What kind of a person works Acute Care?

clearly · Nov 19, 2009

Moving to the NP forum would be hugely helpful, thanks!!

I applied to Columbia's ETP program. It seems that people are allowed to work as an RN after the BS has been completed, but doesn't appear to be a mandatory requirement, no.

Trauma Columnist · Nov 20, 2009

Will move this to the NP forum where you will (hopefully) find some more posters who have dealt with this issue.

sunshine0509 · Nov 20, 2009

Columbia told me in 2007 that they had a 100% job placement rate for their direct entry np's (in np roles).

I suggest you shadow. If you are planning to switch it probably really dosent matter

Advanced Practice Columnist / Guide · Nov 20, 2009

Thanks so much for the reply. ANAL is great. I can do that; & I prefer to be like that.
How emotionally involving is it, though? Also, how much responsibility is in the care of the nurse? For instance, do you have an example of a major procedure that a nurse might have to perform?
I am concerned about whether I can handle seeing the pain. I know that going into nursing requires me to become a stronger person but I am just trying to gauge what lies ahead for me in Acute Care which is supposed to be reasonably different from another speciality. (I'm not weak hearted but I tend to over-empathize and this has been my college professors concern when I indicated I wanted to go into nursing -- but I am sure I can learn to manage that and maintain a professional emotional stance.)

Acute Care training is not limited to Critical Care or ICU settings. The program encompasses acute medical and surgical problems in the adult but also covers chronic illness and some health maintenance. Graduates of ACNP programs do not all work in ICU's. Many work in specialty settings such as Cardiology, Neurosurgery, Nephrology, etc. and some work in Hospitalist Medicine roles.

Being that your program is a combined BS/MS with an ACNP track, it's hard to gauge the backgrounds of your classmates. In my traditional ACNP program, majority of the students in the class were experienced ER and ICU nurses. There were a few who worked in Med/Surg or Oncology. But I do hate to sterotype certain personality traits because some people who do not appear aggressive and remains calm under pressure are better to work with and probably have the same attention to detail as some with so called Type A personalities. You should shadow as much ACNP's as you could in different settings to see if any of the various fields will be a good fit for you.

meandragonbrett · Nov 20, 2009

I have a real problem with these direct entry NP programs....but that's not the place for this thread.

Do you plan on working between RN and NP licensing? I certainly hope so.

Acute Care NPs do not work exclusively in a critical care environment. ACNPs are found in internal medicine, emergency medicine, ICUs, and various other medical specialties that take care of acute problems and sometimes chronic issues that were once acute. You will see ACNPs working in hospitals and in the outpatient setting. They might be functioning in a hospitalist or intensivist role, rounding on their own patients, or in an office seeing patients.

An ACNP is going to order diagnostic tests such as lab work and radiology studies. They diagnose illness and prescribe medications for those. NPs who are working in ICU/Emergency settings are often found to be inserting central lines, chest tubes, intubating, arterial lines, swan ganz, bronchoscopy, etc.

What made you pick Acute Care vs Family?

CrazyPremed, MSN, RN, NP · Nov 21, 2009

You've gotten some great responses to your questions.

I've worked Tele and ICU for a little over two years, and can understand what you are trying to ask. I think great advice would be to work in an ER (or an ICU if possible) as a tech while you finish the Bachelor portion of your program, then move to an ICU while you finish the Master's. This will give you insight and may help you develop the skills that you are looking for.

In all honesty, my transition (which I'm still going through) to becoming a solid ICU RN is only beginning. I wanted to fly through an Nursing school and an Acute Care NP program, and didn't want to take years off in between. I have actually held off on finishing my BSN for a year, just to focus on the ICU that I am currently working in. It is amazing how much time, classes, and energy it takes just to be a functioning ICU RN. To become a leader will take even more.

Secondly, as many have stated before, even if a person can go straight through these programs without having a certain amount of experience, it may be difficult to find certain NP jobs without the RN experience. Although I am frustrated by this fact, I am slowly understanding why. It would be horrible to go through all the schooling and licensing, then have to return to the bedside in an RN role for 2 years just to find work. You might as well work at the bedside now.

Finally, working as an RN in the ICU might even show you that you may not like that particular role as an NP. There have been so many ICU pts that I have taken care of that wouldn't have gotten as sick if they had good primary care. At times, I feel that I may be more fulfilled working in a community clinic managing and educating diabetics than in the ICU managing pts in the throws of DKA. Gaining some RN work experience may actually change your direction.

All in all, that is just my two cents. I think the best way to learn of the ICU is to volunteer, or find a tech job in one.

Good luck on your journey.

CrazyPremed

allnurses Guide · Nov 21, 2009

As a graduate of a direct entry FNP program, I am a huge advocate of these programs and the NPs that successfully graduate. We are well trained and more than competent to work as NPs in most specialties. However, I have to agree with the others that say ACNPs need ICU/ER RN experience, or at least some solid med/surg experience. I think the nature of ACNP work requires inpatient care skills that were not emphasized in my DE program, but can be best gained by experience. Our faculty often stated that our school did not have an ACNP DE program for that very reason. I am very good at what I do in the primary care/urgent care setting, but I'm not qualified to work with very sick patients in the inpatient setting, and wouldn't pretend otherwise.

Browndog · Nov 23, 2009

It is best if you do not expect much from NP school. If you do not have a strong clinical background prior to your graduate program you will, quite likely, find it very difficult to succeed in the clinical arena. This is especially true for ACNPs in ICU environments. Learn the ropes as an RN before moving to the NP role. The other option for MLPs is PA school. These folks are, frankly, much better prepared by the PA educational process. I was, obviously, disappointed in the NP educational process. Just my two cents.

allnurses Guide · Nov 23, 2009

Browndog,

I'm sorry that you had such a disappointing experience in NP school. I can only imagine how frustrating it must have been to put all that time, energy, and money into something that didn't meet your expectations. I was fortunate to have had a very positive experience and felt well prepared to be successful as an NP in the non-acute setting, despite my lack of clinical experience. Like everything else in life, there are good programs and bad programs, and your situation demonstrates how critical it is to check out a school and talk to students who have been through the program.

Browndog · Nov 24, 2009

Please understand, I did not intend, by my last post, to cause any ill feelings. The intent was merely to offer a brief cautionary comment to this forum regarding the potential problems associated with relying soley upon NP school for the development of the neccessary clinical skillset.

That said, I agree that it is very important to choose your NP school carefully. I certainly did. The problem is that all NP programs teach to the certification exams. Take a good look at a typical NP program and compare the courses to a typical PA program. NP school is just not that rigorous, and the clinical component is woefully inadequate (approx 600-750hours).

Can an NP be a solid provider? Of course. No doubt about it. In fact, I intend to be one of the "good ones". The difference is that I recognize the value of my previous experience as a critical care nurse. I would be lost without the clinical acumen it has afforded me.