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What NP specialty offers the most flexibility?

Posted

Specializes in Public Health Science. Has 2 years experience.

I am applying to a nurse practitioner program and would like some advice on what specialties are like. I was a medical school student that left medical school because I realized that the demands of a doctor and quality of life was not something I wanted to pursue further so I left in my first semester of medical school. However, I love patients and I love caring for people so I would like to work as a nurse practitioner. Which specialties offer the most flexibility? I feel like as a Acute Care Nurse Practitioner (ACNP) you can work in different settings such as inpatient care and outpatient care. I want to be able to do research and be able to work in the clinic.

RatchedAfterMidnight, MSN, APRN

Specializes in PMHNP/Adjunct Faculty. Has 7 years experience.

Make sure you pick a track that aligns with your goals to work inpatient and outpatient with your state's scope of practice regarding an NP specialty. Population specific specialties like Adult-Gerontological NP, Psych NP have some of the most flexibility. I would 100% not recommend a FNP program unless you are going back for a certification because online programs are producing FNP grads faster than jobs are available. I can't count the number of people I know who are working an RN job as an NP. FNPs also have a more limited scope of practice to an outpatient setting (although I have seen a handful in hospital). If you are going to pursue FNP I would choose a hybrid program with a lot of in class time. Acute Care NP qualifies you to work in Urgent Care Settings, ER, the floor and if you have experience on the floor this would be a natural progression. 

babyNP., APRN

Specializes in NICU. Has 13 years experience.

If you want to do out patient and in patient with adults then best to get your ACNP and FNP. With the consensus model being implemented in more and more states, NPs are being restricted to their actual trained scope of practice. ACNP is not trained in primary care and FNP is not trained in acute care. Anyone (including RNs) can do research 

adventure_rn, BSN

Specializes in NICU, PICU.

Are you already a nurse? If not, then becoming a PA would be your most flexible option, and would arguably prepare you better than a direct-entry NP Program since it includes far more advanced practice clinical hours.

If your looking for life balance and flexibility.  Continue to work as a nurse.   the NP role will be 8-5 most likely.  I disagree with previous poster about the FNP.  I have plenty of opportunities.  Working primary care also affords me the benefit of a consistent day shift and minimal weekends.   I have seen your other post about stress. I just haven't met many providers who don't feel a little stress in their life.  I think I cope well overall, but the reality is there is some stress with prescribing and diagnosing (I worry most about missing a diagnosis)  and NPs are also brought into the conversation about the bottom line.  There is an expectation (reasonably ) that our production levels will be an asset to the organization.

Future MSN

Specializes in Public Health Science. Has 2 years experience.

On 8/27/2020 at 1:30 PM, dallasmiss said:

Make sure you pick a track that aligns with your goals to work inpatient and outpatient with your state's scope of practice regarding an NP specialty. Population specific specialties like Adult-Gerontological NP, Psych NP have some of the most flexibility. I would 100% not recommend a FNP program unless you are going back for a certification because online programs are producing FNP grads faster than jobs are available. I can't count the number of people I know who are working an RN job as an NP. FNPs also have a more limited scope of practice to an outpatient setting (although I have seen a handful in hospital). If you are going to pursue FNP I would choose a hybrid program with a lot of in class time. Acute Care NP qualifies you to work in Urgent Care Settings, ER, the floor and if you have experience on the floor this would be a natural progression. 

Thank you for the advice. I really appreciate it. 

Future MSN

Specializes in Public Health Science. Has 2 years experience.

13 hours ago, Rnis said:

If your looking for life balance and flexibility.  Continue to work as a nurse.   the NP role will be 8-5 most likely.  I disagree with previous poster about the FNP.  I have plenty of opportunities.  Working primary care also affords me the benefit of a consistent day shift and minimal weekends.   I have seen your other post about stress. I just haven't met many providers who don't feel a little stress in their life.  I think I cope well overall, but the reality is there is some stress with prescribing and diagnosing (I worry most about missing a diagnosis)  and NPs are also brought into the conversation about the bottom line.  There is an expectation (reasonably ) that our production levels will be an asset to the organization.

Thank you for your feedback. I know that every job will have stress at some points. Specially in healthcare and especially if you care about people, which I do. I just want adequate time to recover from that stress. I want to work no more than 40 hours a week so that I have that downtime to recover and feel optimistic about what I am doing. Having a balanced life prevents burnout and that is what I am seeking. 

myoglobin, ASN, BSN, MSN

Specializes in ICU, trauma, neuro. Has 13 years experience.

I believe that PMHNP is decent. Granted I end up working every day of the week, mostly because I'm very ADHD and inefficient.  However, I actually only see clients three days per week and am on track to earn at least 200k (no benefits however) despite being a first year graduate (and I work from home).  As an ICU RN with ten years experience I never received a raise beyond the $38.00 per hour (no benefits) that I earned for my three twelve hour night shifts per week.  Granted, I could have worked an additional one, two or even three days of overtime as many of my coworkers did, but every shift was such a "battle for survival" that there was no way I could have done that certainly not on a regular basis.

Angie Hunter

Specializes in PMHNP Student. Has 26 years experience.

Hi myoglobin, thanks for your advice. I'm in a PMNNP program and am interested in work from home options. Do you have any advice on how to access these kinds of positions? Are there national companies that do telepsych? Or is it just pounding the pavement in your locale to find them? Thanks much for any thoughts you have to offer. 

myoglobin, ASN, BSN, MSN

Specializes in ICU, trauma, neuro. Has 13 years experience.

I would start with getting licensed in as many IP's states as possible (and joining the compact for RN's if your state participates).  States like Arizona, Colorado, Washington, and Nevada, New Hampshire, Maine, and New Mexico offer some of the best opportunities. Also, consider California since even though they are not IP the pay is so "off the charts" and the licensing process so arduous that it creates additional "supply side barriers" that will make you very valuable even as a new grad so that you might potentially be offered a job in the 200K range with benefits.  Also join every national organization possible and every educational resource such as The Carlat Report, Dr. David Puder's educational podcast, and the Psychoterapeutic Institute.  Also list yourself on Psychology Today and Good Therapy and investigate some of the programs that you could use for charting, and ordering medications (such as Therapy Notes and MD Toolbox).  Also join as many NP facebook pages as possible for additional networking opportunities.  

umbdude, MSN, NP

Specializes in Psych/Mental Health. Has 4 years experience.

There are a few national companies that will hire people to do only telepsych (some pay crap). However, I think most of the telepsych jobs are temporary and once the emergency is over they might expect you to relocate.

myoglobin, ASN, BSN, MSN

Specializes in ICU, trauma, neuro. Has 13 years experience.

Keep in mind that you can provide the service yourself and either bill insurance (or use a company to do it for you) or take cash only.  If you go this route your future will be more in "your" hands and less subject to the whims of others.

Angie Hunter

Specializes in PMHNP Student. Has 26 years experience.

Although working for myself sounds attractive, own boss etc...I prefer just to be employed. Don't want to deal with the headache of recruiting patients, advertising to get enough patients etc. Then paying for the overhead of an office and staff. That just seems like too much esp. if starting out. Although I'll be the first to admit I'm a scaredy cat! LOL 

umbdude, MSN, NP

Specializes in Psych/Mental Health. Has 4 years experience.

I don't think I would want to go solo and have to deal with billing and scheduling. It shouldn't be too hard to find a private group that'll give you a lot of autonomy. Although it might be a 60/40 to 70/30 split, you won't have to deal with all the other matters (60/40 is still pretty decent if you're taking private insurance or cash). But these jobs usually will require that you have 1-2 years of NP experience and that you don't need supervision.

Edited by umbdude

myoglobin, ASN, BSN, MSN

Specializes in ICU, trauma, neuro. Has 13 years experience.

Here are some possibly relevant thoughts related to this subject:

a. Many places you will end up doing much of your own scheduling (certainly many tele positions).

b. Finding customers may be a challenge at first. Although, I get notices of about 20 calls per week from my Psychology Today add. I will be honest I don't call any of these back (my number at my group is listed if they want to call intake and ask for an appointment). I do email every customer who emails me back.  My point is that even with Psychology Today being my only advertising I could probably obtain a reasonably full schedule within a year.

c. If you are "cash only" it reduces the headache of billing. Even at the group that I'm at now I don't charge for missed appointments nor do I ever pursue collections (I suppose at some point I might stop seeing a patient if they don't pay or miss too much, but that hasn't happened yet). My attitude is that "over all" I make good money so I don't worry about what falls through the cracks.

d.  Even as a new graduate I had seven or eight offers in the 60-80% range at various locations around the country.  Granted only one of those had a fully remote option (probably about 60% when you consider fees).  

e. My wife worked with a PMHNP who now works in Alabama (not known for pay or good scope of practice) who's supervising MD pays her 80%.  They bill at around $300.00 per hour ($300 for a 60 minute intake and $150.00 for a 30 minute followup) Thus, she earns around $240.00 per hour (minus no shows) and she is full every day.  If you can earn about $200.00 in Alabama you can probably do it in most places with the proper set up.

Angie Hunter

Specializes in PMHNP Student. Has 26 years experience.

wow that's great! Puts a whole new perspective on private practice. I will definitely keep that option open, as I know when I start out I can't be too picky. My one caveat is that I need something somewhere where it doesn't snow. Living in the snow belt I'm just tired of being frozen/cold/chilly 8 months of the year. I wouldn't have imagined in Alabama!!

Angie Hunter

Specializes in PMHNP Student. Has 26 years experience.

Is she salaried or private practice?

Future MSN

Specializes in Public Health Science. Has 2 years experience.

On 9/18/2020 at 1:44 PM, Angie Hunter said:

Although working for myself sounds attractive, own boss etc...I prefer just to be employed. Don't want to deal with the headache of recruiting patients, advertising to get enough patients etc. Then paying for the overhead of an office and staff. That just seems like too much esp. if starting out. Although I'll be the first to admit I'm a scaredy cat! LOL 

Its not a bad thing to be employed than own your own business. I own my own business (not in healthcare) and I am not sure I would own another business again. But it is good to have the option. Thanks for the feedback.