FNP doing procedures

Trauma Columnist · May 5, 2009

What an APN can do in the clinical setting is based on several factors: scope of practice in that state and credentialling in that particular institution. The later is the usually the biggest. For instance, I'm a pre hospital RN certified at the ALS (adv life support level) so as an RN, I intubate, place IV's, etc., in the pre-hospital arena (I'm on a volunteer squad). I am also an APN credentialled at 6 institutions and my credentialling there ranges from doing H&Ps, consults, discharge summaries (which all must be cosigned by an MD) to seeing, examining, treating ER patients (I work two jobs).

So..the answer is that it varies tremendously.

carachel2 · May 5, 2009

I'll speak out here and say that I think the training for procedures is dismal for NPs and the lack of a gross anatomy component for NPs is an embarrassment....especially if we continue to demand that our role allows us to be in hospitals, ERs, etc. Don't get me wrong, I feel very well trained to work in a family practice office, assess, plan and treat most of the patients that come in the door. But I spent maybe three hours sitting in a class suturing a pigs foot and we've never once revisited that skill. When I have asked about this, we were encouraged to attend national and state conferences where they have 1-2 day "pre-conferences" where they offer more intense suture and procedure training. We had a skills class, but without the repetition and the continued skills practice, I just don't feel it is enough.

Maybe this is program dependent and there are other schools that offer more, I don't know. I'm friends with NPs from two other different programs and they say the same thing so I tend to think it is a common flaw.

I love NPs and have one as my main provider, but I would *NEVER* let her suture me or do any other invasive type procedure.

ArkansasFan · May 5, 2009

Well, like I said I knew it would vary between states and it goes unsaid that it would vary between institutions.

I guess those procedures are just not taught then. It's obvious that an FNP would have to take histories and physicals, etc. I just wondered where, if ever, the procedures that you could have done at your family practitioner's (MD) clinic were taught to FNP students. I'm assuming by the replies that joint aspirations, would debriedment, endoscopies, and so forth aren't done at all by FNPs. ?? Thanks for the replies, ladies.

carachel2 · May 5, 2009

Don't get me wrong, the skills ARE taught, but not in depth and not repetitively.

drfitness · May 5, 2009

I want to thank both of you , Arkansasfan and carachel2 for the posts! I am about to possibly start an NP program and I too was wondering where the gross anatomy component was and how intense we would learn to suture , etc! Thanks for the honesty in the replies, Carachel2!

kurtzmobile · May 5, 2009

Dear ArkansasFan,

I believe FNP's are a blessing to a healthcare system that is crying for Family Practice Physicians. Just as any career, there are components that one learns in a fashion that is both learned scholastically and through clinical on the job integration (i.e. suturing, chest tubes, etc...).

I would tend to agree that the lack of additional A&P studies is somewhat a shame. Physicians have the beauty of gross anatomy which I believe would be a great addition to the NP curriculum. One has to remember though that the role of the NP is relatively a new one with the physician dating back centuries; the role and edu is ever evolving. The NP originated in CO in the 1960's out of need for pediatric care and the realization that Nurses could be trained in advance practice and fill a need.

I have completed so many procedures that I cannot begin to count. It is fun and an art that is taught both in school and further appreciated in clinical rotations. I am an advocate for NP's doing procedures. We are just as capable as MD's within our scope of course.

As far as the PA and NP role....the clinical components tend to blur, however, the backgrounds vary. There is one thing that remains the same. The NP always is a BSN prepared RN prior to the NP degree achieved.

I am an advocate for the NP!

Great discussion posed:)

jer_sd · May 5, 2009

Yes NPs do procedures. I work in a procedure heavy area. Learning how to do procedures does not make a health care provider. In the duration of your career new procedures will come into practice and others will almost go away.

Learning to asses patients, plan treatments and manage patients is where the difficulty is. For minor procedures you can train anyone to do them, knowing when to do them or not to do them is the more important part. If you have a firm understaning of the sciences behind what we do you you will be able to learn how to do procedures appropriatly.

Yes in my NP education we had skill labs for suturing and other invasive procedures.

Jeremy

Advanced Practice Columnist / Guide · May 6, 2009

I do believe that many NP programs lack the capacity to expose students in performing invasive procedures because there may not be any available NP preceptors that can provide the training. There is also no standardization in the skills learned in NP schools across different institutions. Moreover, the fact that student rotations are individualized and different for each student even in the same program just proves that NP's graduate with no specific uniform knowledge and skill base. Unfortunately, I have the impression that those involved in NP education seem to be lackadaisical in addressing this disparity. Therefore, I see many new NP's rely on their past RN experience when it comes to competence in the clinical setting.

The good news is that suturing and casting are easily learned in an ER rotation. Unfortunately, exposure to invasive lines, chest tubes, and intubations are probably rare in many geographical areas because some ER's and ICU's will probably not allow NP students to perform these due to liability risk. Even if they do allow them, the duration of NP rotations are probably not enough to develop the actual skills. As an ACNP who have inserted hundreds of triple lumen catheters, temporary dialysis catheters, Swan-Ganz catheters, chest tubes, CASP tubes, and such, I have to admit that I knew the steps in performing these procedures as an RN who have asssited residents in the past but never really gained the competence in the actual skill performance until I started my ICU job.

I found that it wasn't really that hard to perfect invasive skills as long as you have enough volume of cases to be signed off on by a skilled preceptor. It's actually funny because our group once attended a national NP conference where such skills were being taught. To our surprise, the instructors were not nearly as competent in the procedures as we expected to the point that our group ended up being asked to help with the skill stations.

ArkansasFan · May 6, 2009

Great responses!

I'm very satisfied with the information presented. I knew that having the ability to peform those procedures didn't make one a clinician, but it's parts of it.

LuxCalidaNP · Mar 16, 2012

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.

UVA Grad Nursing · Mar 16, 2012

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.