Considering career as NP

nomadcrna, DNP, CRNA, NP · Apr 26, 2011

Do a FNP program where you set up your own clinicals. I did mine mostly in ER and inpatient.

I would imagine the same is true for TWU as well. FNPs are trained for outpatient clinical care, prevention, etc. We did not have classes in all of the flashy procedures that some want to do. If you want to work in a hospital, do Acute Care. They are well trained and have a great clinical mix IN the hospitals.

allnurses Guide · Apr 26, 2011

Do a FNP program where you set up your own clinicals. I did mine mostly in ER and inpatient.

One caveat to that.....It can be hard to find sites. It's nice to have your school find you sites, provided you get veto power.

carachel2 · Apr 28, 2011

Do a FNP program where you set up your own clinicals. I did mine mostly in ER and inpatient.

I just don't get this. For certification and for state requirements, we were required to SHOW that we did X amount of hours in pediatric outpatient, family practice, internal medicine, ob-gyn ,etc. Doing clinicals in an inpatient setting is acute care...not family practice. We had students who tried to manipulate the requirements or manuever around the requirements and a few were required to redo those hours.

If you want to be acute care, be acute care. I don't get going through an FNP program and doing all of your clinics outside the family practice realm.

Advanced Practice Columnist / Guide · Apr 28, 2011

I just don't get this. For certification and for state requirements, we were required to SHOW that we did X amount of hours in pediatric outpatient, family practice, internal medicine, ob-gyn ,etc. Doing clinicals in an inpatient setting is acute care...not family practice. We had students who tried to manipulate the requirements or manuever around the requirements and a few were required to redo those hours.
If you want to be acute care, be acute care. I don't get going through an FNP program and doing all of your clinics outside the family practice realm.

I just don't understand how this case actually got past the review from the certification board without being questioned.

nomadcrna, DNP, CRNA, NP · Apr 28, 2011

Because as an FNP, i can do it all. If I did an acute care NP, I could not be the sole provider in a rural ER. I enjoy seeing all ages of patients in the clinic and having the ability to admit my own patients. Acute care NP is pretty much stuck while an FNP is much more versatile. Since I was already a CRNA, I did not feel the acute care np would offer me much. I already was able to do all the procedures. After 20 years of practice, I was well versed on inpatient and especially ICU medicine.

You do have to do a certain number of hours of OB and Peds. I did much of my OB in a family practice office where we saw everything from babies and OB to geriatrics. So I got OB, pedi and primary care at the same time. I also did OB on the hospital OB unit where I was able to actually, GASP delivery babies. It helps to have a professional relationship already established. I taught one FP doc how to do a subclavian, she taught me how to a chest tube. LOL

The pedi patients I saw in the ER also counted towards my hours.

THe bottom line is the FNP offers me much more flexibility. I can do ER, hospitalist, intensivist and primary care. I would be to limited as an acute care NP.

BTW, what you consider the "family practice realm" in your state may not be in my state.

Family practice encompasses everything. You do realize that family practice providers cover the majority of rural ERs in Montana, Wyoming, Alaska and Idaho?

Is that in your definition of "family practice realm"?

This one should really make you crazy. There is a FNP doing colonoscopy procedures in Anchorage, AK. She got the training and the hospital credentialed her. She does a good job as well.

I just don't get this. For certification and for state requirements, we were required to SHOW that we did X amount of hours in pediatric outpatient, family practice, internal medicine, ob-gyn ,etc. Doing clinicals in an inpatient setting is acute care...not family practice. We had students who tried to manipulate the requirements or manuever around the requirements and a few were required to redo those hours.
If you want to be acute care, be acute care. I don't get going through an FNP program and doing all of your clinics outside the family practice realm.

nomadcrna, DNP, CRNA, NP · Apr 28, 2011

You want to clarify what you are asking? I assume you are not accusing me of not getting the required hours?

If you mean how did I fulfill the hours, read the above post. You do not have to work in a pediatricians office or ob/gyn to get the needed hours.

You do realize that Family Practice means "Family Practice". That is OB, Peds, IM and everything in between. You also realize that an ER or urgent care does a whole bunch of "primary care"?

So maybe give the certifying bodies and the university some credit and assume they know what they are doing.

That is one problem with advanced practice nursing. Being place in a "role" and expected to stay there. I am glad that I practice in a state where I can be do what I've been educated and/or trained in.

I just don't understand how this case actually got past the review from the certification board without being questioned.

CCRNDiva, BSN, RN · Apr 28, 2011

Most schools are now separating their curriculum for FNP and ACNP. All of the schools I'm applying to have said their FNP programs will focus totally on health promotion and prevention in the clinic/office environment while their ACNP programs will focus on managing chronic or acute illness requiring hospitalization. The majority are also offering specific programs for the NP who wishes to practice in the ED. They provide dual certification in FNP and ACNP. One of the program directors at an open house I attended said that there are now legal cases pending about the legality of of someone trained in FNP managing hospitalized patients when their advanced degree did not provide education for that.

We must remember that family practice docs complete a residency that includes inpatient and outpatient experience. Most NP programs do not do that. That's why I like the idea of a dual cert. for an ENP. It provides the education and clinical training from both realms. Just my two cents.

carachel2 · Apr 28, 2011

Most schools are now separating their curriculum for FNP and ACNP. All of the schools I'm applying to have said their FNP programs will focus totally on health promotion and prevention in the clinic/office environment while their ACNP programs will focus on managing chronic or acute illness requiring hospitalization. The majority are also offering specific programs for the NP who wishes to practice in the ED. They provide dual certification in FNP and ACNP. One of the program directors at an open house I attended said that there are now legal cases pending about the legality of of someone trained in FNP managing hospitalized patients when their advanced degree did not provide education for that.
We must remember that family practice docs complete a residency that includes inpatient and outpatient experience. Most NP programs do not do that. That's why I like the idea of a dual cert. for an ENP. It provides the education and clinical training from both realms. Just my two cents.

I completely agree with these concerns. I have no problem with an NP working in a hospital or ER IF they were in an acute care program. I know NPs who did a dual certification in pedi acute and adult acute and now work in an ER setting.

Advanced Practice Columnist / Guide · Apr 28, 2011

You want to clarify what you are asking? I assume you are not accusing me of not getting the required hours?
If you mean how did I fulfill the hours, read the above post. You do not have to work in a pediatricians office or ob/gyn to get the needed hours.
You do realize that Family Practice means "Family Practice". That is OB, Peds, IM and everything in between. You also realize that an ER or urgent care does a whole bunch of "primary care"?
So maybe give the certifying bodies and the university some credit and assume they know what they are doing.

Your way of thinking is the very same reason why physicians laugh at our training and make a mockery of our quest for independent practice. I am embarassed.

That is one problem with advanced practice nursing. Being place in a "role" and expected to stay there. I am glad that I practice in a state where I can be do what I've been educated and/or trained in.

It is what it is. Advance practice nursing trains you for a specific role. There's a better option for those who want to get all the clinical hours you described in a more structured and consistent manner - Physician Assistant programs. But I guess some NP wannabes want the easy way out by not commiting to a full time program where concurrent employment is not possible and the didactics are not offered in the online format.

nomadcrna, DNP, CRNA, NP · Apr 28, 2011

And this is one of the big problems with NP vs PA and MDs. The PA receives a generalist medical education as does the FNP. They specialize afterwards. The MD also initially receives a generalist education and specializes afterwards.

Why should you have an issue with an FNP who has received training in ER or hospitalist care working there? Who do you think diagnoses gallbladders, diverticulitis, appys, peritonsilar abscess, and many more? Do you really think these only come in the ER? Or how about a toddler with bronchiolitis that needs hospitalization? It is ok to diagnosis and treat these conditions in the office but I'm not capable of doing the same thing in the hospital? Lets see, I can treat diverticulits on an outpatient basis but not inpatient? How much sense does that make?

Do you really think the acute care NP can't work in primary care? They might need a mentor initially and the same goes for the FNP working in ER.

So we have the PA who can work in any part of the hospital or office and then we have nurses who guard their turf as in ACNP vs FNP.

Do you really think the many states that used FNP for ER coverage and hospitalist coverage will stop? They can't! I looked in the job adds from npjobs.com. Many, many jobs in specialties areas requesting APRN. These APRNs can be (mostly) FNP and adult. I would make a case for acute as well. I see no reason why the ACNP can't see patients in a cardiology clinic? Although most are looking for FNPs.

FNPs are working in a multitude of specialty areas and I don't see this stopping. Instead of turf wars we need to stick together to advance the NP profession.

What needs to happen is all NP receive a generalist education then specialize afterwards into acute care, ER, peds etc.

I completely agree with these concerns. I have no problem with an NP working in a hospital or ER IF they were in an acute care program. I know NPs who did a dual certification in pedi acute and adult acute and now work in an ER setting.

nomadcrna, DNP, CRNA, NP · Apr 28, 2011

WOW, lets go for personal attacks. LOL

NP wannabes?

Easy way out?

I don't know whether to laugh or be sad for our profession. When you can't discuss your position like an adult instead of personal attacks.

Here are a few examples from very reputable universities.

FAMILY NURSE PRACTITIONER

Roles & Responsibilities of a Family Nurse Practitioner

Depending on the location of practice, the level of independence for a nurse practitioner may vary greatly. Often times the nurse practitioner will work completely independently of a physician. Sometimes nurse practitioners are required to work in collaboration with a physician. The role, duties, medical treatments, and pharmacologic abilities of the nurse practitioner depend on the state of licensure.

Nurse Practitioner role & responsibilities may include:

Diagnosing, treating, and helping patients manage acute and chronic illnesses

Conducting physical examinations and interpreting medical history

Ordering and performing diagnostic tests and procedures

Prescribing age specific physical therapy and rehabilitation

Prescribing pharmacologic treatments (depends on state regulation)

Providing prenatal care, family planning services, and screening services

Primary and specialty care services for adults and children

Performing minor surgeries and procedures

Counseling and educating patients about preventive measures to avoid illness

A Family Nurse Practitioner specializes in the treatment and diagnoses of patients in a wide age range, from childhood to the elderly. People drawn to this specialty are life-long learners who seek more responsibility and independence in their career. They find professional satisfaction in evaluating and treating patients and pay special attention to the family unit. Family nurse practitioners are equipped to work in hospitals, private practice, government organizations, community health organizations, and other health care systems. OMG hospitals and even minor surgeries?

http://nurseweb.ucsf.edu/www/spec-fnp.htm

FAMILY NURSE PRACTITIONER

Roles & Responsibilities of a Family Nurse Practitioner

Depending on the location of practice, the level of independence for a nurse practitioner may vary greatly. Often times the nurse practitioner will work completely independently of a physician. Sometimes nurse practitioners are required to work in collaboration with a physician. The role, duties, medical treatments, and pharmacologic abilities of the nurse practitioner depend on the state of licensure.

Nurse Practitioner role & responsibilities may include:

Diagnosing, treating, and helping patients manage acute and chronic illnesses OMG, the acute word. FNPs can't do that

Conducting physical examinations and interpreting medical history

Ordering and performing diagnostic tests and procedures

Prescribing age specific physical therapy and rehabilitation

Prescribing pharmacologic treatments (depends on state regulation)

Providing prenatal care, family planning services, and screening services

Primary and specialty care services for adults and children WAIT, FNP can't do specialty only primary care.

Performing minor surgeries and procedures. THere is that surgery thing again.

Counseling and educating patients about preventive measures to avoid illness

A Family Nurse Practitioner specializes in the treatment and diagnoses of patients in a wide age range, from childhood to the elderly. People drawn to this specialty are life-long learners who seek more responsibility and independence in their career. They find professional satisfaction in evaluating and treating patients and pay special attention to the family unit. Family nurse practitioners are equipped to work in hospitals, private practice, government organizations, community health organizations, and other health care systems.

I need to talk to the university. FNPs can't work in the hospital. ONLY ACNP should be there. LOL

Your way of thinking is the very same reason why physicians laugh at our training and make a mockery of our quest for independent practice. I am embarassed.
It is what it is. Advance practice nursing trains you for a specific role. There's a better option for those who want to get all the clinical hours you described in a more structured and consistent manner - Physician Assistant programs. But I guess some NP wannabes want the easy way out by not commiting to a full time program where concurrent employment is not possible and the didactics are not offered in the online format.

Advanced Practice Columnist / Guide · Apr 28, 2011

WOW, lets go for personal attacks. LOL
NP wannabes?
Easy way out?
I don't know whether to laugh or be sad for our profession. When you can't discuss your position like an adult instead of personal attacks.
Here are a few examples from very reputable universities.
FAMILY NURSE PRACTITIONER
Roles & Responsibilities of a Family Nurse Practitioner
Depending on the location of practice, the level of independence for a nurse practitioner may vary greatly. Often times the nurse practitioner will work completely independently of a physician. Sometimes nurse practitioners are required to work in collaboration with a physician. The role, duties, medical treatments, and pharmacologic abilities of the nurse practitioner depend on the state of licensure.
Nurse Practitioner role & responsibilities may include:
Diagnosing, treating, and helping patients manage acute and chronic illnesses
Conducting physical examinations and interpreting medical history
Ordering and performing diagnostic tests and procedures
Prescribing age specific physical therapy and rehabilitation
Prescribing pharmacologic treatments (depends on state regulation)
Providing prenatal care, family planning services, and screening services
Primary and specialty care services for adults and children
Performing minor surgeries and procedures
Counseling and educating patients about preventive measures to avoid illness
A Family Nurse Practitioner specializes in the treatment and diagnoses of patients in a wide age range, from childhood to the elderly. People drawn to this specialty are life-long learners who seek more responsibility and independence in their career. They find professional satisfaction in evaluating and treating patients and pay special attention to the family unit. Family nurse practitioners are equipped to work in hospitals, private practice, government organizations, community health organizations, and other health care systems. OMG hospitals and even minor surgeries?
http://nurseweb.ucsf.edu/www/spec-fnp.htm
FAMILY NURSE PRACTITIONER
Roles & Responsibilities of a Family Nurse Practitioner
Depending on the location of practice, the level of independence for a nurse practitioner may vary greatly. Often times the nurse practitioner will work completely independently of a physician. Sometimes nurse practitioners are required to work in collaboration with a physician. The role, duties, medical treatments, and pharmacologic abilities of the nurse practitioner depend on the state of licensure.
Nurse Practitioner role & responsibilities may include:
Diagnosing, treating, and helping patients manage acute and chronic illnesses OMG, the acute word. FNPs can't do that
Conducting physical examinations and interpreting medical history
Ordering and performing diagnostic tests and procedures
Prescribing age specific physical therapy and rehabilitation
Prescribing pharmacologic treatments (depends on state regulation)
Providing prenatal care, family planning services, and screening services
Primary and specialty care services for adults and children WAIT, FNP can't do specialty only primary care.
Performing minor surgeries and procedures. THere is that surgery thing again.
Counseling and educating patients about preventive measures to avoid illness
A Family Nurse Practitioner specializes in the treatment and diagnoses of patients in a wide age range, from childhood to the elderly. People drawn to this specialty are life-long learners who seek more responsibility and independence in their career. They find professional satisfaction in evaluating and treating patients and pay special attention to the family unit. Family nurse practitioners are equipped to work in hospitals, private practice, government organizations, community health organizations, and other health care systems.
I need to talk to the university. FNPs can't work in the hospital. ONLY ACNP should be there. LOL

I think you are the one taking it too personally. Nobody is attacking you. You can do whatever you want - it's your own practice and I am not doubting your skills. All I'm saying is with the limited training that the FNP (or ACNP, ANP, etc. for that matter) that we get in our respective programs and claim that we can be jack of all trades after the 500-750 or so hours of clinicals is a joke. There are people who visit this site who are eager to learn about our role as NP's and I think we are giving them a disservice for not being upfront and honest about the limitations of our training. There are great NP's out there and chances are they have lots of clinical experience like you do, but not everyone has the same background to brag about. And I am not buying that university advertising you just posted...that's a way to hook students to enroll.