What are the roles of FNPs in hospitals?

Specialties NP

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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 to. I am only familiar with the role of an FNP in outpatient clinics and programs. I am wondering what other avenues FNPs can take that do not involve primary care.

I would like to learn about the prospects of working in a hospital. Are you an FNP that works in a hospital, or do you work with them in your hospital? What is your/their job description and why do you/they prefer it over primary care? Is this a common thing, or is there much additional training and degrees required?

I know there are numerous specialties, I am just wondering if an FNP degree can be limiting in this sense.

Thank you in advanced.

That seems to be a a hybrid program that meets both ACNP and FNP certification requirements. I have not come across anything similar anywhere else. Usually there are separate adult ACNP, peds ACNP, and FNP programs within the same institution. I wonder how long the program actually runs because the certification boards for adult ACNP (ANCC) and peds ACNP (PNCB) have specific requirements for clinical hours. That program will need to meet those requirements in addition to the FNP board examination requirements mandated by either ANCC or AANP.

On the topic of credentialing, my state does not clearly define laws that govern the practice of NP's in a particular specialty or area of practice. The state BON grants a generic NP title and certificate to every nurse practitioner regardless of training and source of certification. Because of that FNP's and ANP's have been able to receive credentialling in acute care settings here. One of my colleagues in ICU is ANP trained but had 10 years of experience as a nurse in cardio-vascular ICU. The rest of us are ACNP's. An NP friend of mine who works in In-patient Orthopedics in another hospital is FNP trained.

I'm guessing that there is some overlap in the didactic portion of the ACNP and FNP. 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

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.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
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.

Specializes in Accepted...Master's Entry Program, 2008!.
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.

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. . .

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

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.

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

Specializes in Accepted...Master's Entry Program, 2008!.
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.

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/ilcs4.asp?DocName=022500650HTit%2E+15&ActID=1312&ChapAct=225%26nbsp%3BILCS%26nbsp%3B65%2F&ChapterID=24&ChapterName=PROFESSIONS+AND+OCCUPATIONS&SectionID=22126&SeqStart=8900&SeqEnd=10500&ActName=Nursing+and+Advanced+Practice+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.

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

Specializes in Accepted...Master's Entry Program, 2008!.
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.

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

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