Family NP or Adult acute care NP

shadowflightnurse · Mar 12, 2011

Your welcome TJFRN. I'm pretty new in this arena, but I based my decision on schools/programs on current information and current practice in my region. Things at the certifying bodies/schools/facilities may be totally different next week for all I, but you just have to make your decision on the best availabe info you have at decision time. I plan on getting through school, pass the certification exams and practice with the current BON guidelines and within the constraints of my facility policies. Good luck with your decision and application process. I will gladly answer any other questions. You can PM me if you don't want to re-post to this thread.

Annaiya, NP · Mar 12, 2011

Nomad,

I'm with Juan on this unless you can point to something specific that says FNPs can do all. TX is one of the states that does not allow a broad scope of practice. This isn't restricted by saying only AC NPs can work an inpatient setting, it is restricted by saying the NP needs to have education and experience sufficient to be qualified for what they are doing. From what I saw in what you quoted it said the same thing, that education and experience is required. That means you cannot simply be taught something on the job and be qualified.

From everything I've read this is the way things will be going in the future, and it makes sense. As the NP role is expanded, we will need to have the education to support our practice. The expansion of the NP role does not mean that one NP can do it all. It means that by becoming more highly specialized in one area, we can be utilized by more areas in health care.

To the OP:

There are many good online MSN schools, so you are not limited to only schools in your area. Any AC or NNP degrees are going to require RN experience before you can apply, so don't worry about speciality until after you finish your BSN and start working. Within 3 months of starting your first RN job, you should be in a good position to apply to grad school, assuming you plan on working full-time while going to school. If not, you may need to work 1-3 years before you can apply.

nomadcrna, DNP, CRNA, NP · Mar 17, 2011

Of course you need the education to practice in various areas. That is what I've been saying and what the model proposes. The same way credentialing works in a hospital. I can show training in central lines, chest tubes and minor surgical procedures like i&ds, advanced airway management also. I am able to be credetialed to do these because I can show education in these areas.

The model states that education can occur concurrently or after you graduate. So for instance the FNP who wants to do ER, can obtain education, maybe a short fellowship? It could be a specialized class.

The point is all NP will have the opportunity to add to their abilities without the huge headache it is now.

I would like to see the schools put out something like a generalist practioner who have the opportunity to focus on a particular patient population.

It is very common for the generalist, ie: fp doc, ER doc, FNP to cover the ER and inpatients in rural America. There is nothing wrong with it. It makes for good practitioners.

I'm typing on my iPad which I hate so will add more tomorrow.

nomadcrna, DNP, CRNA, NP · Mar 17, 2011

Ok, much better typing on a keyboard. So anyway, the original topic was not debating the consensus model as much as whether the states are increasing their limitations of various NP. As in what has been said about the Texas model not allowing FNP to treat patients in the acute care setting.

My first point is that texas has one of the most restrictive NP models in the country. This is hopefully changing for the better with this legislative session. I can only speak for the states I'm licensed in so check up on my "opinions" :).

Washington, Idaho, Montana, Alaska, Arizona and California do not place restrictions as onerous as Texas. FNPs can and do function in the acute care settings as in ER and hospitalist rolls.

Now the consensus model and scuttlebutt on the various places make it appear that the states are "hopefully" going to loosen their restrictions. I've not seen anything close to what was said about more states becoming more restrictive and NOT allowing FNPs to function in the ER or as a hospitalist.

A nurse practitioner should be able to function according to their education and training. There are many mini fellowship courses available to get you started in ER or hospitalist type medicine.

In regards to the urban vs rural medical models. What would you have the rural towns do in regards to providing care to their populations? Here in the wilds of Alaska, I may see a patient in the clinic or ER and decide to admit them or transfer. If it is straight forward, admitting and keeping is an option. I have a patient in the clinic today with what appears to be a surgical abd. He will most likely fly out to anchorage to see a surgeon.

Ortho cases: if the fracture is non-displaced and uncomplicated. I may consult with an ortho doc and cast it myself and keep them. Anything more complicated gets shipped.

We have no CT scan here so many patients need to be transferred for that reason alone.

Now when I was in Montana, it was a simple matter to to get an ortho, IM or surgical consult either in the ER or inpatient side. That is what being a "practitioner" is and the NP is no different from a physician practitioner.

We need to know when to refer and get consults. It is an interesting time and it looks good for the NP

NPinWCH · Mar 17, 2011

Okay, scope of practice can depend a lot on the Nurse Practice Act of your state. I know in Ohio that the hospitals are moving away from using FNPs in any capacity except as part of a hospitalist group and occasionally in ER where the FNP would see the non critical patients. An ACNP may work in an urgent care, outpatient surgical area/center or some type of specialty practice, but would not see patients in a family practice type setting. This is due to how the BON views the two specialties.

Wright State University addresses the question here: http://www.facebook.com/topic.php?uid=311686253880&topic=11902

The highlights are: 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(See the OBN Decision-Making Guide for Determining Individual APN Scope of Practice at the end of this document.)

They then quote the Consensus Model that has been posted already, then add:

Furthermore, the scope of practice as a CNP is more specifically defined by the practice of the associated collaborating physician and the standard care arrangement between the CNP and collaborating physician. In the state of Ohio, the requirement by law is that the supervising or collaborating physician's practice is the same or similar to the nurse's practice (OAC 4723-8-04.). The collaborating physician's practice and the standard care arrangement however, do not serve to expand the education and certification as an acute care, or adult, geriatric, pediatric or women's health CNP.

In order for a primary care NP to manage and treat acute, clinically unstable clients, or the acute care NP to manage patients in a primary care setting, both would need appropriate education and certification in that prepares the primary care NP to manage acutely ill clinically unstable clients, and the acute care NP to manage primary care patients. scope of practice is dependent on the NP education and training - not on prior nursing experience. If you plan to be certified as both a primary care and acute care NP, you will have to complete the required hours for certification in both specialties--clinical hours used for one certification cannot be applied towards an additional certification. Nurses with a masters degree in one field, have the option of returning for a second masters or post-masters certification in another specialty.

nomadcrna, DNP, CRNA, NP · Mar 17, 2011

That is from your state board. From the consensus model.

The certified nurse practitioner (CNP) is prepared with the acute care CNP competencies and/or the primary care CNP competencies. At this point in time the acute care and primary care CNP delineation applies only to the pediatric and adult-gerontology CNP population foci.

For the above, it would be nice to see one test instead of two. Incorporate the FNP and acute tests into one.

The bottom line is we are in for interesting times. I hope all the states work toward letting NP practice according to their education and training and not their titles.

I also hope to see the DNP programs become more clinically oriented instead of the EBP approach they have now. I would love it if all DNP programs prepared the NP as a FNP the first couple of years and then specialize into whatever area you want. It could be peds, ER, hospitalist, anesthesia, orth, womens health etc. You see my point.

nomadcrna, DNP, CRNA, NP · Mar 17, 2011

Another tidbit below from the model. I don't even see ACNP under the six foci.

Under this APRN Regulatory Model,there are four roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). These four roles are given the title of advanced practice registered nurse (APRN). APRNs are educated in one of the four roles and in at least one of six population foci: family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women’s health/gender-related or psych/mental health. Individuals will be licensed as independent practitioners for practice at the level of one of the four APRN roles within at least one of the six identified population foci. Education, certification, and licensure of an individual must be congruent in terms of role and population foci. APRNs may specialize but they can not be licensed solely within a specialty area. Specialties can provide depth in one’s practice within the established population foci.

NPinWCH · Mar 17, 2011

That is from your state board.

Yes, it is from my state board, which is what I was stressing. We can talk all we want about how things should be, but in reality we can only practice the way the state board says we can. In Ohio, I don't have full authority to prescribe schedule II drugs. Was I trained to do that? YES. Am I capable and educated? YES.

Unfortunately, it doesn't matter because the board says no. So, the OP needs to know what the realities are for their state of practice.

I hope all the states work toward letting NP practice according to their education and training and not their titles.

I for one can say that I am NOT really qualified to do most of the work an ACNP does. Even if I had 15 years of experience as an ICU RN my FNP courses didn't train me for acute inpatient management of critical patients. I simply am not qualified. Could I work in an ER? Sure. Could I work in a CICU along side ACNPs? Heck no!

My brother in law is an ACNP, but he had no pediatric training. He didn't get the training I did. His focus was on acute care of acutely ill and critically ill patients. My training was on primary care diagnosis, treatment and follow up. We complement each other with some overlap, but we can't completely replace each other.

I also hope to see the DNP programs become more clinically oriented instead of the EBP approach they have now.

I completely agree with you on this point. I still struggle to see the MAJOR difference between the DNP and PhD or other nursing doctorates. If they really mean to make the DNP the only degree available for APRNs then make it practice/clinically oriented. I don't want to be called doctor, but if getting a DNP would help improve my practice, I'd be all for it.

Right now, it just seems like one more degree, a heck of a lot more money, more work and nothing but a piece of paper to hang on my wall.

nomadcrna, DNP, CRNA, NP · Mar 18, 2011

Good post. The key is that you have the foundation to do acute care. All you need is a mentor or class to add to your knowledge.

Inpatient medicine is not that hard, especially with a mentor to guide you until you become proficient.

I agree that the state board is the limiting factor, as it stands now. That is one goal of the consensus is to have the competence at the specialty level be regulated by professional organizations and not the boards of nursing. This is how the physicians do it.

We can always hope. Until then, come to the northwest, we would love to have you.

chagermany · Mar 18, 2011

Another option I have not seen anyone mention is being certified in dual specialties. For example, get your FNP then do a post-Master's program for the acute care. I am about to begin a program that is molded for an ED role. At the end of the program I will be eligible to sit for both FNP and adult acute care. It is a little longer than other programs, but to be prepared to sit for both exams...eithout having to go back to school :) makes it worthwhile to me.
I'm sure you will hear otherwise, but this is purely an opinion. Get plenty of GOOD quality clinical experience before going back to school. Many schools are decreasing/dropping their requirement for experience and I (again, my opinion) think this is a mistake.
Good luck in your efforts!!

What school are you going to?

FNPdude74 · Mar 18, 2011

Yeah the course title turn me off a bit on these DNP programs. I think having dual FNP/ACNP is your best best...there is schools like Duke University doing that. Or you can get FNP, then get ACNP after (1 year post-masters program). You'll be in school for 3 years with dual cert. do it before 2015 though.

ED_Nurse_in_the_Hood · Mar 26, 2011

Wow, do any other schools offer a combined FNP/Acute Care NP program? This seems like an ideal solution for the dilemma. Thanks!