FNP doing procedures - Page 2

I agree that NPs definetely lack A) the thorough gross anatomy training that MDs get, and B) that procedures are not uniformly taught in NP programs. BUT I think it depends on the quality of the clinical training you get. I have friends who opted to spend more time in procedure clinics and ERs, and got 'sufficiently proficient' at some ortho stuff (aspirations and injections, casting/splinting) and lower-risk minor surgery, e.g. laceration repair, cyst/lypoma excisions, I&Ds, biopsies, skin scrapings.

The training, role and practice of Family Nurse practitioners is grounded in primary care. The national NP organizations are encouraging State Boards of Nursing to limit the practice of FNPs to primary care settings, and more employers are encouraging their present staff with FNP certification working in inpatient areas or specialty clinics to go back to school and obtain ACNP certifications.

If the OPs true love is the procedural arena, then a FNP program may not be the best choice.

Disclaimer, I am an independent practitioner in family practice.
I do arthocentesis and intra-articular injections several times a week. I also do a lot of shave and punch biopsies, colposcopy, IUDs, I&Ds, and botox and fillers. Yesterday I removed several large sebacious cysts (and sacs) that required suturing afterward. My rule of thumb is, if it were something I'd want a plastics expert to do for myself or my kid, I refer it to plastics. I do not generally sew faces, except in cases like the patient that insisted he didn't care about the scar and just wanted his eyebrow sewn back on in a hurry, lol. I had suturing in school but I didn't get good at it until I practiced. I had several weeks worth of instruction on reading xrays in school. I am expected to do a preliminary read on my my own films, but like my colleagues, I rely on my own interpretation only to assess the highlights and defer to the radiologist for the final word. This too was a skill I learned with practice and reinforcement from people with more experience. Someone brought me copies of his head CT earlier this week and I honestly wondered what he thought any of us in a primary care office would do with them, lol. I just told him I was clueless about them. If that true solely because I am not a MD provider, well I can live with that and he will too.

I do agree that gross anatomy would have been great fun and a thrilling learning experience. It's a pity that it isn't available to NP students but as I understand it, it is very difficult to get the number of cadavers needed for medical students as it is. Clearly, if they are to be rationed, it makes sense to appropriate these limited resources to medical students.

Yes to all you asked.
suturing is pretty basic. I'm not sure how you can even do clinic without this skill.
Casting, splint, joint injections, aspirations, I&D, minor office surgeries, xray interpretation are all skills you need in the clinic.
I don't do endoscopies but there is an FNP in the large city near where I am that does a fantastic job. She was taught at that hospital.

If you solo ER, you need to be proficient in intubations, chest tubes, central lines, trauma resuscitation etc.
You do not need a physician, period. At least in the states that I choose to work.

As others have said, much depends on the state and facility credentialing. Facilities can be tough. I always work to change the bylaws to be NP friendly.

Where I currently practice. NPs are full members of the med staff. We admit and manage our own patients. It is a great practice.

You just need to figure out a way to get the education and training. There are intensive courses but the best way is to have a mentor who can teach you and lots of opportunities to practice.
If you have an OR, talk to the CRNA. I was always happy to teach NPs to intubate and let them practice.

First I've heard of NP organizations encouraging state boards to limit FNP practice. Do you have link or article to back this up?
More states allow full practice as long as you can back it up with education or training.
Rural areas have a great need and FNPs full a role. Part of primary care IS admitting and managing your patients.
Most rural hospitals WANT the FNP to be well rounded and able to "do it all".

American Academy of Nurse Practitioners
Nurse Practitioners in
Primary Care
Administration
P.O. Box 12846
Austin, TX 78711
P 512.442.4262
F 512 442.6469
Office of Health Policy
P.O. Box 40130
Washington, DC
20016
P 202.966.6414
F 202.966.2856
With 89% of the nurse practitioner (NP) population prepared in primary care and over 75% of
actively practicing NPs providing primary care, NPs are a vital part of the U.S. primary care
workforce. Evidence supports the high quality and cost-effectiveness of NP care and the continued
interest of the discipline to contribute to solving the primary care dilemma.
Ninety percent of the 140,000 NPs credentialed
to practice in the U.S. are actively practicing.
Fulfilling the potential of the Affordable Care Act
(ACA) requires transformation of primary care
delivery within the U.S. NPs are a vital element
of the primary care workforce with a major role
in making high-quality, patient-centered health
care available to the broadest possible range of
consumers. In fact, NPs make up the most
rapidly growing component of the primary care
workforce. As licensed independent providers
prepared with a blend of medical and nursing
preparation, NPs are uniquely prepared and
qualified to provide the patient-centered care
that is central to meeting the existing and future
primary care needs of our nation.
NP Scope of Practice and Preparation
The NP scope of practice includes blending
nursing and medical services for individuals,
families, and groups. NPs diagnose and manage
acute and chronic conditions and emphasize
health promotion and disease prevention. Their
services include, but are not limited to ordering,
conducting, and interpreting diagnostic and
laboratory tests; prescribing pharmacologic
agents and non-pharmacologic therapies; and
teaching and counseling. They practice
autonomously and in collaboration with other
healthcare professionals to manage patients’
health needs.
NPs are prepared through academic graduate
(master’s or doctoral) programs, which include
didactic and clinical courses designed to prepare
graduates with specialized knowledge and clinical
primary care competencies. Members of the
profession are responsible for advancing the NP
role, specifying the professional standards and
competencies, as well as ensuring that these are
met.
NP Commitment to Primary Care
Almost all NPs (89%) are prepared in a
primary care focus; e.g. adult, family,
gerontological, pediatric, or women’s health.
The family NP focus is the most prevalent
category (see below). Regardless of their
population focus, primary care NPs are
prepared to fulfill the definition of primary
care across settings, including the provision
of care at first contact for undifferentiated
conditions, ,ongoing management of acute
and chronic conditions, health promotion,
and care coordination.
Specialty Percent
Acute Care 5.3
Adult 17.9
Family 49.2
Gerontological 3.0
Neonatal 2.3
Oncology 0.8
Pediatric 9.4
Psychiatric/Mental Health 2.9
Women’s Health 9.1
NP Growth
The enrollment and graduation rates of NP

http://www.ena.org/SiteCollectionDoc...hite_Paper.pdf

Advanced practice registered nurses working in emergency settings are experienced providers. In a
survey of 166 advanced practice registered nurses who worked in emergency departments,
approximately two-thirds (63%) of the respondents were nurse practitioners, 28% were clinical
nurse specialists, and 9% were both nurse practitioners and clinical nurse specialists.
8
The
respondents had practiced professional nursing for about 15 years before becoming advanced
practice registered nurses, and most had worked as an advanced practice registered nurse in the
emergency department for more than 5 years.
8
Currently, there are no national specialty
certifications for nurse practitioners or clinical nurse specialists practicing in emergency care
settings; however, many advanced practice registered nurses hold a national certification for
practice as a nurse practitioner or clinical nurse specialist. Advanced practice registered nurses in
emergency settings reported being certified most often as family nurse practitioners (43%), acute
care nurse practitioners (13%), adult care nurse practitioners (12%), pediatric nurse practitioners
(7%), women’s health nurse practitioners (<1%), critical care clinical nurse specialists (9%),
medical-surgical clinical nurse specialists (5%), pediatric clinical nurse specialists (<1%), and
other clinical nurse specialists (10%).
8

National Organization of Nurse Practitioner Faculties: Consensus Model for APRN Regulation

If you look here, you can see what the National Organization of Nurse Practitioner Faculties has to say about scope of practice for Acute vs Primary NP's. I'm attending FNP school, and the administration there is adament that we are being prepared only for outpatient primary care and won't even allow us to do clinicals in a hospital. They also state that when they receive requests for recommendations from hospitals about possible employment for grads, they reply to them that we are trained only for outpatient primary care.

I am familiar with the consensus model. We are discussing it at our state board now. A few states have passed it but it remains to be seen if more do the same. Many rurual states (mine included) do not like the wording as many ERs ar staffed by FNPs.
The model is meeting much resistance in our state and may not pass.
If you read it, you will see that the FNP can still do ER and inpatient care. Intensive care will not be within the scope though.
It remains to be seen if the states will jump on board with the consensus model.
I am against it until the NP schools get their act together. A much better model would be a broad based basic program that incorporates all populations then specialize afterwards. The DNP is a perfect road to that end.

focus. For example, a family CNP could specialize in elder care or nephrology; an Adult-Gerontology CNS could specialize in palliative care; a CRNA could specialize in pain management; or a CNM could specialize in care of the post-menopausal woman. State licensing boards will not regulate the APRN at the level of specialties in this APRN Regulatory Model. Professional certification in the specialty area of practice is strongly recommended.
An APRN specialty
• preparation cannot replace educational preparation in the role or one of the six population foci;
• preparation can not expand one’s scope of practice beyond the role or population focus
• addresses a subset of the population-focus;
• title may not be used in lieu of the licensing title, which includes the role or role/population; and
• is developed, recognized, and monitored by the profession.
New specialties emerge based on health needs of the population. APRN specialties develop to provide added value to the role practice as well as providing flexibility within the profession to meet these emerging needs of patients. Specialties also may cross several or all APRN roles. A specialty evolves out of an APRN role/population focus and indicates that an APRN has additional knowledge and expertise in a more discrete area of specialty practice. Competency in the specialty areas could be acquired either by educational preparation or experience and assessed in a variety of ways through professional credentialing mechanisms (e.g., portfolios, examinations, etc.).
Education programs may concurrently prepare individuals in a specialty providing they meet all of the other requirements for APRN education programs, including preparation in the APRN core, role, and population core competencies. In addition, for licensure purposes, one exam must assess the APRN core, role, and population-focused competencies. For example, a nurse anesthetist would write one certification examination, which tests the APRN core, CRNA role, and population-focused competencies, administered by the Council on Certification for Nurse Anesthetist; or a primary care family nurse practitioner would write one certification examination, which tests the APRN core, CNP role, and family population-focused competencies, administered by ANCC or AANP. Specialty competencies must be assessed separately. In summary, education programs preparing individuals with this additional knowledge in a specialty, if used for entry into advanced practice registered nursing and for regulatory purposes, must also prepare individuals in one of the four nationally recognized APRN roles and in one of the six population foci. Individuals must be
APRN Joint Dialogue Group Report, July 7, 2008
13
recognized and credentialed in one of the four APRN roles within at least one population foci. APRNs are licensed at the role/population focus level and not at the specialty level. However, if not intended for entry-level preparation in one of the four roles/population foci and not for regulatory purposes, education programs, using a variety of formats and methodologies, may provide licensed APRNs with the additional knowledge, skills, and abilities, to become professionally certified in the specialty area of APRN practice.

That is a shame. I did a huge amount of ER and inpatient medicine in my program. I was with two great family practice docs who literally did it all. I did clinic with them, followed the inpatients and did many hours in the ER with them as well.