What are the roles of FNPs in hospitals? - page 2

Hello Everyone, New member here--sorry if this is in another thread and I will gladly go there if you direct me. I have shadowed FNPs and spoken with students in the program that I am applying... Read More

  1. by   zenman
    Quote from mvanz9999
    I'm not 100% sure about that, but the schools I'm looking at have post-masters certificate programs. I don't know whether that is actually required, or if you only need to meet the credentialing requirements.
    As far as I know, you have to complete the formal training in a post masters to add on or change your focus. I'm doing a post masters FNP with a background as psych CNS. Even with the psych CNS, I'd have to do the psych np course work if I wanted to go that route.
  2. by   juan de la cruz
    Quote from core0
    The ortho part is interesting. Do they scrub? We don't see NP's around here in the OR (one actually). Part of the problem is that we have RNFA's that want all the cases so generally you need an RNFA to work in the OR (which requires 2 years of perioperative experience to get). They tried to tell the PA's that we needed RNFA certifcation also but that is a whole different Oprah.

    David Carpenter, PA-C
    They don't. They have a big Ortho team in that hospital that includes a ton of surgeons, a few PA's, and 3 NP's. There was a residency program at one point which unfortunately ended up being shut down. I was told that Ortho is the biggest revenue producer in that hospital. The PA's assist in surgery. The NP's have a unique role since they not only manage the post-op patients from floor admission to discharge but they also do pre-op teaching in the clinic.
  3. by   mvanz9999
    Quote from pinoyNP
    They don't. They have a big Ortho team in that hospital that includes a ton of surgeons, a few PA's, and 3 NP's. There was a residency program at one point which unfortunately ended up being shut down. I was told that Ortho is the biggest revenue producer in that hospital. The PA's assist in surgery. The NP's have a unique role since they not only manage the post-op patients from floor admission to discharge but they also do pre-op teaching in the clinic.
    So what specialty are the 3 NP's certified in? Are they FNP or ACNP?

    I'm really confused by the whole FNP vs. ACNP thing.
  4. by   Kensington
    Quote from mvanz9999
    So what specialty are the 3 NP's certified in? Are they FNP or ACNP?

    I'm really confused by the whole FNP vs. ACNP thing.
    Me too! I want to work in a hospital setting, so am very unclear what the best route to take would be. . .
  5. by   juan de la cruz
    Sorry if I confused you. I was giving the example of my NP friend who happens to be an FNP but is employed in an acute care role in Orthopedics and was credentialled by the hospital for that role. Core0 asked if this friend assists in the OR and I was just reponding to his question. As I've already mentioned, my state is not strict about the difference between FNP, ACNP, and ANP as far as switching in between the acute care and primary care roles.

    It is very confusing I agree. I almost feel like I should have been part of this forum before I even ventured into advanced practice because there are so much things I didn't know when I was deciding on what to do with my career. I am, however, pleased with my APN role and would not change a thing now.

    P.S. To add more to your already confused mind, my friend's other colleague is an ACNP, the other one is an ANP!

    I hope I am writing this clear, I am waiting for 2 patients with fresh heart valve surgeries right now and I am a little ansy.
    Last edit by juan de la cruz on Jan 24, '07
  6. by   core0
    Quote from pinoyNP
    Sorry if I confused you. I was giving the example of my NP friend who happens to be an FNP but is employed in an acute care role in Orthopedics and was credentialled by the hospital for that role. Core0 asked if this friend assists in the OR and I was just reponding to his question. As I've already mentioned, my state is not strict about the difference between FNP, ACNP, and ANP as far as switching in between the acute care and primary care roles.

    It is very confusing I agree. I almost feel like I should have been part of this forum before I even ventured into advanced practice because there are so much things I didn't know when I was deciding on what to do with my career. I am, however, pleased with my APN role and would not change a thing now.

    P.S. To add more to your already confused mind, my friend's other colleague is an ACNP, the other one is an ANP!

    I hope I am writing this clear, I am waiting for 2 patients with fresh heart valve surgeries right now and I am a little ansy.
    At least locally I see some changes on the way NP's are treated in the hosptials. Some of this seems to be anesthesia driven and is catching NP's in the crossfire. The other part is the reason that PA's have resisted specialty exams. Once there is a specialty for a field then someone that does not have that specialty is automatically assumed to be not qualified. Now that there is an ACNP whose job it is to see inpatients and whose description does not include routine outpatient work (outside of urgent care), then hospitals look at the FNP and ANP and see that most of the descriptions involve outpatient care. I would forsee this becoming more the norm. The solution would be either programs like the Pueblo program noted above or to integrate inpatient care as part of the DNP.

    David Carpenter, PA-C
  7. by   mvanz9999
    Quote from Kensington
    Me too! I want to work in a hospital setting, so am very unclear what the best route to take would be. . .
    I think if you want to work in a hospital, you should choose Acute Care Nurse Practitioner. We know that they can work in hospitals. I think the FNP role may or may not be able to, depending on your state. In Illinois, roles are not nearly as strict as other states.
  8. by   caldje
    Quote from mvanz9999
    Darn it! PinoyNP beat me to it.

    The link above looks like something a lawyer needs to interpret, not a layperson. It states "..they [NURSES] are obligated to know and conform to the Nursing Practice Act and BNE rules in addition to all federal, state and local laws, rules or regulations affecting their current area of nursing practice"

    That's absurd. Looks to me like it's still rather undefined, and no matter what position you take as an APN, there are lawyers who can argue in your defense. The article says "....what if a physician wants me to do this procedure and shows me how" and then it goes on to say that you must get proper training (and that is defined as "different depending on procedure").

    In other words, proper training isn't defined. Nurses are nurses, they are not lawyers.

    This Illinois Nursing Act specifically states that multiple advanced practice nursing does not require multiple degrees:

    Those applicants seeking licensure in more than one advanced practice nursing category need not possess multiple graduate degrees. Applicants may be eligible for licenses for multiple advanced practice nurse licensure categories, provided that the applicant (i) has met the requirements for at least one advanced practice nursing specialty under paragraphs (3) and (5) of subsection (a) of this Section, (ii) possesses an additional graduate education that results in a certificate for another clinical advanced practice nurse category and that meets the requirements for the national certification from the appropriate nursing specialty, and (iii) holds a current national certification from the appropriate national certifying body for that additional advanced practice nursing category.

    http://ilga.gov/legislation/ilcs/ilc...Nursing+Act%2E
    I respectfully disagree with most of this post. The link provided to the texas BNE CLEARLY defines that on the job training does not qualify to perform a new procedure not taught in an education program. It encourages NPs to pursue programs that include instruction in possible untoward events, indications for the procedure, and that offer a certification. An examle is an ACNP who wants to assist in surgery MUST complete an RNFA program. I thought it was quite clear and easy to understand.

    In regards to "not requiring multiple degrees." That is true... DEGREES... but, it does say it requires certification. So you will either have to get another degree or do a post masters cert in the field you want to add on to your scope of practice. An example would be, according to what you copied and pasted... and FNP with an MSN would not have to get another MSN in ACNP but would simply have to be eligible for and pass the ACNP exam to recieve certification. To do so that person would have to either do another MSN or a post masters program in ACNP.
  9. by   core0
    Quote from mvanz9999
    I think if you want to work in a hospital, you should choose Acute Care Nurse Practitioner. We know that they can work in hospitals. I think the FNP role may or may not be able to, depending on your state. In Illinois, roles are not nearly as strict as other states.
    I would agree, but this may not be what the physicians are looking for. In private practice the hospital part is more quality of life and harder to quantify as far an monetary reimbursement. With a 50/50 hospital clinic split in a specialty you can easily cover your salary and then the practice gains with down stream revenue and quality of life. What most private practices are looking for is someone who can work in both inpatient and outpatient environments.

    David Carpenter, PA-C
  10. by   mvanz9999
    Quote from core0
    I would agree, but this may not be what the physicians are looking for. In private practice the hospital part is more quality of life and harder to quantify as far an monetary reimbursement. With a 50/50 hospital clinic split in a specialty you can easily cover your salary and then the practice gains with down stream revenue and quality of life. What most private practices are looking for is someone who can work in both inpatient and outpatient environments.

    David Carpenter, PA-C
    I sometimes have trouble following what you are trying to say. The OP is asking about the role of FNP in the hospital setting, and I don't think that has been clarified. They are saying they want to work in a hospital, not in a clinic that has hospital privileges. Since ACNP is the newest specialty and focuses on Acute Care, I would think that they would be most utilized in strictly in-patient hospital settings.
  11. by   core0
    Quote from mvanz9999
    I sometimes have trouble following what you are trying to say. The OP is asking about the role of FNP in the hospital setting, and I don't think that has been clarified. They are saying they want to work in a hospital, not in a clinic that has hospital privileges. Since ACNP is the newest specialty and focuses on Acute Care, I would think that they would be most utilized in strictly in-patient hospital settings.
    I agree that an inpatient setting is the proper role for an ACNP. There are many FNP working in inpatient settings. However, I see this as becoming increasing restricted due to the prescence of the ACNP and lack of inpatient training.

    The point that I was trying to make is that you will not get a job unless you can fulfill all of the physician (employer) expectations. There are hospitalist jobs that only involve inpatient work and clinic jobs that involve only outpatient work. However, the vast majority of the jobs that involve specialty practice want both inpatient and outpatient coverage. This is a job that previously had been filled by PA's and FNP's or ANP's with the new criteria that I see being put into place you would need an ACNP and an FNP/ANP to work the position. Going back to the OP's question, yes there are roles for FNP's in hospitals, but they seem to be going away.

    There seem to be a lot of academic roles discussed here, and I can't comment on the number of NP's that have academic positions, but for PA's it is less than 20%. In private practice, it is all about earning your keep. That is why in a specialty or surgical practice you need to be able to move between hospital and clinic. If you look at the example of an ortho NP, in some states you would need an RNFA, ACNP, and FNP to fulfill all the requirements.

    David Carpenter, PA-C
  12. by   mvanz9999
    Quote from core0
    ....However, the vast majority of the jobs that involve specialty practice want both inpatient and outpatient coverage. This is a job that previously had been filled by PA's and FNP's or ANP's with the new criteria that I see being put into place you would need an ACNP and an FNP/ANP to work the position. Going back to the OP's question, yes there are roles for FNP's in hospitals, but they seem to be going away.

    .....If you look at the example of an ortho NP, in some states you would need an RNFA, ACNP, and FNP to fulfill all the requirements.

    David Carpenter, PA-C
    I see your point and it makes sense, but my question is *who* is going to do all that (ie, get RNFA, ACNP, and FNP) to work in ortho? The pay wouldn't equal the cost of education, not to mention the years required to get all this training. I don't believe those requirements are sustainable except for a few insane people that just love to be in school and pay lots of tuition. And for the cost and no. of years in school, you might as well go to med school.

    If all this holds true, then I think APNs will be phased out because no one is going to want to get all those certifications.
  13. by   core0
    Quote from mvanz9999
    I see your point and it makes sense, but my question is *who* is going to do all that (ie, get RNFA, ACNP, and FNP) to work in ortho? The pay wouldn't equal the cost of education, not to mention the years required to get all this training. I don't believe those requirements are sustainable except for a few insane people that just love to be in school and pay lots of tuition. And for the cost and no. of years in school, you might as well go to med school.

    If all this holds true, then I think APNs will be phased out because no one is going to want to get all those certifications.
    I think that it points out the difficulty of trying to force a nursing model on a medical world. This is probably the primary reason that PA's tend to dominate the surgery market. The real problem I see with the APN model is the lack of training in both inpatient and outpatient medicine. The DPN may solve this problem somewhat or you may see more dual programs such as the one mentioned above. There will still be an APN market in the market that they were originally designed for - primary care.

    David Carpenter, PA-C

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