Can FNPs work in an ICU?

[damalern1]

I have 4 years of ICU experience and am currently in a FNP program. My question is can a FNP work in an ICU and insert central lines, intubate, insert A-Lines, etc.?

[msnmom]

Chances are, you would have to get your Acute Care certification in order to work in a critical care environment. Unless, it is specified that the particular facility you plan to work for are willing to train you, let alone allow it. I am too in the FNP program and an RN in the MICU at a VERY large teaching hospital. The majority of the time the residents and PA's take over and do all of the invasive procedures, and it's very seldom that the ICU ACNP's get to do them-sad, but true. In fact, I find that all of the NP's do all of the undesired work that MD's are licensed to do (ie. H&P's, ordering diagnostic tests, PRN medications, activity orders and such). Pretty much a "pass the buck" game all the way down to the ACNP. This is so the Attendings/Fellows can teach the residents to do cooler things such as: intubations, chest tube insertions, central lines, etc. And our Respiratory therapists do all the A-lines'. Perhaps, you may get lucky if you choose to work in a rural location.

Now being an MICU nurse, I totally have the confidence that you're just as competent as the docs to to these kind of procedures. But in the eyes of the Board, all you have is ICU experience as a Registered Nurse-not an Advance Practice Nurse with a certification in Acute Care.

I hope this doesn't sound discouraging, but I can also tell you that the majority of the ACNP's I have worked with, (whether it be the ICU or Critical Care Transport/Life Flight) all have mentioned that they've wished to have gone the FNP route due to marketability and better pay. So you're in the right ball game. However, if all you're looking forward to is doing invasive procedures, then you should pick another curriculum: ACNP or CRNA route.

[xxlilkacixx]

It depends on where you work I think. My hospital is midsize near a big city and we have 2 FNPs in our icu one of which performes the skills you mentioned. I don't know that she would be able to though if she actually worked in the nearby big city I mentioned.

[Corey Narry, MSN, RN, NP]

I am an ACNP currently working in multi-specialty ICU's in a large academic medical center in California. I am part of a group of ACNP's (12 full time) who work under the Adult Critical Care Medicine service at the hospital. We do not have PA's and the medical center we work for is part of a health sciences university campus with a medical school, nursing school, dental school, and pharmacy school. The university has an ACNP program and many on our NP team are alumni and we also regularly precept the students in this program. Our team only hires ACNP's.

As part of the ICU provider team, we do procedures including all types of central venous access from dialysis catheters to TLC's to PICCS a well as arterial lines. We also intubate and provide conscious sedation. Yes, we have medical students, residents, and fellows as well but the patient load is large enough to accommodate a big team of providers and work is split among every member of the team with the Intensivist being the team captain or leader.

You may not find the same model everywhere. I used to live in the midwest (where I received my ACNP training) and have worked as an ICU NP there in 2 different settings with different staffing models. One large hospital I worked for hired NP's in the ICU (same role with privileges to do procedures) but is not particular about whether the NP is trained as ACNP or not as long as the NP has critical care background as an RN. The other hospital (a smaller community setting) hired both NP's and PA's in the same role.

The Society of Critical Care Medicine (the professional association for intensivists and other critical care professionals) have published some literature on the use of ACNP's in critical care units across the US. Because of that, there is a greater awareness of the role of ACNP's in ICU's among critical care physicians in larger hospitals. Smaller hospitals in more remote areas or community settings probably are not as aware of these, however.

[Corey Narry, MSN, RN, NP]

Also look at your state Nurse Practitioner regulations in terms of Scope of Practice. A few states do not allow non-ACNP's to work in critical care roles.