Acute Care - flexible?

Advanced Practice Columnist / Guide · Sep 6, 2007

Hi everyone,
I am looking into master's level nursing programs and am having trouble differentiating between the scopes of practice. While shadowing at a hospital, I was informed that an acute care nurse practitioner could potentially work as a "family nurse practitioner" (i.e., practice primary care with families) - is this true??
I would like to continue my work in research (I have an MPH), and work in acute/critical care settings. At the same time, I would like to leave a door open for primary care. Is this possible?
Thanks in advance for your reply. I have learned so much from this site!
Raquel

Regarding your first question, I believe you may have been misinformed. Training in Acute Care Nurse Practitioner programs are limited to the age group in which they are intended to provide care. Adult Acute Care NP's should only practice in adult medical and surgical settings and consequently, Pediatric Acute Care NP's should only practice in settings where the population served are infants, children, and adolescents. Primary Care Advanced Nursing Practice with Families (or FNP) are aligned with the Family Practice specialty among physician counterparts and by strict definition, involves care across the human life span. ACNP's can be accountable for practicing out of scope when they care for individuals who do not belong to the age group of their training.

Can an ACNP practice in a primary care setting? It depends on your training and what your state allows you to do. Some ACNP programs also incorporate primary care skills in their curriculum in addition to alllowing students to rotate in out-patient settings for their clinicals. In such case, you may be able to justify the fact that you have a basic understanding of primary care and thus, are qualified for an entry-level primary care NP role (again, with the stipulation that you are caring for the age group you are trained in). I should also mention that a small percentage of questions in the ANCC certification examination for Adult ACNP involve primary care approaches such as management of hypertension, diabetes, asthma, etc. in out-patient settings in addition to health care screenings for healthy individuals.

DaisyRN, ACNP · Sep 9, 2007

hey there,

this has been addressed in a couple other forums so you may want to check them out. with regard for your question about whether an acnp can work in primary care... the acnp (at least with my required curriculum because i was required to do 168 hrs with an internal medicine anp my first semester) can do internal medicine, but that is as close to "primary care" as you can do.

as pinoy mentioned, the adult acnp is not allowed to treat pediatric or pregnant populations, unless you have received additional training that is recognized by your licensing board that makes you qualified to include these people in your scope of practice. for example, if i wanted to take care of pedi patients, i would need to go back and do a "post-masters certification" as a pediatric nurse practitioner or family nurse practitioner. i wouldnt have to do the whole msn program again, i would just have to do the pnp-specific or fnp-specific courses. and generally post-master's programs take about a year to do. something else to consider though... at least from my knowledge... if you were to get a dual certification, i.e. pnp and acnp, you have to acquire so many hours in both populations to maintain your certification. does that make sense? you should browse through your state's board of nursing website for more info about these specifics. it might be different where you are.

you can work in the "outpatient" setting as opposed to "primary care" settings for specialists that take care of acute issues, i.e. cardiologists, nephrologists, pulmonologists, gi, etc. generally speaking, the acnp is better prepared to deal with "hospital-based" type of problems. many times, the acnp that say, works for a cardiologist, will work a couple days in a heart clinic, then do rounds in the hospital on the other days of the week. some may take call while cardiologists are doing interventional procedures... or whatever.

hope this helped... good luck!!

rnhunter · Sep 15, 2007

You guys make some very valid points. FNPs are trained in PRIMARY CARE. They recieve no training in the acute care setting. Therefore, if push comes to schove they can be held liable if they practice in the acute care arena and an incident occurs, they can be found guilty for practing outside their scope of practice. I work with an FNP who is working in the role of an ACNP in cardiac specilty hospital. She stated to me that they recieve NO training in acute care medicine. Calling 911 was the extend of their training for AMIs. Think about it???? The same can be said for an ACNP practicing in a primary care arena.

Advanced Practice Columnist / Guide · Sep 15, 2007

You guys make some very valid points. FNPs are trained in PRIMARY CARE. They recieve no training in the acute care setting. Therefore, if push comes to schove they can be held liable if they practice in the acute care arena and an incident occurs, they can be found guilty for practing outside their scope of practice. I work with an FNP who is working in the role of an ACNP in cardiac specilty hospital. She stated to me that they recieve NO training in acute care medicine. Calling 911 was the extend of their training for AMIs. Think about it???? The same can be said for an ACNP practicing in a primary care arena.

It depends on how you define primary care. Internal Medicine is primary care in the adult population. However, I don't see why ACNP's could not function in an Internal Medicine practice.

core0 · Sep 15, 2007

It depends on how you define primary care. Internal Medicine is primary care in the adult population. However, I don't see why ACNP's could not function in an Internal Medicine practice.

It depends on how the internal medicine practice functions. Some function as consultants for complex adult medical problems and some function as FP without peds.

The ANCC defines the scope as:

"The Acute Care Nurse Practitioner (ACNP) is a registered nurse prepared in a graduate level acute care nurse practitioner program to provide and manage health care of acutely ill, critically or chronically ill adult patients in a wide range of settings."

CCRN defines the scope identically.

So if someone without any medical problems comes in (ie are not ill) it would seem that this is outside the scope of practice. This mostly goes to preventive care and screening which for example is specifically mentioned in the ANP scope:

The Adult Nurse Practitioner (ANP) is a registered nurse prepared in a graduate level adult nurse practitioner program to provide a full range of health care services on the wellness-illness health care continuum at an advanced level to adults.

The main difference that I see is that ACNP only talks about illness and ANP talks about wellness and illness. If you look at what is tested for certification here is the ANP portion:

I. Health Promotion and

Disease Prevention as assoc

with Notes 1 and/or 2

A. Epidemiology/risk analysis

B. Genetics

C. Risk reduction

D. Health behavior guidelines

E. Anatomy & physiology

F. Growth & development

G. Screening tests

H. Wellness assessment

Here is the ACNP:

III. Health Promotion

and Disease Prevention

A. Risk factor analysis

B. Risk reduction

C. Special needs of the

adult across the lifespan

D. Screening tests

So at the very least it appears that the ACNP is missing training in Wellness, risk reduction and behavior guidelines which are important parts of primary care (and increasingly what primary care is rated on by the insurance companies).

From my non nursing standpoint IM would be the domain of the ANP. Specialty care (cardiology derm etc) would be done by both. Critical care would be the domain of the ACNP. Inpatient medicine (either specialist or non critical care would be the domain of both. This seems to echo what nursing theorists have written. The real problem is that nursing domains do not neatly dovetail with the medical specialty.

David Carpenter, PA-C

jer_sd · Sep 16, 2007

You guys make some very valid points. FNPs are trained in PRIMARY CARE. They recieve no training in the acute care setting. Therefore, if push comes to schove they can be held liable if they practice in the acute care arena and an incident occurs, they can be found guilty for practing outside their scope of practice. I work with an FNP who is working in the role of an ACNP in cardiac specilty hospital. She stated to me that they recieve NO training in acute care medicine. Calling 911 was the extend of their training for AMIs. Think about it???? The same can be said for an ACNP practicing in a primary care arena.

Actually in my primary care NP prgram I had in hospital rotations, including cardiac and stress testing.... So my training was more than just call 911. This is one comlicating issue for NP programs they can have a wide scope of clinical learning experience so what is true for one school/student may not apply to all the NPs who have graduated from that specialty. THis also alows for students to focus on the area that they want to work in so it can be a good aspect also.

Jeremy