Working in ICU vs OR?

CRF250Xpert · Apr 13, 2011

As an ACNP you can walk into ICU, review a chart, write orders and walk out. How on earth is sitting at the bedside and carrying out those same orders going to make you a better ACNP? I’m way confused. I don’t think I’d be a better FNP if I did my nurses job (even though I have to sometimes); I’d actually be a poorer provider since my focus would be on stuff that isn’t part of my role as the provider.

sandnnw, BSN, MSN, EMT-B, APRN · Apr 13, 2011

Sounds like she's having trouble getting hired, period.

I vote for SICU. You'll still get exposure with the Surgeons (impressing them) and learning a ton of hands on skills. I would look at trying to get an NP job, even if you have to work outside the hospital for a while. I had to do this and it took a little over a year, but I got a sweet job for my efforts.

Good luck, keep us up to date!

nicrn7 · Apr 13, 2011

Thank you both for your thoughtful responses.

CRF250Xpert - I have heard arguments on both ends of the spectrum with regards to RN experience being necessary or not to be an effective NP. At the end of the day, in my opinion, the job market has the final say and 95% of the NP jobs I have seen (keep in mind that I cannot work in primary care) require at least 1 year of RN experience if not 2 or more.

sandnnw - You are right. I am having trouble getting hired period. I'm having trouble with NP jobs for the reason explained above. I am having trouble with new grad RN jobs due, of course, to the number of new grads being much larger than the number of open spots. I also think part of the reason for my not getting into new grad RN positions might be the fact that I have an MSN degree.

Thank you for the SICU suggestion. I hadn't thought about that but it makes a lot of sense. In terms of an NP job outside of the hospital, do you have any good sources/websites I could look through for possible openings?

Annaiya, NP · Apr 13, 2011

I have a job at the hospital I want to work at, but not on the unit I want. I was told by a manager of a different unit that my being in school for my NP would hurt my chances of being hired by the other unit, because the manager will to hire and train RNs who are going to stay. Maybe try targeting organizations that use a lot of ACNPs and emphasize your desire to stay at and grow with the organization. If you can get a job in an OR or ICU that uses a lot of ACNPs they might not see the cost of training you as such a waste. Just a thought.

nicrn7 · Apr 13, 2011

I have a job at the hospital I want to work at, but not on the unit I want. I was told by a manager of a different unit that my being in school for my NP would hurt my chances of being hired by the other unit, because the manager will to hire and train RNs who are going to stay. Maybe try targeting organizations that use a lot of ACNPs and emphasize your desire to stay at and grow with the organization. If you can get a job in an OR or ICU that uses a lot of ACNPs they might not see the cost of training you as such a waste. Just a thought.

Thank you Annaiya! I will certainly keep this in mind as I continue to apply.

Advanced Practice Columnist / Guide · Apr 14, 2011

I have worked with Direct-entry MSN grads who are ACNP's but were working as bedside RN's in the ICU. While I didn't ask every single one directly if they were still pursuing NP positions, some have actually transitioned into NP roles in the same institution or in another a year or so after. If it is really important for you to have a job that involves assisting in the OR, it may be of benefit for you to pursue a position in the OR where you can segway into RNFA certification. Since you already have training in in-patient management as an ACNP, the RNFA piece is your weakness.

CRF250Xpert · Apr 14, 2011

I have worked with Direct-entry MSN grads who are ACNP's but were working as bedside RN's in the ICU....some have actually transitioned into NP roles

What a waste of education. Those folks should have gotten an ADN and saved $75k in tuition.

I guess I'm odd, but when I started grad school, I was dreaming of the day I no longer had to wipe butts and turn n baste my PTs. I couldn't wait to be the decision maker. To go through all of that school and clinical and go back to the old job - no way. Actually, that was my motivation through grad school - I never wanted to be a RN again.

It just seems like getting an accounting degree to run the cash register at WalMart....don't make no sense.

nicrn7 · Apr 14, 2011

Juan - I can see that you have a lot of nursing experience. May I ask your opinion about whether or not direct entry NP graduates need RN experience or not? As I stated in my previous comments, I don't believe that I have much of a choice.

Advanced Practice Columnist / Guide · Apr 14, 2011

Juan - I can see that you have a lot of nursing experience. May I ask your opinion about whether or not direct entry NP graduates need RN experience or not? As I stated in my previous comments, I don't believe that I have much of a choice.

Oh, I think it depends on the individual. There are people that can definitely be good NP's even though they have little to no NP experience. I've worked with 4 direct entry ACNP grads so far. Two worked as RN's in the ICU for a while after graduating from their program and then transitioned to the NP role later. The other two were hired as NP's in the ICU immediately after their graduation from their respective direct entry ACNP programs. They were actually grads from two different out of state programs and got their first jobs in the same medical center their programs were affiliated with. All four of them have been in the NP role for a while when I began working with them (approximately 1-4 years of NP experience). I have no idea what the two who worked as NP's right away were like when they started their first jobs as NP's but I couldn't tell them apart now in terms of skills compared to ACNP's with lots of RN experience. All four are smart, competent, and at least one had a strong science background from having completed pre-med as a first bachelor's degree.

CCRNDiva, BSN, RN · Apr 14, 2011

I'm an ICU nurse with 7 yrs experience and I can tell you that while I do wipe my fair share of butts, that is a small portion of what I do. I am a code blue and rapid assessmen team responder. During these times, I am responsible for the assessment and development of a treatment plan within minutes. Our family practice residents and occasionally a hospitalist attend these events but I function as an equal partner in the teams and am often depended on for my assessment skills. For example, is this a cardiac, respiratory, neurological event? Does this pt need room in the unit? What lab tests, scans or interventions are needed?

I've learned so much during my years in the ICU and my experience has given me a strong foundation to build my advanced education on. I'm managing critically ill patients suffering from multi-system organ failure, multiple traumatic injuries, heart failure and the like. We are responsible for the management of ventilators, balloon pumps, CRRT, vasoactive gtts and sedation. We are required to interpret data continuously. The physicians depend on us to keep their patients alive and they often base their treatments on the information I provide. I'm quite fortunate to work with intensivists who trust me when I tell them a patient needs intubation or additional intervention. They are also willing, excellent teachers.

I think it would only help you to gain some ICU experience. Your coworkers don't have to know you're an NP. I agree with the advice to seek an organization that utilizes NPs in the function you desire. Good luck to you.