What are the roles of FNPs in hospitals?

  1. 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.
    Last edit by BerkeleyMom on Jan 23, '07
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  2. 41 Comments

  3. by   Kensington
    Hi, BerkeleyMom!

    I'm very intersted in responses to this question as well. The only thing I have to add (as I'm not as nurse yet!), is that my friend is an FNP and works for a cardiologist at a hospital, making rounds on his patients. I shadowed her years ago, and it was a great experience and really inspired me to want to be a NP!

    Best,
    K
  4. by   caldje
    many states are restricting APNs roles to what their educational program prepared them for and practicing outside of that role is considered practicing outside of your scope and to some extent, indefensible. Here is a discussion on the matter provided by the board of nurse examiners of texas. http://www.bne.state.tx.us/practice/...fpractice.html

    FNP education is in the outpatient care (by definition) of patients across the lifespan. I'll let others speak to the role otherwise. But i think the ACNPs would agree, the role of an FNP in the inpatient setting is limited and maybe out of scope and more likely the turf of an ACNP. good luck.
  5. by   juan de la cruz
    Some states are quite explicit in delineating NP roles based on education or specialization (as we NP's refer to it). In those states, an FNP is unqualified to assume acute care roles which may include hospital rounds with a specialty practice such as cardiology. In my state, these rules are not specified by the BON. The Michigan Public Health Code which defines nursing practice does not address it either. It's best for the OP and others interested in the matter to check with their own respective states of residence. I do feel that as an NP, we should follow our educational training for the benefit of the patients we care for since that is the area we received training for. It is also safer for our job's sake, in case our state rules suddenly change. Finally, as an ACNP who is certified through ANCC, I know that this certifying board has specific stipulations that the NP practice in his/her specialty as a requirement for recertification.
  6. by   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
    Last edit by mvanz9999 on Jan 23, '07
  7. by   core0
    Quote from pinoyNP
    Some states are quite explicit in delineating NP roles based on education or specialization (as we NP's refer to it). In those states, an FNP is unqualified to assume acute care roles which may include hospital rounds with a specialty practice such as cardiology. In my state, these rules are not specified by the BON. The Michigan Public Health Code which defines nursing practice does not address it either. It's best for the OP and others interested in the matter to check with their own respective states of residence. I do feel that as an NP, we should follow our educational training for the benefit of the patients we care for since that is the area we received training for. It is also safer for our job's sake, in case our state rules suddenly change. Finally, as an ACNP who is certified through ANCC, I know that this certifying board has specific stipulations that the NP practice in his/her specialty as a requirement for recertification.
    The thing that you don't address here is the hospital credentialling. Locally hospitals are denying FNP's (and ANP's) credentialling for inpatient services. Their standpoint is that the FNP cannot show training in inpatient medicine. They haven't applied this to FNP's that have been working there in the past. You may want to see if you can find a similar program to this:
    http://ceeps.colostate-pueblo.edu/nursing/masterCur.htm

    This gets an ACNP and either FNP or ANP. This would be helpful in working in a specialty where you work in clinic and the office.

    David Carpenter, PA-C
  8. by   mvanz9999
    Quote from core0
    ....

    This gets an ACNP and either FNP or ANP. This would be helpful in working in a specialty where you work in clinic and the office.

    David Carpenter, PA-C
    I don't understand that sentence. Oh...you mean "that's what the degree will offer you?"

    Interesting points you make about hospital credentialing. This doesn't only apply to nurses, it applies to anyone who would have privileges at a hospital. I know an older General Practitioner who left practice to run another business. He got bored and tried to return to his general practice, but cannot get admission privileges because he never did a residency. It wasn't required when he was given a General Practitioner license, and he was not affected since he had admission privileges at the time the new requirements went into effect. But the second he left, he had to prove all this stuff to the hospital. Since he didn't have some of the required items, he was unable to return to practicing medicine.

    So, in your opinion, do you think ACNP's will get privileges?
  9. by   juan de la cruz
    Quote from core0
    The thing that you don't address here is the hospital credentialling. Locally hospitals are denying FNP's (and ANP's) credentialling for inpatient services. Their standpoint is that the FNP cannot show training in inpatient medicine. They haven't applied this to FNP's that have been working there in the past. You may want to see if you can find a similar program to this:
    http://ceeps.colostate-pueblo.edu/nursing/masterCur.htm

    This gets an ACNP and either FNP or ANP. This would be helpful in working in a specialty where you work in clinic and the office.

    David Carpenter, PA-C
    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.
  10. by   MacD
    So what is required for and FNP/ANP to acquire or addon an ACNP certification?
  11. by   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.
  12. by   juan de la cruz
    Quote from MacD
    So what is required for and FNP/ANP to acquire or addon an ACNP certification?
    The prevailing practice is to attend a post-master's ACNP program and then sit for the ACNP boards. Unfortunately, ACNP programs are not as widespread as FNP. The fact that peds and adult ACNP are separate programs make the situation worse. The program that Core0 offered a link for may offer a solution to this dilemma. I hope it catches on in other parts of the country.

    The NP's most affected by the fragmented nature of NP training are those that work in ER. FNP's seem to be the safest choice for this setting since this NP group can care for patients across the lifespan. In addition, a lot of urgent care visits in the ER where midlevels work are primary care complaints. NP's who handle trauma patients in the ER tend to require the ACNP certification in addition to the FNP.
  13. by   core0
    Quote from mvanz9999
    I don't understand that sentence. Oh...you mean "that's what the degree will offer you?"

    Interesting points you make about hospital credentialing. This doesn't only apply to nurses, it applies to anyone who would have privileges at a hospital. I know an older General Practitioner who left practice to run another business. He got bored and tried to return to his general practice, but cannot get admission privileges because he never did a residency. It wasn't required when he was given a General Practitioner license, and he was not affected since he had admission privileges at the time the new requirements went into effect. But the second he left, he had to prove all this stuff to the hospital. Since he didn't have some of the required items, he was unable to return to practicing medicine.

    So, in your opinion, do you think ACNP's will get privileges?
    Sorry I was referring to a medical specialty such as endocrinology.

    The one ACNP that has applied got privleges, and an FNP that had hospital experience got privleges. The problem is for new grads. I agree on the privleges, the hospitals are going as far as requiring board certification within X years. Fail the boards and they yank your privliges. I have to show experience within my specialty, but the in general since PA's have inpatient experience in school, privleging is not a problem. I think this will be a problem for new grad NP's trying to break into a position that has inpatient and outpatient work. In our market it usually doesn't matter since new grad NP's have a hard time getting specialty jobs due to scrip rules. However, one of the NP's that was denied had a bunch of FP experience, just no inpatient experience.

    David Carpenter, PA-C
  14. by   core0
    Quote from pinoyNP
    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

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