APRN Consensus is Complicating Things

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Specializes in AGPCNP-BC.

I am from New York State. My state license and scope seem quite different than the accrediting body (ANCC). I have worked in the ICU for several years. I decided to go back to school to find out there are zero acute care programs in my area. That said, the only two options in my area were AGPCNP and FNP. The state-issued license recognizes the major specialty areas as Acute, Adult and FNP. I choose the AGPCNP route. 

An intensive care group hired me with a rigorous training process. In my area, all hospitals allow AGNP, FNP and ACNP to practice in acute care, including intensive care. Below I have outlined the "scope of practice" according to the state. 

Nurse Practitioner (Acute Care): diagnoses, treats and manages the care of acutely ill patients in a variety of hospital and ambulatory care settings.

Nurse Practitioner (Adult Health): diagnoses, treats, and manages adults' care (young adults from about age 18 to the very elderly). Adult nurse practitioners may provide primary care or acute care; they may address acute or chronic health problems or provide preventive or supportive care.

According to the ANCC, you need 1000 practice hours related to your "certification population focus." My question is, when I recertify will I be able to use my clinical hours? I plan on getting a post-masters in acute care at some point but if it is not within the next five years, am I screwed for renewal? 

Let me know if anyone is in a similar situation. 

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Specializes in Vascular Neurology and Neurocritical Care.

What part of New York State did you live with zero ACNP programs?

You are right that the New York BON (Office of the Professions) licenses you according to specialty, so strictly speaking if your educational background is not acute care, then you may be practicing out of your scope of practice. Honestly, the hospital is not necessarily an authority on such matters. It's a matter of certification. Hospitals have been on the wrong side of things before, so they're entitled to do it again. If I were to testify against you in court as expert witness, you can bet opposing counsel would target your lack of educational preparation (I've seen it). Mind you, you could always defend yourself with the training program you did receive and years of experience, but the argument would be made nonetheless. 

Not that I think you will necessarily be in this boat, but something to consider. As a board member (I won't say what jurisdiction), I would look at this situation askance, but I do not know that I necessarily would find against you just for that if something were to come up. I know there are some on this site who will start a diatribe about how they're FNP/ANP or whatever and doing just fine in ICU, but we have to keep up with the times and things change. For example, it's now recommended that all ED docs be residency trained and board cert'ED in EM, but there are still some FP docs out there doing it. Doesn't change the fact that the recommendation and evidence is for EM trained though....

That being said, none of what I said above constitutes legal advice to you or an advisory opinion. You have to go with your conscience and your understanding of New York law. I would advise you, though, to contact a nurse attorney for a consultation. I know it costs money, but your peace of mind is worth everything. And you'll know where you likely stand from a legal perspective related to your nursing practice. Then you can decide from there. If you really want to do ICU, consider UPenn's post-master's ACNP cert. You can use your job as the clinical hours and it is a really reputable program. I highly advise. Many hospitals in Philadelphia, New York City, and other northeast areas will only hire ACNPs for inpatient roles. It's in the job ads and everything. So don't limit yourself. You never know where you may end up, as that's how life goes.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I'm in CT and we are seeing a shift in hospital hiring away from primary care educated NPs. There are still some FNPs in the ED as admitting hospitalists, but they generally are limited to admission at this point and cannot do cross coverage or inpatient NP. I ended up in an online AGACNP post master's program because I knew I wanted to stay inpatient when I'm done with school. I certainly can't add much of value to what Neuro Guy already stated very well. Good luck with your plans. 

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Specializes in AGPCNP-BC.

which online program did you decide to go with?

 

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I chose Maryville University. I've been pretty critical of the program on these boards in the past. However, I may be overly critical of what is really the reality of online education.  It's supposed to be a well rated program associated with a brick and mortar university, and I knew four grads that recommended it before I enrolled. My clinical experiences, for the most part, have been really excellent and when I graduate in May I'm hoping that I'm prepared for working in the acute care environment. I have just over three years ICU experience as well which has really been the key for me. 

Good luck!

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Specializes in AGPCNP-BC.

Just checked it out.

Thank you! 

It seems to be what I'm looking for. I love going to conferences etc. but would prefer not to go back to school. I have spent five years in critical care and will be pretty much going through a fellowship soon. This is more for "street cred" and to make the ANCC happy. 
 

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