ER NP

aok7, NP · Sep 18, 2021

Family or ED specific NP recommended. You need to be able to see all ages. Adult, which I am, is limited to ages 13 and up. There are always outliers, sure there are some Adult NPs out there working ED, but my suggestion.

Sun1 · Sep 18, 2021

2 minutes ago, aok7 said:

Family or ED specific NP recommended. You need to be able to see all ages. Adult, which I am, is limited to ages 13 and up. There are always outliers, sure there are some Adult NPs out there working ED, but my suggestion.

Thanks for the suggestion. But I was wondering....if there peds specific ED, and adult specific ED why would it better to be an FNP NP to do so. Would the hospital not hire an adult NP ED, if he/she would be working only in the adult ED?

aok7, NP · Sep 18, 2021

The consensus model in many hospitals IS being followed, most notably in the eastern states. I am finding it becoming more important to have a career direction (as you do) prior to going to NP school, if possible. Within the hospital in general (not necessarily ED), acute care NP is important for credentialing. For example, I was still a RN in NP school when a co-worker a semester ahead of me was hired for a hospitalist role at our hospital. She was family. She actually started training, was well-established and respected by the docs, all that...well horrible here she ended up not being credentialed by the hospital. I get goosebumps still thinking about this. She ended up working getting a job in outpatient setting, but it was months waiting for credentialing and turning down job interviews, etc., thinking she had a job. Anyway, if you want to work primary with all ages then family is the way to go in urgent care or family, in general. Ob then the midwife etc. ED, find an ED program. Peds, either acute pediatric program or family. Hospitalist or ICU acute adult. Outpatient specialty or adult/geriatric, adult/gero primary. Psych, of course psych. You will find there are a lot of post-graduate programs, and this will be your answer if you want to cover a spectrum of, say, completing an adult program but then doing a year of post-grad family to capture pediatrics for kids. Or working in a hospital and needing acute, do an acute post-grad, as my friend was considering.

aok7, NP · Sep 18, 2021

And sorry, to clarify your specific question, perhaps if you worked in a specialty geriatric ED which ONLY sees adult you would only need adult. As I said in above, there are outliers.

Sun1 · Sep 19, 2021

2 hours ago, aok7 said:

And sorry, to clarify your specific question, perhaps if you worked in a specialty geriatric ED which ONLY sees adult you would only need adult. As I said in above, there are outliers.

Thanks for the clarification. Does one need to have the ED certification or can one just be an Adult care primary NP certified in order to work in an Adult ED?

Thanks again.

djmatte, ADN, MSN, RN, NP · Sep 20, 2021

On 9/18/2021 at 8:37 PM, Sun1 said:

Thanks for the clarification. Does one need to have the ED certification or can one just be an Adult care primary NP certified in order to work in an Adult ED?

Thanks again.

Needs are at the discretion of the hospital and their credentialing bodies. To piggyback on earlier discussion, you’d be wise to set yourself up for success by ensuring you have all of your areas covered. FEW EDs will see adults only. Many will prefer the person who sees all ages over the alternative. But IMO you still should plan to get a post masters cert for ED as it may be the difference in you and someone else getting the job. Also IMO, any primary care NP cert does little to prepare you for either ED or really any hospital role. So having the additional vets will only benefit your practice.

Sun1 · Sep 20, 2021

5 hours ago, djmatte said:

Needs are at the discretion of the hospital and their credentialing bodies. To piggyback on earlier discussion, you’d be wise to set yourself up for success by ensuring you have all of your areas covered. FEW EDs will see adults only. Many will prefer the person who sees all ages over the alternative. But IMO you still should plan to get a post masters cert for ED as it may be the difference in you and someone else getting the job. Also IMO, any primary care NP cert does little to prepare you for either ED or really any hospital role. So having the additional vets will only benefit your practice.

That's a great post....thanks.

eastsideRN, BSN, MSN, NP · Sep 22, 2021

If you are working in a community ER for all ages then dual certification with ACNP- Adult/Gero and a Post Masters FNP or Post Masters PNP to cover you for the Acute Care component and from Womb to Tomb.

If the ER is designated Adult or Peds only then obviously one could be credentialed only in either ACNP-Adult/Gero or PNP-Acute Care. Being credentialed to work with only adults or peds in the ER setting could be limiting if you are interested in working outside large metro areas as most community hospitals are one size fits all.

YMMV state to state and hospital to hospital.

I have read that FNP are no longer being credentialed to work in the Acute Care setting but this is not true where I am in Central California.

Sun1 · Sep 22, 2021

1 hour ago, eastsideRN said:

If you are working in a community ER for all ages then dual certification with ACNP- Adult/Gero and a Post Masters FNP or Post Masters PNP to cover you for the Acute Care component and from Womb to Tomb.

If the ER is designated Adult or Peds only then obviously one could be credentialed only in either ACNP-Adult/Gero or PNP-Acute Care. Being credentialed to work with only adults or peds in the ER setting could be limiting if you are interested in working outside large metro areas as most community hospitals are one size fits all.

YMMV state to state and hospital to hospital.

I have read that FNP are no longer being credentialed to work in the Acute Care setting but this is not true where I am in Central California.

Thanks for your input. What are things that an acute certified can do that a FNP or Adult Gero cannot do? What procedures, etc?

Is it possible to be dual certified at the sametime in a program? Is it advantageous to do so? Which dual certifications would you recommend to do? Not interested in psych or women's health btw....

For a person to be able to do central lines, and other invasive procedures....what track you suggest one pursue?

If one wanted to be able to work in the ER, Cardiology and also be able to to do cardiothoracic surgery or other surgical specialities....what do you suggest to go about it?

Thanks again.....

eastsideRN, BSN, MSN, NP · Sep 23, 2021

I work in ER and there is always attending physician oversight. As such most of the more critical procedures are done by the physician. As an ACNP my scope of practice and what I was taught in school includes intubation, central line, art line, and LP. I frequently intubate and place lines, I have never done an LP. The the procedures I do frequently in ED include: I&D, lac repair, reduction/splinting of fracture and FB removal. I do not work in primary care, but I imagine common procedures include IUD insertion/removal, Nexplanon insertion/removal, suture, I&D, cryotherapy for mole/wart/seborrheic keratosis removal and toe nail removal? I'm sure I am missing something that is frequently done in primary care! I think procedures are dependent on the state you practice, the type of practice and your supervising physician.

I imagine if an NP worked in specialties like interventional radiology, general surgery, dermatology, pulmonology or cardiology there would be opportunity for specialized procedures specific to that practice and/or specialty.

I'm sure any procedures done in a specialty practice would come with a high level of oversight until proficiency can be established. I know that trauma teams/trauma centers have ACNP's on service but I cannot speak for what their specific role/duties on the team consists of. Also ACNP working in ICU manage vents/lines/drips. It seems to me from reading on Allnurses and networking with other NPs that NP practicing on the east coast have more procedural opportunities/responsibilities than their west coast counterparts, but this may not be entirely accurate.

I assume there are dual programs for ACNP/FNP and/or ACNP/PNP available. As far as what certification I recommend? you need to decide what population you'd like to work with and what patient acuity you'd prefer.

Sun1 · Sep 23, 2021

1 hour ago, eastsideRN said:

I work in ER and there is always attending physician oversight. As such most of the more critical procedures are done by the physician. As an ACNP my scope of practice and what I was taught in school includes intubation, central line, art line, and LP. I frequently intubate and place lines, I have never done an LP. The the procedures I do frequently in ED include: I&D, lac repair, reduction/splinting of fracture and FB removal. I do not work in primary care, but I imagine common procedures include IUD insertion/removal, Nexplanon insertion/removal, suture, I&D, cryotherapy for mole/wart/seborrheic keratosis removal and toe nail removal? I'm sure I am missing something that is frequently done in primary care! I think procedures are dependent on the state you practice, the type of practice and your supervising physician.

I imagine if an NP worked in specialties like interventional radiology, general surgery, dermatology, pulmonology or cardiology there would be opportunity for specialized procedures specific to that practice and/or specialty.

I'm sure any procedures done in a specialty practice would come with a high level of oversight until proficiency can be established. I know that trauma teams/trauma centers have ACNP's on service but I cannot speak for what their specific role/duties on the team consists of. Also ACNP working in ICU manage vents/lines/drips. It seems to me from reading on Allnurses and networking with other NPs that NP practicing on the east coast have more procedural opportunities/responsibilities than their west coast counterparts, but this may not be entirely accurate.

I assume there are dual programs for ACNP/FNP and/or ACNP/PNP available. As far as what certification I recommend? you need to decide what population you'd like to work with and what patient acuity you'd prefer.

That's a very informative post....thank you for your kind input.