What direction in APRN

[somethingwitty]

Would like some direction to go in when choosing a APRN degree and jobs.

So currently I work in an Level 1 Trauma ER that is a teaching hospital, but am considering going back to school for my APRN.

My main question is what direction should I go in if I really want to be able to do more procedures?

I love and am good at working with my hands: IV's, NG's, Foley's are the highlight of my work day. Being at a teaching hospital there are tons of residents floating around who seem to get to do all the procedures while the NP's seem to deal more with minor illnesses and maybe some suturing here and there. I know this might be different at hospitals with less MD's floating around.

I am not necessarily set on staying in the ER or in a teaching hospital.

What degrees and specialties will allow me to do more hands on procedures?

I would love to do art lines, central lines, chest tubes etc. I have also considered doing NP and getting my First Assist, but it seems like it is a very narrow job market.

Have considered getting ICU experience and going for CRNA, but tend to see myself getting a bit bored in that role.

I know that some people will say go for my PA and I haven't completely ruled it out, but I would prefer not to have to go back and fulfill undergrad science courses to meet PA program prereqs.

Thanks in advance for your experiences and recommendations!

[AAC.271]

Why not just stay as an ER nurse if you enjoy it? It's like everyone feels like they need to be an np now lol.

On on a more serious note, if you want procedures, getting an fnp online truthfully has limited opportunities as I've noticed in my situation. One of my best friends is studying to be a pa and I get pretty jealous of her Facebook posts doing all these procedures at Cornell pa program.

[babyNP., APRN]

My guess is that you'd get to do some of these procedures if you worked in an adult ICU as a NP; I've read some folks that do that here on AN.

[traumaRUs, MSN, APRN]

If you want to stay at your current hospital, start networking with APRNs:

1. See if you can shadow one in the ICU, ER, clinic, etc - find out what they do.

2. What certification exam did they take: FNP, AGACNP or something else?

3. Whats orientation like? While you may like procedures, doing them on a simulator or in clinicals is FAR different than being responsible for the patient.

4. Is there a pay difference at your facility for these APRNs. While not a deal breaker if you like your job, money is often a decision making factor in choosing an APRN specialty.

[MurseJJ]

Sounds like you want the Acute Care NP (adult vs. peds?) program. Hopefully one of the ACNP's here will comment, but if you search prior threads, you'll read many of their roles including placing central lines, arterial lines, chest tubes, intubating, etc. Some also work in academic hospitals and still do these procedures (generally the NP will have their own patients while the residents will have their own).

Seminal Program Has Changed, Improved Acute Care in Northern California | UCSF Science of Caring

[YoutubeTheNP]

Some good feedback here. There are several ways you can go. if you want to do critical procedures like you mentioned Art lines, central, intubation, chest tubes, etc acute care NP program would be good. Though keep in mind being able to do these procedures versus your attending allowing you to do these is another story. Some docs want all the procedures because it is higher billing if they are paid with RVUs.

If you want to do some hands on procedures that aren't critical like I&D, suturing, dermatology stuff like punch biopsy, lipoma or cyst extraction than a FNP like me is a good way to go.

Also be cautious of the limitations an acute care NP has. You can work in a hospital setting only. If you find part time work in an office, or get sick of the hospital you'll need a post masters certificate in FNP to work in the office/clinic setting.

[somethingwitty]

Thanks for all the comments so far.

Acute care is my passion, I don't really see myself out of the hospital setting.

Knowing that it is possible for NPs to be able to perform some of these procedures is encouraging.

Would love to hear from some aprn's that are doing these things. What type of hospitals are you working in? Did you learn in school/clinical rotatiotions or not until you were on the job?

Thanks everyone

[YoutubeTheNP]

Thanks for all the comments so far.

Acute care is my passion, I don't really see myself out of the hospital setting.

Knowing that it is possible for NPs to be able to perform some of these procedures is encouraging.

Would love to hear from some aprn's that are doing these things. What type of hospitals are you working in? Did you learn in school/clinical rotatiotions or not until you were on the job?

Thanks everyone

Im in the ER, I learned how to intubate just by watching the docs do it when I was an RN. When I was in NP school I read the textbooks that explain it. When I became an NP I actually did it. I also went to a very special CME that used cadavers, we performed chest tubes, central lines, and intubations on them for 3 days. Was very expensive but well worth the educational benefit!! I can provide link if I'm allowed too. They do it once a year and accept less than 50 people in the class.

[FolksBtrippin, BSN, RN]

I'm in nursing school finishing my RN in December. But I wanted to let you know that at one of my clinical sites, there is an NP who does Interventional Radiology. I watched her use an ultrasound to visualize as she inserted a catheter into my patient's peritoneum to drain fluid (he had ascites). She was not directly supervised by an MD. I asked about her role as I was very curious, and she told me she does all the IR procedures. Lots of "pinhole surgery". This might be something you would enjoy. Good luck!

I agree with others that you definitely need the ACNP.

[MurseJJ]

Also, from what I understand, ACNP's are not limited to hospital settings. They also work in specialty clinics.

[Corey Narry, MSN, RN, NP]

Thanks for all the comments so far.

Acute care is my passion, I don't really see myself out of the hospital setting.

Knowing that it is possible for NPs to be able to perform some of these procedures is encouraging.

Would love to hear from some aprn's that are doing these things. What type of hospitals are you working in? Did you learn in school/clinical rotatiotions or not until you were on the job?

Thanks everyone

NP's doing lines, intubations, chest tubes aren't that uncommon. I've worked as an ICU NP since 2004 and I've performed those procedures as part of our role. I would have to say though that it also depends on specific situations and ICU settings. I previously worked in a Cardiac Surgery ICU where chest tubes are common and the surgeons wanted to make sure the NP's can place chest tubes in emergencies and during the night so we were trained on them as part of our skill set.

In my current role, chest tubes are the domain of Thoracic Surgery and they have their own staff that place them (fellows, NP's). I have been placing lines (central, arterial) of all sizes, locations, and indications since 2004. I've seen the technique change from blind insertion using anatomical landmarks to ultrasound guided placement. I trained as an Adult ACNP and graduated in 2003 and my program did expose us to invasive procedures in a lab environment and clinical setting but I got more hands on training and tips on the job.

It may surprise you that the only places I've worked at as an NP also have residents and fellows so I don't think working in teaching hospitals as a a rule, means that NP's do not get to do procedures. It's best to pursue ACNP given your interests. However, I do notice that you have an ER background. Being familiar with a few ICU NP groups, I know that some prefer ACNP's with ICU experience as RN's.