kdawnz

Hi all, I’m an AGACNP and considering getting post grad certificate for FNP or one of the peds specialties so I can get the peds component covered. For those that have done that, did you just do clinicals on top of regular work? Any program recommendations that are the cheapest, most flexible, and with the least amount of clinical hours? I’m frustrated this is such an ordeal when the difference in pediatric training I received vs an FNP is literally 1 class. Over half my curriculum was with FNP’s, and I have several FNP friends who never touched a child outside of the 1 ped class and rotation. Wish I could just take the 1 class and call it good- but that’s a rant for another day. Mostly just wondering what folks have done that worked well to get the peds component in.

WOW!, pretty harsh there. I never said I wouldn't move regionally and have applied for jobs in 8 states. It is not being entitled to say that the current reality over the past year in terms of NP market saturation was not the reality when I started school or even 18 months ago. I have a spouse with a job, a child, and obligations related to that. Because I didn't go to NP school as a young pup of 25 I don't have all the freedom in the world to work 80 hours a week and move 3000 miles away for very low pay. My husbands job gives him some flexibility, but not much. Given the fact that there are no fellowships or internships in a 2000 mile radius around me, I don't think I'm being crazy, lazy, or stupid for thinking staying somewhat regionally would be feasible. Especially given that 80% of the NP's I have worked with over my entire career in 2 different large trauma centers was locally grown. You seem to have a lot of malice towards NP's in general. It's sad that you think so poorly of so many of your colleagues. I wonder, is every physician you've ever worked with God's gift to medicine? That certainly hasn't been my experience. There are good and bad, as there are in nearly every profession. Any fully formed physician's depth and breadth of knowledge is far beyond mine, but I am not looking to run a pulmonary service solo or be a trauma surgeon. I am there to help, and I'm not an idiot so am certainly capable of managing basic things even as a new grad and hopefully can become more and more helpful over time. If your program didn't prepare you for even this then I'd have some concerns about your schooling.

Of course I agree... being an RN in general doesn't necessarily prepare you to be an NP. I know many many RN's who would be abysmal providers no matter how much time they spent the role. It's just a personality type, but I do feel that if you have the personality type and the experience you are less likely to be deemed utterly worthless as a new provider. The reality is that at this moment there are not sufficient internship/fellowship programs for all ACNP's to go through. It's not feasible or possible for us all to do with the lack of programs. So what do you recommend living in this current time? Are we all screwed? I would say not... I did most of my clinical in an ICU that relied heavily on their ACNP's, and nearly all were hired as new grads. Most already worked on the unit or in the facility, but were fresh out of school. They do most all procedures and manage around 8 ICU patients at any given time and seem to do just fine (several were about 8 months in when I started). In fact some of the weakest team members were the ones that had prior experience in a different setting. My frustration is the huge influx of NP's that seems to have happened in the last year. Jobs that had 7 applicants 15 months ago now have 30 in my area. Maybe just lots of these online programs saturating the market? I don't know. Everyone seems suprised. When I started school this was not the situation at all... so no, I didn't really sign up for a scenario where moving across the country and working 80 hours a week for $60,000/yr was the plan or expectation for myself and my family. Since my RN time is meaningless I guess I should have just gone to school 6 years ago instead of wasting my time becoming a leader and "mastering" the role before going on. Figuring out how to navigate this and contemplating working in a setting/specialty (clinic) that I am entirely unfamiliar with feels a bit odd since the learning curve there will be much steeper than the learning curve inpatient where I have spent my entire career and done all of my training.

I would say you are oversimplifying a tad as well... not all work places are built alike nor is RN experience. New grads such as myself certainly need a lot of support and I understand that is hard to come by depending on the setting and location, but even interns just out of med school come in and are expected to hit the ground running though they seem to be woefully unprepared. I routinely have 4th year medical students walk in to an ICU room and ask what the tube in their mouth is and what's that big machine next to the bed. 3 months later they are on call for a 15 bed ICU by themselves at night with an attending at home 10 miles away. It's hard and it's a steep learning curve, but it seems to be what medicine demands. Do I have more to offer right at this moment than the average intern I've worked with and probably even an R2? Yes, I would say that I do. I have familiarity, instinct, and a decade spent hand holding said interns and residents followed by 2.5 years of education and time actually doing the job. I worked in a somewhat unique setting that was insanely under covered with 1 attending running an OR 40+ hours a week in addition to the 15 bed ICU, so an awful lot was expected of nurses. However, I don't think this is necessarily unique to those of us that worked long enough as an RN to have really started to grasp the medicine and gotten well past the point of just checking off the task list. That being said, school and clinical was very humbling and I worked my butt off to try and fill the gaping holes in my knowledge. I did get a lot out of school and was given a lot of autonomy in clinical, but maybe this is somewhat unique? I am wondering what you recommend for a new ACNP graduate? It sounds like you don't believe starting in a hospital is feasible. Hospitalist internships are not a thing anywhere near me.. I've looked in the 20 states that surround me. I have found several CT surgery NP internships but as I ultimately do not want to live in a metropolitan area that has this service specializing doesn't seem wise. Should every ACNP in the country head back east and try to get in to one of the highly competitive hospital internships there? It doesn't seem terribly reasonable or feasible for a nation of ACNP's to do this.

I think that sounds like a great setup. I interviewed for a Pulmonary position today. It’s mostly outpatient for the first year or so and then I should start doing consult and critical care stuff a bit too if I were to get it. Definitely eyebrows raised that all of my clinical time and degree specialty is inpatient, but overall it seemed to go well. Again, I feel like I’m in a rock and hard place. I’ve applied for inpatient jobs everywhere and am getting told over and over they want experience... and then the clinics are like “do you even know how to work in a clinic?” Frustrating. What things do you like about pulmonary specifically? Most of my clinicals were with pulmonary critical care which I really enjoyed, but wondering what things you enjoy in the clinic world with pulm?

Gotcha, thanks for the info, that's helpful. Just trying to figure out how to navigate all of this. I did all of my clinicals in hospital and mostly with critical care, so I really don't know what to do in a clinic or with long term management of chronic conditions. I'm sure I can figure it out, but seems weird to go to an area I'm unfamiliar with when I can walk into a hospitalist or intensivist position and know what to do and how to do it. Obviously I have a lot to learn and need much greater depth in practice, but it will take me much longer to figure out my role in a specialty clinic than it will in inpatient medicine. Since the job situation has been hard I received advice in another post to go wherever will give me a job, put in a year or two and leave. This seems less feasible if I'm in a specialty that won't translate to inpatient medicine. Ugh, the struggle is real!

Hey all, curious what your first ACNP job was out of school? I am job hunting (which isn't great during this pandemic I realize), and have been told by 2 recruiters that I will almost certainly need to work in a clinic setting for my first job. This is a bit confusing to me since I did acute care as my specialty, spent my entire career inpatient, and did all of my training inpatient. When I have told them I am looking for an inpatient position they literally all say "you and everyone else". All of the inpatient positions I have applied for require prior experience, which is difficult to get when no one will hire you. AGACNP's seem to be somewhat of a rarety in the 5 state area I'm primarily looking and FNP's are working inpatient so that makes it tough for me without prior experience. If I need to bide my time in a clinic for a bit I will for sure, but I feel a bit backed in to a corner: I did Adult/Gero Acute Care which means I can't get any clinic job that cares for all ages. That pretty much leaves the specialties. Again, this is fine, but if my interest is to be a hospitalist or intensivist at some point, will clinic experience in a specialty be considered applicable?

Thank you, I will try to push my concerns about duration out of my mind. I just know I would be frustrated when we would have new RNs come and we put all of his time, energy, and money in to training them only to have them leave after a short time. Given the lengthy process to get hired as a provider I assumed that there was quite a bit of stigma with leaving after a short duration. But you’re right, I will be a good provider in the long run and need to do what’s best for myself and family. I did quite a bit of research on the main place we are wanting to move to. I interviewed for two positions, there were four total available as of last month. One of the positions I didn’t get, the other three were all postponed or taken down due to Covid. It’s a small area so I’m not sure if/when they will become available again. Since those jobs were taken down, I have been looking all over in the neighboring states and applied for several jobs with minimal interest. Some of this is likely covid related but it’s hard to know for sure.

Agree, and good luck to you too! I think I need to not get too worked up until things with Covid start to get somewhat under control... I applied for a PRN ICU RN job near me and haven’t even heard back on that either. Low census and other things are definitely a huge contributor.

Thanks for the tips guys! Part 2 of my question: I’m willing to cast a wider net if need be, but I’ve typically been a person who sticks in the same place for a long time. Last job I was at for 11 years. I feel really weird moving somewhere, going through the lengthy credentialing process, getting trained, and then leaving after a year or two. I guess that’s why I’ve been somewhat picky about location. I don’t think that my husband or I have the mental fortitude to spend 5 years somewhere without access to the things in the outdoors that bring us joy. We can suck it up for a short time, but as I said, I feel guilty even considering doing that to a prospective employer. Is that just the norm and I’m being a baby about it? My husband and I have also considered having me just go work as a nurse in a desired place so that I can network and hopefully gain an in, especially in a smaller community. I have mixed feelings about this. It seems risky, but may pay off. Like you said, lots of people get jobs by word of mouth. My old job was not a good fit for me as an NP. I may come to deeply regret passing up the opportunity that I had there, but it had become a toxic environment and I really don’t think it would have been a safe space to be a new grad even though I spent 11 years with the group as an RN. Lots of change over the last 18 months so I chose to walk away. Very sad.

Thanks for the input! ACNP residencies aren’t really a thing where I’m at in the Intermountain west. I’ll look into it though for sure and see if I can find something like that. It’s just weird because at the level 1 trauma hospital I used to work in we were hiring new grad PA’s all the time even as recently as 18 months ago in a specialty ICU. In my clinical rotations I spent most of my hours in the medical ICU and was taking 5-7 patients independently with notes and orders by the end of clinicals. I was pretty good at central lines, thoracentesis, and was able to get a handful of intubations. Of course more training never hurt anyone and I have so much to learn, but I am not years away from being able to contribute in any sort of meaningful way.

I need a pep talk or moral support or something. I'm an AGACNP-BC as of December and am having a horrible time finding a job. I've been a critical care/ER nurse for 9 years, teach PALS and mock codes, charge nurse, CCRN, all the things. Went to a public and reputable university and graduated with a 4.0 GPA. I live in the West and want to be in a smaller community, which I figured would work in my favor, but I am getting nothing. I have been a little picky about location because I want to be near skiing and biking, but even drastically broadening my search area I'm still getting minimal interest. I'm hearing back from some of the places that hopital jobs it took them over a year to fill in 2018 are having 10 applicants in 2 weeks. Jobs that used to have 5 applicants have 30. WTH?! How did things get this saturated so quickly?! I just got set up with several recruiters in the last week or so and am considering locums assignments if need be, but I'm just really frustrated. I feel like I shouldn't have wasted so much time "mastering" the nursing role and just gone to NP school quickly like most of the other people I know. I feel like my whole RN career means nothing and that I'm stuck in this weird place where no one will take me without experience but I can't get experience if no one will hire me. Anyone have any tips or positive stories or anything?

Has anyone heard back from the ACNP Fall 2017 program yet? I interviewed mid June, but am still waiting! Eek!

I signed mine on 7/31, the same day they sent me the finalist email.

My contract was signed on Friday too! Hopefully a congrats email will be soon to follow!