Tell me again why I should choose FNP over ANP

[abcdefg]

Hi, here's my scenario- tell me if you think FNP is the way to go:

I am currently working as an RN on a general med-surg-oncology floor and I'll have about 3 years of experience when I graduate with the MSN next December. I would like to work in primary care for adults, a some type of specialty or women's health. While I fully expect to work full time for a year or two, I have three kids at home and definitely want to move into something part time while they are growing.

I really can't see myself doing anything with peds though I have no particular aversion to it- I would just rather work with adults..

So, should I really bother with all the peds stuff required for the FNP? Isn't is better to focus on the ANP and have better job opps in hospitals? Or will I still find myself limited if I can't work with children?

Thanks for the input..I'm currently in the FNP track and if this is my last chance to switch- clinicals start in Jan.

[traumaRUs, MSN, APRN]

Much depends on what is needed in your area (unless you are willing to relocate). Where I am (central IL), the FNP is the way to go: ANPs and GNPs and PNPs have a difficult time finding employment but FNPs all have jobs.

Also, the FNP gives you a broad scope which again gives you more leverage when looking for employment.

[Pmdc]

Much depends on what is needed in your area (unless you are willing to relocate). Where I am (central IL), the FNP is the way to go: ANPs and GNPs and PNPs have a difficult time finding employment but FNPs all have jobs.

Also, the FNP gives you a broad scope which again gives you more leverage when looking for employment.

It seems that the FNP is definitely the most versatile, at least from what I have read and heard.

What would be the advantage in a combined CNS/NP program? I saw some info today on such a program in Georgia, and wondered about it.

[7starbuck7]

I do not think ANP will give you an advantage for jobs in a hospital. If you want to work in acute care, you should really consider ACNP. ANP or FNP, those are both focused on primary care.

Like trauma said, so much of this is based on your location. Where I am, FNP and ACNP are the ways to go.

GL

[traumaRUs, MSN, APRN]

pmdc - As to the combined NP/CNS tracks - personally I think they are redundant. However, again depends on where you are. I live in IL and the nurse practice act doesn't distinguish what you are, just that you are an APN and this includes: NP, CNS, CNM, CRNA. We all have the same practice act.

7starbuck7 - you are so right...like in real estate: location, location, location! lol

[abcdefg]

Where I live (north florida), I've been warned that they are "cracking down" on FNP's working in hospitals- apparantly it's outside of the scope of practice. So, if that is true wouldn't the ANP give you the most versatility in that you could work both in hospital or outpatient? Maybe the rules are different in different states?

I can see how the FNP/ACNP dichotomy makes sense however, maybe the ANP doesn't fit well with where most practitioners end up.

[core0]

Where I live (north florida), I've been warned that they are "cracking down" on FNP's working in hospitals- apparantly it's outside of the scope of practice. So, if that is true wouldn't the ANP give you the most versatility in that you could work both in hospital or outpatient? Maybe the rules are different in different states?

I can see how the FNP/ACNP dichotomy makes sense however, maybe the ANP doesn't fit well with where most practitioners end up.

As usual it depends on the state and the BON. In the states where FNPs are being excluded from inpatient duties the BONs and the hospitals seems to be making a distinction between ANPs and ACNPs.

I will use Texas as an example since they are the only ones that have put any guidance out.

ANP can see hospital patients if they can show inpatient experience as an ANP student. They can function as hospitalists as well as doing specialty medical care. They cannot do critical care medicine as this is outside their scope of practice (and specifically claimed by the ACNP). The can also see outpatients in specialty medicine and outpatients in adult primary care medicine. There privileges essentially parallell IM and IM subspecialties with the exception of critical care. Some hospitals will allow ANPs to consult on ICU patients for their specialty practices, others will not. Probably cannot see non-urgent care EM patients but this is in flux.

ACNP can see inpatients in both the inpatient and critical care setting. May see medical and surgical specialty and subspecialty patients in both an inpatient and outpatient setting. May see all variety of adult EM patients.

So far their seems to be resistance to making the ANP-ACNP divide more like the PNP-ACPNP divide where the primary care PNP cannot see any inpatients. Right now there is quite a bit of overlap between the ANP and the ACNP as long as you can show inpatient experience.

The FNP ACNP combination really doesn't make sense to me. Most of the issues are seeing pediatric patients in a setting where the ACNP normally works (ie. inpatient or outpatient specialty medicine). For this the ACPNP seems to be a more logical fit allowing the entire age spectrum of critical care and specialty medicine.

David Carpenter, PA-C

[abcdefg]

So then, for someone interested in outpatient adult primary care but who would also like to have ability to work in an IM specialty is the ANP the better fit over FNP? Do do you see the profession moving to a place where FNP's do everything outpatient and ACNP's work the inpatient side, making the ANP obsolete?

[core0]

So then, for someone interested in outpatient adult primary care but who would also like to have ability to work in an IM specialty is the ANP the better fit over FNP? Do do you see the profession moving to a place where FNP's do everything outpatient and ACNP's work the inpatient side, making the ANP obsolete?

Answer uncertain. The Texas BON would probably say yes, but once again it really depends on your market. The Texas BON has revoked a number of FNP's NP licenses because they did not do their clinicals in an FNP setting (examples given were an aesthetics clinic and a neurology office). On the other hand they have never come out and stated that an FNP cannot do specialty medicine. The view seems to be though, that FNP is a primary care specialty while the ANP covers a wider range of adult medicine. Realistically given the range that FNP covers its hard to see stretching it to fit all comers. The PNP requires didactic training in pediatrics and 500 hours of clinicals in pediatrics. The ACNP or ANP requires adult didactic training and 500 clinical hours in adult medicine. Somehow we are supposed to believe that the FNP gives the same competence with the same amount of didactic training in peds and adults and 500 hours clinical training in peds and adults?

FNP programs are popular because they are widely available and give access to all age ranges. However, now that there are specialties with more training in individual parts of the spectrum and more importantly specifically claim that part of nursing practice they are being looked at in a more critical manner. The AACN in particular is quite vocal about stating that the FNP has no business seeing inpatients. This puts the AANC in a precarious position since they also administer one of the FNP exams as well as one of the ACNP exams.

If you want to look at how much this is worrying them, you can look at the changes on the description of the FNP. The description went from a primary care oriented NP that egages in wellnes and illness prevention in all age groups to an NP that egages in illness wellness treatment in all age groups. They have completey removed any reference to primary care in the test description.

Its going to depend on your state and you locality to see how much it affects nursing practice. If you are in a state with no ACNP programs and many FNP programs it probably won't be of much impact in the forseeable future. If you are in a state with ACNP programs then I would expect to see this issue come up at your BON in the near future. The other possibility is that someone else may step in and decide things themselves. I haven't seen the MEDPAC minutes yet, but apparently this is being discussed by CMS. The discussion was along the lines of why are we paying for NP services when it is outside their scope of practice. If Medicare refused to pay for inpatient services provided by FNPs for example, then that would initiate a wholesale change in NP demographics (similar to what happened with MSN programs when Medicare mandated an MSN for UPINs some time ago).

My opinions for what its worth

David Carpenter, PA-C

[abcdefg]

hey, thank you for your thoughtful reply. I had not considered the wider political ramifications behind FNP scope of practice. But I completely agree that is seems strange that the 500 hours clinical instruction would be enough to be competent when most other specialties have much more focused curriculum. Which is exactly why I'm questioning my current FNP path- it seems a much better use of my time to do the ANP if I expect to only work with adults. Yet the standard advice is to get the FNP if you want the most marketability.

I live in Florida, where there are many ACNP programs. I was told about possible restrictions of FNP practice by faculty of an ANP program. My "gut" is telling me to switch to the ANP- if my knowledge base isn't improved by focusing just on adults I'm sure my confidence level will be. Yet lingering doubts remain- I don't plan to stay in Florida and I'm not sure how the ANP will affect marketability in other states. Perhaps this is less of an issue once I have some work experience?

[KatieRN04]

Core0:

I do not hope to come across the wrong way, and this is in no way meant to be an attack or insult, or any judgement in any way.

I was wondering though how you always have such insightful and in depth answers on the practice of nurse practitioners, even on the different specialities of NP's such as FNP, ANP, GNP, PNP, ACNP, when you are not an NP yourself, but rather a Physician assistant? Do you work closely with NP's that you seem to have so much knowledge on the different states and scopes of practice?

Once again, this is not meant to be an insult, but a simple question. I believe we all need to get along regardless of our title, to make healthcare a multi-disciplinary approach for the patient to recieve the best outcomes.

[core0]

Core0:

I do not hope to come across the wrong way, and this is in no way meant to be an attack or insult, or any judgement in any way.

I was wondering though how you always have such insightful and in depth answers on the practice of nurse practitioners, even on the different specialities of NP's such as FNP, ANP, GNP, PNP, ACNP, when you are not an NP yourself, but rather a Physician assistant? Do you work closely with NP's that you seem to have so much knowledge on the different states and scopes of practice?

Once again, this is not meant to be an insult, but a simple question. I believe we all need to get along regardless of our title, to make healthcare a multi-disciplinary approach for the patient to recieve the best outcomes.

I look at it two ways. As a PhD student working in the field of health policy, one of my interests is health delivery systems. NPs play an integral role here. I find the way that the regulatory environment developed for nurse practitioners very interesting. I also am working with large data set outcomes analysis and NPs play a large role here.

My interest in NP practice comes from my role in PA leadership. When I was with the Colorado PA academy we had issues with RNFAs trying to dictate PA practice. The more I looked into the issues with RNFA and then NP licensure the more questions were raised. I won't claim to know everything but I have studied the various state nursing practice acts enough to know some. Allnurses remains a tremendous resource of course and I have learned a lot about NP practice here. I also learn a lot from the NPs that I work with.

As I become more involved in PA leadership, I constantly am looking for issues that not only affect PAs but also issues that the PA profession can learn from. I am fascinated by the NP profession not only because of the gains that they have made, but also because the profession as a whole is choosing to follow a path that the PA profession rejected more than 30 years ago (although elements of this continue to percolate today). There are a number of things that PAs can learn from NPs and a number of lessons on what not to do.

I remain fairly amazed that the NPs at work have a very poor understanding of their own practice act (although I will have to admit the act here in Georgia is fairly confusing). I find that the NPs on this forum have a much better handle on professional issues.

David Carpenter, PA-C