Considering career as NP

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Specializes in Anesthesia, Pain, Emergency Medicine.

Your reading comprehension is annoying me and I'm usually patient. A few posts ago I got offended at the term wannabe NP who attend online schools. Seems a big different in and what you say below. You might try reading it over and a bit more slowly.

Are you a NP? Having our profession strive for independence means we are competing with the physicians. It has nothing to do with ego. I have no idea where the entitle attitude comes from but I'll attribute it to your lack of understanding about NP and your trouble reading english.

I don't think we're really saying the same thing. Just a few posts ago you seemed to get really offended when someone mentioned that NPs should partake in more non-online education and post graduate training. If the scope of practice and level of independence are to increase, so does the practitioner's duty to educate themselves to best treat the patient.

btw, why is it all of a sudden about competing with physicians? The job is to take care of patients, not to feed your ego. Sorry but the entitled attitude annoys me ;)

Specializes in Anesthesia, Pain, Emergency Medicine.

Hmm, ok. LOL

That article just has a list of what a practitioner should be capable of doing, it doesn't even mention how the practitioners are trained to achieve that competency.
Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Our main difference is the definition of Family Practice. Many rural parts of the country and even semi rural areas basically have Family Practice coverage for most all parts of the hospital. They have always been jack of all trades. Many FPs still do surgery and OB. It is not just primary care.

I am well aware of the realities of rural health. There is such a shortage of specialized physicians and facilities in that setting. Not everyone practices in rural settings. You should already know for a fact that family physicians don't even have admitting privileges in some major hospitals in big cities. I've worked in two states and in both places our hospitalists are either IM or Peds trained or trained in both.

I believe you are in Michigan, which comes in 44th out of the 50 states in regards to practice restriction. Michigan may have restrictive rules about practice but many other states do not. Thankfully, I'm in an independent practice state. I would fully support an increase in education or a mechanism for ACNP to get training to do primary care or office based medicine and the FNP to do ER or acute care medicine.

I practiced in Detroit from 2004-2009. I am now in San Francisco.

I don't agree with sticking to an "order" or "role" for each practitioner. The APRN joint dialogue group report consensus statement is pushing for four types of APRNs. CRNA, CNM, CNS and CNP(certified nurse practitioner). The CNP will be educated in in one of six population foci: family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women's heal or psych/mental health. The APRN education programs will consist of a broad-based education. APRNs may specialize but they cannot be licensed solely within a specialty area. Education for a specialty can occur concurrently with APRN eduction or through post-graduate education. Scope of practice of the primary care or acute care CNP is not setting specific but is based on patient care needs.

I agree with where it seems we are heading. Instead of focusing on the title and where they fit in a box. NP must document their education and training in a specialty area. I am all for increased education and agree that it does not have to be in the original NP program. There are to many ways of acquiring education and training after graduation.

Would you please read what the Consenus Model states in its entirety. You keep alluding to this document and misinterpeting its objective.

I would love to see a basic, broad based NP education and then you specialize afterwards. So everyone takes the fnp education then goes on to ACNP, pedi, anesthesia etc. I think this would further our profession.

I actually thought the DNP change was an effort to generalize NP education and training during the first two years and then specialize during the last or third year. I am a supporter of this model you mentioned, that I totally agree with.

Specializes in Level II Trauma Center ICU.

I'm sorry, but I have no desire to compete with physicians when I become an ACNP. I am looking forward to working with a team of intensivists. I believe we serve patients best when we collaborate. I love being a nurse and I am proud to say I am a nurse, but our level of education is not on par with physicians. The DNP (in its current form) does not adequately address the disparity between NP and MD/DO education (but that's for another thread, lol).

Many FNPs do not have any training or nursing experience in critical care. In our CV/ICU, there exists a hierarchy of care. While most FP docs can admit patients to our unit, they must consult a level I physician who has received adequate training (ie residencies, fellowships), certifications and credentialing to manage a critically ill patient. This is true even though FP complete rotations in critical care during residency. This is how it should be because it is in the best interest of the patient. Our hospitalists are allowed to manage ventilated patients for 48hrs before they must consult our intensivists. Some of them were trained as FPs, some as IM. In our experience, the best are the IMs but most of them still do not compare our intensivists. Just last night, I was running a code and I was kind of frustrated because I was calling all of the shots. Don't get me wrong, I'm glad I knew what to do to save the patient but there were 3 residents and a hospitalist in the room who should have been able to contribute. Later, the hospitalist told me he like working with me because he felt I was very knowledgable and knew what I was doing. He then confessed that he had not been in a code in the 6yrs since his residency and felt overwhelmed. I felt bad for him and his patients because he has no business managing critically ill patients or codes independently. I can only imagine the outcome had he been working with a less seasoned ICU nurse. Thankfully, the paient's cardio-thoracic surgeon came in and we were able to stabilize her.

Docs are no longer expected to be a jack of all trades. Physicians realize their limitations, we must do so as well. Our hospital routinely receives transfers from rural or small hospitals because their docs are not trained or they don't have access to the level of care our facility can provide. I'm sorry, but I wouldn't want my FP doc managing my multi-system organ failure or cardiac arrest, etc. in the ICU when there are docs who are trained and board certified in critical care available.

I feel that it is irresponsible for us to accept or promote "the FNP can do anything" mantra when even physicians (who recieve more didactic and clinical education than NPs) recognize, value and support specialization with education in the intensivist role. Just my two cents worth.

Specializes in FNP.

And on the other hand, at our ICU there were no such rules. Every physician was expected to manage his/her own patients themselves. That would apply to NPs as well. Anyway, if there was one thing about NP education that I would change, I would add a post grad residency in specialty area, similar to the physician model.

Specializes in Anesthesia, Pain, Emergency Medicine.

+1000 on this.

Look at the classes offered at this years national conference.

Ron

And on the other hand, at our ICU there were no such rules. Every physician was expected to manage his/her own patients themselves. That would apply to NPs as well. Anyway, if there was one thing about NP education that I would change, I would add a post grad residency in specialty area, similar to the physician model.

FNPdude74

219 Posts

Specializes in FNP-C.
+1000 on this.

Look at the classes offered at this years national conference.

Ron

You're talking about the AANP conference in Vegas? I'm going :D. I'm taking the sccm critical care course too.

Specializes in Anesthesia, Pain, Emergency Medicine.

Cheer, I'll see you there.

Ron

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
And on the other hand, at our ICU there were no such rules. Every physician was expected to manage his/her own patients themselves. That would apply to NPs as well. Anyway, if there was one thing about NP education that I would change, I would add a post grad residency in specialty area, similar to the physician model.

Just out of curiosity, does this ICU not have intensivists?

Specializes in Anesthesia, Pain, Emergency Medicine.

Many small to mid-size hospitals do not have intensivists.

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Many small to mid-size hospitals do not have intensivists.

I know that. I'm just trying to get an idea what kind of settings our regular posters are coming from.

Specializes in FNP.
Just out of curiosity, does this ICU not have intensivists?

There is one available for consults.

I am referring to the place where I used to work as a RN. I do not work there now, and never did in the capacity of NP.

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