F(%@$)NP, I have to go back to school for my ACNP!?

I’m back in school, again. I hesitated telling friends, family members, and colleagues that I am again going back to school for fear of the response.

Are you finally becoming a physician? Are you going back for your DNP? Will you make more money? No, No, and No (at least not initially).

When I first considered pursuing my NP, I heavily debated between family vs. acute care specialties. I was a critical care nurse by trade, but job opportunities in the surrounding area for acute care NP’s were not plentiful at the time. I ultimately decided I would be more marketable as a Family Nurse Practitioner. I was accepted into a MSN-Family NP program, was one year into the program, and then promptly accepted a job with a Pulmonary/Critical Care group. The initial position was for a residency/RN position with the intent to transition to a NP role within the practice (Insert head slapping emoji here). I’ve worked for the past 4+ years as a Family NP in a pulmonary world.

I don’t place lines, intubate, or perform other procedures like thoracentesis. I do most of my work in the outpatient clinic, but I do round in the hospital with one of my physician partners every 6 weeks.

The community hospitals that I am affiliated still credential Family NP’s, but do not allow for critical care procedures to be performed by the FNP. Other hospital’s in my community have started to transition FNP’s out of their ranks and only hire ACNP’s. The writing was on the wall, if I want to continue to round in the hospital or increase my inpatient presence I would have to go back and get my acute care certification.
Nurse practitioners are used nationwide but scope of practice is not yet uniform and varies state to state.

In my home state of Arizona, NP’s have full practice authority within the population focus and role that we are educationally prepared if competency has been established and maintained.

The nurse practice act goes on to define educational preparation as academic coursework or continuing education activities that include both theory and supervised clinical practice. Hospitals and insurance company’s also have opinions as to who can practice what and where, but this also varies state to state.

This is vague and confusing for some including our physician partners. Nursing as a profession has created this grey area of practice by carving out different nic­hes and narrowing certifications by patient population, different than our physician assistant partners. When a pulmonary/critical care practice hires a FNP they should be aware of their scope of practice based on their training, state practice acts, hospital, and insurance requirements. In some areas of the country there are residency programs in hospitals and larger critical care groups, but these are most often only open to ACNP’s. It’s up to the FNP to protect themselves and their patient’s by knowing their educational limits and being able to document and prove continuing education and training beyond their didactic education for procedures or other acute care work.

I spent the last several years contemplating adding the acute care certification and there are multiple post master’s certificate programs currently available around the country, both online and in person. I could have gone back for my acute care and added the DNP, but ultimately decided against this route (that’s a topic for another blog).

I am currently enrolled at the University of Arizona and the base of the program is online and 3 full semesters in total.

I did add a refresher general pharmacology class that I could have waived. I found it helpful since I have spent almost 5 years specialized in pulmonary medicine. In addition to the class work, approx. 26 credit hours, there are 180 clinical hours per semester. In my program there are 3 post master’s certificate students shuffled in with the University Adult Gerontology- Acute Care NP (AG-ACNP) DNP cohort.

Because the I am already a FNP, we are only required to do 540 total hours compared with the 720 hours of the other students. I won’t make any more money in my current role (initially), I’m not becoming a physician or obtaining my DNP. I joke with my peers that what I’m gaining is “street cred”.

I’m excited and stressed about completing this program while working full time, but in the end, I will have an additional certification that more closely matches my current role and passion. Wish me luck!