To be a NP at the VA...

core0 · Mar 22, 2009

Should I do FNP or ACNP? I have applied to an Acute Care Adult/Geri NP program, but now have doubts if this is the right tract for me. I really don't want to do the higher level procedures, but I do prefer adults. My career plan is to work for the VA as an RN and continue through the BSN-DNP program, switching over to an NP position when I get to that point. As an older student (35 lol!), I want to do the VA route to go ahead and get a decent retirement that allows me options to relocate and maintain those benefits if I so choose. I would prefer a clinic position at the VA, but those are hard to come by. So I was thinking Acute Care would make me more marketable to the VA because I could also work as an NP at the Nursing Home/Hospital. I know that the basis for the Acute Care program is doing higher level procedures to critical care patients, but I read a study that stated 50% of acute care NPs work in specialty clinics, which is what I would prefer. It is so hard to know what the best route is! As I type this, it seems apparent that FNP is the better route, and just doing as much of the clinical in adult/geri sites as possible (NO desire to work with children). Does anyone have any input? Any NPs at the VA who can answer which path is more desirable?

I think that you missed the most obvious path - Adult NP. Adult NPs can do primary care and work in specialty clinics. Depending on your hospital they generally do not work in critical care areas. Of course this depends on the hospital and the state you are licensed in (which may be different than the state you are working in). Most of the NPs that I know at VA are ANPs. Given the patient population your chance of seeing peds is virtually nil. No real need for an FNP. Gerontology cert on top might help though.

David Carpenter, PA-C

sandnnw, BSN, MSN, EMT-B, APRN · Mar 23, 2009

UM, doesn't really matter.

Of the NPs at my VA, most are FNPs, a couple are ACNPs. I'm an ANP. I chose ANP for exactly what Dave states above. FNP - no kids, ACNP - I'm already cute, don't need anymore help with that, just kiddin! Our ACNP path was a little too ICU/trendy for me, coming from ICU, I felt I had that t-shirt and I enjoy primary care more. Didn't want to spend my graduate money on listening to vent/swan/drips/renal/trauma lectures. ANP just seemed to fit ME, you may be different. I want an office with a stereo, be able to drink coffee and take my time with non-compliant diabetics, drug seekers and grab the attention of smokers, not put up with screaming kids/irate parents or listen to vents/pumps blurp all day/night anymore.

Trust me, ANP is THE WAY to go. You can always get your CCRN/CEN, post-masters FNP if you need it later. BTW, do you already work at the VA??? Are you a vet? That helps more than any track you can take! The VA has generous programs to pay your way to any NP program. Good luck!!!

UMCSN4 · Mar 24, 2009

I think you are both right. I was overlooking that option. The more I think about it, even if I could work in a clinic with ACNP, I don't really want to go that route for school. I am looking into the adult route now. Thanks to you both for your advice!

Sand - No, I don't work at the VA yet, but I hope to start there after graduation in July. I was hoping that working there for 3 or so years while doing school would guarantee a NP job when a position became available. I have a very similar idea of your work environment! Do you work for the VA now? I have heard nightmare stories about working there (patient loads mostly) but I think the vets are a great group to provide care for and surely it will not be as bad as people say...right??? Say it ain't so!?!?

Mike L. · Mar 24, 2009

I know a bunch of NP's (ANP, FNP's) at the VA, in acute care, in specialty clinics (Cardiology, Urology, GI) - I've worked as an NP at the VA for 3 years - in Geriatrics (Home-Based Primary Care). I worked in the SICU for 2.5 years while in FNP school, and that helped. Being a Vet myself didn't hurt. My Peds rotation as FNP taught me a valuable lesson - patience, patience, patience - even though I had no intention of 'doing Peds'. Sometimes it may take a while to land your 'dream assignment' - sometimes you take the job that's open and wait for the one you want (anyway, that's how I did it) - but be careful, you're developing a career path and a track record. I don't think it matters at all, ANP, FNP. The older vets that I work with are a very, very challenging bunch of guys with laundry lists of comorbitities and longer lists of medications. Great job, every day is different. If you want to work at the VA, they could sure use you.

JDCitizen · Mar 24, 2009

I know a bunch of NP's (ANP, FNP's) at the VA, in acute care, in specialty clinics (Cardiology, Urology, GI) - I've worked as an NP at the VA for 3 years - in Geriatrics (Home-Based Primary Care). I worked in the SICU for 2.5 years while in FNP school, and that helped. Being a Vet myself didn't hurt. My Peds rotation as FNP taught me a valuable lesson - patience, patience, patience - even though I had no intention of 'doing Peds'. Sometimes it may take a while to land your 'dream assignment' - sometimes you take the job that's open and wait for the one you want (anyway, that's how I did it) - but be careful, you're developing a career path and a track record. I don't think it matters at all, ANP, FNP. The older vets that I work with are a very, very challenging bunch of guys with laundry lists of comorbitities and longer lists of medications. Great job, every day is different. If you want to work at the VA, they could sure use you.

Wow just what my friends have told me.....

Also I don't know if its the same process for every VA but here in Georgia I have been told it is a long drawn out affair measured in months... Is this true across the board??

Also told once in pretty easy to transition to other jobs (assignments) as wanted???

sandnnw, BSN, MSN, EMT-B, APRN · Mar 24, 2009

UM, Yes, I work at a VA smack in the middle of a metro city. We are connected to where I used to work, a top ten university medical center. I wasted 10 years working for them, hopped over to the VA and have been much happier myself. I am a vet as well. I chose to go back to school after a few years and the VA paid for almost all of it (at that prestigious university!)

I can tell you, working with most of the vets is a joy. There are some who are challenging, but you will see that in private practice as well. There are more comorbids for the vets as a population (smoking, ETOH and psych/econ don't help) but again, you'll see that in just about any clinic. Another overlooked item, the computer charting system at the VA is just simply FANTASTIC. No paper, everything is at your fingertips, including labs, x-rays/ECGs and consults. The VA is supposed to be the model EMR for the country!

At my old job, I rarely heard, "yes sir, no sir and thank-you" in the VA, I hear it every hour. They are so grateful that you are giving them the time and energy as a provider. Yes, the government is a very quirky place to work. My first year I thought, "what have I done to myself???" But, after 8 years, and literally being my own boss, not having to worry about production, five weeks of vacation, a 401K that's actually done well, and being able to walk out the door at 1600, a support staff (RNs) that actually works/cares. Uh...I'm spoiled.

All the NPs I work with NEVER leave (transition, yes, leave? no). It is almost impossible to get a NP job, unless you already work there, are a vet (member?) or just simply impress the **** out of the interview team

Trauma Columnist · Mar 24, 2009

I'm a vet and also an APN. It is also important to realize that you will see female vets today and in increasing numbers. I worked in the VA in Indy in the mid-90's. Was not difficult to get into the system since I had vet preference. However, it is the government. We did go 2 months without getting paid when the government didn't pass the budget one year - got it all back of course, but still something to consider in the Aug-Oct time.

ver401 · Mar 27, 2009

Hello Everyone,

I am currently a RN on the cardiac step-down unit at the VA and I am thinking about becoming an Adult NP. One of my employment options is to stay in the VA and hopefully work in one of the outpatient clinics. I was wondering how he pay system works. Would I still follow the nursing pay scale or will I be considered a GS employee?? Also I was wondering if anyone here has a MSN/MPH degree??? Thanks

sandnnw, BSN, MSN, EMT-B, APRN · Mar 27, 2009

I used NNEI, believe it is the only option I had. I actually went down to part-time for two years, working on weekends and one evening (my choice). Owe them three years.

You are still a title 38 employee, just different pay scale. You should have access to the pay scale on your VA workstation, need to know your site code. Appears very similar to the RN critical care pay scale. You won't get rich, but consider other perks.

Good luck!

ver401 · Mar 27, 2009

Thanks Sandnnw,

I thought with the NNEI program you had to work fulltime for three years after you graduated if they paid for you to go to school?? You have the option of being part-time? Also did you have to stay in the same facility and work whatever specialty they wanted you to work or did you have options??? I always hear so much about this program good and bad so it is nice to actually get an opinion from someone that is actually in it...Thanks

sandnnw, BSN, MSN, EMT-B, APRN · Mar 28, 2009

Yes, you work full-time during the payback period, three years. I worked part-time during grad school (imagine three days of clinicals and work full-time???)

Remember, its a government program. They OWN you for THREE years and you have to give updates (grades, every semester). As well, they require a "plan of study" which is your realistic plan of courses. Any variance requires a new plan.

Afterwards, the director of NNEI wanted my transcript, diploma and any certifications that I obtained. Good thing is, they don't care what you do after graduation. You did the work, the degree is yours. NNEI is not a guarantee for an NP slot. I know several NPs that work as staff RNs on a daily basis. NP pay is only slightly more than that of critical-care RNs, and then, one has to weigh the differentials (pm, w/e) to see which is better for them (slightly more $, M-F or RN flex shifting).

I really wouldn't say I had any bad experience with NNEI. Don't expect them to be timely. Don't rely on NNEI as your only source of cash. Keep copies of EVERYTHING, the NNEI clerk lost a couple of items. Include everything in your plan of study budget, books, lab coat, supplies (PDA, steth, opthal/otoscope) and tuition increases (5% annual). I had a very good administrative NNEI person. She was so supportive and nurturing. Tried to get me every dime from George Bush ($26/32K). Not bad in my book! Good luck!