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FNP in Hospital Setting

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by NewBostonFNP NewBostonFNP (Member) Nurse

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Hi,

I just accepted my first job as an FNP in a hospital setting. I'll be rounding on all patients in the hospital that will be on my service. Is there a specific personal malpractice insurance I should have? Certain criteria it should meet? I basically know nothing about this as I've been a home health RN for 8 years. Thanks!

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ArmaniX has 5 years experience as a MSN, APRN and specializes in Surgical Critical Care.

286 Posts; 6,515 Profile Views

Ensure you are practicing to your trained scope while walking the hospital halls. 
 

Additionally, did your schooling not cover malpractice insurance and the types of available coverage? 

Edited by ArmaniX

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

166 Articles; 21,045 Posts; 191,314 Profile Views

Are you in a specialty practice? In my area, FNPs are no longer being credentialed at the hospital a their training/clinicals focused on primary care not acute care. 

Will you be seeing ICU pts?

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10 hours ago, traumaRUs said:

Are you in a specialty practice? In my area, FNPs are no longer being credentialed at the hospital a their training/clinicals focused on primary care not acute care. 

Will you be seeing ICU pts?

Yes it’s a speciality, not a hospitalist-type job. I will be rounding on ICU patients but in a largely consultative role for the specialty - so, not responsible for day-to-day care, but rather consultative for things like vent weans, etc. I feel like this would fall in scope given the nature of the job in the hospital. But not sure if there is a type of insurance more suited for hospital v primary care role. 

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ArmaniX has 5 years experience as a MSN, APRN and specializes in Surgical Critical Care.

286 Posts; 6,515 Profile Views

1 hour ago, NewBostonFNP said:

so, not responsible for day-to-day care, but rather consultative for things like vent weans, etc. I feel like this would fall in scope given the nature of the job in the hospital.. 

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8 minutes ago, ArmaniX said:

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I mean, instead of a snarky gif, perhaps you could be helpful and use your actual, adult words and elaborate on what you are saying here? I did not ever work in a hospital as an RN so this is foreign to me on every level and I am asking for guidance/advice...not gifs. 

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WestCoastSunRN has 20 years experience as a BSN and specializes in CVICU, MICU, Burn ICU.

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14 hours ago, NewBostonFNP said:

Yes it’s a speciality, not a hospitalist-type job. I will be rounding on ICU patients but in a largely consultative role for the specialty - so, not responsible for day-to-day care, but rather consultative for things like vent weans, etc. I feel like this would fall in scope given the nature of the job in the hospital. But not sure if there is a type of insurance more suited for hospital v primary care role. 

You will be responsible for writing orders to wean patients off vents?  Is there a residency that will be preparing you for this kind of work?  With FNP cert in the new age of Consensus Model, you may be walking a dangerous line, here.  Look carefully at your state board of nursing law for APRN scope.  If something goes wrong you are going to have to defend that you had the training/education to manage care for critically ill patients.  You have not worked in ICU, or even acute care before this, so you cannot even claim relevant RN experience.  If you went to an FNP program, you did not receive this preparation.  Thus my question about a residency (which still does not meet Consensus guidelines, but at least would give you some defense).  

Is it possible for other team members to cover the ICU and you round only on ward-status patients?  

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babyNP. has 11 years experience as a APRN and specializes in NICU.

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I agree- it sounds like you don’t know what you don’t know about hospital care. Tread lightly- ignorance is not a defense in healthcare.

A regular pediatrician would have no business rounding in a PICU...I don’t see how this is different unless you have an attending ultimately responsible for the care of the patient.

How long of an orientation are they giving you?

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1,727 Posts; 15,444 Profile Views

Agree with the others about scope of practice issues. Did you receive training in weaning vent patients and taking care of other critical patients in your FNP program? How is your scope of practice as an FNP defined by your state Nurse Practice (or similar) Act? Around here (Philly area) most, if not all, hospitals no longer allow FNPs to work in the ED or round in the hospital unless they get a post-Master's in acute care. You may find your malpractice insurer to be reluctant to extend coverage for your new activities.

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196 Posts; 4,375 Profile Views

This was drilled into me when I as in grad school that the FNP is not the appropriate training for the acute care role.    It's not that you can't get a job....but if you are sued, the consensus model and certifying bodies are clear.........they will not have your back.   I have no doubt the BON might come down hard as well.    

If that is what you want to do , I would make sure to start the process to get into a FNP to ANP  program (some are discussed on allnurses)    Good luck!

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On 10/14/2019 at 6:51 PM, NewBostonFNP said:

I will be rounding on ICU patients but in a largely consultative role for the specialty - so, not responsible for day-to-day care, but rather consultative for things like vent weans, etc.

An FNP with no acute care experience at any level acting as a critical care consult? What could go wrong?

To answer your question OP it's not what type of insurance to get, it's can you get insurance at all? I would run from this job. I guarantee the first time something goes south you will be thrown under the bus. You are risking your license, your livelihood, your finances and potentially your freedom. Please, please carefully scrutinize your state's APRN scope of practice for an FNP. Your "feeling" the job fits in your scope is not the same as it actually doing so.

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adventure_rn is a BSN and specializes in NICU, PICU.

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The scary thing to me is that for every well-intentioned post like this, there are hundreds of other new grad FNPs out there starting jobs just like this one, blissfully unaware of how far outside of their scope that they may be practicing.

Lately on AN I feel like I've seen a concerning number of FNP students and hopefuls claiming, "I'm going to be an FNP, therefore my scope is all patients," including acute care specialties, emergency medicine, mental health, etc. (that's not necessarily what this OP is saying, but just a general observation).

We talk all of the time on this site about the proliferation of FNP programs flooding the market. Maybe in an effort to sell their program, recruit students and increase revenue, those programs are telling their participants "You can be whatever you want to be" instead of being realistic about their scope of practice regulations and limitations.

I'm a little disappointed (but not necessarily surprised) that hospitals still offer jobs to new grads that are outside of their scope under the Consensus Model. It seems like something the hospitals would do to try to get cheaper labor based on the glut of new graduate FNPs. Meanwhile, it puts people like the OP at risk of practicing outside of their scope without even realizing it (because 'why would a hospital hire them if they weren't qualified?') I'm guessing that at some point, CMS is going to stop reimbursing for inpatient care provided by 'primary care providers;' billing issues might be the only thing that stops hospitals from this sketchy practice.

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