AANP recert

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Hi everyone- I'm new here and have a pressing question.

I have been a nurse practitioner for almost 5 years so it's time for my first AANP recert. I was looking over all the requirements and have a question. I work as a palliative care consultant. I do not prescribe or order diagnostics but do recommend those things to the referring provider. One of the questions asked about the clinical site during the recert process is whether or not you "treat" patients. I educate them, have goals of Care conversations and make recommendations for symptom management. Is this "treating"? Also wondering about those NPs out there who do the health insurance risk assessments. They don't "treat" in terms of ordering diagnostics or prescribing either but they educate and update the PCP. Can they answer yes to the treat question? What about any hospice NP's out there who do face to face visits?

i'd appreciate any insight into this!

thanks!

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Specializes in DHSc, PA-C.

Could an RN do what you are doing? If you are making recommendations and then another provider actually initiates the treatment, then I would say no. I also feel that an RN could make recommendations just as easily. So, are you actually performing at the higher functioning level of an NP? I'm sure others will disagree, but that's my street smarts opinion.

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Thanks for your input! I appreciate it.

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I disagree with DizziJohn on this. You are making recommendations within the scope of your NP license. This is treatment in every respect. An RN cannot make these recommendations within the scope of her license. Further, if you make an error, you will be held to the standard of an NP. Your recommendations require knowledge of advanced human pathophysiology and pharmacology. So I absolutely believe that you were treating within the legal definition and the definition of your nursing board. If in doubt, you can discuss this with your nursing board.

Your work as an NP in hospice require skills and analysis at an NP level by law. Legally, and RN cannot do the certification assessments that you do. Your assessments include recommendations for certain levels of care. In addition, having done face-to-face assessments in hospice, I fail to believe that there is not at least one piece of advice that you gave to the family or patient in every assessment. This is treatment.

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Specializes in DHSc, PA-C.

Are there not nurses that make recommendations at this same level? School nurses, diabetic educators, foot care nurses, wound care nurses. Again I say if you simply make a recommendation and another provider makes the decision to carry out said recommendation or not then you are not actually treating the patient. If you directly tell the patient to do something and they do it, then yes you provided treatment. I think an RN can say "I suggest you keep the patient comfortable with proper pain control" and talk about end of life care.

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Thank you TammyG. I have thought a lot about this and I agree with you. I absolutely use my NP education and skills everyday and I could not do what I do at an RN level. Providers are consulting me for my expertise in palliative care. It is true that RN's make recommendations but at least speaking for myself, my recommendations when I was an RN were not at all the same as my recommendations now. Now I take into account such a deeper understanding of patho, pharm, etc. I did write AANP about the hospice face to faces as I am thinking about taking on a per diem position doing that too. And received a response that the position would fulfill clinical hours at the NP level as well. I tend to overthink things and was worried that since I wasn't prescribing I wasn't treating. Clearly not true! Thanks again!

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DizzyJon- I think that it is the level at which one is treating that may be the issue. RN's definitely treat patients - a wound care treatment, applying ice, hanging an IV. Providing a consultation with the expertise of an NP (or an MD for that matter) is also a treatment. So, if a nephrologist is asked to consult on a patient in the hospital, for example, and they make recommendations to the hospitalist, the hospitalist takes that information into account in their care of the patient and may or may not choose to implement those recommendations (for whatever reason). I do not think, however, that the nephrologist is practicing as an RN because he/she is only making recommendations. That doctor has a specialized expertise and is contributing to the treatment of that patient. My recommendations are not at the RN level. My education and experience has enabled me to practice at a higher level. Maybe the question is whether or not a consultant is treating (which I believe they are), not whether a consult is at an RN or NP level solely because it's a consult. Interesting discussion! Thanks for your input!

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Specializes in DHSc, PA-C.

When you consult a specialist inpatient they always see the patient and initiate any treatment they deem necessary. It is rarely they simple make a recommendation and not act on anything unless they feel there is nothing for them to do. They have the power to initiate treatment. This individual is saying they don't initiate any treatment and only make recommendation. I've known an NP in palliative care and have also met nurses and social workers doing basically the same job. Bottom line is that the OP is employed in a position as an NP and therefore working as an NP and that allows her to say to she has the required hours to recertify. I'm not arguing that. I'm just saying that a non NP could also do her job. So is she really practicing medicine....I mean advanced nursing?

I worked hospitalist medicine and it is rare to have a specialist just make a note of recommendations and leave treatment initiating up to the hospitalist unless they felt nothing needed to be done inpatient. And if nothing needed to be done inpatient I wouldn't have consulted them to begin with.

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Thanks for the discussion, DizzyJon. I appreciate your point of view.

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That is not the law Dizzijon.

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Specializes in DHSc, PA-C.
That is not the law Dizzijon.

Who said anything about "the law"?

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OP, I am certified through ANCC, not AANP. However, whenever I have a question like yours, I go straight to the source and email ANCC. They answer pretty quickly and then I have something in writing. I'll bet AANP would answer you quickly, too.

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