FNP/AGNP

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

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.

I'm don't know where you live. I live in California and we also have many small towns and rural areas. NPs who practice outside of their scope are setting themselves up for big trouble. I am currently interviewing for NP jobs in these areas and they are very strict about observing proper scope of practice. An FNP who is working in the ER should go back to school and earn an Acute Care NP post master's certificate. While I am very sympathetic to the plight of underserved areas, it would only take one malpractice suit to cause grievous financial harm to a small clinic or hospital, not to mention the patient. A responsible organization would require the additional training within a reasonable period of time.

On a personal note, one of the opportunities I am pursuing is on a small island with 3,000 residents. Since I am an AGPCNP, if I were to receive the offer, I would be required to complete a post master's FNP. Even on an isolated island with a small population, they do have an ER staffed with appropriately trained providers and do not allow the primary care providers to work in the ER.

Bumex, DNP, NP · Dec 23, 2017

Anecdotally, I got my job over FNPs (I'm an AGNP) because all of my hours where in internal medicine and specialty practice, which was more applicable to my job

KatieMI, BSN, MSN, RN · Dec 24, 2017

I'm don't know where you live. I live in California and we also have many small towns and rural areas. NPs who practice outside of their scope are setting themselves up for big trouble. I am currently interviewing for NP jobs in these areas and they are very strict about observing proper scope of practice. An FNP who is working in the ER should go back to school and earn an Acute Care NP post master's certificate. While I am very sympathetic to the plight of underserved areas, it would only take one malpractice suit to cause grievous financial harm to a small clinic or hospital, not to mention the patient. A responsible organization would require the additional training within a reasonable period of time.
On a personal note, one of the opportunities I am pursuing is on a small island with 3,000 residents. Since I am an AGPCNP, if I were to receive the offer, I would be required to complete a post master's FNP. Even on an isolated island with a small population, they do have an ER staffed with appropriately trained providers and do not allow the primary care providers to work in the ER.

Something tells me that isolated islands in California rarely have 40% population living below powerty level.

Anyway, I am in Central Michigan and had line of doctors wanting to hire me months before graduation. Most of these jobs were mix of office, home visits (yes, they are coming back, too), nursing homes and hospital rounds, specialties (all kinds) and internal medicine. Nobody had any problems with me being FNP because they all saw what I was doing with the sickest of the sick human beings in that med/surg on steroids atmosphere of LTACH.

I plan to come back for Acute Care postmaster in a couple of years but as of right now 90% of NPs working in hospitals here are FNPs and everyone seems to be OK with it.

FullGlass, BSN, MSN, NP · Dec 24, 2017

Something tells me that isolated islands in California rarely have 40% population living below powerty level.
Anyway, I am in Central Michigan and had line of doctors wanting to hire me months before graduation. Most of these jobs were mix of office, home visits (yes, they are coming back, too), nursing homes and hospital rounds, specialties (all kinds) and internal medicine. Nobody had any problems with me being FNP because they all saw what I was doing with the sickest of the sick human beings in that med/surg on steroids atmosphere of LTACH.
I plan to come back for Acute Care postmaster in a couple of years but as of right now 90% of NPs working in hospitals here are FNPs and everyone seems to be OK with it.

First, the APRN Consensus Model has changed, as a previous responder noted. "The Consensus Model provides guidance for states to adopt uniformity in the regulation of APRN roles. The target date to complete that work is 2015. Today, many states have adopted portions of the Model elements but there still may be variation from state to state."

APRN Consensus Model | NCSBN

Second, the island I was referring to is not in California.

Third, 1/3 of all US welfare recipients live in California. People in the rest of the US think of California as San Francisco, Los Angeles, and San Diego - glittering, rich, fun in the sun, and celebrities. However, there is extreme poverty in inner cities and especially in the San Joaquin Valley, where most of the US fruits and veggies are grown.

These Are The 1

Trauma Columnist · Dec 24, 2017

Here is info on the LACE model. It delineates out the scope of practice for the different certifications:

FNP - Primary care

AGACNP - Adult/gero acute care - in-hospital care