ACNPs working in clinic settings...

  1. I am certified as an Adult Acute Care NP. I currently work in a hospital, but am thinking about changing my job. I am curious about ACNPs who work in clinic settings. Wouldn't a clinic setting be considered more primary care vs. acute care? Say for example, I wanted to work in a Cardiology Clinic...would that be considered primary care or acute care? I guess I am trying to figure out where I belong. I enjoy acute care, but maybe I should go back and get a post-Master's certificate in adult primary care as well.
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  2. 7 Comments

  3. by   core0
    Quote from christvs
    I am certified as an Adult Acute Care NP. I currently work in a hospital, but am thinking about changing my job. I am curious about ACNPs who work in clinic settings. Wouldn't a clinic setting be considered more primary care vs. acute care? Say for example, I wanted to work in a Cardiology Clinic...would that be considered primary care or acute care? I guess I am trying to figure out where I belong. I enjoy acute care, but maybe I should go back and get a post-Master's certificate in adult primary care as well.
    This is from ANCC's certification:
    "The Acute Care Nurse Practitioner (ACNP) is a registered nurse prepared in a graduate level acute care nurse
    practitioner program to provide and manage health care of acutely ill, critically or chronically ill adult patients
    in a wide range of settings."

    From a physician point cardiology is not primary care. I have a hard time seeing how it would be from a nursing standpoint. Does primary care take care of cardiology issues? Yes. But its in the setting of primary care and preventative health care. Cardiology also does preventive health care but in the realm of chronically or acutely ill cardiology patients.

    If you listen to Tracy Klein speak she roughly delineates the range like this:
    FNP = Primary care in all age groups in an outpatient setting, nursing home, urgent care.
    ANP: Primary care for adults in an outpatient setting. Specialty medical care in an outpatient or inpatient setting (if you can demonstrate clinical and didactic experience in inpatient medicine). No critical care. Nursing home. urgent care
    ACNP: Specialty medical care for adults in outpatient, inpatient and critical care settings. Emergency medicine. urgent care.

    So the only real overlap for all three per the various certifications is urgent care. We are looking at hiring additional NPs and PAs in our group. The word from hospital credentialling is that to see the patient in all three environments (clinic, floor and ICU) we should only look at ACNPs. If you want to do adult primary care then an ANP would benefit you (although a FNP would probably benefit you more). If you want to work in specialty medicine then you have the appropriate degree (at least in my non nursing opinion).

    David Carpenter, PA-C
  4. by   DaisyRN, ACNP
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    the problem lies in how you are trained. as an acnp, i received both inpatient and outpatient training (because my school mandated it in the curriculum)... therefore, my formal apn education can support my current cardiology position, as discussed in your other posting. the scope of practice issues usually relate to someone working in a position where they have no educational exposure. if i had not received an outpatient clinical rotation in my program, i don't know that i should be in outpatient cardiology. the information out there is so vague, but i did purchase a book from aacn that is the scope and standards of an acnp and it does specifically say, "inpatient and outpatient" settings. but, i am not aacn certified... it's just the only place i could find that information.

    in cardiology, it is my thought that the information you need to know would not adequately be covered in a primary care program because there is sooooo much to learn, so an acnp would be appropriate as most of acnp programs incorporate more in depth lectures and topics related to cardiology. i think there should be straight cardiology nps because there's enough cardiology information to take up a whole program... but that's neither here nor there. i know that several of my fnp friends did not get a great deal of cardiology exposure. they touched on all the major issues you would see in primary care like hypertension, hyperlipidemia, heart failure, but the higher level of education was not there. in the cardiology group i am with, we get referrals from pcps regarding difficult to control blood pressure, heart failure exacerbations, etc. which is beyond pcp comfort levels. they usually exhaust all their efforts in managing the primary care issues and by the time they get to us, they really are an "acute" patient... even though you're in an outpatient setting. does that make sense? i think as an acnp you are fine to work in cardiology.

  5. by   ghillbert
    ACNP scope is not related to geographical location, but to the acuity of the patients. If your patients are chronically, acutely or critically ill, it's my understanding that you're covered.
  6. by   christvs
    Quote from daisyrn, acnp
    [font="comic sans ms"]
    the problem lies in how you are trained. as an acnp, i received both inpatient and outpatient training (because my school mandated it in the curriculum)... therefore, my formal apn education can support my current cardiology position, as discussed in your other posting. the scope of practice issues usually relate to someone working in a position where they have no educational exposure. if i had not received an outpatient clinical rotation in my program, i don't know that i should be in outpatient cardiology. the information out there is so vague, but i did purchase a book from aacn that is the scope and standards of an acnp and it does specifically say, "inpatient and outpatient" settings. but, i am not aacn certified... it's just the only place i could find that information.

    in cardiology, it is my thought that the information you need to know would not adequately be covered in a primary care program because there is sooooo much to learn, so an acnp would be appropriate as most of acnp programs incorporate more in depth lectures and topics related to cardiology. i think there should be straight cardiology nps because there's enough cardiology information to take up a whole program... but that's neither here nor there. i know that several of my fnp friends did not get a great deal of cardiology exposure. they touched on all the major issues you would see in primary care like hypertension, hyperlipidemia, heart failure, but the higher level of education was not there. in the cardiology group i am with, we get referrals from pcps regarding difficult to control blood pressure, heart failure exacerbations, etc. which is beyond pcp comfort levels. they usually exhaust all their efforts in managing the primary care issues and by the time they get to us, they really are an "acute" patient... even though you're in an outpatient setting. does that make sense? i think as an acnp you are fine to work in cardiology.
    ok, i see what you are saying. i did one of my np clinicals in a cardiac surgery clinic. i assessed pts before and after their cardiac surgeries, and also did f/u phone calls once they went home...so i do feel i have some good exposure to cardiology at least...that and with my 3 years of work as an rn on a tele unit, plus i did a cardiology subspecialty in my np program as well. hopefully my interview with a cardiology group on friday will go well!
  7. by   DaisyRN, ACNP
    [font="comic sans ms"]
    keep us posted!!

    good luck!

  8. by   CrazyPremed
    It also depends upon where you live and your state's nurse practice act. I have three close NP friends (I'm an RN myself) - and work with NP's in the hospital setting - who all work for specialists and follow their patients in the hospitals and clinics. They are all FNP's who have been trained to do so. Eventually, some of them would like to go back to school for the ACNP, but - at this time - they don't have to.

    I do think that the trend in some areas will be to change this, but - where I live - this is not current practice. Many of the NP's that I speak with recommend pursuing the FNP for the greatest job opportunities, then specializing later if need be.

    CrazyPremed
  9. by   christvs
    Quote from CrazyPremed
    It also depends upon where you live and your state's nurse practice act. I have three close NP friends (I'm an RN myself) - and work with NP's in the hospital setting - who all work for specialists and follow their patients in the hospitals and clinics. They are all FNP's who have been trained to do so. Eventually, some of them would like to go back to school for the ACNP, but - at this time - they don't have to.

    I do think that the trend in some areas will be to change this, but - where I live - this is not current practice. Many of the NP's that I speak with recommend pursuing the FNP for the greatest job opportunities, then specializing later if need be.

    CrazyPremed

    I know that the patients I would be seeing in this Cardiology NP position are all adults, so at least I don't have to go back for my FNP or PNP. As long as I get a good orientation (not like the one I had with my current position-that orientation was just 1 month long), I think I will like it. Wish me luck!

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