Considering career as NP

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

He said, she said. Do you have a specific example of a lawsuit? I searched and could not find it. I would not be surprised if it were out there but FNPs work in hospitals all over the country. Maybe that particular FNP could not show education or training?

Why would universities describe their FNP programs as they do below? Why would so many hospitals in rural areas use FNPs in the ER and hospitalist positions? Why do FNPs have admit privileges in many hospitals?

Just a few I pulled in in a couple of minutes. Just because something is not done in your hospital or region does not mean it is not standard of care in another region.

http://www.sedonafamilyhealth.com/

Marian Diamond has been a registered nurse (RN) in Arizona since 1978. She has worked in medical/surgical units, as Assistant Charge Nurse in the Critical Care Unit at Verde Valley Medical Center, and as a Charge Nurse at Kachina Point Health Care Center in Sedona.

Marian completed her Batchelor's degree in Nursing at Northern Arizona University in 1998, and her Master's degree in Nursing as a Family Nurse Practitioner in 2001. She is licensed to practice as a Registered Nurse Practitioner in Arizona with full prescribing and dispensing privileges and holds national certification through the American Academy of Nurse Practitioners. She is Advanced Cardiac Life Support (ACLS) certified. She currently has admission privileges at Kachina Point Health Care Center.

https://allnurses.com/nurse-practitioners-np/fnp-admission-privelages-337623.html

I lived in Arizona for 4 years and worked family practice and had admitting privleges at the local hospital. I also worked in the ER. You need to fill out privleges forms usually for each area of the hospital you want to work in as the forms designate certain skill sets you are asking to cover. I had inpatient peds, inpatient adult, ER and ICU areas I could admit and follow patients. The ICU patients I was usually just writing admit orders until the doc got to see them but for my family practice pts I would admit, round and discharge. For the hospital Medicare usually makes the hospital assign you a "supervising" physician. IIt was more of a paperwork formality. ts not required by the state though but some insurances and medicare want it for inpatient.

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

Lets see, you called me a NP wannabe? Thats not personal?

If you feel your program was "limited" thats fine. Many programs are not.

By generalizing your practice into other states and regions practice is not doing anyone a fair service. Check around, many states have FNP handling inpatient, ER and even OR stuff.

Many states allow total independent practice, including full prescriptive authority.

My advice to the people here looking for NP school is to learn all you can and don't let anyone put you into a box. AFter you finish, keep learning new procedures. Find a mentor who will teach you areas you are not comfortable in.

Why can't a FNP, ANP or ACNP do a central line or chest tube? YOU CAN! Learn how.

How about reducing fractures? YOU CAN! learn how.

We need to push our profession forward, not hold it back.

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.

Advanced Practice Columnist / Guide · Apr 28, 2011

Lets see, you called me a NP wannabe? Thats not personal?
If you feel your program was "limited" thats fine. Many programs are not.
By generalizing your practice into other states and regions practice is not doing anyone a fair service. Check around, many states have FNP handling inpatient, ER and even OR stuff.
Many states allow total independent practice, including full prescriptive authority.
My advice to the people here looking for NP school is to learn all you can and don't let anyone put you into a box. AFter you finish, keep learning new procedures. Find a mentor who will teach you areas you are not comfortable in.
Why can't a FNP, ANP or ACNP do a central line or chest tube? YOU CAN! Learn how.
How about reducing fractures? YOU CAN! learn how.
We need to push our profession forward, not hold it back.

I don't understand why you felt that I was referring to you as an NP wannabe when I know well that you are already a fully certified and practicing FNP based on your frequent posts?

Yes, my ACNP program focused on in-patient management from ED to ICU and specialty clinic practice in Cardiology and Pulmonary Diseases. I've worked in ICU for 7 years now as an NP. Yes, I do place central lines, arterial lines, intubate, manage vents, provide conscious sedation, and order drips. I have also placed chest tubes for pneumothorax and drained pleural effusions. I have floated Swan-Ganz catheters at a previous job. In my current job, CCNP's are required to have a minimum number of cases each year for central lines, arterial lines, intubations, etc. to maintain competency. And yes, we do get patients from rural hospitals who barely were admitted in their institution and was sold to us as an ICU patient yet turned out to be not as acute as we would have assessed.

carachel2 · Apr 28, 2011

I don't understand why you felt that I was referring to you as an NP wannabe when I know well that you are already a fully certified and practicing FNP based on your frequent posts?
Yes, my ACNP program focused on in-patient management from ED to ICU and specialty clinic practice in Cardiology and Pulmonary Diseases. I've worked in ICU for 7 years now as an NP. Yes, I do place central lines, arterial lines, intubate, manage vents, provide conscious sedation, and order drips. I have also placed chest tubes for pneumothorax and drained pleural effusions. I have floated Swan-Ganz catheters at a previous job. In my current job, CCNP's are required to have a minimum number of cases each year for central lines, arterial lines, intubations, etc. to maintain competency. And yes, we do get patients from rural hospitals who barely were admitted in their institution and was sold to us as an ICU patient yet turned out to be not as acute as we would have assessed.

And I would totally let you care for me in a hospital. Don't come to my bedside with "FNP" on your badge though because I KNOW you didn't do all that in school! I don't care who trained you afterwards.

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

LOL, its your choice. Sometimes you get what you wish for.

Nurses truly can be our own worst enemy. :)

I was doing OB anesthesia a number of years ago. A pediatric MDA(medical doctor anesthesiologist) came in laboring. She wanted an epidural but did not want a CRNA to do it. So an MDA was called who came in and wet tapped her twice trying to get the epidural in. He finally got it in and it never really worked. She got a post dural puncture headache afterward of course and I was called to blood patch her. I would not touch her and had them call the MDA who did the epidural. He wet tapped her again trying to do the blood patch.

But he had magic initials and must of had more training, right?

And I would totally let you care for me in a hospital. Don't come to my bedside with "FNP" on your badge though because I KNOW you didn't do all that in school! I don't care who trained you afterwards.

Advanced Practice Columnist / Guide · Apr 28, 2011

And I would totally let you care for me in a hospital. Don't come to my bedside with "FNP" on your badge though because I KNOW you didn't do all that in school! I don't care who trained you afterwards.

Well, I also want to make things clear that I just don't go around stabbing at people's chests to put in lines or chest tubes. It's a collaborative decision with our attending physician and the entire ICU team when we decide to perfrom these invasive procedures. The truth is anyone with a functioning brain and a pair of hands can be trained to do these safely especially with new technology. But there are major risks involved in performing these procedures so the possession of sound judgement and clinical decision making is more important and that comes from extensive training in the clinical specialty or setting. If we as NP's are going to continue to assert or claim that we are competent enough to be independent, we better make sure that our educational training matches the field of medicine we are "encroaching" upon. Medicine as a field is going farther as to add more years of true clinical training in a structured environment in many residency programs across the country and that's how it should be. Sadly, that trend is not happening for us NP's. At the current time, we already have some form of structure in our training programs: the FNP is analogous to family practice, ANP is to IM primary care, ACNP is to hospitalist/intesivist. I am fully aware that there are FNP's working in critical care settings in many states and regions but must we continue to propagate this practice knowing that this is not the ideal preparation for an NP especially now that we have been certifying ACNP's since 1995? I am all for us NP's advancing as a professional group but can we at least have some degree of order in our ranks and stick to a standard where we only practice under the formal training we completed instead of throwing the rules out the door?

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

I also perform those procedures and have for years. The only difference is that I usually make the decision. Unless I get a consult to place a central line for someone else.

Judgement is learned many times after your schooling, hopefully with a mentor. I agree that we need changes in our NP education system. I've been yelling that at the top of my lungs for quite a while now. But I disagree that we need to put all NP into a "role". We have mechanisms for learning new procedures, techniques and even specialties after graduation from a NP program. I agree that we should train our NP better to better compete with the physicians.

Our main difference is the definition of Family Practice. Many rural parts of the country and even semi rural areas basically have Family Practice coverage for most all parts of the hospital. They have always been jack of all trades. Many FPs still do surgery and OB. It is not just primary care.

I believe you are in Michigan, which comes in 44th out of the 50 states in regards to practice restriction. Michigan may have restrictive rules about practice but many other states do not. Thankfully, I'm in an independent practice state. I would fully support an increase in education or a mechanism for ACNP to get training to do primary care or office based medicine and the FNP to do ER or acute care medicine.

I don't agree with sticking to an "order" or "role" for each practitioner. The APRN joint dialogue group report consensus statement is pushing for four types of APRNs. CRNA, CNM, CNS and CNP(certified nurse practitioner). The CNP will be educated in in one of six population foci: family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women's heal or psych/mental health. The APRN education programs will consist of a broad-based education. APRNs may specialize but they cannot be licensed solely within a specialty area. Education for a specialty can occur concurrently with APRN eduction or through post-graduate education. Scope of practice of the primary care or acute care CNP is not setting specific but is based on patient care needs.

I agree with where it seems we are heading. Instead of focusing on the title and where they fit in a box. NP must document their education and training in a specialty area. I am all for increased education and agree that it does not have to be in the original NP program. There are to many ways of acquiring education and training after graduation.

I would love to see a basic, broad based NP education and then you specialize afterwards. So everyone takes the fnp education then goes on to ACNP, pedi, anesthesia etc. I think this would further our profession.

Instead of turf wars, lets try and move our education forward.

Well, I also want to make things clear that I just don't go around stabbing at people's chests to put in lines or chest tubes. It's a collaborative decision with our attending physician and the entire ICU team when we decide to perfrom these invasive procedures. The truth is anyone with a functioning brain and a pair of hands can be trained to do these safely especially with new technology. But there are major risks involved in performing these procedures so the possession of sound judgement and clinical decision making is more important and that comes from extensive training in the clinical specialty or setting. If we as NP's are going to continue to assert or claim that we are competent enough to be independent, we better make sure that our educational training matches the field of medicine we are "encroaching" upon. Medicine as a field is going farther as to add more years of true clinical training in a structured environment in many residency programs across the country and that's how it should be. Sadly, that trend is not happening for us NP's. At the current time, we already some form of structure in our training programs: the FNP is analogous to family practice, ANP is to IM primary care, ACNP is to hospitalist/intesivist. I am fully aware that there are FNP's working in critical care settings in many states and regions but must we continue to propagate this practice knowing that this is not the ideal preparation for an NP especially now that we have been certifying ACNP's since 1995? I am all for us NP's advancing as a professional group but can we at least have some degree of order in our ranks and stick to a standard where we only practice under the formal training we completed instead of throwing the rules out the door?

TicAL · Apr 28, 2011

I agree that we should train our NP better to better compete with the physicians.
....
Instead of turf wars, lets try and move our education forward.

Forget the turf wars, the last thing that I would want is someone who isn't adequately trained to try and take care of me or my family for the sake of "competing with the physicians". The only way to truly start comparing an NPs ability to a physician is for the NP to receive more education and training...I don't know why you see that as "holding the NPs back"?

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

Hmm, I'm a bit confused on this one. This is what you quoted me as saying.

I agree that we should train our NP better to better compete with the physicians.

....

Instead of turf wars, lets try and move our education forward.

And you say: The only way to truly start comparing an NPs ability to a physician is for the NP to receive more education and training.

So it appears to me that you are saying the same thing that I am saying?

I say we should train our NP better to better compete with the physicians.

You say The only way to truly start comparing an NPs ability to a physician is for the NP to receive more education and training.

Forget the turf wars, the last thing that I would want is someone who isn't adequately trained to try and take care of me or my family for the sake of "competing with the physicians". The only way to truly start comparing an NPs ability to a physician is for the NP to receive more education and training...I don't know why you see that as "holding the NPs back"?

TicAL · Apr 28, 2011

I don't think we're really saying the same thing. Just a few posts ago you seemed to get really offended when someone mentioned that NPs should partake in more non-online education and post graduate training. If the scope of practice and level of independence are to increase, so does the practitioner's duty to educate themselves to best treat the patient.

btw, why is it all of a sudden about competing with physicians? The job is to take care of patients, not to feed your ego. Sorry but the entitled attitude annoys me

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

Interesting reading here from the Emergency Nurses Association on NP competencies.

http://www.ena.org/IQSIP/NursingPractice/advanced/Documents/ENANPCompetency.pdf

Altough the authors are 1 - ENP 2 - FNPs and 1 - CRNP (not sure of this one)

TicAL · Apr 28, 2011

Interesting reading here from the Emergency Nurses Association on NP competencies.
http://www.ena.org/IQSIP/NursingPractice/advanced/Documents/ENANPCompetency.pdf
Altough the authors are 1 - ENP 2 - FNPs and 1 - CRNP (not sure of this one)

That article just has a list of what a practitioner should be capable of doing, it doesn't even mention how the practitioners are trained to achieve that competency.