FNP in hospitalist or internist role?

allnurses Guide · Mar 26, 2015

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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Trauma Columnist · Mar 26, 2015

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

allnurses Guide · Mar 26, 2015

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.

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AnnaN5 · Mar 27, 2015

Absolutely. Much more on the education and experience and much less on the credential.
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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 · Mar 27, 2015

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.

ashurtle · Mar 27, 2015

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!

sauce · Apr 1, 2015

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.

sauce · Apr 1, 2015

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.

SassyRN_972 · Apr 3, 2015

You may need to switch from FNP to acute care NP

WKShadowNP, DNP, APRN · Nov 3, 2016

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

That

That's what I'm thinking. If I had my 'druthers, I'd be in an urgent care or ED setting. Friday I have a meeting to explore this with an administrator of my current employer. She already told me when I graduated that the agency wants to hold on to their high performing, higher education attaining employees.

I'm gonna take her up on that. Wish me luck.

WKShadowNP, DNP, APRN · Nov 3, 2016

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.

My program would not allow those in FNP clinicals to round and precept with inpatient providers. (Even if they had a family practice and were rounding on their patients.) Likewise, the ACNPs from that school had to have inpatient clinicals for at least 75% of their total hours.

There are FNPs as hospitalists in my state, but I wonder about the liability, what orientation and training is offered, and how that would work.

Trauma Columnist · Nov 3, 2016

Right - I started an FNP program and was told all clinicals had to be outpt. Well - I already am an outpt APRN so why do more of the same clinicals? Duh - dropped that quickly!