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Current AGACNP student and cannot get a clear answer from anyone, including program faculty. The consensus model does not offer any clear answer as well. The Texas BNE gives no clear scope specifics. The AACN also does not list clear defintions to scope of practice. Of course the hot debate continues regarding FNP practice in hospital setting vs ACNP, and I have found several journal articles suggesting FNP's are not qualified to work in acute care settings. However, I cannot find anything from my state board supporting this. I cannot find anything restricting ACNP practice to adult only populations. Although, many age ranges have been suggested to me, but all are personal opinion.
I am now considering doing the post master FNP just to avoid further controversy. However, I find it quite unnecissary since my practice will be with a physician present. I am not interested for independant practice, and have several ED and ICU job offers already. Of course the ICU job does not include pediatrics, and I personally feel treating stable noncomplicated ED peds with multiple physicians present acceptable.
So, please no opinions, we have enough of those floating around. Where can I find supporting state or credentialing board information that answers this question? What does your state practice? Thanks for any educated input.
Regards, Another Puzzled NP Student.
I can see adults and peds in primary care, inpatient, acute, and ER as a FNP. (In the states I practice in)
NOT Texas obviously. Thankfully, my states are more progressive.
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.
I have an entire semester with mixed ED hours and urgent care clinic. The consensus model could not be more clear regarding FNP practice in hospital based settings. Especially in Texas, which is the belt buckle of conservatism, FNP practice is focused on primary rural outpatient settings. While the clinic hours are appealing, my background is all critical care. I have always enjoyed treating high acuity patients and performing the procedures they require. FNP training simply lacks the basic ICU or ED procedure training or patient experiences, although I'm certain comparable on the job training occurs.
Regardless, that is my opinion, and not the original intention of this thread. Emotions always run high with this topic, as with the whole "respect of your peers" bit. To be honest the FNP vs ACNP debate is pretty comical to read in endless chats and discussions web wide. The single recurrent deciding factor I find is either physician or facility preference. In other words........continues to be up to the boss.
Remember the consensus model must be passed by EACH state. I can tell you that in my state, it will not affect FNPs doing ER and inpatient medicine.
I would bet other states such as Washington, Montana, Idaho, Wyoming and I have high hope for Arizona will continue to allow FNPs to function to their level of training.
To many rural hospitals use FNPs as ER providers as well as inpatient medicine.
Btw, I think it is ridiculous that a ACNP can't treat a peds. I also think it is really silly that the ACNP can't do Primary care. A little ojt!
We are shooting ourselves n the foot and playing politics. For how many decades have FNPs been covering inpatient and ERs? I can remember back to 1988 at least. Go, go Arizona
Nomad I couldnt agree more. There continues to be friction among the many overlapping roles for NP's. While I appreciate the opportunity to build on a career I once felt plateaued, at the same time it feels bitter sweet. Hopefully as our profession evolves a more dynamic provider will emerge dissolving the many ambiguous NP scopes. More than anything, the constant debate among these forms of providers robs us of respect in the medical community. In my experience I have firsthand seen physician groups go with PA's over NP's because of the clear scope of pracitice and credentialing for PA's. Hopefully this is a dying trend and as the future of nurse practitioning we can spark a new awakening to what we can offer patients in all areas of healthcare.
I'm going through a similar situation and am frustrated as well. My certification is ACNP, and our program advisor always said 13 and over. However neither in Ohio nor Kentucky can I find any information from the BON that gives a clear cut answer. I am entertaining the opportunity to work in a derm clinic, but they also treat peds. The physicians in the practice are willing to train me to get certified as a derm NP, but is that enough to cover me for treating peds??
I'm going through a similar situation and am frustrated as well. My certification is ACNP, and our program advisor always said 13 and over. However neither in Ohio nor Kentucky can I find any information from the BON that gives a clear cut answer. I am entertaining the opportunity to work in a derm clinic, but they also treat peds. The physicians in the practice are willing to train me to get certified as a derm NP, but is that enough to cover me for treating peds??
If your state BON did not specify, you can defer to your national certification as a guideline. The Test Content Outline for ANCC's Adult-Gerontology Acute Care Nurse Practitioner certification exam states that each item in the test addresses patients aged 13 and up. That would be the population you should only be allowed to provide care for as an NP.
See Page 3 in http://www.nursecredentialing.org/Documents/Certification/TestContentOutlines/AdultGeroAcuteCareNP-TCO.pdf
That's more helpful--thank you. But, what are your thoughts on becoming derm certified with training from a dermatologist that treats adolescents and younger?
That's a gray area, unfortunately. There is a Dermatology NP Certification developed by the Dermatology Nurses' Association. There is no specific requirement for eligibility in terms of NP type other than a state NP license and national certification (i.e., any type is eligible from FNP to PMHNP?) which you have. In addition, the Derm NP exam covers patients across the lifespan.
This certification program appears to be in its infancy and while it would substantiate and affirm your knowledge and skills in this specialty, the certification is not recognized by state BON's and CMS. That's not necessarily a bad thing because in the physician realm, there are some subspecialties that are not recognized by the medical specialties board either, yet physicians are practicing in them.
If I were you, I would consult with a malpractice provider to discuss your risk like TraumaRUs suggested. This is going to be a special situation with you being both an AG-ACNP (13 and up) with Derm NP (all ages) certification.
traumaRUs, MSN, APRN
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@annaiya- so you are an ACNP working in a Peds ICU?.....