Questions for ACNP and students

Advanced Practice Columnist / Guide · Jul 6, 2012

my question to current acnp and students:

1.) are you happy choosing this route instead of fnp?

i am. i love working in hospitals and dealing with acute patient issues. i loved critical care as a staff nurse and being a nurse practitioner in the same settings makes me even happier.

2.) what made you choose this route?

got advice from np's i've talked to when i was a staff nurse. talked to an acnp and an anp program director. i didn't actually consider fnp because the thought of caring for sick kids doesn't appeal to me, neither does women's health or psych. that helped me weigh the pros and cons between primary care and acute care practice. made connections with in-patient np's as a staff nurse and realized that there is somewhat of a demand in the in-patient setting in the job market where i lived.

3.) what is the job market like? what setting do you practice in?

where i went to school and practiced after graduation in the midwest, the job opportunities were there and i didn't have problems getting a job. i work in critical care then and now. where i am now in california, i think the market is a bit saturated though the acnp grads from the local program (which our hospital is affiliated with) seem to get jobs if not locally, within the state (somewhere between san diego and sacramento).

4.) how many years did you work as a nurse before going back to school? is it difficult getting back into the school routine?

roughly 10 years. i didn't find it hard to go back to school after a long absence from it and actually enjoyed the routine of attending classes, studying, and having clinical rotations. it's almost like college again, but with a lot of thirty something's and middle-aged people, at least in my class. being with a class full of experienced icu and ed nurses from various hospitals can be intimidating though. everyone liked to talk about how awesome their icu and ed experience were. there was an element of one-upmanship.

5.) what do you like/dislike about your career?

having to work holidays and picking up some night shifts, maybe. but that's not interfering with my personal life really. i have a lot of time off to have fun and our physician colleagues are jealous of that.

also, any tips on choosing a good program and tips in general would be appreciated. i've read on this websites that fnp have a wider job market. even with that notion, it isn't enough to stir me away from acnp lol. as far as cc experience, i will be working as an nt in the micu with previous cna med/surg and float floor/icu experience. i am thinking about beginning grad school in my late 20s so i have a good foundation of experience to draw upon. thanks!

you should get critical care experience as a staff nurse if you want to get a job in critical care at the very least. i'm not going to debate the benefits of rn experience prior to becoming a nurse practitioner but the fact is, you will be working with icu nurses who can be known for being badass and intimidating to newbies. also, the job market almost calls for it because of the competitive nature of the field -- you'll be competing against acnp applicants who are seasoned icu nurses and not having that experience will hurt your chances.

juan de la cruz, msn, rn, acnp-bc, ccrn-csc

not my real name btw :)

LifesAJourney · Jul 6, 2012

Thank you for the insight! I definitely need to start building up my connections with local ACNP here. It is good to hear that the job market is one that is not entirely saturated. One of my biggest concerns was the length of time away from school. I am not one to rush in too quick, but definitely do not want to wait too long. Things may change, but if I start grad school when I am between 28-30 yrs old, it will give me about 5-7 yrs of work experience for to draw upon. How flexible are your hours? Can you choose between 8hr and 12hr shifts? You can count that I plan on getting experience as a CC Nurse. I am hoping to land a job as a nurse after graduation within the unit I am about to start. I have another offer in our TSICU, but I still have a year of school left so nothing is set in stone. Nonetheless, I am still excited! What advice do you have about choosing a good program?

Advanced Practice Columnist / Guide · Jul 6, 2012

Most CC NP's I know work 12-hr shifts. I know a few PA's who do the same. However, when I was a student in 2003, I did a clinical rotation at a VA Hospital where the PA's work M-F day shift only. The fellow or resident covers the off shifts. It's out there if you can find it. Nowadays, that's probably going to be hard to find. There are strict rules for duty hours among PGY-1/R1 or interns now. The most they can stay in the hospital is 16 hours straight. PGY-2/R2 house officers (residents) can take 24-hour call but it's typically every 3 days only. Fellows can not be abused to work a lot of 24-hr shifts either. House officers lose the daytime learning opportunities if all they do is work nights. That's why there's a need for more providers in ICU's who are not house officers or fellows.

What I notice is that it is typically the large medical centers that have CC NP's. I live in the San Francisco - Bay Area. I can tell you that the major medical centers here (UCSF, CPMC, Stanford, VA Palo Alto) have a group of CC NP's in various stages of planning and/or development. UCSF and CPMC's are the more established groups. Another large concentration of CC NP's are in the Northeast (NY, PA). It is definitely an exciting time for NP's who wish to pursue a career in critical care but I don't know if this momentum will continue. There is a wealth of literature on a national level on the utilization of NP's and PA's in the ICU. SCCM (Society of Critical Care Medicine) have had ACNP's invited to talk in their conferences.

Choosing a program can be daunting I'm sure. Where do you live and do you want to stay locally for school? I did and I don't regret it. It is important that the school is able to provide the critical care rotation if that's the direction you want as an ACNP. As you must know, ACNP's are not limited to critical care practice so not all schools offer critical care rotations. There are big name schools out there for NP programs and most regions have at least one if that's what you want. Sometimes, going to a local school with a good reputation is not a bad idea. I can't comment on online programs as I didn't do that and could never be successful in such a program due to my learning style.

I'm happy to give you advice but don't get upset if I say that since you are pretty early in your career, you may find a different interest later on and might want to change your direction if that should happen. It's good to have goals, however.

Dutch Tulip · Jul 7, 2012

hi! juan gave you lots of good info, so i'll just chime in with a few more thoughts.

1.) are you happy choosing this route instead of fnp?

110% yes! the thought of caring for children as an np gives me hives. and i absolutely love and thrive in the critical care setting. i feel that my gifts are best used in the inpatient, critical care setting. one thing that helped me make the decision to be an acnp is that i am a very visual person and i love to have my patient right in front of me or easily accessible at all times. when you're working as an fnp in a clinic, you have to "picture" the patient as you evaluate their labs/test results/etc long after the encounter. i don't know if that makes sense, but it is one of the things that drew me to an acute care setting.

2.) what made you choose this route?

i would say i chose the acnp route based on my rn experience in critical care, seeing acnps in action, advice from a trusted advisor, and the availability of a well-respected acnp program in my area at the time.

3.) what is the job market like? what setting do you practice in?

in my current area the job market is very good. i practice in unique progressive care unit (50+ beds) where we care for cardiology/cardiovascular surgery patients from admit to discharge (all levels of acuity).

4.) how many years did you work as a nurse before going back to school? is it difficult getting back into the school routine?

i worked as a nurse for 2 years before going back to school and had no problem getting back into the school routine. i also continued to work a 0.5fte while going to school full-time.

5.) what do you like/dislike about your career?

i am just jumping back into the acnp waters after a hiatus, so will reserve an answer to this for now :).

regarding your other questions - we work 8 or 10 hour shifts during the day only, including some saturday coverage. no nights, no holidays.

good luck!

kayceeACNP · Jul 9, 2012

Hi! I think the ACNP is a great route for you if you want to stay in the critical care environment. So, here's my answer to your questions:

1.) Are you happy choosing this route instead of FNP?

Yes, incredible happy!

2.) What made you choose this route?

I was an ICU nurse prior to becoming an ACNP and knew I wanted to stay in the ICU. When I was looking to go back to school I knew a few things I wanted in a future job, they were; 1. no clinic, 2. not working 5 days a week, 3. stay in the critical care environment. I thought the best option for me was to become an ACNP and so far that seems to be true.

3.) What is the job market like? What setting do you practice in?

Honestly, I thought the job market was fine (and only going to get better in my opinion) I graduated in Dec of 2011 and honestly only applied for 3 jobs because they were what I wanted to do (meaning ICU). Well, I interviewed for all 3 and got offered 2 of them, then withdrew my application for the 3rd because I had accepted one of the first two. I work as an Intensivist in a Neuro ICU and really love it.

4.) How many years did you work as a nurse before going back to school? Is it difficult getting back into the school routine?

I worked as an RN in an ICU for 2 years before I started school again and then worked all the way through school. At times I found it difficult to get back into the school routine, especially with the boring introductory courses like research and theory but really actually enjoyed school once it got to clinicals.

5.) What do you like/dislike about your career?

Likes: the patient population, the autonomy I have in my practice, the opportunites for continued learning, the fact that I get to do procedures

Dislikes: the schedule (and only SOMETIMES) It gets old working my share of weekends and holidays but I get lots of days off and that was something I knew would be the case when I went into this field. The ICU doesn't close on weekends and holidays so if you want to work there you probably better accept working your share of that time

LifesAJourney · Jul 11, 2012

Juan: I appreciate all your feedback. You are very knowledgeable in this area, so expect me to bug you with all sorts of questions lol! I debating on whether to stay in-state or venture out-of-state. We do have an acnp program where I am currently getting my BSN and it is "so-so." The reason why I want to stay in-state for at least the first year is because I have a better opportunity to land a job in a familiar enviroment. I can get my feet wet then transfer perhaps.Dutvh Tulip: thank you for the encouragement :) I do have another question. How many years can one expect to finish the program if working full-time and going to school part-time? 3-4 years? Or is it best to work part-time and go to school part-time?KayceeACNP: I soooo glad to hear that you are "incredible" happy with your decision! What are clinicals like in school? What is the protocol with invasive procedures? This question is for all of you. When it comes time for me to interview for an CC RN position and the employer ask about your future goals, do you tell them your desire to eventually become an NP? Or do we keep mum about it? Will that hurt your chances of landing that job in the end?

kayceeACNP · Jul 11, 2012

Ha! incredible, incredibly.....thats what I get for posting when I've been up for a long time!

Clinicals are really what you make of them. We had to find our own preceptors so I was sure to find things I was interested in. We had to do some general stuff each semester like make sure we had a medicine rotation, a surgical rotation and then some ER hours but really beyond those requirements it was up to us. I know some people I went to school with took the easy road and were specifically looking for easier rotations but they pretty much got out of them what they were willing to put into them.

While I was in school I had one clinical site that wouldn't let me do any procedures and then the rest of them it was up to my preceptors what they were comfortable letting me do. I got a lot of procedures during my ER and ICU rotations. At my job, it was a matter of doing so many with my collaborating physicians and then I was allowed to do them independently.

I think telling a perspective employer could go either way. If it were me I would want nurses that were interested in going to school and becoming better care providers, but some may not want to put the resources into orienting someone that is going to leave. I know I mentioned it because the job had a tuition reimbursement benefit that I intended to use so they were going to find out anyway.

Advanced Practice Columnist / Guide · Jul 11, 2012

I attended a classroom for didactics and had preceptors arranged by the program director though some students already had preceptors in mind and lined up for most of the entire program. I did procedures in my EM rotation at a Level II, privately-run hospital ED. It was limited to suturing, pelvic exams, casting which are actually more of an Urgent Care skill set. During my ICU rotation at a Veteran's Affairs hospital, I got to insert arterial lines and attempted a central line.

I have been working at a university hospital with an affiliated ACNP program. We have one ACNP student with us all the time. The students do invasive procedures under our supervision (arterial lines, central lines: triple lumens, dialysis catheters, PICC). However, the number of procedures to be done vary, at times some ACNP students don't get to do as much as the previous students.

I think procedures can be learned safely by most individuals with a brain and good hand-eye coordination. As the field of heath care advances, a bigger emphasis is on patient safety and the use of technology has played a great role in making sure that happens. Many campuses have Simulation Labs now and that's a good starting point for learning procedures. Learning on a dummy helps in identifying landmarks and acquiring technique.

When I started in the ICU as an NP in 2004, I learned placing lines, chest tubes, doing thoracenteses and bronch's by watching and doing with supervision. I was supervised either by an attending, a fellow, a chief resident, or a senior PA or NP. Ultrasound guidance (and ultrasound technology in general) has become extremely handy at the bedside. When I started, the introduction of real-time ultrasound guidance in vessel identification for line placement and marking pleural effusions for thoracenteses was not widely used yet but when it did become available, it made a world of difference in making these skills easier and safer.

I wouldn't worry too much about procedures right now. As part of an ICU NP group, we like to see our ACNP students develop the cognitive capacity for diagnostic reasoning first. Our ACNP students have their own patients to pre-round on, look at numbers, present on rounds including explaining what assessment and plan they came up with. They get "pimped" just like medical students do. To me, acquiring analytical skills and expanding one's knowledge base in pathophysiology is the harder part in the transition from a unit staff nurse to a nurse practitioner.

Advanced Practice Columnist / Guide · Jul 11, 2012

When it comes time for me to interview for an CC RN position and the employer ask about your future goals, do you tell them your desire to eventually become an NP? Or do we keep mum about it? Will that hurt your chances of landing that job in the end?

That's a tough one. I personally never had problems mentioning graduate school plans during an interview. Most of the managers had a positive response like, "Oh we have a few staff nurses who are in graduate school right now". The ICU I worked in was a revolving door for nurses with dreams of CRNA school as well.

kayceeACNP · Jul 11, 2012

I wouldn't worry too much about procedures right now. As part of an ICU NP group, we like to see our ACNP students develop the cognitive capacity for diagnostic reasoning first. Our ACNP students have their own patients to pre-round on, look at numbers, present on rounds including explaining what assessment and plan they came up with. They get "pimped" just like medical students do. To me, acquiring analytical skills and expanding one's knowledge base in pathophysiology is the harder part in the transition from a unit staff nurse to a nurse practitioner.

YES! This!

Juan- It sounds like you have a great set up for the orientation and training of ACNPs. I wish we had that going on where I am. Unfortunately, we don't have a lot of ACNPs in my area because the closest program is 180 miles away. In fact, I find that a lot of people in my area don't even know what an ACNP. It sounds very structured and like a great place for ACNPs to be clinicals. I'm jealous. :)

hjb4 · Dec 31, 2013

Have you mentored any students who had to seek out their own clinical experiences for ACNP? I'm worried that it may be more of a challenge to find preceptors (in the bay area) than the school makes it out to be. I'm grateful for any insight.