Can I work in a hospital as a FNP?

DeeRN,BSN · Apr 5, 2015

HI!

I am going to be a FNP student. I dont start until this fall at Drexel. But what I have heard and from what i see in the hospital I work in is that FNp's can work in the hospital, usually an ER. Or they can specialize. We have several NP's that work here as well that are Acute Np's that specialized with a certain group too... like infectious disease. What were you interested in doing in the hospital?

sauce · Apr 5, 2015

Hours are usually 12 hour shifts. sometimes rotating and such. you can work in the hospital as an fnp but if that is what you want to do your whole life it may be better to do acnp. I am an fnp in the hospital but I just fell into this job, didnit really plan on it. It isn't wrong to work in hospital as FNP but its just like other specialties, go to school for what you want to do for your career.

Its usually more stressful and more hectic than a clinic job, of course depending broadly on who you work for. We have a really supportive group that listens well so it works out well for us.

Plus it usually pays more than your run of the mill clinics, of course depending on how many patients you see daily also.

Our entire group uses fnp for hospital, and one PA, then our lead internal medicine doc, and the owners of the practice who all round on patients.

But i am in the rural southeast, this would probably not fly in university settings ( at least some )

zmansc, ASN, RN · Apr 5, 2015

nyc2011 said:

Hello,
I am in FNP school and have heard that you cannot work in a hospital setting as a FNP.

Is this true?

What have you seen?

I've seen FNP's work in a hospital but they said it's because they had lots of experienceâ€¦â€¦?

Any FNP's out there currently working in the hospital? If so, how do you like it? Are the hours good?

Thanks in advance

An FNP can work anywhere that is within their state's scope of practice law (with caveat below). So, by that, the question to you would be, what does your state's scope of practice law say in regards to this?

The caveat to this is: does your local hospital, or the hospitals within your region, hire FNPs? If so to do what role? Within the scope that your state allows, facilities can choose whomever they wish to hire. Either by having formal limitations, or informal ones. They often consider insurance reimbursement limitations in your state in making these decisions.

My own state's SOP law is very vague on this, basically saying that if you are trained to perform the work, you can do it. Thus there are ERs in my state that are fully staffed by NPs. I'm only partially familiar with them, so I can't say how they determine if the provider is trained to treat all of the patient population that is/will come into the ED. I also know of several EDs in other states that are staffed by NPs exclusively. All of these hospitals that I know of are rural hospitals, and at the very least the vast majority of the NPs are trained as FNPs (I don't have the credentials of all the providers here).

My own local community hospital has two providers, one MD 24x7 and one NP/PA 12x7. The mix of NP to PA has varied over the years. All of the NPs are FNPs as the facility wants them to be able to see all patients. One ACNP was considered mainly because she had many years of experience in our ED.

Officially, our ED policy states that the NP/PA take levels 3-5 pt only unless the physician is overloaded and directs them to take 1&2s. Unofficially almost all the providers split the patients on a provider available basis. Level 1&2 probably get a physician 75-80% of the time. Also, our provider group has protocols for the providers to become checked off on skills (for physician provider as well as NP/PA, many of the physician providers are not board certified although they are working on improving that ratio), so that is how the group and facility meet the "trained" aspect of the SOP.

My own facility has toyed with the idea of, and hired both NPs & PAs for the hospitalist group, but they have never stuck. I think the main issue has been the distribution of work, basically the physicians have only given the grunt work to the NP/PA. In the cases I know of the NP has been an FNP, again for the reason of all age groups. I think this will improve over time, and at some point there will be FNPs hired into the group that will stick. I know of several FNP Hospitalists in many states, so I have to believe we will figure out how to make it work at some point.

The medical director of our ICU has expressed interest in hiring FNPs to staff the ICU. At this point it is a proposal, so I don't know where that will end up. Again there will be issues of putting the proper training and checkoff procedures in place to meet the SOP.

Personally, if I was to try to make a career in any of these settings, I would consider going back and getting my ACNP.

Alicia777, MSN, NP · Apr 5, 2015

I'm a FNP in surgery. Meaning I act similar to that of a surgical resident. I see patients in ER for consult and admit them to surgery. I first assist in the OR (in my state you must be a RNFA to do this), I care for these patients as inpatients. My co-workers are a mix of NPs and PAs.

My hospital also has NPs working in our ICU but only PAs in the ER.

I work in a community hospital but I've seen similar job postings elsewhere..

Oh and I work two 8's two 12's with optional weekend hours.

MallysMama · Apr 10, 2015

I'm curious why you went the FNP route if you want to work in an acute care setting?

I'm going through an ACNP (adult/gero) program right now. We get told a lot that we aren't being trained to do primary care, just like FNPs aren't being trained to do acute care. From what I understand, a lot of what determines your scope of practice comes down to what you have been educated to do (and then what your facility allows you to do). But if you haven't been taught it in the first place....seems kinda risky to jump into that line of work.

Having said this, I've seen lots of FNPs who work in the ER (usually with non-critical patients and those who aren't needing to be admitted). And as others have shared- they are hired in other areas too (probably depends a lot on the city/state).

Wherever you end up- good luck in your program and with finding a job doing what you love!!

DeeRN,BSN · Apr 10, 2015

Alicia777 said:

I'm a FNP in surgery. Meaning I act similar to that of a surgical resident. I see patients in ER for consult and admit them to surgery. I first assist in the OR (in my state you must be a RNFA to do this), I care for these patients as inpatients. My co-workers are a mix of NPs and PAs.
My hospital also has NPs working in our ICU but only PAs in the ER.

I work in a community hospital but I've seen similar job postings elsewhere..

Oh and I work two 8's two 12's with optional weekend hours.

Alicia,

I was very interested in being a surgical FNP as well. I worked in the OR as an RN, now Im in the ICU, but would love to be back in the surgical setting as a FNP. Do you have to have your RNFA to first assist the surgeon?? What kind of surgery are you in and how did you get that job?.... if you don't mind me asking ?

Alicia777, MSN, NP · Apr 10, 2015

DeeRN,BSN said:

Alicia,
I was very interested in being a surgical FNP as well. I worked in the OR as an RN, now Im in the ICU, but would love to be back in the surgical setting as a FNP. Do you have to have your RNFA to first assist the surgeon?? What kind of surgery are you in and how did you get that job?.... if you don't mind me asking ?

Hi Dee,

Yes, I was an OR nurse before this as well. Yes, in my state an RN (or NP) must have their RNFA to first assist. It's really not that arduous a task, the course was a week and then you have to find a surgeon to oversee your progress for 175 hours, other programs the hours may vary slightly.

I assist in mainly general and Ortho cases (total joints, lap chole etc). I got the job just by being persistent really. My husband worked on the corporate side so I personally emailed my soon to be boss. I figured the worst he could tell me was to get lost, ha!

PM me if you'd like any more deets..

DeeRN,BSN · Apr 11, 2015

Thanks Alicia,

Ill keep that in mind. I definitely would like to keep my NP career in the OR if I can. Once it gets closer to that I will PM you if I think of any questions. Thanks a bunch!! :yes:

Dranger · Apr 11, 2015

MallysMama said:

I'm curious why you went the FNP route if you want to work in an acute care setting?
I'm going through an ACNP (adult/gero) program right now. We get told a lot that we aren't being trained to do primary care, just like FNPs aren't being trained to do acute care. From what I understand, a lot of what determines your scope of practice comes down to what you have been educated to do (and then what your facility allows you to do). But if you haven't been taught it in the first place....seems kinda risky to jump into that line of work.

Having said this, I've seen lots of FNPs who work in the ER (usually with non-critical patients and those who aren't needing to be admitted). And as others have shared- they are hired in other areas too (probably depends a lot on the city/state).

Wherever you end up- good luck in your program and with finding a job doing what you love!!

ACNPs can't do primary care because it is not in their core training. However, FNPs can do everything because they have extensive experiences with all age groups from a child with impetigo to a intubated adult with multifactorial ARDS (associated with liver/heart flow issues) on aggressive APRV vent settings. It's kind of like how you see family med docs work in the ICU, right? Why don't you know this?

Trauma Columnist · Apr 11, 2015

@dranger - few family docs admit to hospitals anymore. Every hospital that I'm credential at (7 at the moment) use hospitalists and intensivists. The keywords now are decreased length of stay and cost containment and the hospitalist and intensivist models cater to these results.

Here are some studies that support this:

The Effect of a Multidisciplinary Hospitalist/Physician and... : Journal of Nursing Administration

This is a multi-disciplinary approach with a hospitalist and APN who also follows the pt. 77,000 subjects

Clinical Medicine Journal

Short history of hospitalist movement

MallysMama · Apr 11, 2015

Dranger said:

ACNPs can't do primary care because it is not in their core training. However, FNPs can do everything because they have extensive experiences with all age groups from a child with impetigo to a intubated adult with multifactorial ARDS (associated with liver/heart flow issues) on aggressive APRV vent settings. It's kind of like how you see family med docs work in the ICU, right? Why don't you know this?

I've never seen a regular family med doc work in the ICU. We have intensivists here. (And where I lived before- the only family med docs who admitted pts to ICU were ones who specialized in pulmonary medicine and had been doing it for decades.)

FNP programs teach vasopressors, tpa, central line insertion, LPs, intubation, CRRT, how to present a patient on rounds, etc?? Guess I didn't realize that- I thought they were ONLY taught primary care management.