What should my list consist of for more traditional brick and mortar AGACNP programs?

SopranoKris, MSN, RN, NP · Jul 3, 2018

Are you currently a critical care (ICU) or ER RN? Most ACNP programs require that you have at least one year experience at that level of nursing.

Xlorgguss · Jul 3, 2018

I currently have a year of experience in Cardiac Surgery Stepdown. I have considered jumping to ICU but I have wanted to finish getting my certifications and am trying to decide which kind of ICU I would like to go for (Cardiac, Surgical, Medical, Trauma, etc). The programs that I have looked into haven't had the stipulation of requiring ICU experience per se. I know that Vanderbilt specifically does not as brother does the programs located immediately around me.

SopranoKris, MSN, RN, NP · Jul 4, 2018

While there are some schools that don't require critical care experience for ACNP, it is definitely most helpful when you're going to practice at the acute care level to have that experience under your belt. Do you manage vents? Art lines? Sheaths? SLICCs? Rotoprone? CRRT? Are you on the code team? Have you had to participate in an emergent intubation? These are things you are going to need to be comfortable with going in to ACNP, otherwise, it's going to be a very steep learning curve. What specialty do you want to practice in when you obtain your ACNP? Most critical care/intensivist positions will want to know your nursing background (at least, where I live, they do :) )

Xlorgguss · Jul 9, 2018

I have some experience with Vents, however in general respiratory takes ownership of most of the vent stuff in my facility. I know the basic nursing considerations. Likewise I have some experience with arterial lines. I am not entirely sure what specialty I would like but I work CardioThoracic now and I really like this patient population. Our CTICU just recently (within last few months) started doing CRRT and to my knowledge doesn't do rotoprone therapy. I do have some experience with putting chest tubes at bedside as well as cardioversion at the bedside (but that is uncommon). I would like to get specific ICU experience but that might wait until I relocate for school. I am looking at working while doing school part time so assuming I start working in an ICU after relocating for school that would give me a good two years of experience while completing my Masters. I'm honestly not concerned about my experience because I know that it will come with time and continued experience. Currently I am looking to compile a list of schools to look into applying to.

algae1492 · Jul 9, 2018

While there are some schools that don't require critical care experience for ACNP, it is definitely most helpful when you're going to practice at the acute care level to have that experience under your belt. Do you manage vents? Art lines? Sheaths? SLICCs? Rotoprone? CRRT? Are you on the code team? Have you had to participate in an emergent intubation? These are things you are going to need to be comfortable with going in to ACNP, otherwise, it's going to be a very steep learning curve. What specialty do you want to practice in when you obtain your ACNP? Most critical care/intensivist positions will want to know your nursing background (at least, where I live, they do :) )

Would the experience vary depending on the candidate applying for AGACNP hospitalist vs intensivist focus? I assume inten require icu experience and the hospitalist to be acceptable with acute/no icu.

Xlorgguss · Jul 9, 2018

Would the experience vary depending on the candidate applying for AGACNP hospitalist vs intensivist focus? I assume inten require icu experience and the hospitalist to be acceptable with acute/no icu.

I have now looked through a good 15 or so programs (some being USA World News ranked) and have yet to see a program that required ICU employment. Undoubtedly it is helpful but "critical care" is poorly defined in my opinion. Patients that are routinely taken care of in some larger institutions stepdown floors would often be considered ICU criteria for other institutions.

Rocknurse, MSN, APRN, NP · Jul 9, 2018

Would the experience vary depending on the candidate applying for AGACNP hospitalist vs intensivist focus? I assume inten require icu experience and the hospitalist to be acceptable with acute/no icu.

It is not differentiated in the program. Acute means acute and you will be exposed to critical care philosophies. In my opinion, as someone who's about to graduate from an AGACNP program, it would be in the OP's best interest to work in an ICU prior to starting the program. There is a reason many schools only consider AGACNP students with critical care experience. Being already familiar with art-lines, vents, pressors etc will be a vital asset to your practice. In my first clinical semester we were already placing a-lines and central lines and assisting with chest tubes. If you haven't already had that exposure, and are not familiar with vent setting and various other equipment in the ICU, you'll be placing yourself at a disadvantage and could easily become overwhelmed.

SopranoKris, MSN, RN, NP · Jul 9, 2018

I have now looked through a good 15 or so programs (some being USA World News ranked) and have yet to see a program that required ICU employment. Undoubtedly it is helpful but "critical care" is poorly defined in my opinion. Patients that are routinely taken care of in some larger institutions stepdown floors would often be considered ICU criteria for other institutions.

I'm not talking about patients that are borderline step-down/ICU. I'm talking about TRULY critical patients. As an ACNP, you're going to have to know what you're doing and you're going to have to jump in and treat someone who is crumping right before your eyes. This is where having experience as an ICU nurse comes in to play. You will know what is the correct pressor to start with. Is it OK or not OK to give that fluid bolus for pressure? Can your patient tolerate CRRT? You absolutely need exposure at the RN level to practice at the ACNP level. You need to have that foundation that you can't get outside of ICU or trauma ER. In my area, you would never be considered for an ACNP position if you didn't have a critical care background as an RN first. If you've never managed a post-open heart patient (I'm talking immediate post-op, not a few days post-op on a step-down), how do you expect to stay in CV critical care? It's going to be a rough learning curve. You don't know what you don't know yet because you haven't been exposed to it.

I'm not saying this to be rude or crush your desire to further your education. I'm trying to be realistic here. Get the experience. You need to know what to do in a split second. Sometimes, you don't have time to go look something up. You need that experience in emergent situations, and you can't learn that from a book or a simulation.

Xlorgguss · Jul 9, 2018

I'm not talking about patients that are borderline step-down/ICU. I'm talking about TRULY critical patients. As an ACNP, you're going to have to know what you're doing and you're going to have to jump in and treat someone who is crumping right before your eyes. This is where having experience as an ICU nurse comes in to play. You will know what is the correct pressor to start with. Is it OK or not OK to give that fluid bolus for pressure? Can your patient tolerate CRRT? You absolutely need exposure at the RN level to practice at the ACNP level. You need to have that foundation that you can't get outside of ICU or trauma ER. In my area, you would never be considered for an ACNP position if you didn't have a critical care background as an RN first. If you've never managed a post-open heart patient (I'm talking immediate post-op, not a few days post-op on a step-down), how do you expect to stay in CV critical care? It's going to be a rough learning curve. You don't know what you don't know yet because you haven't been exposed to it.
I'm not saying this to be rude or crush your desire to further your education. I'm trying to be realistic here. Get the experience. You need to know what to do in a split second. Sometimes, you don't have time to go look something up. You need that experience in emergent situations, and you can't learn that from a book or a simulation.

I have no intention on skipping out on ICU experience as that was what I wanted to start my nursing career with anyways. Personally I chose stepdown to start my career because I liked the patient population and our Cardiac ICU did not offer the support I was expecting as a new graduate (indications for different pressors, understanding different hemodynamics, etc). They had a steep orientation of being able to recover open hearts independently around week 8 whether or not you were an experienced RN or not. I have heard of some institutions having staff learn to recover open hearts after a year, but it seems like our ICU is not that case. As such I decided to do stepdown to get a good fostered education and environment while I went back for my BSN. I have hit my one year mark as a nurse, I have a year left of my BSN, and I am currently studying for certifications. This thread was in no way intended to argue whether ICU experience is necessary for AGACNP programs or whether I was looking to circumvent that experience for "easier" Stepdown experience. I was simply looking to seek out programs to compile a list to look into for the future. In reality I am likely 1.5-2.5 years away from starting a program which gives me time to start my ICU experience in addition to the time while in school part time.