Serious illness: More seen by NP or CNS?

[Joe NightingMale, MSN, RN]

I've thought about becoming an ACNP, because I like complex illness and the ICU atmosphere and don't really care for primary care and prevention.

However, I've heard from some ACNPs and it seems that they primarily deal with less serious illnesses at the clinic...ie giving a stress test to someone with angina...rather than more serious illnesses at the hospital...ie adjusting a vasoactive drip on someone with cardiogenic shock. At least that's the impression I got.

Which makes me wonder if maybe a CNS role with a critical care focus would be better, more likely to be hospital-focused and more likely to be hands-on with the sicker patients.

[lifelong]

Hi there,

I think it depends on area of country and role expectations within the hospital setting. I am ACNP in an ICU and I line, manage 18 patients (our ICU size), round, place chest tubes, intubate in some fashion most days. Sometime, I go to the ER and consult there and end up lining to initiate the Sepsis protocol, etc... Most of the CNS I am around focus mostly on education and the NP is more hands on at the bedside. That said I know there are a number of CNS who likely perform similar to me. So I think it depends on area of country, hospital job functions, and what you like and want to do. Both positions have areas (education, research, pt. care focus, another one I can’t remember) that overlap. The prescriptive piece might be different. For some medications you have to be an ACNP to prescribe in Ohio (again state specific). Maybe check into that a little and see if that helps. If one role has a broader prescriptive element that works better in an ICU setting then that might be most helpful for you. Anybody else have a thought?

[lifelong]

Another thing I thought about as I hit the reply button is the type and time in clinicals. I know where I went to school the type and required time in clincials was vastly different with the two roles. In fact, we couldn't graduate until we wrote vasoactive drip orders and read chest x-rays to confirm placement of lines. We were only allowed one rotation outside of the hospital and some didn't even do that. Perhaps looking at both programs at the institution you're are looking at and delving into the clinical portion may be helpful. Some of the didactics will be identical. Personally, I struggled with the decision to go ACNP versus CRNA. I had gotten in at 2 universities for CRNA, but couldn't bring myself to go because I couldn't see myself living in gray walls behind a table 8-10 hours a day. CRNAs in Ohio are supervised by MDs...not collaborative with MDs as the ACNPs are (our practice act is different). In the end it was the type of role and how it played out day to day that helped me make my decision. If I can think of anything else I will send.