Orthopedic FNP Texas - page 2

by littlebelle1293

2,086 Unique Views | 12 Comments

Hello all I'm currently in the FNP program at Texas Tech, due to graduate in August and trying to figure out what to do afterwards. My background is ICU for 2 years and Ortho for the last 3 years. I always thought I would go... Read More

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    Quote from littlebelle1293
    Thanks TX RN,
    I too have seen the same thing in Austin hospitals. While I don't feel that I would be prepared to see inpatients based on Texas Tech's FNP program, there are others who have better experiences or additional education that could give them that ability.

    Core0, I can't seem to understand why an FNP working in the clinic setting only (no inpatient no OR) of an orthopedic practice would be working outside of their scope. FNPs in primary care clinics see patients with orthopedic complaints, and have completed instruction on medical management of those disorders, giving joint injections, splinting, etc... Could you clear this up for me a bit? Is this because it is a Surgical practice?
    Its all going to depend on your risk tolerance. If you were in New Mexico for example where the BON interprets the roles quite liberally and no collaboration agreement is required then you would probably be fine. On the other hand if you choose to practice where the BON interprets the role very tightly then you are one complaint away from losing your job. If you look at what the BON says:
    Determining scope of practice includes:

    • Advanced practice education in a role and specialty
    • Legal implications (e.g. compliance with the Nursing Practice Act and Board Rules)
    • Scope of practice statements as published by national professional specialty and advanced practice nursing organizations

    You can read it any way you choose. One way is as you stated that FNPs in primary care see orthopedic complaints. The other way is that specialty practice in orthopedics is outside the scope of someone trained in primary care. I'm sure that there are FNPs practicing in Texas hospitals. I am also sure that the BON would take a dim view of it when the found out.

    We are going through this currently here. The hospital has given FNPs that work in critical care more than 50% of the time 1 year to get their ACNP. The suspicion is that this will move to all inpatient positions over the next few years. The state BON has refused to rule on scope issues saying its up to the individual nurse to make sure they are in compliance. On the other hand the state BOM has to sign off on all collaboration agreements. Under the current rules they would probably find that orthopedics is not a primary care specialty and an orthopod could not collaborate with an FNP.

    Like I said you can try to stretch an FNP to fit a situation, it just depends on your risk tolerance.
  2. 0
    The following were taken from the 2008 Consensus APRN model.
    The link is provided on the Texas BON website.

    I think you're ok. Get the speciality certification once you have completed hours.
    Also document and keep any and all training in your specialty. All for CYA reasons.


    "Scope of practice of theprimary care or acute care CNP is
    not setting specific but is based on patient care needs. Programs may
    prepare individuals across both the primary care and acute care CNP competencies."

    "Preparation in a specialty area of practice is optional, but if included must build on the APRNrole/population-focused competencies. Specialty practice represents a much more focusedarea of preparation and practice than does the APRN role/population focus level. Specialtypractice may focus on specific patient populations beyond those identified or health care
    needs such as oncology, palliative care, substance abuse, or nephrology."

    "State licensing boards will not
    regulate the APRN at the level of specialties in this APRN Regulatory Model."
  3. 0
    Thanks so much questions answered