Help me! Desperate for this job!

Advanced Practice Columnist / Guide · Mar 10, 2010

Theoretically, this job is out of scope for someone trained as a FNP. However, what happens in reality is entirely different. I am an ACNP working in a critical care setting and I would be lying if I say that there are no FNP's working in my field. In fact, I know of a few who does and I've practiced in 2 different states now. Best bet for you is to check with your BON and see how they weigh in on the issue. Some BON's have a very general view of what the scope of a nurse practitioner is and does not delineate the difference in what the acute care and primary care tracks involve. These states grant a blanket NP role regardless of specific NP training and leaves details on what other stuff NP's can do to whatever is arranged between the NP and the collaborating physician. Some states, however, are very specific and makes distinctions on practice settings for primary care and acute care NP's (an example would be Texas and Maryland).

ALCCRN · Mar 10, 2010

You may want to check with the hospital's policy on NPs as well. I know at my hospital (will graduate with FNP in May), NPs can: 1) write orders that are countersigned by the physician, 2) write progress notes and dictate discharge summaries and H&Ps, 3) round on patients, but the patient must still be seen by the physician.

Another question that you may want the anser to is 'Are there specific protocols you need to go by?'. I think it may be easier on you if you knew that every patient gets weaned from the vent the same way, using the same steps. That way, you'd be writing orders, but it'd be a protocol of sorts...Or that all patients on the vent get Chest xrays every morning...Things like this would be helpful to know.

I will agree with previous poster that several NPs round/write orders in the hospital and very few are acute care.

kanzi monkey · Mar 11, 2010

Can you get a copy of the practice guidelines? Those should delineate the NP role and give you a better sense of what you will be accountable for. In my state an ANP license is the general requirement for most posted NP hospital jobs. I have seen few posted positions that specify ACNP. Since many of the schools are offering an ACNP route I wonder if this may change at some point.

I'd follow some of the suggestions above, look into the requirements for your state, look at some guidelines. I WOULDN'T say no to such a potentially interesting job based on one warning, but you may want to speak to your instructor again--get a little more background info, see where s/he's coming from, etc.

Good luck, and congratulations!

AlishaNHayzley · Mar 21, 2010

There is nothing really specific in our regs. Broad terms and loose guidelines. So I called the board, and the "know all" lady there said she felt like it was out of my scope in that setting, and that I wouldn't be very covered if I got sued. So- I asked her about having protocols and she said something like that would be covered under medically delegated acts. Don't know if this may be an option. Sounds limiting, which is not what I want. I also discussed documenting all of my orientation hours to try and expand my scope, but she said it wouldn't count towards scope. So what exactly is the difference in documenting procedures and different aspects of care to "expand scope" and the inability to do it in other situations. Why is there not anyone who can give me a cut and dry yes, no. There are a ton of FNP's in my state doing hospital rounds. So is everyone just practicing out of scope? I need this job, just not sure how I can go about doing it!

JALEXSHOE · Mar 22, 2010

Honestly, if I am interpreting what you are saying rightly, it sounds as if your state's guidelines are vague. Without knowing what they are for sure, it is hard to answer your questions. If they are indeed vague, then interpretation is up to the interpreter...

That being said, IF you did get sued, then you would have to be able to substantiate that you have sufficient scope (if that was the question) and have proof to back it up. If your educational institution will not back you up, then that is a detractor. But to get rounds at the hospital, I believe you have to go through an approval process for this. And I am pretty sure, you would not pass their requirements, if you are an absolute no.

I, personally, think I would talk to an attorney, who specializes in this area of law...pay the 50 dollar or so consult fee, and get their gestalt... The rest of what you are asking for a opinions, and none of them legal, if albeit somewhat educated.

In my state, FNP's do work in hospital settings. But I could see where there would be places, where the scope would be limited. It is a shame, that this is such a gray area in some places. As nurses, it is so hard for us to understand that in a profession, where we gravitate to the fields we are interested and train in after graduating, that once we get into advanced practice, we are locked into a very tight subcategory of education prior to working. It kind of goes away from our initial model, and I think this is why so many people have role confusion with this stage of the process.

You could always keep in mind, that you could do an acute care program, online while working, obtaining dual certification. This would probably take another year, but you could work at the same time, and perhaps work this out this way. You might want to discuss your concerns with your potential employer and get his input also.

You have options, you always have options, don't give up...

But with all this said, and I like it was mentioned, these are just opinions, sometimes the things, we think, we want most, may not be the best thing for us, and then we walk right into the very thing that was meant for us al along and we just didn't know it yet. When something is RIGHT, it shouldn't take that much work to make it so...it will happen, whatever is meant to, will...just have faith, and keep trying to do things in exactly the way you are doing, and it will come to you. God has a way of opening windows, when doors are closed...

Bonosgrrl · Mar 22, 2010

I had a similar situation, I called the BON and it was vague, they said as long as I had written protocols in place with the MD I was working with and a written practice agreement outlining everything it would be fine.

I think you should take the job, I think you will be fine with it.

cruisin_woodward · Mar 24, 2010

I'm glad this issue was raised. I hate that we have to specialize. I was going to go with the FNP at one point so that I would be more general. But I really just want to be in a hospital, so I guess it doesn't matter...I was told that many FNPs are in the hospital...I guess the question is...are they supposed to be? Ugh. Too many regulations!