FNP in In-Patient Settings

[TeachEm, MSN, RN]

Hello all! I wanted to reach out to our AllNurses community and get some feedback on a question I've been pondering. So I've recently been accepted into an MSN/DNP program to become a Family Nurse Practitioner, and as excited as I am, I was stuck on the prospects of finding jobs within a hospital. In my head currently, I'm leaning towards working in an in-patient setting, but reading through some threads here note that becoming an ACNP would be more appropriate for that endeavor. I just wanted to hear from some of you, any FNPs who are working in an in-patient setting, or for anyone who has had experience as an FNP in an in-patient setting. Looking forward to chatting with you all!

[traumaRUs, MSN, APRN]

Be mindful of the consensus model. Hospitals in my area won't credential FNPs for inpt roles

[FullGlass, BSN, MSN, NP]

If you want to work in a hospital, it is best to choose either Adult/Geri Acute Care or Peds Acute Care. Yes, there are FNPs who work in ERs, but not all hospitals will hire FNPs for this role.

FNPs do not receive any acute care education and they do not get any acute care clinical rotations.

If you really want to do acute care, PA is another option.

[TeachEm, MSN, RN]

Be mindful of the consensus model. Hospitals in my area won't credential FNPs for inpt roles

Got it. Do you think that FNPs are solely limited to outpatient departments within a hospital?

[TeachEm, MSN, RN]

If you want to work in a hospital, it is best to choose either Adult/Geri Acute Care or Peds Acute Care. Yes, there are FNPs who work in ERs, but not all hospitals will hire FNPs for this role.

FNPs do not receive any acute care education and they do not get any acute care clinical rotations.

If you really want to do acute care, PA is another option.

Well, I'm already in this program, it would be hardcore back-tracking to rescind my seat and re-apply to PA school. Ahaha. This is a discussion for me to consider re-routing specialties to maybe Adult-Gerontology or Acute Care. I guess I still need to do some soul-searching to figure it out.

[traumaRUs, MSN, APRN]

Got it. Do you think that FNPs are solely limited to outpatient departments within a hospital?

At least at our local hospitals yes. In fact, the hospital won't even credential FNPs who work for private practices so they can round on pts. And..our state (IL) is also one that hasn't completely bought into the consensus model. However, all the big hospitals are definitely leaning that way

[twozer0, NP]

We have several FNP's working inpatient with the hospitalists. I also see them working for other specialty groups and rounding on patients in the hospital. Community hospital setting, non academic center.

[MSNrunner]

A few of my preceptors have worked in the inpatient setting as FNPs. As others have stated, it depends on the hospital

[Dodongo, APRN, NP]

The hospitals in my area are highly favoring ACNPs as new hires, (or PAs), versus FNPs. All inpatient positions are advertised for ACNP, preferably. And my area is pumping out the ACNPs (and PAs even moreso) to snatch up these positions. Many FNPs in my area can be found in the hospital, but they have been there for quite some time. So, around here if you want an inpatient job as a new grad, you should go ACNP.

[djmatte, ADN, MSN, RN, NP]

At least at our local hospitals yes. In fact, the hospital won't even credential FNPs who work for private practices so they can round on pts. And..our state (IL) is also one that hasn't completely bought into the consensus model. However, all the big hospitals are definitely leaning that way

That imo is a complete disservice to the patient and an affront to the primary care team that cares for that patient. Especially if they credential an md to round on that patient from the same clinic, but not an fnp. From a continuity of care perspective it's absolutely ridiculous.

[Riburn3, BSN, MSN, APRN, NP]

So this is really going to depend in where you live and company policy. FNP's in some states get away with inpatient hospital work because their state laws are vague and there is high demand. Where I work in New Mexico everyone is a CNP and they could care less. It might be the same in your state, but you have to find out for yourself.

I also work in Texas and FNP's do inpatient work, but the state is pretty grey about this and cracking down on it more. Some companies and hospital groups refuse to hire FNP's for inpatient jobs. A large hospitalist group in Houston recently got rid of over 40 FNP's working in inpatient facilities due to state and company pressure. The only ones spared were those currently pursuing their AGACNP.

Personally, I got my FNP first, but when I started putting more hours on the inpatient side, went back and got my AGACNP to protect myself. I have no clue if where I am now will be where I am in 5-10 years, but I know if I head elsewhere, I'm very well covered.

In summary, comb over your state laws and NP culture. A friend of mine in Alaska did her FNP program up there and they encouraged just as much inpatient rotations in school as they did clinic work since FNP's there do everything (including working with surgeons), so there is a lot of variance. My FNP program did allow some inpatient rounding but severely restricted it overall.

[djmatte, ADN, MSN, RN, NP]

Mind you I'm not advocating for FNPs to do inpatient work. But if you have a patient you care for and want to ensure their meds and treatment regimens are what you're expecting, you shouldn't be denied just because you are a FNP.