A couple questions

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    Are there bridge programs for acute/critical care nps to become a primary care adult np?

    Can acute care nps have their own practice/do primary care?

    Thanks for your replies.
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  3. 7 Comments so far...

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    Not really a bridge program. You just complete a post-masters certificate in primary care, which will include more courses and clinical. Then take certification exam.
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    I agree with Zenman. Everyone I know with more than one certification went back to a post master's program. I have never heard of a "bridge" program for NPs.
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    I'll touch on your second question by saying check with your state BON. Independent practice for ANY NP varies by state. The acute care vs. family/primary care debate continues to argued, so I don't know if there is a clear answer. I know in my state, Ohio, the BON has issued an opinion that acute care should focus on acutely ill inpatient, hospital based clients and primary care NPs (WHNP,FNP,ANP, PNP) are just that, providers of primary, outpatient care. This is based on guidelines from the National Organization of Nurse Practitioners Faculties:

    According to the competencies set forth by the National Organization of Nurse Practitioner Faculties (NONPF),2 the Scope and Standards of Practice for the ACNP (acute care nurse practitioner),3 and NAPNAP,4 acute care nurse practitioners are educationally prepared to provide advanced nursing care to patients with complex acute, critical and chronic health conditions, including the delivery of acute care services, such as those patients found in the critical care areas throughout the hospital. These programs of study do not contain adequate clinical and didactic content to support the ACNP for a broader role in outpatient primary care diagnosis, treatment, and follow-up. In contrast, adult, women, geriatric, family and some pediatric nurse practitioners educational focus is on primary care. For instance, the family nurse practitioner is a specialist in family nursing, in the context of community, with broad knowledge and experience with people of all ages.5 NPs prepared with a primary care focus primarily practice in ambulatory care settings, including family medical practices and women health centers. This environment of primary care is not congruent with the acute care secondary or tertiary care training focus. A lack of congruence between the practice environment and level of expertise results in a decreased level of safety for the patient and increased risk of liability for the CNP.6,7


    The Consensus Model goes on to say:

    The certified nurse practitioner (CNP) is prepared with the acute care CNP competencies and/or the primary care CNP competencies. Scope of practice of the primary 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. If programs prepare graduates across both sets of roles, the graduate must be prepared with the consensus based competencies for both roles and must successfully obtain certification in both the acute and the primary care CNP roles. CNP certification in the acute care or primary care roles must match the educational preparation for CNPs in these roles.

    There are still some grey areas. Is ER considered to acute for an FNP? Derm may be okay for an FNP, but is cardio ACNP only? No one really knows. So, many hospitals are making their FNPs working inpatient go back and add ACNP and any ACNPs in primary care are being told they need to get their FNP/ANP within a certain time frame. The BON isn't saying fire anyone, but they are hinting that after the dreaded 2015 you may not have a legal leg to stand on in certain situations. All a lawyer has to do is point at the consensus model and say, "It says right here that your training as an acute care NP would not fully prepare you to care for patients in a primary care setting. You didn't certify as and FNP, yet you took care of Mr. Doe in Anytown Family Practice. How can that not be malpractice?...Thank you very much, Mr. Doe here is your $$$$$ check."

    APN Scope of Practice Council for Ohio Health Care Advocacy
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    In my state they have not yet begun the transition to the Consensus Model and the acute care NP positions here still ask for FNP. I assume that will change in time, but I don't know if those already holding those positions will be allowed to stay. I assume yes, b/c there isn't going to be anyone to replace them! I checked the University listing and there is one ACNP, in cardiothoracic surgery. ONE. All of the rest are FNPs and PNPs, and very occasionally, a PA.
    sandnnw likes this.
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    How long does does post master's certification take? Do some of the courses transfer if you complete the certification at the same school that you got your MSN?
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    Do you feel like an ACNP would have better diagnostic skills than an FNP or an ANP?
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    Quote from BSN Student +Tech
    How long does does post master's certification take? Do some of the courses transfer if you complete the certification at the same school that you got your MSN?
    Most post masters certificates take three semesters, HOWEVER, that is if you stay within the adult realm. My ACNP classes did not include Any pediatrics at all, and very little OB. in other words, if say I wanted a post masters in FNP, then I would need to retake patho and pharm as well as my other FNP classes. I think the FNP program is also longer than the others.

    To answer your next question about diagnostic skills, the answer is no. All roles require diagnostic skills, one isn't better than another. The training is just different. I work in a critical care setting, I don't know much about primary care. If a patient came to me with a fever, I'd start thinking of all of the things that occur in critical illness, and totally miss that it was a sinus infection. Neither is better, neither is really harder either. It is just what your scope and training and clientele contains


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