs saw patients, wrote orders, performed procedures, and did whatever else that patient needed--just like the physicians. Only if the NP needed help was the physician consulted--they did not have to check in after every patient. ICU patients required that the physician be notified immediately of admission and a physician had to "lay eyes" on the patient within 2 hours of admission. The state I'm speaking of is Virginia. Here, NPs don't have to have direct supervision but are supposed to have collaborative agreements with a physician. However, in the hospital setting, NPs are treated synonymous with PAs to make everyone's life a little bit easier.

I really thought about doing a dual program. I also entertained the programs at Vanderbilt and South Alabama. When I talked to other NPs, they told me that they didn't feel it was necessary to do so. However, with further research, I think they may have been wrong. In Maryland, an FNP can not work inside the hospital. They can see patients in a clinic setting, but they can't round in a hospital. You have to be a AGACNP in Maryland in order to work in the hospital. I had instructors who worked as AGACNPs in D.C. in the ER who's employers sent them back to school for a post-masters FNP certificate. As an AGACNP, you can't care for pediatrics. The hospital in question did not seperate their pediatric and adult population in the ER. Therefore, the NPs would be more valuable if they have BOTH AGACNP and FNP. I would consider what you want to do. You can still do primary care as an AGACNP--just not pediatrics. However, I will tell you that I have compared my education to my fiances (who is completing FNP) and they are completely different. AGACNPs don't receive hardly any preventative health education--it's all about acute care, procedures, and the care of the patient from admission to discharge from the hospital. I know very little about health maintenance and I feel I would be better served to complete a FNP certification if I ever decided to pursue primary care.

I know that I'm going to catch a bunch of crap for this, but I'm going to voice my opinion anyway. There are no standards for schools such as Kaplan and Walden. These schools take anyone who applies--it's a money racket. They have poor academic quality and from what I've seen they produce poor quality practitioners. Additionally, most of the people I know who have gone to Kaplan or Walden applied to real colleges or universities and were denied. Yes, you may learn enough information to pass your boards. But, passing your boards is not what makes a provider. There is so much more. I personally attend Georgetown University's AGACNP program, and when compared to Walden, Maryville, and Kaplan our education surpasses by far. If you want a quality education and to become a quality provider, go somewhere else.

I only know for sure about MD because i was looking to move there. I know you can contact each states BON and they will inform you about requirementa. Keep in mind that the NCSBN is working on creating a national NP system. You will chose an age group (Neonatal, pediatric, adult/Gerontology) and then a specialty (primary, acute care)--much like physicians. The goal is to gain national recognition so that regardless of where you live all laws governing NPs will be the same. Granted, I foresee this taking forever. If it does happen, you will see laws like MD move across the U.S. FNPs are being asked to pull out of the inpatient setting and into the clinic setting due to a shortage of primary care physicians. The goal is to have FNPs provide the majority of prehospital care and physicians provide specialty care. You'll also see more and more hospitals start to seek out ACNPs in place of FNPs. As I stated earlier, it's because the training is vastly different. Keep in mind, ACNP has only been around since 1995, FNP goes way back. It will take time for ACNPs to train. Additionally, there are only about 20 schools who offer the ACNP education at this time.

Go to the ANCC website. They provide a lot of certifications for RNs. Additionally, they list all of the certifications you can get as a NP. Such as Emergency Nurse Practitioner. Each certification has requirements such as hours practiced in the field you are seeking certification in.

I think it really depends on where you are looking to practice. I live in VA and FNP/ANP/ACNPs all work in the hospital setting, however, ACNPs are given preference. Most hospitals are like this, they will hire ANPs or FNPs and provide on job training. There are states (Maryland) who have state laws governing the practice of NPS and their specialties. In MD, you must be a ACNP in order to practice in an inpatient setting. I am finishing a ACNP program and my fiance is finishing a FNP program. I can tell you from experience the training is as different as night and day. The ACNP program is focused on acutely ill patients--think ICU and trauma. We have very little training and education in preventative health, health education, women's health, and OB. From what I've seen in his program (FNP), they cover all of those areas but don't cover critically ill patients as in depth as ACNP does. Additionally, ACNP school teaches ventilator management, central line insertion, chest tubes, thoracentesis, paracentesis, surgical airways, and a bunch more of critical procedures. Honestly, I've thought of going back for a post masters FNP certification to better round myself. I hope that gives you some insight.