FNPs in the Hospital?

BostonRN13 · Feb 25, 2014

Just curious if I go the FNP route am I limiting myself to outpatient forever? Is it possible to be hired inpatient hospital positions as an FNP? What about emergency room? Thanks![/quote']
Yes, it's possible. That's actually all I've been applying/ interviewing for. Not sure about the ER part. Right now I'm interested in a surgical NP and an inpatient GI position. So, many opportunities out there..

futureeastcoastNP · Feb 25, 2014

Good to know, thanks! I wonder if it's location dependent.

allnurses Guide · Feb 25, 2014

I am credentialed at my community hospital and round on my practice's patients every morning.

I have several colleagues that work full-time inpatient.

mammac5 · Feb 25, 2014

I'm an ANP and I've worked inpatient ever since graduation and now do just 2-3 days/month in an outpatient setting as well.

hubcaps · Feb 28, 2014

No you are not... at least right now. I am a FNP and I care for both inpatient and outpatient. If you want to do ED, FNP may be the way to go because you are trained in both peds and adults. Most ED positions that I came across wanted FNPs.

However, in the long run this may change. The hospital that I was at as a RN will only hire acute care NPs for inpatient care. This change probably won't happen for a long time. Community hospitals depend heavily on NPs and there are not enough acute care programs to meet the demand.

allennp · Feb 28, 2014

I see very few ACNP if any as inpatient, almost all are FNP or ANP. Plus most hiring teams want a FNP type to have a comprehensive overview so as to integrate families/discharge/ admission issues, as well as the multitude of chronic and acute medical conditions.

It might change 15 years or so from now but I do not think the national organizations will ever be able to agree with the states on much of any thing.....thankfully as all I see them do is cause more fragmentation of our practice.

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Dranger · Mar 1, 2014

In my state (very NP friendly) you could do ER but inpatient is almost always ACNP or PA. FNPs with hospital rights just see their own patients and they are not common. So it depends where you go but keep in mind thora, para, intub and central line placement are key in inpatient and most FNPs programs lack these skills while ACNP sometimes covers them. You could always OJT to be credentialed for them but I see it as if you definitely want inpatient go ACNP

zmansc, ASN, RN · Mar 1, 2014

I don't have any experience with this in other states, or other facilities, so strictly ancedotal information here.

I know my state allows FNPs to work in both the ED and as hospitalists, we have one of each in our facility. Both had several years of experience prior to coming here, which helped them get credentialed. We have had more FNPs in the ER over the past few years, no other FNPs as hospitalists, I think this is related to the hospitalist group being less willing to work with NP/PA in their group than the ER docs being willing to work with NP/PAs. In fact several of the PAs who joined the hospitalist group were dissatisfied with their work and subsequently moved to the ED where they have been happy. To our hospital (both the hospitalist group and the ED providers group) FNP and PA roles are identical. Both have their notes signed by a MD/DO provider even though the state does not require it for APRNs. This may change in the future as L&D recently changed and now allows the CNMs to write and sign their own notes.

In our provider community, the numbers are small, we have 22 APRNs practicing in outpatient clinics, most in primary care a few specialists offices (1 cancer center, 1 dialysis clinic, 1 cardiologists office, 4 urgent care clinic/primary care, 2 high school clinics/primary care, rest full time primary care). We have 1 FNP in the ED and 1 FNP in the hospitalist group. For contrast there are well over 100 RNs in the hospital, and atleast another 100 in the three LTC facilities in town, I would guess less than 20 in outpatient clinics in the area.

The easier nut to crack in my area is urgent care. We have far more FNP/PA to MD/DO ratio in the urgent care clinics in my area, close to 2:1, and there are more NPs than PAs currently. I think this is because the urgent care clinics are less resistant to change than our hospital's medical director is. We also have less positions in the hospital than urgent care. There are only three not quite full time NP/PA positions to fill in the hospital's ED, where there are I think 6 NP/PA positions in one urgent care. The other two urgent care clinics are in neighboring towns, I did not include them in the number of NPs earlier as I don't know the specifics of their provider communities, but I know they have no hospitals. One is a mining town (owned by the mine company) and only has one clinic, part primary care, part urgent care staffed almost like a remote ER, I do know most of the providers in that clinic reside here and there are at least three NPs in the clinic, full autonomy. The other urgent care is in a small town about an hour away, owned by the same local practice that does the urgent care in this town, again no hospital in that town. I'm told the staffing is similar to our urgent care, but I haven't researched it.

Hope that helps.

futureeastcoastNP · Mar 1, 2014

I don't have any experience with this in other states, or other facilities, so strictly ancedotal information here.
I know my state allows FNPs to work in both the ED and as hospitalists, we have one of each in our facility. Both had several years of experience prior to coming here, which helped them get credentialed. We have had more FNPs in the ER over the past few years, no other FNPs as hospitalists, I think this is related to the hospitalist group being less willing to work with NP/PA in their group than the ER docs being willing to work with NP/PAs. In fact several of the PAs who joined the hospitalist group were dissatisfied with their work and subsequently moved to the ED where they have been happy. To our hospital (both the hospitalist group and the ED providers group) FNP and PA roles are identical. Both have their notes signed by a MD/DO provider even though the state does not require it for APRNs. This may change in the future as L&D recently changed and now allows the CNMs to write and sign their own notes.
In our provider community, the numbers are small, we have 22 APRNs practicing in outpatient clinics, most in primary care a few specialists offices (1 cancer center, 1 dialysis clinic, 1 cardiologists office, 4 urgent care clinic/primary care, 2 high school clinics/primary care, rest full time primary care). We have 1 FNP in the ED and 1 FNP in the hospitalist group. For contrast there are well over 100 RNs in the hospital, and atleast another 100 in the three LTC facilities in town, I would guess less than 20 in outpatient clinics in the area.
The easier nut to crack in my area is urgent care. We have far more FNP/PA to MD/DO ratio in the urgent care clinics in my area, close to 2:1, and there are more NPs than PAs currently. I think this is because the urgent care clinics are less resistant to change than our hospital's medical director is. We also have less positions in the hospital than urgent care. There are only three not quite full time NP/PA positions to fill in the hospital's ED, where there are I think 6 NP/PA positions in one urgent care. The other two urgent care clinics are in neighboring towns, I did not include them in the number of NPs earlier as I don't know the specifics of their provider communities, but I know they have no hospitals. One is a mining town (owned by the mine company) and only has one clinic, part primary care, part urgent care staffed almost like a remote ER, I do know most of the providers in that clinic reside here and there are at least three NPs in the clinic, full autonomy. The other urgent care is in a small town about an hour away, owned by the same local practice that does the urgent care in this town, again no hospital in that town. I'm told the staffing is similar to our urgent care, but I haven't researched it.
Hope that helps.

That is very helpful, thank you. Urgent care is actually something I'm interested in, and I was thinking of moving to New Mexico upon graduation. I know your governor is fairly pro-NP.

Sunshinepeds · Mar 2, 2014

I am a FNP (16 yrs) and the last three years have worked inpatient peds heme/onc/BMT. I love it and plan to continue for the near future here in ohio!

allennp · Mar 2, 2014

The easier nut to crack in my area is urgent care. We have far more FNP/PA to MD/DO ratio in the urgent care clinics in my area, close to 2:1, and there are more NPs than PAs currently. I think this is because the urgent care clinics are less resistant to change than our hospital's medical director is. We also have less positions in the hospital than urgent care. There are only three not quite full time NP/PA positions to fill in the hospital's ED, where there are I think 6 NP/PA positions in one urgent care. The other two urgent care clinics are in neighboring towns, I did not include them in the number of NPs earlier as I don't know the specifics of their provider communities, but I know they have no hospitals. One is a mining town (owned by the mine company) and only has one clinic, part primary care, part urgent care staffed almost like a remote ER, I do know most of the providers in that clinic reside here and there are at least three NPs in the clinic, full autonomy. The other urgent care is in a small town about an hour away, owned by the same local practice that does the urgent care in this town, again no hospital in that town. I'm told the staffing is similar to our urgent care, but I haven't researched it."

This is a trend I think???

The way I have understood it is that the EM programs for docs are pumping out alot of EM boarded MD's with jobs tight. AT least in the larger metro areas that are desirable to live(subjected to preference) there seems to be a lot of hungry Boarded ENM folks looking for work, and NP's are out in more UC's. That also reflects here at least where ED volumes are down due in large part to a large number of UC's going in, many rather well staffed with RN's and services such as ultrasound/CT/MR, these being felt to be a catchment system to feed sicker folks in to the ED's. They can be busy places tho seeing 30-40 patients if not more in ten hours and some of them occasionally pretty sick.

Hope that helps.