FNP no longer allowed to practice inpatient

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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?

Specializes in Vascular Neurology and Neurocritical Care.
13 hours ago, Numenor said:

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

I'll concede there are more PAs in the OR, but again ACNPs can do just as well. Clinical surgical rotations in school even for PAs just aren't long enough to really be able to say with a straight face will make you proficient. So both providers can be trained after school to do well in the OR. Just because something has traditionally been a certain way doesn't mean it's better. And here in the northeast it's very common to see surgical positions listed for ACNPs. Maybe not in your area, but here it is. I've spent my fair share of time in the OR when I did neurosurgery. Now I'm strictly Neurocritical.

Again, this is just an old stereotype that just doesn't hold true anymore. It's a stereotype from the time when FNP was pretty much the dominant NP type - there weren't any ACNP programs. I would take a PA over an FNP for the OR because of the educational background. Just saying.

2 minutes ago, Neuro Guy NP said:
2 Votes
On 6/13/2020 at 12:57 AM, Numenor said:

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 ....

That’s kind of true of PAs, too, though. They may get a few more peds clinical hours, but most still can’t get hired into peds specialties without an additional fellowship.

Specializes in DHSc, PA-C.
On 6/12/2020 at 4:20 AM, 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've been a PA 13 years and have changed specialties a few times. I don't know if I ever "mastered" them, but felt very comfortable and knowledgeable to manage my patients. I did ER for years, hospitalist 2 years, outpatient psych 2 years, and now I'm inpatient urology.

I would say that if someone wanted to strictly be an inpatient acute care provider, then ACNP is a fine choice as well. If you want flexibility/options in the future, such as outpatient, then the broader PA training would be better.

As far as inpatient procedures, PAs have exposure to surgery/procedures during school. However, both ACNP and PA can be trained to do these procedures.

4 Votes

Consensus model. FNP is primary care in focus. I'm a firm believer if you want to do inpatient, you need an AGACNP degree. FNPs are valuable in our healthcare system, but it doesn't substitute for focused, specialized training.

4 Votes
Specializes in Vascular Neurology and Neurocritical Care.
19 hours ago, DizzyJ DHSc PA-C said:

I've been a PA 13 years and have changed specialties a few times. I don't know if I ever "mastered" them, but felt very comfortable and knowledgeable to manage my patients. I did ER for years, hospitalist 2 years, outpatient psych 2 years, and now I'm inpatient urology.

I would say that if someone wanted to strictly be an inpatient acute care provider, then ACNP is a fine choice as well. If you want flexibility/options in the future, such as outpatient, then the broader PA training would be better.

As far as inpatient procedures, PAs have exposure to surgery/procedures during school. However, both ACNP and PA can be trained to do these procedures.

Yeah ACNPs get exposure too, and I always had medical and ACNP students do things (intubate, lines, maybe even do a pass with a bronchoscope) with me when they rotated, but I wouldn't say they became proficient just because they did a few procedures with me.

12 hours ago, Jory said:

Consensus model. FNP is primary care in focus. I'm a firm believer if you want to do inpatient, you need an AGACNP degree. FNPs are valuable in our healthcare system, but it doesn't substitute for focused, specialized training.

Exactly. I wouldn't dare go get a primary care job in the office. Not my scope, and these days when we can point to specific educational preparation for roles, people are looking at that and becoming educated on this.

5 Votes

This is totally ridiculous and just a way to continue to put APRNs down from an executive standpoint and a way for the schools to continue to bring in revenue. What is not understood is as they think there is a saturation of RNs and NPs, there are very few that want into this profession and we will see a shortage in upcoming years.

Yes, a lot of places are requiring the ACNP or ERNP for hospitalist, ICU and ER. You can work in palliative care, wound care and some other select specialties with the FNP in-patient without issue. Most WOC NPs I know have the FNP and it is actually preferred in order to be able to see both pediatric and adult patients.

1 Votes

The problem with that degree is you can’t take care of patient s of all ages. Most the FNPs I know currently are hospital it’s. I know there is a drive to change that, I would rather have the FNP at this point to care for all age groups.

Specializes in Vascular Neurology and Neurocritical Care.
On 7/2/2020 at 10:29 AM, RN/WI said:

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Specializes in Vascular Neurology and Neurocritical Care.

But very few positions will you be caring for patients across the lifespan so generally it doesn't matter. Cardiologists, Neurologists, Gastroenrerologists, etc. are all either adult or peds focused in their practice, not both.

The only times being able to care for patients across the lifespan matters at all is generally primary care (and even then there are PLENTY of internal medicine - ie no peds - practices), ER, and maybe a couple others. So this argument in support of FNP is quickly dying. Even for ER there are many level 1 trauma academic centers with separate Peds ERs and an ACNP can be in the adult side. I've seen it plenty.

I support advanced practice nursing of all stripes but the tropes that perpetuate facts that are either inaccurate or outdated are getting very old. I'm active with the ANCC and AACN, including writing questions for the board exams and no matter how much education is provided about the various specialties and scope of practice, etc. it just seems that it doesn't get through sometimes.

3 Votes
Specializes in tele- 7 yrs, Pyxis- 3 yrs, med/surg 4.

Can anyone list what states enforce the consensus model? What is driving this? Medicare? States? BON?

Specializes in Vascular Neurology and Neurocritical Care.
14 hours ago, phil1968 said:

Can anyone list what states enforce the consensus model? What is driving this? Medicare? States? BON?

In my area, Delaware, Pennsylvania, New Jersey, New York, and Connecticut all are very adherent to the consensus model. You see job postings explicitly say 'ACNP'. It is individual BONs who decide on this policy.

1 Votes
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