Acute vs Primary Track?

[cleback]

Hello all,

My school offers both the adult-gero acute care and primary care DNP tracks, and I am having trouble choosing between the two. My interests are in infectious disease and infection prevention. Initially, I thought primary care would fit my goals better, as I would like to primarily practice in the outpatient setting. If I am unable to gain employment in the specialty area of infectious disease, I would want to work in primary care. I have no interest working for an inpatient hospitalist service.

However, in the infectious disease service in my current employment (and in many of the specialty services in my organization), the NPs also help with rounds at the hospital, even though the bulk of their practice is at the clinic.

I heard that in the future it will be harder for NPs trained in primary care to be able to practice in the hospital and vice versa. If I continue with the primary care track, would I be barring myself from my first choice practice area of infectious disease?

Thanks!

[Corey Narry, MSN, RN, NP]

Much of the contention between acute care vs primary care arise from state-specific interpretation of the APRN Consensus Model. You can follow the blue underlined link I posted but the defining sentence in that Model states "scope of practice of the primary care or acute care CNP is not setting specific but is based on patient care needs". True to nursing form, this statement does not clear up confusion and does not apply to real life health care situations encountered by providers such as NP's.

Take for instance examples of patients in hospital settings: does it mean a primary care trained NP could see a patient with a cardiac problem in a hospital but is only allowed to manage his/her primary care issues and not acute exacerbations that he/she was admitted for in the first place? That's quite ridiculous in the eyes of other providers (MD's) who do not have the same restrictive training.

However, it is what it is and we already created this set of complicated rules and turf restrictions and states are supposed to be adopting them. Enforcement is rather slow, however, and many states do not have specific language in their scope of practice that speaks to these rules as of yet. Having said that, it is wise for any NP wannabe to be prepared for changes that can happen anytime.

That is my general comment on the issue but your specific situation is a gray area. ID as a specialty is neither acute care nor primary care in a strict sense. Do you see ID providers initiating blood pressure and diabetes treatment? Do you see ID providers intubating? managing sepsis with fluid boluses and pressors? They are omnipresent in the hospital as consultants but rarely have their own "primary" patients aside from ones they see in the clinic.

But then again, you go back to that troublesome statement in the Consensus Model. If you decide to work in ID as a primary care NP, does that mean you can only consult with patients who are on the regular floors and not the ICU? I think, and this is purely my thoughts, you would be best served in an acute care track if we are to strictly apply that statement.

[cleback]

Thank you for your thoughtful answer!