How broad/narrow is your scope of practice as an NP?

jer_sd · Jun 16, 2008

Somedays I wish I had an quick clinic job, brainless repetition. But most days I like my employment in radiology as a NP.

For me specilty practice fits my personality more than primary care would at this point in my life. The good thing about being a NP is that is if I want to switch in a few years I could go to priamry care or another specilty practice. One good benifit of the quick fix jobs is not dealing with HMO authorizations ect.... that is my least favorite part of my current position.

Jeremy

Advanced Practice Columnist / Guide · Jun 16, 2008

Yes, I'm back, with yet another question about the NP role.
Meaning, do you find yourself using a wide variety of skills you learned in NS? Or not?
Many of my classmates are talking about going on for their NP and working for those pharmacy clinics which are becoming increasingly popular. But I can't help but think that such positions wouldn't offer much in the way of variety...just an endless parade of earaches, sore throats, colds, etc...
Would doing primary care in other settings offer more variety? Or what about specializations other than primary care?

It's a matter of personal choice. Some people may enjoy a setting where patients seen are stable and have minor complaints and are sent home after being seen in a clinic. Others prefer a fast paced setting where patients can change easily from being stable to unstable and advanced skills are required to function in the role. I personally like the latter and have made a decision to pursue the acute care field when I started NP school.

I love being challenged by a sick patient with medical problems involving multiple organ systems. I like immediately seeing the result of the medications I order such as when a patient needs a vasoactice IV drip and I see hemodynamic improvement after the nurse initiates the pharmacologic agent I ordered. I also prefer to hone advanced clinical skills and enjoy the thrill of placing a chest tube on a patient at risk for tension pnumothorax and then seeing the x-ray later and knowing that the lung has re-expanded. It also makes me feel better that I have a vast amount of expertise immediately available for consultation in the hospital setting especially in a large academic facility like the one I work in.

As I age and feel that I am no longer able to keep up with the fast pace of critical care medicine, I think that will be the time when I apply for a teaching position or do research and hope that my years in adult acute care have prepared me enough to train the next batch of acute care nurse clinicians.

ANPFNPGNP · Jun 17, 2008

I work as an independent contractor in primary care and urgent care and I LOVE the variety. After NP school, I went to work in pain management...good pay, but totally repetitious and boring. In urgent care, I get to take care of lacerations, fractures, abscesses, etc. I LOVE doing all the hands on stuff, but I'm 100% on my own, which can be scary at times. During the week I work with 2 doctors in primary care and I get to see everything you can possibly imagine. I love nothing more than getting to see something different behind every door and there is no way I would ever specialize again, even though it would mean more money.

BTW, I would grow very tired of the Minute Clinic stuff you are describing. I know someone who works at one of those and she's bored to tears!

Joe NightingMale, MSN, RN · Jun 17, 2008

Pain management (and palliative care) has always been a field that's interested me. Though I really don't want to do hospice, too much traveling and not enough money. But as an NP it might be more doable...

Are NPs more sought after in more rural areas? I seem to remember that's one of the reasons the position was created. I'd think they'd be much more common in large urban areas.

VivaRN · Jun 17, 2008

I'm still a student, but we had a manager from the retail clinic industry come talk to our class. She said they look for NP's with solid primary care experience to fill retail clinic positions.

Occasionally they will hire new grads, but only those with nursing experience and the confidence that brings to start out with limited orientation in an independent practice setting (where you are the only one there).

My instructors told us not to go there right off - because you don't have the autonomy or scope, and as a new grad if you don't have your skills down it could be detrimental to your professional development.

I appreciate them because they pay well and it raises salaries overall. But it doesn't seem like something to aspire to. As I near the end of my program I realize there is so much more I can do - I want to get out there and do it! Why do you think your classmates are looking to this opportunity?

ANPNY · Jun 17, 2008

I have come to find that there is no such thing as "just a sore throat". People are far more complex than that. i have had patients come in practically crying because their nose is stuffy. And sometimes they really are uncomfrtable, but alot of times they just need a mental health day or a little TLC/sympathy. One thing that NPs bring to the table in all settings is our focus on seeing the patient as more that the sum of their parts and focusing on how to educate patients and promote health at every encounter. I think retail clinics are a great idea that will probably need alot of tweaking before they become a brilliant idea. But I think our stance as NPs should be to rally behind them because they fulfill a basic tenet of NP roots and that is increasing accesssibility of quality health care.

Joe NightingMale, MSN, RN · Jun 17, 2008

Why do you think your classmates are looking to this opportunity?

$$$$$

Same reason many are talking about CRNA.

I think it's a mistake to focus so much on money, it could end up leading to a position that might be high paying but also very boring and limited.

I'm with you, I'd like to do a wider variety of things and work in a wide variety of places.