hi everyone. currently i'm an adult health cns working in a large nephrology practice with three fnps. part of our job is to spend the weekends doing hospital call where we do consults, h&ps, discharged summaries and generally seeing patients. i am now hearing that in order to work in the hospitals, you will need an acnp versus the fnp that my peers have. has anyone else heard this and can you please refer me to a source? also, i live in il and is this going to be state specific? thanks in advance for any assistance - i really appreciate it.

What does IDPR say about this? When does the IL Nurse Practice Act sunset? I wouldn't think that education requirements or practice privileges would change unless/until the NPA changes.

I feel for all of you advanced practice nurses. You have been pioneers in an exciting area of nursing practice, and have had to contend with ever-changing educational requirements and terms of practice.

Thanks Jolie - I actuallyl am on the state-wide membership committee for the ISAPN (IL Society of APNs) but I don't have a source to cite. Thanks much for your kind words.

I've not heard this, traumaRUs.

Is this something for IL hospitals?

Siri - I wish that I could remember where I've heard this, but unfortunately I don't. We had an APN meeting today at our practice and it just came up and I do remember either hearing or reading something about it. However, I have looked at the NCSBN, AACN, IDPR websites w/o success so maybe I've imagined this - lol.

I looked as well and didn't see anything. Will keep my eyes and ears open.

hi everyone. currently i'm an adult health cns working in a large nephrology practice with three fnps. part of our job is to spend the weekends doing hospital call where we do consults, h&ps, discharged summaries and generally seeing patients. i am now hearing that in order to work in the hospitals, you will need an acnp versus the fnp that my peers have. has anyone else heard this and can you please refer me to a source? also, i live in il and is this going to be state specific? thanks in advance for any assistance - i really appreciate it.

is this banner health?

there is a lot of discussion about this in the credentialling world. i was on a phone conference about this last week. the genesis was an acnp that wanted a job and told the hospital credentialling that fnp's were outside their scope of practice working in an inpatient setting. not sure what state this was in, but i suspect this is texas (which has fairly strict scope of practice rules). according to the conference there was also a case recently where the hospital got hit for credentialling a fnp (siri may know more about this). lot of innuendo out there right now. this then led to an email exchange with another big hospital system about this same subject.

my advice would be - be prepared to document your experience in inpatient medicine. also for those who were doing this before acnp's existed you should be safer. i think this is going to be a big problem. it doesn't help that some nursing theorists are essentially stating that if you don't have the training as an np in the setting then you are outside you scope of practice. it also doesn't help that the ancc changed their scope of practice in 2004 to remove reference to outpatient medicine without posting justification (haven't checked that one) and apparently the aacn and the aanc are having a pissing contest about the acnp certification with the aacn claiming that the defacto standard for critically ill patients is the acnp.

i'll be honest, usually during these conversations if the word pa is not mentioned i usually don't pay much attention. however, in my area this has the possibility of dramatically affecting patient care. the people that are doing these jobs are more than qualified.

i do get the sense that part of the driving force is $$$. if the fnp's have to return and get an acnp post grad thats more $$$ for the nursing programs. just my opinion.

david carpenter, pa-c

Thanks David. Its not Banner health care. It isn't even the hospitals - the four of us as well as our 4 PAs in our practice are all credentialled at all the five hospitals here in central IL and they are all run by different entities.

Since I'm not even an NP, am unsure where I would stand on this. My clinicals included three areas: acute care, chronic care and geriatrics and I was told I could practice in any of these settings but I can only see adults of course.

At any rate, I'm going to let this go unless I hear something else. Here in IL, APNs are the same: NP, CNM, CNS. The CRNA has another scope of practice.

I have heard this as well nothing official just rumors that hospital credentialing not state law may limit this. It may also be affected my professional liability policies. Personaly I would fight this to the best of my ability. I have noticed that changes in medical staff bylaws take forever to pass in my area so I don't think it will happen in san diego soon, also we don't have an acnp program locally so that will hopefully help keep NPs in hospitals who are not acnpsJeremy

I am a credentialed FNP BUT...

everything ANY NP does in the hospital setting has to be signed off by the collaborating physician in our facility within 24 hours and we can't admit patients. We also can't order any Dx testing without a physician signature. That is just the policy in this particular facility - it isn't the case everywhere.

No NP in our facility is doing anything on their own.

Basically - all I use my credentialling for is the convenience of patients. IE - to get someone discharged timely when they might otherwise have to wait hours, to get them a new order for the GERD medication they have been taking prior to the hospitalization but which didnt end up on the admit orders etc. I don't admit patients, I don't manage hospital patients. In any event - at this facility - no matter what- my collab still has to sign everything off within 24 hours. And frankly - I'm still new enough where I am not doing anything over there without him on the horn at least anyway.

I think that is wholly different from an NP assuming a patient management role. I can't see that an ACNP certification should be needed for that.

Thanks Jeremy.

I am a credentialed FNP BUT...

everything ANY NP does in the hospital setting has to be signed off by the collaborating physician in our facility within 24 hours and we can't admit patients. We also can't order any Dx testing without a physician signature. That is just the policy in this particular facility - it isn't the case everywhere.

No NP in our facility is doing anything on their own.

Basically - all I use my credentialling for is the convenience of patients. IE - to get someone discharged timely when they might otherwise have to wait hours, to get them a new order for the GERD medication they have been taking prior to the hospitalization but which didnt end up on the admit orders etc. I don't admit patients, I don't manage hospital patients. In any event - at this facility - no matter what- my collab still has to sign everything off within 24 hours. And frankly - I'm still new enough where I am not doing anything over there without him on the horn at least anyway.

I think that is wholly different from an NP assuming a patient management role. I can't see that an ACNP certification should be needed for that.

This is the quote that I am seeing:

Unlike physician assistants, nurse practitioners are already directly licensed as professionals, and as such, are legally accountable for their actions. While physician assistants work under the supervision of the physician, on the physician's license and malpractice insurance, in most states nurse practitioners carry separate licensure or certification as a nurse practitioner, in addition to their licensure as a registered nurse.

It comes from a NP outfit in California. It's the accountability of the actions that is worrying the credentialling comittees. While I would agree with you on the collaboration/supervision issue, there are nurses out there that parrot the party line which is you are only allowed to do what you are trained to do as an NP (both educational and experiental). I was talking about this with one of the nurses in the chest pain center who is in an FNP program. Her instructor is telling their class that if you are an FNP and are not working in the role that you should not be eligible for certification as an FNP. Having looked at the requirements I don't see this. It does say you have to retest every six years if you are not working in the role instead of submitting CEU's.

As far as changing medical bylaws, at least around here, bylaws have nothing to do with credentialling. We have had multiple instances where credentialling has refused to credential MD's that were eligible under the bylaws (mostly failing to be board certified). We had an instance where all the PA's in the facility were told they had to get their RNFA in order to work in surgery (guess where that came from). Some of these decisions were overidden by the medical chief of staff, but some weren't.

Our CEO is on an MGMA mailing list for GI and this is a constant topic. In private practice this is potentially a problem because of the use of NPP's to cover clinic and inpatient services.

******controversy warninig*********

Nothing personal here, just my opinion.

In a lot of ways this is the fault of the NP profession. From my perspective there are three main sources of this:

1. Multiple certification agencies with different scopes of practice. All the other areas that a hospital deals with have only one certification agency. With NP's there are at least 5. This is confusing to the credentialling groups and reflects badly on the profession.

2. Lack of cohesion within the profession. A lot of time (my opinion again) it seems that NP's would rather fight among themselves than do what is right for the profession. You have NONPF with one vision for NP's. BON with another. From the outside it looks like there are major problems with NP education (whether they exist or not) and nobody can figure out how to fix them.

3. Independence. In my opinion this is the thing that will hurt NP's the most in the market. The sad thing it is not your fault. Mostly in my state the drive is coming from the CRNA's. However, you have to remember that the physicians are the King Kong in this room. They have a tendency to be bullies and don't really differentiate between the different APRN's. When you go directly at their ability to make money they lash out and things get ugly very quickly.

In my admittedly limited experience the number of NP's that desire independence is small. There have been numerous discussions about this here and my perspective is that there are few NP's (if any) that acheive real indepedence. This is really a stalking horse for the ANA to use to bludgeon physician groups. Ask yourselves this if given the choice between NP indepence nationwide and 1:4 Nursing ratio on the floor which would they choose? Yes NP's are part of a very powerful nursing group, but your interests may not be that same.

******end controversial rant**********

sorry about the rant, but I lost nine hours of my life that I will never get back over this crap last week. Sadly it real doesn't affect me. My advice for what it's worth is make sure your physicians are behind you. If push comes to shove they are the only ones that the hospital cares about. If they are willing to go to bat and make a stink then you will probably be OK. If they aren't they will probably take the path of least resistance. This is also a good time to dust off any calculations you have on how much you bring to the practice and how much you impact thier quality of life.

David Carpenter, PA-C

make sure your physicians are behind you. If push comes to shove they are the only ones that the hospital cares about. If they are willing to go to bat and make a stink then you will probably be OK. If they aren't they will probably take the path of least resistance. This is also a good time to dust off any calculations you have on how much you bring to the practice and how much you impact thier quality of life.

Well said.