Adult NP seeing kids

mountainaireNP · Feb 26, 2014

I know how you feel about going back to school. As an adult NP myself with ridiculous student loan debt the thought of going back to school makes me cringe nut that's exactly what I'm having to do, as jobs are virtually nonexistent.

Wish I had some advice for you, I just know I'm kind of in the same boat.

Advanced Practice Columnist / Guide · Feb 26, 2014

The truth is Michigan does not currently have a Scope of Practice for NP's. The roles NP's perform fall under Registered Nursing practice (Scope of Practice as an RN) and the provider roles (evaluation and management, prescribing) are performed as a physician delegated role. Michigan defers to national standards in terms of NP practice but this is not written into the Michigan Public Health Code.

Technically, you won't run into trouble by BON criteria but you could potentially be questioned when something goes wrong as far as your competence in caring for children in a court of law. I am not sure if there has been actual cases of such in Michigan. When I worked in that state, I knew practicing NP's violating training-specific stipulations of their certification (WHNP working in an IM setting, ANP seeing kids in ER). I personally would err on the safe side and avoid those circumstances. Sorry you have to be in this situation.

cruisin_woodward · Mar 5, 2014

Thank you Juan, that is my concern. I am less concerned in the OR, because I am assisting. But I will be in the office by myself (that is a very scary thought LOL). I think for now, I will tell them not to schedule children on days that I am alone in the office. Perhaps once my loans ease up, and I start actually making money, I can go back. It is only 10 credits post graduate certification. That seems achievable. It's more the $$ aspect and finding clinical sites that stresses me out. I wanted to go for my FNP originally, but assumed that I would be more acute care based, and FNP is, from how it was explained to me, a primary care role. Working in a specialist office is in the "grey area". I really hate that the powers that be have split NP roles up into so many categories.

allnurses Guide · Mar 5, 2014

Juan provided some great advice.

If it were me, I would not risk my education, license, and livelihood without having a discussion with the BON and my malpractice provider. It's just tok much of a risk.

What would your response be in court if you were asked what your training was in pediatric pharmacology after an adverse reaction?

I would want to protect myself and my patients by not practicing outside of my scope. I am an FNP and occasionally I have a patient in the ICU which I defer to my colleague MD because I don't feel that level of acuity is within my training and scope.

kguill975, MSN, APRN, NP · Mar 5, 2014

I've been in this situation before, I'm an ACNP/First Assist, too. You can first assist, because that's a certification that is gained with RN licensure, it has nothing to do with NP scope of practice. You can round on the pt, and do dressing changes, but you cannot prescribe or order any thing. When you write your note, you can write the A/P, but you have to tell the nurse that they need a telephone order from the doctor, if the pt needs something. The role is similar to that of a scribe. Any duty that can be done by a RN without a doctor's order can be carried out by you for a pedi pt. Anything else, they need an order from the Dr. It's a hassle, but being a first assist is so much fun!

Edited to say that if you decide to see those pedi pts, it's YOUR responsibility to make sure that the MD is signing your chart. We all know how prompt and attentive they can be. (Hint of sarcasm)