Hospitalist NP's - How do you do it?

Specialties NP

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Specializes in Telemetry, ICU, Psych.

I'm considering becoming a Hospitalist NP, but am concerned with the training (my 1 year of tele, then 1-2 yrs ICU, then a 1-2 year acute care NP program).

For the NP hospitalists (or those working in specialty clinics who round on inpatients), do you feel that your training has been enough to see patients in the ICU/acute care setting? How long did it take for you to feel comfortable? How much autonomy do you have?

Is there something that I can do now to help down the road?

Thanks in advance!

CrazyPremed

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Specializes in Acute Care - Cardiology.
i'm considering becoming a hospitalist np, but am concerned with the training (my 1 year of tele, then 1-2 yrs icu, then a 1-2 year acute care np program).

for the np hospitalists (or those working in specialty clinics who round on inpatients), do you feel that your training has been enough to see patients in the icu/acute care setting? how long did it take for you to feel comfortable? how much autonomy do you have?

is there something that i can do now to help down the road?

thanks in advance!

crazypremed

hey there,

i, too, considered working with a hospitalist group upon graduation, but i am glad i went with the specialty focus of cardiology. and as much exposure you can get as an rn is great, but you need to understand that regardless of your training as a nurse, you will likely be shocked at how much different the roles are. the reason i say that is because as an rn, i always thought i knew how to treat certain things that always came to the er because i had a lot of exposure to them. once becoming an np, i was very surprised how much i didn't know. so just be prepared for that. i am glad that you are getting well rounded in imc/icu... i only had er experience before becoming an np and i wish that i had done at least icu. i have to be very cautious of asking the icu nurses to do something for me because i haven't ever done what they do... so i try to make them aware of that fact and ask them to teach me things i don't know. i haven't ever had problems with that approach.

as for training, i did an acnp program so 3 of the 4 semesters of mine were spent in the hospital setting: hospitalist group, icu, and cardiology foci. i was appreciative of those experiences, and it was helpful... but, you have a sense of insecurity coming out and i think that's common for a while as a new grad. i'm a year out and still unsure of some things. but... i have a wonderful supervising doc that is very academic-minded and i would recommend that you build a strong relationship with your supervising doc and utilize orientation time to your advantage. ask questions. even make notes about how they do things (if it's essentially "right) and the more exposure you get, the more confident you will become.

as for right now and in your program, get in as much clinical time as you can and take it seriously. i know some people that just breezed their way through clinicals without really "taking it all in," ya know? i even had days that i just didn't feel like being there and looking back, i wish i had consumed every minute of time i had to learn. also, you may want to invest in something like "the icu book" by marino. that seems to be a staple with intensivists and that's what my preceptor np asked me to buy before my icu rotation. also, i rely on my palm program: pepid (far superior to epocrates, but that's just my opinion...) and that way i don't have to carry around a bunch of pocket cards or books.

autonomy? i'm still building it because i am relatively new. i do stress test supervision autonomously... and rounds/consults on my own. i'll write orders for med changes or things like k/mag replacement, but my supervising doc and i work very closely together, so i normally document what i think we need to do in my note, i.e. "consider increasing to metoprolol succinate 100 mg po qday" or for specialized testing: "plan for stress versus catheterization in am"... knowing that i will be talking with my supervising doc about each patient before the day is over. it won't be like this forever, and i do more things autonomously now than 3 months ago, but its nice that i am not feeling overwhelmed. basically, i normally come up with the plan, tell the doc, and then we do it or he explains why/why not my plan would work.

hope this helped!

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Specializes in CTICU.

Wow Daisy, sounds like a great relationship!

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I'm considering becoming a Hospitalist NP, but am concerned with the training (my 1 year of tele, then 1-2 yrs ICU, then a 1-2 year acute care NP program).

For the NP hospitalists (or those working in specialty clinics who round on inpatients), do you feel that your training has been enough to see patients in the ICU/acute care setting? How long did it take for you to feel comfortable? How much autonomy do you have?

Is there something that I can do now to help down the road?

Thanks in advance!

CrazyPremed

Everything else improves with time. Although my program did provide me with the necessary knowledge of human physiology and how to apply that to making decisions regarding treatment and drug therapy, many of what I know now was attained on the job. I was actually an ER nurse prior to becoming a nurse practitioner. And although I have SICU experience as a nurse, the cardiothoracic surgery population was an entirely new experience for me.

I would say many physicians who venture into a physician-nurse practitioner collaborative care model are smart enough to know that they would need to provide additional training to a new NP to ensure success in the relationship. I was fotunate enough to be provided the necessary on the job training, conferences, and reading materials (including textbooks and research articles) by my employer when I started my job. It took me a good year to achieve a healthy dose of confidence as a clinician in my specialty field.

Other challenges I also had to hurdle were learning to perform invasive procedures and knowing specific preferences of each attending physician on how their patients are managed. I work with 4 cardiothoracic surgeons and while their patient management modalities essentially lead to the same goal, they have certain differences in their choices of drugs as well as timing of treatments and interventions. What I also realized, that you have to earn the trust of your collaborating physicians before they will let you do things on your own.

I have been in my role for 3 years now. I make independent decisions with intubations, changing vent settings, and extubations. I make independent choices in starting meds including oral and vasoactive. I can perform invasive procedures including all sorts of lines, chest tubes, and bronchoscopies. However, I am still expected to let the physicians know that there was a change in status in a particular patient and explain why I did what I did. I am also expected to ask their input if I have a complex patient case and couldn't figure out the route to choose in terms of patient management before it's too late.

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Specializes in ER, ICU, Med/Surg, Pedi.

I am happy to see such a bright NP make this statement. I agree. I think NP's should make decisions like you make. I look forward to that day. I am just getting started in my quest for NP"ism".

What school did you go to? Any advice? Any suggestions? How do RN's respond to taking orders from you? What do you think of the new DNP requirement? What do other NP's think of the new DNP role?

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Specializes in ER, ICU, Med/Surg, Pedi.

Hi, you have a lot of knowledge. I would like more information and be able to pick your brain more. I agree with your statement on "use the clinical time". I can remember in my undergraduate studies as both a LVN student and a ADN student being in clinical watching my clock waiting to go home.

I don't want that as a FNP student. I want to be able to learn as much as I can. I want to be a competent practitioner. I don't want to kill anyone or give any wrong advice. I really want to use that clinical time to learn.

What other suggestions do you have while in school? What program did you attend?

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Specializes in ER, ICU, Med/Surg, Pedi.

What do you guys think about me going to Paramedic school during the Spring semester before getting into NP school in the fall?

I have been accepted to one program out of my application to 40 so far. I have been accepted to University of Phoenix ground campus in Phoenix starting in May 2009.

I thought about going to EMT-P school for a little more "street medicine" knowledge. Any advice on preparation for FNP school?

I want to be ready. Should I go to a community college and take a quick A&P review course?

Chelsea:D

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
How do RN's respond to taking orders from you?

Never really had problems with RN's carrying out my orders. ICU RN's especially are very receptive to carrying out an order such as a new medication or treatment when they are kept in the loop about what we are treating. Our ICU RN's have developed the habit of referring to us NP's a lot about any issues they are having with patients. In fact, the residents feel jealous that the nurses listen to the NP's more than the residents.

What do you think of the new DNP requirement? ?

It's something we NP's have to deal with if it becomes a requirement. However, I'm not planning to start a program in the next year or maybe two.

What do other NP's think of the new DNP role?

There shouldn't be any changes with roles as far as a nurse practitioner who has a DNP or an MSN.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
What do you guys think about me going to Paramedic school during the Spring semester before getting into NP school in the fall?

Would you practice as an EMT on the field for a while? I guess, that would be beneficial if you want to take the long route. As have been established before, ICU experience is probably the most useful in terms of being prepared for an ACNP program.

Any advice on preparation for FNP school?

Be aware that FNP is an entirely different ballgame than ACNP. Regardless of how things are done in some parts of the country, if your interest is in in-patient or hospitalist roles, ACNP is your best bet. FNP is focused on primary care across the lifespan - very little training is offered in in-patient clinical settings as the NP is trained to provide care in ambulatory healthcare settings.

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Specializes in ER, ICU, Med/Surg, Pedi.
Would you practice as an EMT on the field for a while? I guess, that would be beneficial if you want to take the long route. As have been established before, ICU experience is probably the most useful in terms of being prepared for an ACNP program.

Be aware that FNP is an entirely different ballgame than ACNP. Regardless of how things are done in some parts of the country, if your interest is in in-patient or hospitalist roles, ACNP is your best bet. FNP is focused on primary care across the lifespan - very little training is offered in in-patient clinical settings as the NP is trained to provide care in ambulatory healthcare settings.

Well, I have years of ER experience. I am just now getting back into full time ICU experience. I have been accepted for fall 2009 FNP school. I had my interview with Johns Hopkins yesterday for their program, that is my first choice of course. But I wondered if working in the field as a EMT would help any. Just a thought. I don't really want to spend the money to go to EMT school if not needed. I know it would be a great experience to work as a EMT in the Baltimore area if I get that training before going off to JHU if accepted.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Well, I have years of ER experience. I am just now getting back into full time ICU experience. I have been accepted for fall 2009 FNP school. I had my interview with Johns Hopkins yesterday for their program, that is my first choice of course. But I wondered if working in the field as a EMT would help any. Just a thought. I don't really want to spend the money to go to EMT school if not needed. I know it would be a great experience to work as a EMT in the Baltimore area if I get that training before going off to JHU if accepted.

Well, ER would be great experience for you if you plan on doing FNP. By the way, congrats on getting admitted - you picked a nice program. I automatically assumed you were interested in acute care since you posted in a hospitalist NP thread but if you like the primary care field, I don't see the point in working in the ICU.

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Specializes in ER, ICU, Med/Surg, Pedi.
Well, ER would be great experience for you if you plan on doing FNP. By the way, congrats on getting admitted - you picked a nice program. I automatically assumed you were interested in acute care since you posted in a hospitalist NP thread but if you like the primary care field, I don't see the point in working in the ICU.

I have not been accepted to Johns Hopkins. I just got an interview for the program. I have been accepted to another program though. I currently work ICU and ER.

I am going for FNP which from research the training is mostly outpatient. I 've considered doing an ACNP program later...Is that needed?

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