ACNP in adult primary care

HollowayNP · Sep 18, 2012

I was a ACNP for over 4 years working in family practice (seeing 13 year old and up). I have since obtained my Post MSN FNP certificate. Before I ever started my position in family practice, I spoke and emailed my state BON to clarify what I was and wasn't able to do as a ACNP in family practice. Some states are more black and white while TN is very gray in that area. I was told whatever I learned in my MSN program, I was able to do in practice. I would contact your BON to be sure.

Hi everyone,
I feel like I've seen this topic discussed briefly here and there but the topics always seem to center around FNPs or ANPs practicing in acute care instead of the other way around (ACNPs practicing in primary care). I'm a board certified ACNP with 7 years of experience in primary care (family practice for 2 years and then internal medicine for 5 years). I know some consider internal medicine a specialty clinic but in general it is simply primary care of patients with complex medical problems. I haven't worked for the past 3 years b/c I was at home with my kids and now I'm ready to get back to work. Even though I'm an ACNP I am of course looking for a job in an internal medicine clinic b/c that is where all my experience is! However now I just discovered the APRN Consensus Model and it's making me doubt my ability to practice in primary care, even if it's just primary care of the adult population. I know ACNPs in primary care is rare but this is what I did for 7 years!! Any ACNPs out there working in Internal Medicine or other adult primary care settings? I've been planning on getting a post-master's certificate for FNP in the future but I'd still like to get a job now too...

rlianne · Sep 18, 2012

Thanks for the reply. Fortunately my state board of nursing is very vague and doesn't actually list specific scopes of practice for each specialty. They do state that you need to practice within the scope outlined by whatever organization you are certified by which for me is ANCC. I think there is a lot of grey in ANCC wording too so I think I'm fine treating adult patients in primary care, just wanted some other opinions.

SycamoreGuy · Sep 18, 2012

The other thing you need to think about is if something goes wrong can you show that what you did was within your training and scope of practice.

apocatastasis · Sep 20, 2012

Rlianne, I agree that the scope and standards of your certifying body in concert with your board's rules and state law would dictate what you can/cannot do. It is a very gray area, and very state-dependent.

I was a ACNP for over 4 years working in family practice (seeing 13 year old and up). I have since obtained my Post MSN FNP certificate. Before I ever started my position in family practice, I spoke and emailed my state BON to clarify what I was and wasn't able to do as a ACNP in family practice. Some states are more black and white while TN is very gray in that area. I was told whatever I learned in my MSN program, I was able to do in practice. I would contact your BON to be sure.

This is the difficulty with the varying quality/scope of NP programs and with the wide variations in state rules... I would think that in an ACNP program, there are far more conditions in your scope of practice than what you truly can be prepared to manage in school... there ends up being a lot of on-the-job, real-world training that needs to take place, and this is true whether you're an RN, NP, MD, PA, RT, PT.

"Whatever I learned in my MSN program" is also not always true. As a psych NP, I had to take one of the three semesters of primary care theory/clinical that the FNP students did... but according to ANCC standards of practice, it is NOT in my scope of practice to prescribe or diagnose anything that isn't psychiatric. Even though as a student I diagnosed/treated more people with bronchitis, scabies, ringworm, and ear and sinus infections than you can shake a stick at. Still... some psych NPs manage hypothyroidism... and some prescribe metformin to try to ward off metabolic syndrome caused by antipsychotics... etc., etc.