FNP in Hospital Setting

kjh1228, BSN, RN · Oct 23, 2019

On 10/17/2019 at 4:10 PM, NewBostonFNP said:
Again, I shifted the conversation away from the role I will be having for Internet/security reasons. I was very vague in my description for privacy reasons. Yes, I’ll have some patients in the ICU but won’t be working with them outside of a consultative capacity with my specialty. Nothing hands on. Nothing that will be solely my discretion. A focus of my role will be on discharging/outpatient patients, hospital policies, etc etc.
I am part of an ambulatory clinic and will only round on inpatient patients in prep for discharge and I am responsible for outpatient follow up! Please, please, please. I am not a child; no more slaps on the proverbial wrist about my choice.
As I’ve stated, I’m not sharing the job for privacy concerns since stupidly made a username with a location.

Enjoy your new gig. I would love to have something similar.

romantic, BSN, RN · Nov 12, 2019

On 10/17/2019 at 2:58 PM, adventure_rn said:
Part of the scary thing about being new is that you don't know what you don't know; if you're in over your head, you may find yourself in a dangerous situation and not even realize it.

Very well said and so much true!

This year during NTI conference, I attended a few classes for Nurse practitioners. That was the issue that was discussed. New FNP who never were trained to work in critical care, who never had experience working as a nurse in ICU were hired to work in critical care.

jeshelby · Jan 22, 2020

Sorry I am a bit late to the party. Many of you have referenced the consensus model, unless I am missing there are very few specifics on the actual scope of each group other than that of a population, such as age. I could easily see how this could be mis interrupted. Many states scope of practice don't outline specifics what is or is not considered appropriate. Would your answer have been different if the OP had ICU experience has an RN prior to taking this job?

While it may not be right, there are several FNPs in my area that work as first assist. I understand there are some strong feeling on this board about this topic, but it is evolving topic and definitely can understand how a poster would have questions on it.

allnurses Guide · Jan 23, 2020

On 10/14/2019 at 8:50 PM, NewBostonFNP said:
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.

((To be clear the OP is not me...for those of you that messaged to ask. ? ))

I recognize this is an old post, I'm curious i there is an update on how the job went? Did you have acute care/critical care clinical rotations are part of your NP preparation?

I am sure you can understand how concerning posts like this are, at least on the surface, to bedside RNs, out-patient FNPs, experienced acute care FNPs, and ACNPs (along with basically anyone that might ever be a patient with a serious illness)!

1. Unless you had significant APRN clinical experience(s) in acute and critical care, you are practicing so far outside your scope that it puts you in legal jeopardy, let alone the risks to the patients under your care.

2. Anything can be learned with time: we all start somewhere and our didactic and clinical experience makes us into safe effective clinicians. The danger here is being in an environment where you lack both the education and experience while functioning in a role with unclear level of collaboration/supervision. For example, a first year medical resident (who has the education not the experience) in the ICU is dependent on the expertise of the RNs and the senior residents/attending physician while they gain experience. Unfortunately, a novice NP in this same scenario doesn't have the education, likely doesn't have the direct supervision, and has probably alienated most of the RNs.

3. All of us, OP included, as APRNs need to protect our profession/career/future, which is entirely dependent on maintaining safe, effective, quality, and cost-efficient care. Other people reading this post considering the same path as the OP, I hope will consider the danger in this route.

FWIW: I graduated as an FNP with a relative lack of acute care RN experience (about 16 months) but I did two acute care rotations in my program. I took a job in a internal medicine practice that covered our patients in the hospital. I worked for a year as an NP before I started rounding in the hospital. I spent six months rounding with a very experienced physician before I started rounding myself. If our patients were admitted to the ICU, neither of us would continue to attend them, either transferred to a intensivist or transferred to a OSH.