FNP in hospitalist or internist role?

allnurses Guide · Mar 24, 2015

Hello,
I'm seeking advice and insight on FNPs that are practicing in the inpatient setting in a hospitalist group or internal medicine type role. What does the job outlook look like for NPs in this setting and if you currently practice in this role, do you enjoy it? I'm in the middle of my FNP program and exploring my options on what I want to do when I'm finished. I think that I would really enjoy this type of position, but definitely need more information. Also, what type of experience would help in landing a job in this setting. Right now, I'm an OR nurse and I don't see that being an easy transition.
Thanks in advance!

The best thing you can do right now is shadow; network with local inpatient NPs and get a feel for if administration is hiring FNPs for inpt in your area.

You want to focus as much of your clinical rotations on inpt care as possible, most schools will let you do up to 50%.

I spend part of my time covering my panel of patients in the hospital. I have privileges at several small local community hospitals. These hospitals will hire FNPs but the real push is to hire ACNPs for the strictly hospital roles as our hospitals have no intensivists and so hospitalists cover ICU.

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Jules A, MSN · Mar 24, 2015

In my area they hire FNPs for the urgent care portion of the ED but not as hospitalists because they require ACNP.

carachel2 · Mar 24, 2015

If you really want to work in an inpatient role then get out of your FNP program and switch to acute ! Your family program will not give you what you need and a lot, if not most, states and hospitals require you to be acute certified. Good luck!

nennydee · Mar 25, 2015

If you really want to work in an inpatient role then get out of your FNP program and switch to acute ! Your family program will not give you what you need and a lot, if not most, states and hospitals require you to be acute certified. Good luck!

I definitely agree with the above post! A lot of FNP programs don't adequately prepare you for the role of hospitalist. I think you would benefit most from an ACNP program. Keep in mind that some hospitalist positions might require you to round on ICU patients which would be out of your scope of practice as an FNP depending on where you practice.

automotiveRN67 · Mar 25, 2015

States do not have laws governing acute vs FNP or Adult NP practice with regards to acute care settings. Nor do they limit acute care NP's from working in outpatient settings. It falls on the hiring group, or hospital to decide. FWIW, I have seen this question way too many times on this site. I have seen more FNP and Adult NP's in practice in both hospitalist and intensivist roles than I have ever seen acute care NP's.

automotiveRN67 · Mar 25, 2015

Rounding on ICU patients is not outside the scope of practice for either family NP's or adult NP's.

Jules A, MSN · Mar 25, 2015

Rounding on ICU patients is not outside the scope of practice for either family NP's or adult NP's.

Our FNP school told us no way no how and if our intention was to work inpatient we needed to get our ACNP.

allnurses Guide · Mar 25, 2015

Rounding on ICU patients is not outside the scope of practice for either family NP's or adult NP's.

For most, it actually is both legally and ethically.

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carachel2 · Mar 26, 2015

Rounding on ICU patients is not outside the scope of practice for either family NP's or adult NP's.

We had ZERO hours of inpatient acute care. ZERO. And this was at a well known, respected state university. I would love to see you give that argument on the witness stand at a case. I do understand you can take critical care courses, maybe perhaps have an elective in critical care. But in my opinion, my hours of chronic disease management in an outpatient setting did not prepare me to round on patients in the ICU (I don't care how many years I did this as an ICU RN) and I wouldn't do it.

AnnaN5 · Mar 26, 2015

At my current hospital they are making it harder to get inpatient credentials/privileges if you are not acute care certified.

Trauma Columnist · Mar 26, 2015

With the APRN Consensus Model implementation date of 2015, here is what the AACN says about Adult-Gero ACNP:

The patient population of the adult-gerontology acute care NP practice includes the entire spectrum of adults including young adults, adults and older adults. The adultâ€“gerontology ACNP provides care to patients who are characterized as physiologically unstable, technologically dependent, and/or are highly vulnerable to complications (AACN Scope and Standards, 2006, p 9). These patients may be encountered across the continuum of care settings and require frequent monitoring and intervention. The role encompasses the provision of a spectrum of care ranging from disease prevention to acute and critical care management to stabilize the patient's condition, prevent complications, restore maximum health and/or provide palliative care (AACN p. 10). It is assumed that preparation of the graduate with these competencies unless otherwise specified includes preparation across the entire adult-older adult age spectrum. It also is assumed that the graduate is prepared to implement the full scope of the adult-gerontology acute care NP role.

I have bolded the pertinent portion about settings where an AGACNP can practice.

From the National Organization of NP Faculties comes this:

A fundamental premise of the Consensus Model is that NP competencies are not setting specific. Historically, the acute care NP (ACNP) practiced predominantly in the hospital and the primary care NP (PCNP) practiced within a community setting. These setting boundaries often overlap, however. It is inappropriate and restrictive to regulate acute and primary care scope and practice based on settings but instead regulation should be based on educational preparation and scope of practice. Formal NP educational programs prepare adultgerontologicaland pediatric NPs to provide either primary care or acute care services

So, while some individual facilities may request/require ACNP for in-hospital positions, it is not required by our credentialing organization.

FNP in hospitalist or internist role?

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