What was your first AGACNP job?

[kdawnz, MSN, NP]

Hey all, curious what your first ACNP job was out of school? I am job hunting (which isn't great during this pandemic I realize), and have been told by 2 recruiters that I will almost certainly need to work in a clinic setting for my first job. This is a bit confusing to me since I did acute care as my specialty, spent my entire career inpatient, and did all of my training inpatient. When I have told them I am looking for an inpatient position they literally all say "you and everyone else". All of the inpatient positions I have applied for require prior experience, which is difficult to get when no one will hire you. AGACNP's seem to be somewhat of a rarety in the 5 state area I'm primarily looking and FNP's are working inpatient so that makes it tough for me without prior experience.

If I need to bide my time in a clinic for a bit I will for sure, but I feel a bit backed in to a corner: I did Adult/Gero Acute Care which means I can't get any clinic job that cares for all ages. That pretty much leaves the specialties. Again, this is fine, but if my interest is to be a hospitalist or intensivist at some point, will clinic experience in a specialty be considered applicable?

[Neuro Guy NP, DNP, PhD, APRN]

No, it won't be applicable to an ICU or hospitalist position because it isn't related to those specialties. It just shows thst you've worked. You may need to consider relocating if possible. Otherwise, keep looking until you find a position.

[KatieMI, BSN, MSN, RN]

Specialty adult practice where you will do both clinic and rounds in hospital. Nephrology, Cardiology, Neuro/strokes, Surgery, Ortho, whatever. You'll get hospital privileges this way, and after couple of years it will be applicable experience. Plus, you'll get contacts which are equally important.

Private internal medicine practices often utilize this model, bit get ready to work your tail and soul off for this type of job and be "utilized" in office, Urgent, SNFs and hospital as needed for less money and benefits.

There are also strictly nocturnist jobs for overnight coverage (from home by phone or in house but you will be in call room and able to snatch a bit of sleep here and there).

Sound Physicians hire all the time (but they are much less than terrific about everything except for salary).

From providers point of view, the fact that you are "acute care" or "family" means nothing by itself. They care about what you can do and with what you have experience as an NP (not RN). And, yes, everybody wanna hospital jobs, especially right now when clinics will deal with decreased revenue for quite some time ahead.

[kdawnz, MSN, NP]

Gotcha, thanks for the info, that's helpful. Just trying to figure out how to navigate all of this. I did all of my clinicals in hospital and mostly with critical care, so I really don't know what to do in a clinic or with long term management of chronic conditions. I'm sure I can figure it out, but seems weird to go to an area I'm unfamiliar with when I can walk into a hospitalist or intensivist position and know what to do and how to do it. Obviously I have a lot to learn and need much greater depth in practice, but it will take me much longer to figure out my role in a specialty clinic than it will in inpatient medicine. Since the job situation has been hard I received advice in another post to go wherever will give me a job, put in a year or two and leave. This seems less feasible if I'm in a specialty that won't translate to inpatient medicine. Ugh, the struggle is real!

[Guest1144461]

I did an inpatient internal medicine NP residency (basically I was an intern...literally). Prepared me for any job inpatient and it looks good to have some formal training on your CV.

[Guest1144461]

4 hours ago, kdawnz said:

Gotcha, thanks for the info, that's helpful. Just trying to figure out how to navigate all of this. I did all of my clinicals in hospital and mostly with critical care, so I really don't know what to do in a clinic or with long term management of chronic conditions. I'm sure I can figure it out, but seems weird to go to an area I'm unfamiliar with when I can walk into a hospitalist or intensivist position and know what to do and how to do it. Obviously I have a lot to learn and need much greater depth in practice, but it will take me much longer to figure out my role in a specialty clinic than it will in inpatient medicine. Since the job situation has been hard I received advice in another post to go wherever will give me a job, put in a year or two and leave. This seems less feasible if I'm in a specialty that won't translate to inpatient medicine. Ugh, the struggle is real!

FWIW I would absolutely be terrified to walk out of ACNP school into a independent hospitalist role. Make sure you do a residency or something that has a solid mentorship/preceptor beginning role.

[KatieMI, BSN, MSN, RN]

I do not know... I started from running hospital floor with FNP, it was nothing "terrifying" except for number of nursing calls, out of which at least 70% were pure nonsense. Was working for two years (still FNP) doing everything within the same practice except Urgent, which I hated from the day#1. Hospital floor census was rarely below 20 patients a day. After two years of doing everything and anything there, I found a sweet and reasonable hospitalist job, again started running floor from the day #1.

I am still going for acute care certificate, but I only need it in case we will move or if I'd like to try ER or ICU one day.

Did it all without any "residency" and with minimal orientation. It is not that complicated if one had a couple of years of hospital experience and did not spend those years mastering bedpan placement and "policy application" skills and hanging on the phone all the time for "updates".

[ArmaniX, MSN, APRN]

Started directly in an ICU with 3 month orientation. Certifications, experience (RN) all very much do have weight as a new grad NP.

Your timing is unfortunate (pandemic), but I would consider casting a wider net. I graduated in Florida and moved 1000 miles for that first job. It was not ideal but a very reputable organization and great orientation. After a year I was able to secure a job in a location I wanted... another 3000 mile drive.

I knew as a new graduate I wanted to be in an ICU in a teaching/trauma 1/academic center. My desires made my options of available jobs smaller and smaller, hence I opened up my search to the entire US.

[Neuro Guy NP, DNP, PhD, APRN]

21 hours ago, KatieMI said:

Specialty adult practice where you will do both clinic and rounds in hospital. Nephrology, Cardiology, Neuro/strokes, Surgery, Ortho, whatever. You'll get hospital privileges this way, and after couple of years it will be applicable experience. Plus, you'll get contacts which are equally important.

Private internal medicine practices often utilize this model, bit get ready to work your tail and soul off for this type of job and be "utilized" in office, Urgent, SNFs and hospital as needed for less money and benefits.

There are also strictly nocturnist jobs for overnight coverage (from home by phone or in house but you will be in call room and able to snatch a bit of sleep here and there).

Sound Physicians hire all the time (but they are much less than terrific about everything except for salary).

From providers point of view, the fact that you are "acute care" or "family" means nothing by itself. They care about what you can do and with what you have experience as an NP (not RN). And, yes, everybody wanna hospital jobs, especially right now when clinics will deal with decreased revenue for quite some time ahead.

Not necessarily. At least in larger cities, like where I am there are plenty of inpatient only specialty jobs, like neurology, cardiology, ortho etc with separate outpatient ACNPs. Though I suspect your advice applies to smaller towns where hospitals are staffed by private practices almost exclusively.

Also, here in the northeast ACNP vs FNP absolutely does matter. In Philadelphia, NYC and most of New Jersey the hospitals will not hire FNP for inpatient roles. It's formal policy. I've recently moved into an administrative role in the hospital besides continuing to teach. This may not apply to smaller markets, but in larger cities, especially here, it must definitely does matter.

[KatieMI, BSN, MSN, RN]

1 hour ago, Neuro Guy NP said:

Also, here in the northeast ACNP vs FNP absolutely does matter. In Philadelphia, NYC and most of New Jersey the hospitals will not hire FNP for inpatient roles. It's formal policy. I've recently moved into an administrative role in the hospital besides continuing to teach. This may not apply to smaller markets, but in larger cities, especially here, it must definitely does matter.

That's why I am going back to school. Docs couldn't care less, but formal policy is formal policy. The situation varies incredibly wide around the country and even within states (rural vs. metro areas and places attracting population vs. ones where people just refuse to live even for $$$$$).

[RunNP]

I went straight into a Pulmonary practice with 50/50 inpatient/clinic work. I had wanted all inpatient work, but overall I have grown to enjoy my clinic patients more than the inpatient side.

[kdawnz, MSN, NP]

10 hours ago, RunNP said:

I went straight into a Pulmonary practice with 50/50 inpatient/clinic work. I had wanted all inpatient work, but overall I have grown to enjoy my clinic patients more than the inpatient side.

I think that sounds like a great setup. I interviewed for a Pulmonary position today. It’s mostly outpatient for the first year or so and then I should start doing consult and critical care stuff a bit too if I were to get it. Definitely eyebrows raised that all of my clinical time and degree specialty is inpatient, but overall it seemed to go well. Again, I feel like I’m in a rock and hard place. I’ve applied for inpatient jobs everywhere and am getting told over and over they want experience... and then the clinics are like “do you even know how to work in a clinic?” Frustrating.

What things do you like about pulmonary specifically? Most of my clinicals were with pulmonary critical care which I really enjoyed, but wondering what things you enjoy in the clinic world with pulm?