FNP/AGNP

FullGlass, BSN, MSN, NP · Dec 9, 2017

FNP is viewed as a Primary Care role; most FNP programs do not train for ED work (acute care).

If you want to work in an ED, you must be Acute Care certified. Currently, an Acute Care NP must specialize in Adult/Geri or in Peds.

If you want to work in Urgent Care, the FNP certainly meets the requirements. However, almost all Urgent Care jobs require 1 to 2 years of NP experience.

Good luck

Shanimal · Dec 10, 2017

The AGNP requirement may just be a regional thing or employer-specific. I've worked with several FNPs in the ED-most but not all had prior ED experience as an RN.

JDougRN, BSN, RN · Dec 11, 2017

I JUST went through this same issue in TN. I work with FNP's that just graduated and are working in clinics. Walden University told me I had to have an Geriatric/Acute care NP- This makes no sense to me because they aren't allowed to care for anyone under the age of 12- A LOT of what mid-levels see are simple peds cases. The lady at Walden told me that the BONs are changing their regulations and soon FNPs will be considered working out of their scope if they are in EDs or clinics. This makes no sense to me at all either, and I was actually going to talk to the TN BON.

Trauma Columnist · Dec 11, 2017

Consensus Model and LACE:

Here are some FAQs about the Consensus Model and Lace.

From the Nurse Journal:

Changes in Population Focus Meant Changes to Scope of Practice

Since the FNP's scope of practice doesn't include care for patients with acute or chronic illnesses in deteriorating or life-threatening conditions, the AG-ACNP is the go-to credential for NPs looking to serve adult patients in areas like emergency rooms, trauma units, and intensive care units.

Now, only NPs certified to care for a narrower population focus â€“ the adult-gerontology and pediatric patient populations â€“ can select acute care as part of their primary certification.

As expected, these changes brought about quite a bit of confusion, leading many aspiring NPs to question the differences between the seemingly similar FNP (Family Nurse Practitioner), AG-ACNP (Adult-Gerontology Acute Care Nurse Practitioner), and AG-PCNP (Adult-Gerontology Primary Care Nurse Practitioner) titles.

Dodongo, APRN, NP · Dec 22, 2017

Consensus Model and LACE:
Here are some FAQs about the Consensus Model and Lace.
From the Nurse Journal:
Changes in Population Focus Meant Changes to Scope of Practice
Since the FNP's scope of practice doesn't include care for patients with acute or chronic illnesses in deteriorating or life-threatening conditions, the AG-ACNP is the go-to credential for NPs looking to serve adult patients in areas like emergency rooms, trauma units, and intensive care units.
Now, only NPs certified to care for a narrower population focus â€“ the adult-gerontology and pediatric patient populations â€“ can select acute care as part of their primary certification.
As expected, these changes brought about quite a bit of confusion, leading many aspiring NPs to question the differences between the seemingly similar FNP (Family Nurse Practitioner), AG-ACNP (Adult-Gerontology Acute Care Nurse Practitioner), and AG-PCNP (Adult-Gerontology Primary Care Nurse Practitioner) titles.

Honestly, something like this should be written up as an article on this site and pinned to the top of the Nurse Practitioner and Nurse Practitioner Student Sections. I'm frequently amazed at so many posters here who "want to be a Nurse Practitioner" but "don't know what the best track is" and "don't know what they want to practice in" but "want to get the FNP to keep their options open..." thinking they can do whatever they want with an FNP.

KatieMI, BSN, MSN, RN · Dec 23, 2017

They wrote approximately the same and stronger about LPNs some 30 years ago. Guess what: LPNs are returning to many hospital systems because they can do 90% of what RNs can do and cost less to provide for. It is a question how it would affect patients' care, but in modern American healthcare the mover and motor is not outcome for any particular Ms. Mary Doe. It is all-mighty $

That's just a fact of life: whatever the people who write Consensus Model might want, FNPs are working everywhere but in the kitchen sink. They might be not hired by hospital systems as direct staff but only 1/3 or less of physicians who work in hospitals are employed by them. The rest are private practitioners and no nursing organization would ever order them whom to hire. The very same private practitioners bring the lion's share of money in almost all hospitals in the USA, so no credentialing committee would ever cross their road. And, last but not least, doctors do not care for a second for the letters behind someone's names because they are quite used to exploring their own credentials to the fullest. They have not much limitations in what they can and can't do themselves and freely become "certified aesthetic medicine specialist" or "addictiologist" after a few days workshops which gives them rights to inject Botox or ask questions from a printed list and legally charge $$$$$ for doing so. So, they mostly care nil and zero if a smart, knowledgeable, good-natured, hard-working and flexible Nurse Practitioner has FNP or ACAGNP or any other credentials. Unless the talk is about high-level ICU or ER or other area which requires specialized set of skills, credentials matter much less than Nursing Powers would like to see.

Consensus Model and such documents just show one more time that so-called Nursing Leadership and today's US healthcare system happily exist in parallel Universes, which is a crying shame.

To the OP, I can get that the ERs are often picky with NPs but Urgent Care may require just experience, not different credentials. I am pretty sure that it is a regional thing brought by market being overflown with new FNP grads. Where I am (Central Michigan) FNPs (either from pure online grad school factories like Walden, local low-prestige brick-and-mortars or any type of higher-level programs) can have their pick of specialties (within reason) and practice conditions (again, within reason).

FullGlass, BSN, MSN, NP · Dec 23, 2017

They wrote approximately the same and stronger about LPNs some 30 years ago. Guess what: LPNs are returning to many hospital systems because they can do 90% of what RNs can do and cost less to provide for. It is a question how it would affect patients' care, but in modern American healthcare the mover and motor is not outcome for any particular Ms. Mary Doe. It is all-mighty $
That's just a fact of life: whatever the people who write Consensus Model might want, FNPs are working everywhere but in the kitchen sink. They might be not hired by hospital systems as direct staff but only 1/3 or less of physicians who work in hospitals are employed by them. The rest are private practitioners and no nursing organization would ever order them whom to hire. The very same private practitioners bring the lion's share of money in almost all hospitals in the USA, so no credentialing committee would ever cross their road. And, last but not least, doctors do not care for a second for the letters behind someone's names because they are quite used to exploring their own credentials to the fullest. They have not much limitations in what they can and can't do themselves and freely become "certified aesthetic medicine specialist" or "addictiologist" after a few days workshops which gives them rights to inject Botox or ask questions from a printed list and legally charge $$$$$ for doing so. So, they mostly care nil and zero if a smart, knowledgeable, good-natured, hard-working and flexible Nurse Practitioner has FNP or ACAGNP or any other credentials. Unless the talk is about high-level ICU or ER or other area which requires specialized set of skills, credentials matter much less than Nursing Powers would like to see.
Consensus Model and such documents just show one more time that so-called Nursing Leadership and today's US healthcare system happily exist in parallel Universes, which is a crying shame.
To the OP, I can get that the ERs are often picky with NPs but Urgent Care may require just experience, not different credentials. I am pretty sure that it is a regional thing brought by market being overflown with new FNP grads. Where I am (Central Michigan) FNPs (either from pure online grad school factories like Walden, local low-prestige brick-and-mortars or any type of higher-level programs) can have their pick of specialties (within reason) and practice conditions (again, within reason).

I must respectfully disagree with your post. NPs should only practice to the extent of their training and experience. NPs are liable for malpractice. An NP practicing outside their authority, like an FNP working in an ED, will be in big trouble legally were there ever a malpractice suit. In addition, credentialing may be rejected for an NP working outside their scope - if an FNP gets hired to do PMHNP work, their credentialing could be rejected. Most MDs are quite capable of understanding this, as they also have to worry about malpractice. And contrary to your assertion, an MD who performs a procedure after only a 3 day workshop, could indeed face serious malpractice claims if anything goes wrong. It appears you know many irresponsible MDs, which is unfortunate.

Urgent Care requirements are typically either an FNP (which is primary care) or ED experience (acute care). In addition, urgent care almost always requires a minimum of one year prior NP experience. Individual employers may have different requirements.

KatieMI, BSN, MSN, RN · Dec 23, 2017

I must respectfully disagree with your post. NPs should only practice to the extent of their training and experience. NPs are liable for malpractice. An NP practicing outside their authority, like an FNP working in an ED, will be in big trouble legally were there ever a malpractice suit. In addition, credentialing may be rejected for an NP working outside their scope - if an FNP gets hired to do PMHNP work, their credentialing could be rejected. Most MDs are quite capable of understanding this, as they also have to worry about malpractice. And contrary to your assertion, an MD who performs a procedure after only a 3 day workshop, could indeed face serious malpractice claims if anything goes wrong. It appears you know many irresponsible MDs, which is unfortunate.
Urgent Care requirements are typically either an FNP (which is primary care) or ED experience (acute care). In addition, urgent care almost always requires a minimum of one year prior NP experience. Individual employers may have different requirements.

Unfortunately, what you wrote is, while being absolutely correct, is how things should be. I wrote how they mostly are in reality.

Nursing organizations may have great ideas in mind but they have zero tools to enforce them. And there is a critical access rural local hospital near which I work. It is a poor region overwhelmingly affected by lack of providers, opioid epidemics and all other evils. ER is staffed by family practitioners M.D. because hospital doesn't have anything to attract specialists. Two CNMs do all the OB except for really critical cases (in locality, families with 10 to 12 kids are norm). One of them is now in school for FNP so she also could cover ER for everything else.

Is it good? No. I would be the first one to say it. But otherwise these 40000 or so of people, every fourth of them without any transportation, would have no option but to go 30 miles one way in already overwhelmed urban center for anything and everything. There were cases of some of them killed on winter roads while driving there to get Augmentin for earache for their friends or family members. It is USA, 2017.

Dodongo, APRN, NP · Dec 23, 2017

The LPN comparison is not appropriate because LPNs and RNs are not trained in specialty areas. LPNs are trained to do most of what RNs are trained to do. This is true. So all you really need is a RN available to supervise the LPN. But the LPN has actual formal training to prepare them for the work they are doing. (And your area must be very different from mine because LPNs do not work in the hospital but for a very few and then only med-surg/long-term care floors).

FNPs are not trained to work inpatient medicine. So unlike the LPN, they are attempting to work in an area that they have no training in. My university, in fact all the programs in my area (and unfortunately there are many), do not allow their FNP students to do any inpatient rotations and they receive no didactic training for inpatient medicine. The students are told this from day one. Similarly, the ACNP students are told all of their rotations must be inpatient (but unlike the FNP students we are not shocked by this...). Your training determines what specialties or areas of medicine you are eligible to work in. The only reason FNPs have been practicing inpatient medicine for so long is because FNP training was the only training available, historically. ACNPs are newer to the scene. But times are changing. Rural America will always have access issues and the models of care delivery will be different in the middle of nowhere than in an urban setting because it's difficult to get providers to go to those areas. But I can tell you right now that metropolitan areas are beginning to follow the Consensus Model. I don't think it's because of the Consensus Model necessarily, but it's happening none-the-less.

All providers should practice within their population focus and their scope of practice. Even PAs are beginning to experience limitations to their laterality in the form of specialty exams called CAQs (they are not mandatory yet). The trend in medicine is to drive in your own lane - for the safety of the patient and your own license.

Dodongo, APRN, NP · Dec 23, 2017

Anecdotally, I know an NP that was trained AG-ACNP initially, who took a job in the middle of absolutely no where, doing a job that was essentially primary care/urgent care, doing chronic/maintenance medicine. She did it for a couple years then did an post-master's FNP because, even though she was given on the job training, it was outside of her scope. It seems to me that all NPs worry about working within their scope except FNPs. I don't understand why FNPs are not worried about working within the bounds of their training and scope. RNs are overly worried about it - annoyingly so at times.

Another anecdote. A few months ago I had to explain to the PA and one of the physicians I work with the difference in training models for NPs. There was a new FNP hired onto an inpatient service and this FNP was on orientation for months. The PA was talking to the NP and the NP was saying how she needed more time because she was never trained for this, etc. And the PA was bad mouthing the NP to the MD. So I had to try to explain why she had no training in this and why my training was different than her training.

In the end, it makes NPs look bad.

Bumex, DNP, NP · Dec 23, 2017

Just FYI: many people confuse AGNP/AGPCNP with AGACNP. Could be the person who wrote the job posting was doing the same.