What do ER's hire more: PA-C, FNP or ACNP ?

[treejay]

Hi all. I am at the pinnacle of a very important decision that needs to be made by this upcoming Friday. I am hoping folks on here can help. I have been accepted to a great PA program and a great direct entry NP Program (accepted to FNP but could switch to ACNP if desired).

Currently, I have a strong interest in emergency medicine. I have worked only a little bit as an EMT and an ER Tech. I love the excitement of not knowing what's coming next and thinking on your feet. The pay is great, and I am very attracted to the flexibility in hours/shifts. But to be sure, there might be other specialties I'm interested in, I'm not sure yet. Primary care is also inviting, as is a hospitalist position, and perhaps international work.

So, first, I need to decide between PA and NP. I know this forum is loaded with discussions on this topic and I've probably read most of them. But it's still not an easy choice. Comparing PA school to direct-entry NP school, the education (in terms on clinical hours and breadth of didactic content) is stronger in PA school. I would come out and be better equipped to work my first ER job (not to mention that there are a number of 12-18 month residencies available for PA's [maybe there are a few for NP's, haven't seen them though]) On the other hand, I relate with the more holistic model of nursing, and also find the possibilities of independence and international opportunities (not to mention possibly more management and academic possibilities) very enticing. However, the fact is the MSN portion of the direct entry only has 700 clinical hours vs 2000+ for the PA program. The NP Program is only 3 days a week and they want you to work as an RN simultaneously.

I also have a hunch that more ER jobs are for PA's but am also aware that many NP's work in ER's too. I plan on living in Washington, Oregon, or California. So does anybody know if ED's on the west coast prefer PA's or NP's?

Secondly, for those that hire NP's, is FNP or ACNP more desirable? Clearly ACNP is better geared towards to ER and acute care in general, I understand that FNP's are sometimes preferred because their scope of practice includes peds and adults.

Any thoughts on my decision or as to who is preferred in the ED setting (especially on the west coast) are much appreciated!

[Debbie Nurse]

NPs have more opportunites, flexibility and room for growth. My friend is a Head PA in an ER and she teaches. She told me that she wishes she had become a nurse instead of a PA. I have another friend that is a PA that said the same. I also saw a female MD say that she should have chosen nursing so she would have more life balance for her family. She siad nurses have more voice and better benefits like days off and union representation than MDs.

[Spadeforce]

7 hours ago, Debbie Nurse said:

NPs have more opportunites, flexibility and room for growth. My friend is a Head PA in an ER and she teaches. She told me that she wishes she had become a nurse instead of a PA. I have another friend that is a PA that said the same. I also saw a female MD say that she should have chosen nursing so she would have more life balance for her family. She siad nurses have more voice and better benefits like days off and union representation than MDs.

probably depends on specialty. if this is ER i know a lot of docs who work 3 days a week and rake in 400k. and this is not uncommon in rural areas

any nurses that do that?

in response to OP probably whichever the hiring director has had better experience with.

[WinterWolf90]

The area I lived at in Tennessee mostly hired FNPs, the acute care NP thing hasn't caught on yet and almost all the internists were FNPs as well.

[Jory, MSN, APRN, CNM]

FNPs in my opinion, are working outside of their scope of practice by working in an ER or as a hospitalist. They are primary care, not acute care providers. There is a big difference.

We have an acute care NP designation. If they want to work in acute care, they need a certification to do so.

Some states are already cracking down on this and I suspect this trend will continue. FNPs while valuable, are WAY over-utilized in areas they should not be in.

[djmatte, ADN, MSN, RN, NP]

1 hour ago, Jory said:

FNPs in my opinion, are working outside of their scope of practice by working in an ER or as a hospitalist. They are primary care, not acute care providers. There is a big difference. 

We have an acute care NP designation. If they want to work in acute care, they need a certification to do so. 

Some states are already cracking down on this and I suspect this trend will continue. FNPs while valuable, are WAY over-utilized in areas they should not be in.

Some might argue acute care would be outside their scope when an ENP designation exists. Also with the fact that most ACNP programs don't cover the life span. Albeit generally I agree with you that FNP without the ENP is absolutely working outside their scope.