The right track?

Do you have any contacts in the area so you could arrange a day to shadow a surgical NP or PA? That would probably be the best way for you to find out the answers to your questions. It does seem that you hear more about PAs working in surgery, but I don't think that means you couldn't do it as an NP. We have NPs and PAs in surgery where I work and I know there are a couple of ACPNPs in surgery at my friend's hospital as well. In my area the acute care certification seems to be preferred for surgery and sometimes the RNFA. But every area of the country is different and I'm no where near Boston.

NPs may be involved in surgery in some cases, but I think the PA training is far more geared towards that and if you know you want surgery it makes sense to pursue PA school.

The PA that works in my Cardio Surgery ICU has helped out with the heart surgeons as she had experience from a prior job, and if there's an emergency open chest scenario it's the PAs that would open while waiting for the surgeon, not the NPs....though they do otherwise perform identical jobs in the 24/7 running of the unit.

Trying to get FNP and ACNP certificates seems like a waste of time and money - it's generally done if you do one and discover your dream job requires something else or your interests change. I'm doing FNP with the hope of doing outpatient specialty. As this "straddles the line" of the intended population for the two certs I wish you could double-board without an extra year of clinicals, but even then you have to accumulate practice hours to retain your certification (or retake the board exams). I know I need to just decide - am I doing cardiology or do I still want the options of work in dermatology or allergy etc. If I focused on one job type my certification decision would be made. Really you need to figure out where you want to work, then talk to people doing it to decide what the best path is.

Are you looking for a position with lots of direct OR time, or just taking care of surgical patients? In a city with lots of teaching hospitals and big residency programs (Boston!), I imagine there's limited OR time for both NPs and PAs since the surgical residents need that time and are available much cheaper (a bit more than half the salary for twice the hours).

I dont know what NPs scope of practice is like in Boston, but in Michigan its pretty vague. My friend is a FNP and she works in the OR as a first assist with a neurosurgent. Doesnt get any more surgical than that :). So it can be done. But if it were me I would get my BSN and go to PA school if I really wanted to work in the OR. So there are no if ands or buts when you graduate :)