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FNP in hospitalist or internist role?

ashurtle ashurtle (New) New

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!

BostonFNP, APRN

Specializes in Adult Internal Medicine.

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

Specializes in Family Nurse Practitioner.

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

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!

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.

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.

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

Jules A, MSN

Specializes in Family Nurse Practitioner.

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.

BostonFNP, APRN

Specializes in Adult Internal Medicine.

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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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

Specializes in AGNP.

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

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU.

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 andolder adults. The adult–gerontology ACNP provides care to patients who are characterized as physiologically unstable, technologicallydependent, and/or are highly vulnerable to complications” (AACN Scope and Standards, 2006, p 9). These patients may be encountered acrossthe continuum of care settings and require frequent monitoring and intervention. The role encompasses the provision of a spectrum of careranging from disease prevention to acute and critical care management to stabilize the patient's condition, prevent complications, restoremaximum health and/or provide palliative care” (AACN p. 10). It is assumed that preparation of the graduate with these competencies unlessotherwise specified includes preparation across the entire adult-older adult age spectrum. It also is assumed that the graduate is prepared toimplement the full scope of the adult-gerontology acute care NP role.

http://www.aacn.nche.edu/geriatric-nursing/Adult-Gero-ACNP-Competencies.pdf

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 settingspecific.Historically, the acute care NP (ACNP) practiced predominantly in the hospital and theprimary care NP (PCNP) practiced within a community setting. These setting boundaries oftenoverlap, however. It is inappropriate and restrictive to regulate acute and primary care scopeand practice based on settings but instead regulation should be based on educationalpreparation and scope of practice. Formal NP educational programs prepare adultgerontologicaland pediatric NPs to provide either primary care or acute care services

http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/imported/NPPrimaryCareAcuteCarePracticeFINAL.pdf

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

BostonFNP, APRN

Specializes in Adult Internal Medicine.

Historically, the acute care NP (ACNP) practiced predominantly in the hospital and theprimary care NP (PCNP) practiced within a community setting. These setting boundaries oftenoverlap, however. It is inappropriate and restrictive to regulate acute and primary care scopeand practice based on settings but instead regulation should be based on educationalpreparation and scope of practice.

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

For me this is where the legal/ethical issue arises: the vast majority of FNP/AGNP grads don't have any significant education/training in provider-level intensivist role.

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traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU.

I have no problems with this BostonFNP. However, I do think much depends on what you do with your clinical experiences also.

BostonFNP, APRN

Specializes in Adult Internal Medicine.

I have no problems with this BostonFNP. However, I do think much depends on what you do with your clinical experiences also.

Absolutely. Much more on the education and experience and much less on the credential.

Sent from my iPhone.

AnnaN5

Specializes in AGNP.

Absolutely. Much more on the education and experience and much less on the credential.

Sent from my iPhone.

I agree that is why it is discouraging to me that my current system and others around and saying only ACNP for inpatient. I am AGNP but did half of my hours inpatient so while I do not feel I could perform as an intensivist I do have some education/training on the inpatient side.

On the flip side a friend just completed her FNP and wasn't allowed to do any inpatient hours. I think because of the variability on what different programs allow they find it easier to make the blanket statement no ACNP=no inpatient

Jules A, MSN

Specializes in Family Nurse Practitioner.

I agree that is why it is discouraging to me that my current system and others around and saying only ACNP for inpatient. I am AGNP but did half of my hours inpatient so while I do not feel I could perform as an intensivist I do have some education/training on the inpatient side.

On the flip side a friend just completed her FNP and wasn't allowed to do any inpatient hours. I think because of the variability on what different programs allow they find it easier to make the blanket statement no ACNP=no inpatient

Although I would agree that there are some FNPs who have a critical care background and did hours inpatient as a student who would be able to work competently as a hospitalist I would still suggest getting the ACNP or post masters cert. It doesn't make sense not to have the specialty cert imo and I would imagine there will come a time when it is the BONs are also saying you can't do it not just the facilities. In Maryland for example FNPs are not able to practice solely in psychiatry and can lose their license over it. It has been my experience that some FNPs are of the mind set that "we can do anything" and in many cases that just isn't true.

Thank you all for your input. After reading the comments and doing some research. I believe that you are right. Although my program does offer acute care education, I believe it is still outpatient based. I think my bet bet to get the best of both worlds is to maybe work in the ER, doing outpatient care. I could still be in the intense setting I like, yet work within my scope of practice. Thank you!

If you are in a rural area like me you probably could. I am an fnp and admit and round on icu patients all the time. They did give us training for it though with our internal med physician in the group though. Taught us most of what we need to know in a couple months. Thing is a pulmonologist is usually consulted on these patients too so its not like we are swinging along. Except at night, during which we do pretty much everything including change vent settings and stuff. We can't put in lines though, surgeons come in and do that.

I am far far far from an expert but it seems a lot of people have questions about this. I may create a post to spark some peoples interest in regards to this.

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