Can an ACNP treat pediatrics in Texas?

linzlace, BSN, RN · May 25, 2013

I live in texas and work with two ACNPs. They told me they are able to treat age 14 and above. One is going back to get her PNP so she will be able to practice with all ages in the hospital setting. I agree with you, the boundaries of the different types of nurse practitioners is very blurred and confusing for many!

Annaiya, NP · May 25, 2013

No you cannot see pediatrics as an ACNP, it is the same that a PNP cannot see adults. However, what constitutes a pediatric patient may vary depending on what you are doing. Your scope of practice agreement with the hospital you work for may have something specific in it, however, I've found it to generally be a more flexible statement. You can find the information you're asking about in terms of the TX BON at:

APN Scope of Practice

Uroboros, APRN · May 25, 2013

Annaiya I began reading that section of the Texas BNE link to APN scope years ago. And now, like then, it continues to give no clear specific AGE range for the acute care nurse practitioner. It is not the same as a PNP treating adults. By definition, the Pediatric Nurse Practitioner is limited to children and adolescents. The only clear scope I continue to find is illustrated under consensus models beginning in July 2008, which assign acuity and or clinical setting to the ACNP, FNP, ect. The ACNP under this model is assigned to acute care settings, i.e ED's, ICU's, ect. In contrast the FNP is primary care based, followed by women's care, adult NP, and pediatric NP's.

Indeed practice settings may develop more flexible agreements, although they certainly cannot supercede national standards or legislature. I continue to recieve numerous opinions with no governing body mandates and or stipulations that support what appears to be personal preferences in practice.

Annaiya, NP · May 26, 2013

There is no bright line rule, which is why you aren't finding one. And there shouldn't be. The question is too complex to not allow some flexibility. The ages that might be appropriate for one practitioner might not be the same for another. I do not understand why you feel the standard for an ANP would be any different than that of a PNP. PNPs can see some adults, just like ANPs can see some kids. Age isn't the overriding factor when determining scope of practice issues. It is just one piece of the overall puzzle.

Uroboros, APRN · May 26, 2013

This thread is another good example among the long list of ambiguous nurse practitioner roles. There simply exists too many credentials, too many roles, with too many over lapping scopes. When you refer to ANP I'm assuming you mean Adult Nurse Practitioner? My original question is regarding ACNP= Acute Care NP. However, under the consensus model of 2008 that continues to be adopted on a state by state basis the ANP and geriatric NP roles were combined with the ACNP, to create a credential soup of AGACNP. Focus is now on adults, geriatrics, and acute care.

There desperately needs to be a clear defintion of practice for these roles, especially given the head scratching credentialing and patient care roles. It's quite sad the NP role has not evolved into a more dynamic provider, and continues to be seperated into so many areas of patient care. Because there is so much flexibility and personal opinion on the matter we have NP's basically doing whatever they want, so long as a physician or facility signs off. A clear example is ANP (ADULT Nurse Practitioner) treating pediatrics, or PNP (PEDIATRIC Nurse Practitioner) treating adults. There could not be a brighter line to that rule.

Yet roles like the program I am in are plagued by confusion in every direction with no clear answer. By continuing to receive no answer, it appears I have my answer. And if I wish to avoid more of the same in my practice, pursuing the FNP after completing my current ACNP program is the only clear solution. Just more tuition, more exams, more CME's, three more courses, ect, ect.....it's all really beginning to make me wish I had went to PA school. Really sad to say after a 15 year career that includes ER, ICU, flight, now a house super/ rapid response nurse first year ACNP student.

Annaiya, NP · May 26, 2013

I'm sorry you find this so frustrating, but I actually like how there are so many specialties for NPs. I think that gives us an advantage over PAs. We are focused on one thing and do that one thing really well. An ACNP is an ADULT acute care NP. It is the adult equivalent of an acute care PNP. If you want to be able to see kids in an in patient setting, then you need to go back for an AC PNP certification, not FNP. PNPs can see adults when what they are treating is a pediatric disease, and the age of the patient doesn't impact the care they are receiving. For example, a pediatric cancer in an adult. Whereas, an adult NP can see a child when their illness is an adult issue. For example, my hospital has refused a pediatric patient (13 years old) who was critically ill due to giving birth. That issue is going to be treated better by an adult medical team, not a pediatric one. For patient safety, it's important that we aren't so limited by our scope of practice that we can't treat patients who we are fully qualified to treat simply based on age. This is a huge departure from our scope as an RN. RNs can see any age, because the job that we are doing is very different than that of an NP. I hope that as you get to your clinical phase in your education, you will agree more with this delineation.

Trauma Columnist · May 26, 2013

I'm in IL and its my understanding that ACNPs see ages 13 and up as that is what their certification testing covers.

Psychcns · May 26, 2013

I think every BON has a APRN who helps answer questions like this.

Maybe your insurance carrier may have some thoughts.

Uroboros, APRN · May 27, 2013

Thank you for your input. I too hope my perspective changes, and I'm certain it will. Worst case scenario I have to take two more semesters for the pediatric coverage. Restricted to seeing only adults in only ICU settings would severely limit my job opportunites. As you well understand I do not want to sacrifice all the time and money to miss out on ED or clinic jobs, although critical care is my passion.

Annaiya, NP · May 27, 2013

I really wouldn't worry about missing out on jobs. Some EDs might require PNP certification, since they can see all ages, but if the adult AC program is anything like the AC PNP program you will still be fully qualified for specialty clinic jobs. The only thing my program did not train me to do was well baby/child checks, routine vaccinations, routine sick visits of otherwise healthy kids. Which is only your basic primary care clinics. I learned all about outpatient management of chronic illness, so I could work in any specialist's office. Critical care is what I love, and I've been hired to work in a PICU. I had multiple job offers before I graduated. I have no doubt the time and money that you put into school will be worth it:)

kguill975, MSN, APRN, NP · May 27, 2013

The BON gives you the scope of practice, but what did your education include? Did you complete a clinical rotation in an ED setting seeing pediatric patients? If not, you'll have a target on your head if there is ever any question about your practice while treating pedi patients. Any physician you work under will have treated pediatric patients in their ER residencies, and will be able to prove it. For the safety of your patients, and the respect of your peers, I think completing an FNP program would be best. I don't know where you live, but UT has a FNP program that offers an ER focus.