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FNP no longer allowed to practice inpatient

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by Heather7 Heather7 (New) New Nurse

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I live and work in Oklahoma and I am currently in NP school. A lot of the NPs I work with in the ER and hospital setting are having to go back to school in order to maintain their job. I am not finding any legislation saying FNPs cannot practice inpatient, where is this coming from? Is it federal or Oklahoma legislation that changed?

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Numenor has 8 years experience as a MSN, NP and specializes in Internal Medicine.

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2 hours ago, Heather7 said:

I live and work in Oklahoma and I am currently in NP school. A lot of the NPs I work with in the ER and hospital setting are having to go back to school in order to maintain their job. I am not finding any legislation saying FNPs cannot practice inpatient, where is this coming from? Is it federal or Oklahoma legislation that changed?

This is nothing new, has been in place for years. It's called the consensus model and yes it is true. ACNPs are going to be preferred or required for the inpatient setting. If you are still in school and want to work inpatient I would look at getting a dual cert. I find it strange they are forcing already working NPs to go back, but for future NPs you will DEFINITELY need your ACNP to work inpatient. All the job postings in my city list it.

https://www.nursingworld.org/certification/APRN-consensus-model/faq-consensus-model-for-APRN-regulation/#:~:text=The Consensus Model for APRN Regulation%3A Licensure%2C Accreditation%2C Certification,%2C and education (LACE).

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Neuro Guy NP has 7 years experience as a DNP, PhD, APRN and specializes in Vascular Neurology and Neurocritical Care.

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On 6/3/2020 at 11:56 PM, Numenor said:

This is nothing new, has been in place for years. It's called the consensus model and yes it is true. ACNPs are going to be preferred or required for the inpatient setting. If you are still in school and want to work inpatient I would look at getting a dual cert. I find it strange they are forcing already working NPs to go back, but for future NPs you will DEFINITELY need your ACNP to work inpatient. All the job postings in my city list it.

https://www.nursingworld.org/certification/APRN-consensus-model/faq-consensus-model-for-APRN-regulation/#:~:text=The Consensus Model for APRN Regulation%3A Licensure%2C Accreditation%2C Certification,%2C and education (LACE).

Same in this region. No FNP for inpatient in Philadelphia, New Jersey, or New York City. ACNP only. New York actually licenses you according to your specialty. So your registration says "NP in Acute Care" or "NP in Family Health" etc

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NICUmiiki has 5 years experience as a BSN, RN and specializes in NICU/PICU Flight Nursing.

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The state board of nursing probably has wording in one of the laws pertaining to NPs regarding practicing within your scope. If you have no formal education in the acute care setting, you aren't really practicing within your scope. My state is strict with the consensus model.

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babyNP. has 12 years experience as a APRN and specializes in NICU.

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If you want to work in a hospital I would suggest ACNP. I believe there are emergency NP programs, not sure what type of certification they have.

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Lipoma has 2 years experience as a BSN, RN and specializes in Certified Emergency Nurse.

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On 6/9/2020 at 10:58 AM, babyNP. said:

If you want to work in a hospital I would suggest ACNP. I believe there are emergency NP programs, not sure what type of certification they have.

Dual FNP and ACNP. 

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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If you want to work in acute care, I'd advise going for a PA.  That is the most versatile degree and I think it is better for acute care.

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Neuro Guy NP has 7 years experience as a DNP, PhD, APRN and specializes in Vascular Neurology and Neurocritical Care.

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11 hours ago, FullGlass said:

If you want to work in acute care, I'd advise going for a PA.  That is the most versatile degree and I think it is better for acute care.

I think ACNP is just fine for acute care. That's the whole point of the degree. And you can do outpatient specialty with ACNP as well. I don't see any advantage of PA. The main reason people like to talk about versatility in my experience is changing specialty, but who really does that? Who wants to spend 5-10 years building a knowledge base and expertise in a field only to switch to something else and be a newbie all over again? 

Besides, if I see someone who radically changes specialty (derm to cardiology to GI, not hospitalist to LTACH or ICU to hospitalist, which are more changes in setting of one specialty - internal med) several times throughout a career, I'll show you someone who probably hasn't mastered any of them. Rationale: it takes a long time to build an expertise and if you keep changing, you're not getting the time to truly build and hone that expertise before you're off to the next venture - jack of all trades master of none. We see our physician colleagues stick to a specialty, and that's for a reason.

So I think if you carefully reflect on what you want and decide thereafter, the degree choice will be fine. The problem is that too many embark on a path without having an idea of what they want, hoping to figure it out, much like college kids who take two years to figure out their major - costs time and money and may lead to dissatisfaction with the choice. I advocate for prospective NP students to shadow, double up on a rotation of interest to see if that's what you'd want for your career even while in school. 

~end of tangent~

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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16 hours ago, Neuro Guy NP said:

I think ACNP is just fine for acute care.

 

The reason I said that is an Acute Care NP has to choose Adult or Peds.  If they want to work in an ER, that is a disadvantage requiring additional schooling to overcome.  The PA will cover Peds and Adult, plus PAs can do more procedures, which is an advantage in the inpatient setting.  I agree with you that Acute Care NP can be fine, depending on what area the NP wants to practice in

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Numenor has 8 years experience as a MSN, NP and specializes in Internal Medicine.

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3 hours ago, FullGlass said:

The reason I said that is an Acute Care NP has to choose Adult or Peds.  If they want to work in an ER, that is a disadvantage requiring additional schooling to overcome.  The PA will cover Peds and Adult, plus PAs can do more procedures, which is an advantage in the inpatient setting.  I agree with you that Acute Care NP can be fine, depending on what area the NP wants to practice in

 

20 hours ago, Neuro Guy NP said:

I think ACNP is just fine for acute care. That's the whole point of the degree. And you can do outpatient specialty with ACNP as well. I don't see any advantage of PA. The main reason people like to talk about versatility in my experience is changing specialty, but who really does that? Who wants to spend 5-10 years building a knowledge base and expertise in a field only to switch to something else and be a newbie all over again? 

Besides, if I see someone who radically changes specialty (derm to cardiology to GI, not hospitalist to LTACH or ICU to hospitalist, which are more changes in setting of one specialty - internal med) several times throughout a career, I'll show you someone who probably hasn't mastered any of them. Rationale: it takes a long time to build an expertise and if you keep changing, you're not getting the time to truly build and hone that expertise before you're off to the next venture - jack of all trades master of none. We see our physician colleagues stick to a specialty, and that's for a reason.

So I think if you carefully reflect on what you want and decide thereafter, the degree choice will be fine. The problem is that too many embark on a path without having an idea of what they want, hoping to figure it out, much like college kids who take two years to figure out their major - costs time and money and may lead to dissatisfaction with the choice. I advocate for prospective NP students to shadow, double up on a rotation of interest to see if that's what you'd want for your career even while in school. 

~end of tangent~

I think the biggest places where PAs shine are the ER and OR, other than that I think ACNP is better for inpatient. Granted, I have seen some badass specialty GI/Cards PAs though. FNP in the ER is meh, how much do those 150 of these Peds hours really matter LOL. I average that in 2 work weeks ....

Edited by Numenor

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Neuro Guy NP has 7 years experience as a DNP, PhD, APRN and specializes in Vascular Neurology and Neurocritical Care.

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18 hours ago, FullGlass said:

The reason I said that is an Acute Care NP has to choose Adult or Peds.  If they want to work in an ER, that is a disadvantage requiring additional schooling to overcome.  The PA will cover Peds and Adult, plus PAs can do more procedures, which is an advantage in the inpatient setting.  I agree with you that Acute Care NP can be fine, depending on what area the NP wants to practice in

I don't think the PA can do more procedures, as for example I do the full range of critical care procedures including bronchoscopy, intubation, EVD insertion, etc. Just not true. I do agree, however, about ACNP having to choose adult or pediatrics. That is true. A couple neurosurgery groups in the area only hire NPs. Otherwise, within a specialty, it's a misconception that PAs have something to offer that we don't. I'd very much like that misconception to die. It's high time. I'm not the only NP procedurally well prepared either that I know, so it isn't a fluke. 

Edited by Neuro Guy NP

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Numenor has 8 years experience as a MSN, NP and specializes in Internal Medicine.

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7 hours ago, Neuro Guy NP said:

I don't think the PA can do more procedures, as for example I do the full range of critical care procedures including bronchoscopy, intubation, EVD insertion, etc. Just not true. I do agree, however, about ACNP having to choose adult or pediatrics. That is true. A couple neurosurgery groups in the area only hire NPs. Otherwise, within a specialty, it's a misconception that PAs have something to offer that we don't. I'd very much like that misconception to die. It's high time. I'm not the only NP procedurally well prepared either that I know, so it isn't a fluke. 

Well I have worked at multiple places and PAs outnumber NPs in the OR 10:1. It is what it is. Procedural does not equal OR

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