Tell me again why I should choose FNP over ANP

abcdefg · Aug 9, 2008

What path are NP's taking that PA's chose not to 30 years ago? The history of a profession is always interesting. Also, are you saying that given my background/interests the ANP is a better way to go?

core0 · Aug 9, 2008

What path are NP's taking that PA's chose not to 30 years ago? The history of a profession is always interesting. Also, are you saying that given my background/interests the ANP is a better way to go?

The first PA program was developed with the concept of using Navy Corpsman to augment physicians in the hospital. Around this same time a number of other physicians developed similar models which emphasized specific portions of medicine instead of the generalist model proposed by Stead. These included the Child Health Associate program, the MEDEX program (primary care), and the Surgeons Assistant program. In 1969 the National Academy of Sciences at the request of the AMA looked at the different PA programs. They classified them into three types, A B and C. The type A PA was a generalist PA capable of handling most medical problems and exercising independent judgement. The Type B was a specialist PA who was capable of exercising independent judgement in their specialty but no over the whole medical specialty. Examples would be the Child Health Associate and the Surgical Assistant (MEDEX falls somewhere in between). The type C was capable of preforming technical tasks but not interpreting medical results or exercising independent judgement. Examples would be Cardac cath PAs or Orthopedic PAs.

The essentials of the PA practice that was adopted by the AMA validated the type A PA and the first PA program accrediting commission only accredited type A programs. There was a separate surgical PA exam and certification by the ABS but this was folded into the PA certifying exam in the mid 70's in exchange the surgical PA programs agreed to expand their programs to include education in other areas of medicine. The Child Health Associate program refused to include adult medicine and as such graduates were unable to sit for the PA exam until the program changed in the late 1980's. The OPA programs were either unwilling or unable to meet accreditation standards. They limped along until essentially disappearing in the mid 90's.

So initially the PA and NP programs looked very similar with specialization in different areas. The PA programs fairly rapidly coalesced into one type of program while the NP educational model fragmented. The NP model continues to train within various areas of nursing specialty while the PA program has addressed specialization by remaining generalists with additional training the responsibility of the physician. The increase in post graduate programs addresses needs somewhat but remains a very small percentage of PAs. As long as the BON does not enforce the distinctions between the various areas of NP practice there is no disadvantage for NPs regarding what type of specialization they get (hence the popularity of the FNP). Once they do (or others start enforcing this) then moving between areas becomes more difficult.

As to your particular situation its really hard to say. If you are in an area like TraumaRus where FNPs dominate the market, then that's probably the way to go. You just have to keep in mind that you may lose your ability to practice in the hospital at any time if the winds change at the BON (or the hospital). If you are in an area like Daisy where ACNP's are in demand then that may be the way to go. The problem with the ANP is that its not "popular" right now. On paper it seems to be the best match for the internist and IM subspecialties. However, the FNP is much more common in the primary care role and has the advantage of being able to see peds. The ACNP has not only staked out inpatient work but also outpatient medical specialty. Depending on who you talk to the exposure of the ACNP to outpatient medicine seems somewhat sketchy (ie it remains to be seen if they can "keep" this area).

If you want to work in the hospital the ACNP is probably the best bet now (if it is accpeted in your area). An ANP/ACNP would be the best bet if in the future the BON decides that ACNPs can only see inpatients or you want to do adult primary care medicine. An ACNP/ACPNP would also allow you to see the full range of specialty patients and do EM. As you can see its not very easy to porifice it all out.

Good luck

David Carpenter, PA-C

djc1981 · Aug 10, 2008

I think there are a number of things NPs and PAs can learn from each other. There is also things PAs can teach us so that we don't follow in their mistakes. NPs are making leaps and bounds not being subservient to physicians, for example. So, its a give and take. The PA profession is certiainly not above reproach, and NPs should stake their own piece of the medical pie and continue to not walk in anyone's shadow. :twocents:

JDCitizen · Aug 10, 2008

This may not explain why ANP over FNP but it does seem to go with the flow the thread has taken. Whatever you decide to do for the most part will have to be a personal decision. The laws and regulations from state to state and facility to facility can be daunting. What I could tell you would be Georgia related and really not apply if you are in another state. This is why I keep stating unity in programs.

NP

"The first nurse practitioners (NPs) were educated at the University of Colorado in 1965. That program prepared Pediatric Nurse Practitioners"..

PA

"The PA profession came into existence in the mid-1960s due to the shortage and uneven geographic distribution of primary care physicians in the United States"…

For your reading enjoyment:

A Comparison of Changes in the Professional Practice of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives: 1992 and 2000.

http://bhpr.hrsa.gov/healthworkforce/reports/scope/scope1-2.htm

How Nurse Practitioners Obtained Provider Status: Lessons for Pharmacists

http://www.medscape.com/viewarticle/464663

I have had more than a few of my patients tell me they picked up their information from Wikipedia so here is what it states about NPs and PAs:

Nurse practitioner (what Wikipedia has to say)

One might enjoy perusing the Post-nominal initials section

http://en.wikipedia.org/wiki/Certified_nurse_practitioner

Physician Assistant (what Wikipedia has to say)

http://en.wikipedia.org/wiki/Physician_Assistant

JerseyGir1 · Aug 11, 2008

Can anyone describe in some detail the role of the ACNP in the hospital setting? How does it compare it to that of an internist (MD/DO), and in what capacity do the two collaborate?

JDCitizen · Aug 12, 2008

Can anyone describe in some detail the role of the ACNP in the hospital setting? How does it compare it to that of an internist (MD/DO), and in what capacity do the two collaborate?

Do you just want ACNP role description or what a FNP does in a hospital also?

abcdefg · Aug 13, 2008

This thread has been very useful toward helping make the FNP vs ANP decision. I spoke with another faculty member and apparantly Florida is like some other states in that ACNP's work the inpatient side of things and ANP/FNP are more restricted to the outpatient setting. ANP/FNP's still work in specialties however, but only in an outpatient capacity.

With this in mind, it seems like graduates of the FNP will have enhanced job opportunities because they can do everything the ANP does + peds. The difference lies in the educational preparation- with only 500 clincal hours, it makes a lot of sense to be focused on the population one plans to eventually work with. If you plan to work with only adults "why put yourself through that" in the words of one faculty member and learn all the peds stuff.

So, for me, I'm going to go against popular advice and go for the ANP. I'm so busy right now with work/school/family the thought of learning the large knowledge base necessary to work in pediatrics when I plan to work with only adults is just exhausting. I know this means I'll be limited in some ways- I can't do retail clinics,true family practice or peds. But I've seen many jobs nationally where both ANP or FNP is ok, and some that prefer the ANP. I also feel I'll be at an advantage in terms of my clinical experiences and confidence by using all my clinical time on adults.

I wish in a way NP's followed the generalist model (with attendant more clinical hours) that PA's have so we don't have to make these kinds of decision- sometimes it's hard to know where you want to end up before starting grad school.

ANPFNPGNP · Aug 13, 2008

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.

When I went to NP school I was adament that I wanted to only see adults and become an Adult NP. I completed a dual ANP/GNP and everything was great...until I started looking at job opportunities! I found my "calling" in urgent care, but I could only see ages 12 and up! I rarely saw any patients under 12, but there would be occasions when both a parent and child came in and both needed treatment, but I had to send the kid away! I had to go BACK to school to get the FNP certification...it was only one class (Child/Maternal), BUT I had to complete a full 500 clinical hours...I actually had to duplicate a lot of them with patients that I was legally able to treat! It was a huge hassle that I wouldn't wish on anyone! Personally, I have no doubt that all those specialty NP's are getting better training, but the FNP is still the way to go.

JDCitizen · Aug 14, 2008

This thread has been very useful toward helping make the FNP vs ANP decision. I spoke with another faculty member and apparantly Florida is like some other states in that ACNP's work the inpatient side of things and ANP/FNP are more restricted to the outpatient setting. ANP/FNP's still work in specialties however, but only in an outpatient capacity.
With this in mind, it seems like graduates of the FNP will have enhanced job opportunities because they can do everything the ANP does + peds. The difference lies in the educational preparation- with only 500 clincal hours, it makes a lot of sense to be focused on the population one plans to eventually work with. If you plan to work with only adults "why put yourself through that" in the words of one faculty member and learn all the peds stuff.
So, for me, I'm going to go against popular advice and go for the ANP. I'm so busy right now with work/school/family the thought of learning the large knowledge base necessary to work in pediatrics when I plan to work with only adults is just exhausting. I know this means I'll be limited in some ways- I can't do retail clinics,true family practice or peds. But I've seen many jobs nationally where both ANP or FNP is ok, and some that prefer the ANP. I also feel I'll be at an advantage in terms of my clinical experiences and confidence by using all my clinical time on adults.
I wish in a way NP's followed the generalist model (with attendant more clinical hours) that PA's have so we don't have to make these kinds of decision- sometimes it's hard to know where you want to end up before starting grad school.

So Florida is stating that FNPs do not have the training to care for patients in a hospital? Kind of funny that a BSN can but a MSN can't.

Best wishes with school... :yeah:

ANPFNPGNP · Aug 14, 2008

So Florida is stating that FNPs do not have the training to care for patients in a hospital? Kind of funny that a BSN can but a MSN can't.
Best wishes with school...

There is a HUGE difference between what a Nurse Practitioner does and what a RN is trained to do. RN's can work in any specialty as a NURSE. Also, someone with a MSN isn't necessarily a NP.

I've heard that more and more hospitals are refusing to credential FNP's simply because they are not trained to work in an inpatient setting and it makes perfect sense. If you check out the websites for the AANP & ANCC, you can read all about the scope of practice of a FNP...PRIMARY CARE!

I've heard of a couple of universities that offer a dual FNP/ACNP programs, but even then, it's up to the state whether they will accept it or not. I've been through the ANP/GNP & FNP programs and I certainly don't feel qualified to function in a hospital setting as a NP, however I certainly feel qualified to function as a RN in those settings. The ACNP's I know had a very different educational/clinical focus than I had. Look at it this way...if a FNP can do it all, then why have all those different specialties?

JDCitizen · Aug 15, 2008

There is a HUGE difference between what a Nurse Practitioner does and what a RN is trained to do. RN's can work in any specialty as a NURSE. Also, someone with a MSN isn't necessarily a NP.
I've heard that more and more hospitals are refusing to credential FNP's simply because they are not trained to work in an inpatient setting and it makes perfect sense. If you check out the websites for the AANP & ANCC, you can read all about the scope of practice of a FNP...PRIMARY CARE!
I've heard of a couple of universities that offer a dual FNP/ACNP programs, but even then, it's up to the state whether they will accept it or not. I've been through the ANP/GNP & FNP programs and I certainly don't feel qualified to function in a hospital setting as a NP, however I certainly feel qualified to function as a RN in those settings. The ACNP's I know had a very different educational/clinical focus than I had. Look at it this way...if a FNP can do it all, then why have all those different specialties?

I understand what you are saying and I have also been hearing about restrictions hospitals have been putting on NPs.

Sort of true, sort of not (here goes my rambling)...

With all the standing orders and such RN's are often times as not working off protocols...

I don't know how other practices work but my rounds are not/were not the only rounds being made. Our practice tried to make sure every patient was seen a minimum of twice daily (if it was going to be less that single visit was by an MD).

Questions of scope: If I checked out the websites for the AANP & ANCC in two years what changes would I see? What did I read about the scope of practice when I first became a FNP years ago?

There are programs for training so-called country doctors for rural clinic care and I bet their privileges are not restricted. There are also more than a few hospitals that look the other way when the doctors' nurse is making rounds/decisions. I don't know how other practices work but my rounds are not/were not the only rounds being made. Two things in our practice we did at minimum: One: We tried to make sure every patient was seen a minimum of twice daily (if it was going to be less that single visit was by an MD). Two: Every morning the providers comming on and those going off had a meeting. Three: If I was faced with an emergency situation I knew my backup was inhouse. My rounds were always done with at least one of the practices doctors inhouse (no exceptions).

Over the years the nomenclature for NPs keeps changing. Partly to compensate for all the varied degrees that keep popping up, settle turf arguments and/or to protect jobs. If on the other hand is for the protection of the patient thats another whole story.

I kind of see what hospitals are going through so many different formulations in education and training that no single intitiy could hope to keep up with. This is another reason why I think mandatory minimal training across the board with additional training in the field one wants to go in. The term nurse practitioner is streached really thin, just like the term nurse...

abcdefg · Aug 15, 2008

Well, not two days since I made my "i'm doing the ANP track" declaration I'm having doubts again. I found some old theads on the subject and it seems to be a somewhat common problem that the ANP can't find a job, especially if in the case of an unexpected move to a different part of the country. So, since will likely be moving elsewhere in a few years I guess the best thing to do is stay with the FNP track, even though it doesn't align perfectly with my career goals (that include only adults). This is not the first nor last thing in nursing that doesn't make sense, I guess.

JD- were you rounding/making decisions on inpatients while you were an RN? That I have not heard of.....

You're right about how the nomenclature keeps changing- that makes it hard to chose a grad program that will endure for the long haul.