Clarification on NP Curriculum?

[DO_question]

Hello allnurses,

I'm a DO student dating a RN who is looking into obtaining her DNP in the near future. Currently, she's interested in FNP due to the flexibility and her interests. We try to support each other as best we can, so she has asked me my thoughts on pros & cons of various programs. I feel woefully inadequate for this task just due to unfamiliarity with graduate nursing education and I hope some of you can help me out. So now to the questions...

1. I note the courses at several institutions cover stats, leadership, roll transition, and research but I don't see courses in anatomy, microbiology, immunology, or biochemistry. Are these integrated into other courses? Or is this varied enough that it would be on a school by school basis? I ask this specifically wondering if the undergraduate courses in these subjects are considered adequate for FNP practice or if they are covered at the advanced level. Keep in mind, I'm familiar with her undergrad courses, I took most of them.

2. Is there a general expectation of established clinical sites? To what level does this vary? I'm not finding much on school websites about clinical sites.

3. For those of you in practice, can you offer any resources that would benefit her in making the most of her education? Anything you wish you had done prior to enrollment?

4. Any pitfalls that might not be so obvious to a significant other? Any pitfalls you see that a medical student or resident might need to understand specifically?

I appreciate your time and forgive me if this is some beaten horse, I did try to some rudimentary searches on the site and did not see these questions addressed. Please, if I seem ignorant, just know I'm trying to understand to the best of my ability and support her in her career moves.

[DO_question]

Thanks guys!

She hasn't said, and she may not until she shadows, but what if she wanted to be in the ED? Still FNP?

[babyNP., APRN]

That would depend on which state she intends to practice. The Consensus Model for NPs was created several years ago and I think about 10 states have adopted it so far. Essentially you can only work in the area for which you are trained, i.e. acute care can only work in hospitals, primary care only in out-patient. A family NP could not work in an ICU even though theoretically the degree is across the lifespan. You will see on this forum and others about FNPs working in acute care, but that is location dependent. I suspect that will be a good many years before every state adopts the Consensus Model, but it is coming and I think folks would be wise to cover themselves for the eventuality.

If she wants to have flexibility, many programs allow you to do FNP and acute care adult at the same time, which only takes a couple of extra semesters.

[FullGlass, BSN, MSN, NP]

Thanks guys!

She hasn't said, and she may not until she shadows, but what if she wanted to be in the ED? Still FNP?

If she wants to work in the ED, that is acute care. She must then choose either Adult/Geri Acute Care NP or Peds Acute Care NP. The current FNP curriculums do not include acute care didactic education or clinical rotations. If she doesn't know if she wants acute care or primary care, then go the PA route.

[DO_question]

If she wants to work in the ED, that is acute care. She must then choose either Adult/Geri Acute Care NP or Peds Acute Care NP. The current FNP curriculums do not include acute care didactic education or clinical rotations. If she doesn't know if she wants acute care or primary care, then go the PA route.

So I've heard of several EDs steering away from providers that are not trained to treat Peds. Run into that much? Mostly a non-issue?

[BostonFNP, APRN]

So I've heard of several EDs steering away from providers that are not trained to treat Peds. Run into that much? Mostly a non-issue?

The vast majority of NPs working in UC and ED settings are FNP trained because of the ability to see all ages plus OB; prior poster was incorrect about that.

There is now a board certification exam for Emergency NPs available (as of 1/2017). It requires an FNP certification plus practice hours in an ED, an approved ENP graduate/postgraduate program (FNP+AGACNP combined program), or an approved ED fellowship. More info on this at AAENP's website.

[DO_question]

Thank ya

[Oldmahubbard]

The most interesting thing I have done in my Psych NP career is to appear in court for the State as an expert witness, in an attempt to obtain a court orders to force inmates to take medication against their will.

I did it many times over 10 years and only lost once. The patient had started taking his medications.

Great to hear all the different things that APRN's are doing today, that were unheard of 20 years ago!

[FullGlass, BSN, MSN, NP]

The vast majority of NPs working in UC and ED settings are FNP trained because of the ability to see all ages plus OB; prior poster was incorrect about that.

There is now a board certification exam for Emergency NPs available (as of 1/2017). It requires an FNP certification plus practice hours in an ED, an approved ENP graduate/postgraduate program (FNP+AGACNP combined program), or an approved ED fellowship. More info on this at AAENP's website.

Actually, this is in line with what I said. While in the past, FNPs may have had acute care training, that is not generally the case now. Current FNP students only receive primary care didactic education and clinical rotations, with the exception of urgent care. They do not have hospital or ED rotations, nor do they receive didactic education geared to acute care. Reputable schools are very clear on the dangers of a new FNP grad working in an acute care setting. given they have received NO education or training to do so! How can a new grad NP who has had NO clinical rotations in acute care safely practice in that setting? In addition, this would be a serious liability issue.

Your post correctly points out the additional education and training required for an FNP to safely practice in an acute care setting.

I understand that in the past, things were different. Currently, the fastest route for someone who wants to care for all ages in an ED is to become a PA.

As for EDs preferring NPs who can treat all ages, that is going to depend on the area and on the facility. Large hospitals often have a separate ED, or section of the ED, for children. There are also children's hospitals. In addition, acute care is not just the ED.

This is what UCSF nursing school says about their FNP program: "The Family Nurse Practitioner (FNP) meets the healthcare needs of the individual and family by providing comprehensive primary care through the lifespan." [added underline]

Family Nurse Practitioner (FNP) | UCSF School of Nursing

Here is UCSF on the AGACNP: "Adult-Gerontology Acute Care Nurse Practitioners (AG ACNP) are needed to help assess and manage acutely ill patients within the inpatient/hospital setting and across hospital-to-clinic settings, including the emergency department, intensive care unit, specialty labs, acute and sub-acute care wards, specialty clinics, or any combination of the above."

Adult-Gerontology Acute Care Nurse Practitioner (AG ACNP) | UCSF School of Nursing

Let's look at an East Coast school - U Penn. Note that the FNP clinical curriculum only has primary care content:

https://www.nursing.upenn.edu/family/plans-of-study/

U Penn AGACNP curriculum. Note there is only acute care clinical content:

https://www.nursing.upenn.edu/adult-gerontology/adult-gerontology-acute-care-nurse-practitioner/plans-of-study/

I find it ironic that many on this forum are opposed to NPs who did not work as RNs, yet are fine with an NP who did not get any NP-level acute care education or clinical rotations practicing in an acute care setting. It is imperative to adhere to scope of practice, just like a peds NP should not practice in a geriatric facility.

[BostonFNP, APRN]

Actually, this is in line with what I said.

It is not in line with what you said, your statement was factually inaccurate. Again, the vast majority of ED/UC NPs are family trained (upwards of 70+% compared to ~10% acute care). The APRN Consensus Model (with a failed target date of 2015) has sought to provide more structured guidance to scope of practice but has largely been unsuccessful (for better or worse). We can debate the merits of this but the fact remain the same.

While in the past, FNPs may have had acute care training, that is not generally the case now. Current FNP students only receive primary care didactic education and clinical rotations, with the exception of urgent care. They do not have hospital or ED rotations, nor do they receive didactic education geared to acute care. Reputable schools are very clear on the dangers of a new FNP grad working in an acute care setting. given they have received NO education or training to do so! How can a new grad NP who has had NO clinical rotations in acute care safely practice in that setting? In addition, this would be a serious liability issue.

This also isn't totally true, many FNPs still have acute care, emergency, and UC clinical rotations. Many quality NP programs have added additional training in emergency and urgent care to their NP programs and other have had this for decades. FNPs certainly have more training in emergency and urgent care than ACAGNPs have in pediatrics.

More importantly, all of the extant data that on the quality of care provided by NPs in the ED/UC settings was based on the majority of NPs being family trained.

Your post correctly points out the additional education and training required for an FNP to safely practice in an acute care setting.

Again, this is inaccurate. My post points out what is required to be board certified in emergency for an NP: and FNP degree in total or in part, with a few small caveats.

As for EDs preferring NPs who can treat all ages, that is going to depend on the area and on the facility. Large hospitals often have a separate ED, or section of the ED, for children. There are also children's hospitals. In addition, acute care is not just the ED.

The post asked about ED not acute care in general. Again here, the vast majority of ED/UC care is provided without the luxury of having an adjacent pediatric or obstetric hospital ED. Sure it exists, just outside of the norm.

I find it ironic that many on this forum are opposed to NPs who did not work as RNs, yet are fine with an NP who did not get any NP-level acute care education or clinical rotations practicing in an acute care setting. It is imperative to adhere to scope of practice, just like a peds NP should not practice in a geriatric facility.

Every provider is bound by their board to practice within the breadth of their experience and training (physicians to PAs to NPs). If you are practicing outside of this your license could be in jeopardy.

That being said, it may also be ironic that some on this forum who have no experience in any type of nursing or provider role feel inclined to post as experts on topics they have zero to little experience or expertise in.

[ACNP-Ray]

I spent most of my time at Brook Army Medical Center in San Antonio between the ER, Trauma ICU, and medical ICU. I did a full semester with a urology group as well. For my assessment course I did time with my kids pediatrician, a womans health NP doing more paps than I ever thought I would do and I spent time with a Geriatric NP in some nursing homes doing H & P's. That course alone I had over 100hrs of assessment. I graduated with over 600 total hours, which to me is still inadequate but the knowledge and experience I've gained since graduating in 2013 has brought me up to a level I feel fairly comfortable now.

As far as Acute Care NP's market a lot of the places I tried getting on with wanted experienced people to fill the roles and I got lucky that I finally got with a company that had a rural hospital that needed a hospitalist for nights. Once I had that one year experience behind me, things definitely opened up as far as both the intensivist role and more hospitalist jobs opening up

[ACNP-Ray]

One of my professors at Tech was dual board certified in both Family and Acute Care. I asked him about it and he said he loved working in the ER so he went back for his post Masters certificate as a FNP so he would be covered to treat kids as well as the adults and that opened up the ER for him since a lot of places require you to be able to treat kids as well. It's a good move to cover yourself legally and it opens up a lot more jobs to a person to be dual certified.

[Dodongo, APRN, NP]

The ED is a unique environment that no NP program adequately trains their graduates to practice in.

ACNP programs have the acute care/emergency medicine aspect, but you don't train in peds or OB (beyond truly obvious management or emergent situations). FNPs can see peds and OB but they're not trained in emergency/acute care medicine (beyond when to send a patient to the ED).

So now we are seeing ENP programs cropping up which merge the FNP and ACNP curriculums. There are just too few of these programs producing too few graduates to fill all the positions across the nation. Similarly with all specialties. There aren't enough specialty grads to fill all specialty positions. So FNPs are still able to be hired in these roles because 1) many hospitals and physicians don't know or care about the difference in training and 2) many FNP grads think they know it all - it's only ever FNPs practicing in areas they weren't trained for - specialty trained NPs generally don't try and practice outside of their training. You see it on this forum all the time. FNPs saying they went FNP to "have more options" and "to be able to practice wherever they want". It's unfortunate that schools promulgate this idea. The specialty NPs understand the difference.

It is what it is. FNP has been the traditional training for NPs - it was around first. Now that more and more specialty NP programs are churning out graduates, I think we'll see that over time (and this will take years and years) FNPs are relegated to what they are trained to do - outpatient primary care - and specialty trained NPs will dominate those specialty roles (as they should, duh). I don't think the state boards of nursing will ever be specific (about anything) and say where a certain NP can and can not practice. It will be hiring preferences by hospital systems and medical groups that delineate where NPs are practicing. Rural areas will still take anyone they can get.