FNP in hospitalist or internist role?

Specialties Advanced

Updated:   Published

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!

Nurse A: She has 18 months experience in a med-surg unit and earns her ACNP from a paid for profit school

Nurse B: She has 15 years experience in SICU/Traums and ED and earned her FNP thru a local well respected program.

The position open is for an ICU NP position. Both interview well. Who would you hire? (this is a real scenario and I know both individuals) - both applicants are/were RNs at the facility.

Up Vote Up Vote ×
Specializes in Family Nurse Practitioner.
Nurse A: She has 18 months experience in a med-surg unit and earns her ACNP from a paid for profit school

Nurse B: She has 15 years experience in SICU/Traums and ED and earned her FNP thru a local well respected program.

The position open is for an ICU NP position. Both interview well. Who would you hire? (this is a real scenario and I know both individuals) - both applicants are/were RNs at the facility.

Who needed extra time to consider this choice? lol

Up Vote Up Vote ×

So why did the RN with all the ICU experience train as an FNP, then apply to an ICU? Having cognitive dissonance.

Up Vote Up Vote ×
For most, it actually is both legally and ethically.

Sent from my iPhone.

I checked with by BON and have been told this state has no such restriction in practice. Ethical? I am not following how you claim it is an ethical issue.

Up Vote Up Vote ×

I was glad to find this thread as I am finishing my AGNP certification in a few weeks but was offered an interview at a large medical center for their hospitalist team. Apparently I am in the final pickings! This issue has now been running through my mind a lot. All but ONE of the providers in this team are AGNP or FNP, only ONE actually has their ACNP! Apparently they don't take an issue with it yet, though they said they may make ACNP a requirement in the future.

Despite the good arguments on both sides of this issue presented in the above comments, I have yet to seen any conclusive assessment of the legal risks to the provider. Has there ever been a published case of successful litigation against an AGNP or FNP who was providing care in the hospital setting where the type of their certification was the major issue? If not legal action then BON action?

The job is a wonderful opportunity for me and my family. It is not what I was originally looking for (was planning on outpatient) but the opportunity kind of fell into my lap. (For any of you who would simply say "why didn't you do acute care then?")

Now, there is a state university just down the road that offers post-master's ACNP so that is an option for me to cover myself and improve my skills. I am just worried about taking a job that will put me at increased legal risk because of the letters behind my name.

Up Vote Up Vote ×
Specializes in critical care.

Both of my preceptors in the ICU were FNP. They were amazing. I graduate next week with my AGACNP.

Up Vote Up Vote ×
Specializes in Family Nurse Practitioner.
Both of my preceptors in the ICU were FNP. They were amazing. I graduate next week with my AGACNP.

But whether they were amazing isn't the point if they happen to be practicing out of their scope based on your state's mandates or if there is an adverse outcome. My fear is even a 1/2 rate lawyer would be all over a FNP who was practicing in an acute setting without the available appropriate credentialing regardless of their track record. I know that would be my luck so I am very careful to practice within my scope and I got the additional certification to do additional prescribing.

Up Vote Up Vote ×
Specializes in Vascular Neurology and Neurocritical Care.
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.

you're absolutely right. Even though the years of ICU RN experience are certainly valuable and in my book might tip the balance in favor of the FNP candidate we do have to remember that RN experience while helpful is NOT provider experience. Apples and oranges!

if ICU is the goal, really people ACNP is the best choice. I don't know why that ruffles peoples feathers. FNP/ANP is permitted because ACNP is the new kid on the block. But like all things in medicine the standard of care does evolve. And I believe ACNP will eventually be the gold standard for inpatient work.

As university faculty, I teach NP and RN students. I also precept fourth year medical students in their neuro rotations. But I'll tell you that in addition to teaching, I have precepted both FNP and ACNP students on my neuro job and I do notice a difference. The education is different. Bottom line.

FWIW, while I know a lot about hypertension and diabetes, you won't find me in primary care managing those issues. In a lawsuit, I'd be torn apart about my preparation.

To give an example, before there were NPs to cover the neurosurgery service, one of our hospitals was having general surgery reside ts cover us on weekend nights. An issue came up in which a patient had a bad outcome and the surgery resident didn't notify someone from neurosurgery in a timely fashion. In the ensuing lawsuit, the lawyer tore the hospital and other parties involves to shreds basically saying "show me where in the general surgery curriculum that a general surgery resident receives instruction on neurosurgical topics?"

because they don't (which is why neurosurgery is a separate residency) the hospital lost the case and ultimately stopped general surgery from covering us.

As the scripture says, "all things are lawful, but not all things are advantageous."

Up Vote Up Vote ×
Specializes in Vascular Neurology and Neurocritical Care.
I was glad to find this thread as I am finishing my AGNP certification in a few weeks but was offered an interview at a large medical center for their hospitalist team. Apparently I am in the final pickings! This issue has now been running through my mind a lot. All but ONE of the providers in this team are AGNP or FNP, only ONE actually has their ACNP! Apparently they don't take an issue with it yet, though they said they may make ACNP a requirement in the future.

Despite the good arguments on both sides of this issue presented in the above comments, I have yet to seen any conclusive assessment of the legal risks to the provider. Has there ever been a published case of successful litigation against an AGNP or FNP who was providing care in the hospital setting where the type of their certification was the major issue? If not legal action then BON action?

The job is a wonderful opportunity for me and my family. It is not what I was originally looking for (was planning on outpatient) but the opportunity kind of fell into my lap. (For any of you who would simply say "why didn't you do acute care then?")

Now, there is a state university just down the road that offers post-master's ACNP so that is an option for me to cover myself and improve my skills. I am just worried about taking a job that will put me at increased legal risk because of the letters behind my name.

the NP profession really needs to abolish most the specialties' and have generalist training like the PAs

Up Vote Up Vote ×
But whether they were amazing isn't the point if they happen to be practicing out of their scope based on your state's mandates or if there is an adverse outcome. My fear is even a 1/2 rate lawyer would be all over a FNP who was practicing in an acute setting without the available appropriate credentialing regardless of their track record. I know that would be my luck so I am very careful to practice within my scope and I got the additional certification to do additional prescribing.

This topic seems to keep coming up over and over again. In my state we have a supervising physician who is responsible to sign off all IP orders. So in that respect we have some coverage. Now in states where they have more independent practice then maybe the ACNP is more appropriate.

Up Vote Up Vote ×
Specializes in Hospital medicine; NP precepting; staff education.
This topic seems to keep coming up over and over again. In my state we have a supervising physician who is responsible to sign off all IP orders. So in that respect we have some coverage. Now in states where they have more independent practice then maybe the ACNP is more appropriate.

.

I have a collaborative physician who signs off on my orders. Especially as a brand new FNP, I feel much more comfortable taking on the hospitalist role with that back up. That's not to say I don't need extra training. As new RNs we couldn't just up and take a load of patients alone. Granted, the roles are quite different and expectations are varied even more so.

I think I'm straying from my point. In my state I am within constraints to go into this role and supported by my overseeing physician(s). I will not go outside of scope or training and get checked off on skills they have already said I will be needed to do. They have a onboarding process to ensure safety in practice. That's better than "hit the ground running," which is what a second entity who offered me a job wanted from me.

Up Vote Up Vote ×
Specializes in critical care.
But whether they were amazing isn't the point if they happen to be practicing out of their scope based on your state's mandates or if there is an adverse outcome. My fear is even a 1/2 rate lawyer would be all over a FNP who was practicing in an acute setting without the available appropriate credentialing regardless of their track record. I know that would be my luck so I am very careful to practice within my scope and I got the additional certification to do additional prescribing.

They were not practicing outside the scope based on state mandates. They both had extra training and there are requirements and competencies to be met in the ICU. At this point, it all depends where/how you obtain your training at least in my state. Even had a TJC visit while I was doing rotations and the ACNP who was with TJC (new grad, never practiced) was all over the fact that our NP was a FNP, except this FNP I was precepting with kept careful records of all her procedures. They knew their limitations, and always consulted with the intensivist should the need arise.

Up Vote Up Vote ×
+ Add a Comment