Is anyone here a Hospitalist NP?

yellow finch, BSN, RN · Dec 18, 2007

Hi there! I posted threads like this ages ago and never really got much of a response. It's possible we just don't have anybody here working in that area.

I was initially interested in going into the Hospitalist role after graduation, but the health system that is nearby doesn't do this. Some of the MDs are all for it while others are not. According to my former preceptor (a Hospitalist) it doesn't look promising despite the fact that the NP can divert a lot of the calls that come in and pull the docs away from their rounds.

There are quite a few articles written on the topic. If you don't have access to medical libraries online I'd be happy to do some searching for you since I'm still in school. If anything, the articles are very pro and have some excellent ideas on how the NP can take over care of the inpatient after 72 hours, freeing up the MD to admit new patients. This is just one of the concepts that other hospitals have come up with for the NP-Hospitalist.

Let me know if you have any luck with your search for current NPs. I'd like to pick their brain as well. :)

christvs, DNP, RN, NP · Dec 18, 2007

Hi there! I posted threads like this ages ago and never really got much of a response. It's possible we just don't have anybody here working in that area.
I was initially interested in going into the Hospitalist role after graduation, but the health system that is nearby doesn't do this. Some of the MDs are all for it while others are not. According to my former preceptor (a Hospitalist) it doesn't look promising despite the fact that the NP can divert a lot of the calls that come in and pull the docs away from their rounds.
There are quite a few articles written on the topic. If you don't have access to medical libraries online I'd be happy to do some searching for you since I'm still in school. If anything, the articles are very pro and have some excellent ideas on how the NP can take over care of the inpatient after 72 hours, freeing up the MD to admit new patients. This is just one of the concepts that other hospitals have come up with for the NP-Hospitalist.
Let me know if you have any luck with your search for current NPs. I'd like to pick their brain as well. :)

Hi Yellow finch. I am still in my NP program (6 months to go!!!!!!) so I do have access to my medical library and have read some articles on Hospitalist NPs. Thanks. :) I just don't think there are very many of NPs working in this role in my area. I keep asking all my NP professors and preceptors about this, and they all say the same thing-that it's such a great role for NPs, and they don't know why the role is not being utilized. I know I also like cardiology and urgent care....but I am stuck on internal medicine still, as my first choice. Do you know what are you'd like to work in once you graduate?

Advanced Practice Columnist / Guide · Dec 18, 2007

Unfortunately changing the way physicians utilize NP's is a job we NP's have to take on ourselves. This would involve a lot of self-marketing, education, and networking. I think physicians do read the studies that show how NP's have been utilized. However, it's a matter of approaching the right physician and administrator who are open to changing current practice by working with a mid-level provider.

Hospitalist NP's are a newer role even in this area where I live and the three hospitals that utilize NP's in In-patient Internal Medicine are very different from each other. Two of them are suburban medical centers and one of them is located in an affluent suburb. The NP's (and PA's which they also hire in the same role) admit patients from the ER and write admission orders after calling the attending physicians to inform them of the patient's admission. It is a 24-hour service and the mid-level providers work in shifts.

The not so thrilling part of their job is that oftentimes, they do not follow the patient on a daily basis anymore after they have done the initial H&P and admission orders. However, they are called upon when the patient is being discharged so that they can fill out discharge orders and prescriptions. Here and there, they are also paged to troubleshoot and put out fires with patients who are "not doing well", needs to see a physician, and things of that sort.

The other hospital I know of that utilize hospitalist NP's is located right in the inner city area of Detroit. Not the greatest place to work in terms of personal safety. However, the role is pretty similar but there is much more autonomy in terms of allowing the mid-levels to do more for the patients. Many of the patients are followed on a daily basis by the the mid-levels who have the autonomy to direct their entire hospital care from admission to discharge.

All three hospitals have a residency program in Internal Medicine. However, the mid-level providers only care for patients whose attending physicians are not part of the Academic Internal Medicine group. The residents follow the patients of that group.

yellow finch, BSN, RN · Dec 18, 2007

Hi Yellow finch. I am still in my NP program (6 months to go!!!!!!) so I do have access to my medical library and have read some articles on Hospitalist NPs. Thanks. :) I just don't think there are very many of NPs working in this role in my area. I keep asking all my NP professors and preceptors about this, and they all say the same thing-that it's such a great role for NPs, and they don't know why the role is not being utilized. I know I also like cardiology and urgent care....but I am stuck on internal medicine still, as my first choice. Do you know what are you'd like to work in once you graduate?

Internal Medicine seems like a terrific area to work in, but I would want to earn a few years of experience in order to build up my knowledge base and skills in IM before seeking out a Hospitalist position. Emory University's Hospital system hires NPs in that role, but I've also heard from the Hospitalists who did their residencies there that they were the dumping ground for the entire hospital. They all said it was miserable working there.

I'm kinda of leaning towards a large and very busy Pulmonary group in my area after graduation. Granted, I don't finish up until next December, but I'll be able to specialize in clinicals starting in the summer. Hopefully, I can get some hours in there and see if that's something I'd actually like to do. This group manages more than just pulmonary issues in the hospital, and after I earn my ACNP certificate, I may be able to intubate, start central lines, and chest tubes. We'll see. It's all just theory until the time actually comes.

Cardiology for you would certainly be an exciting role to step into. The cardiologist groups that round in my hospital hire NPs who manage a large loads of patients. Urgent care would give you lots of IM experience. Not a bad idea!

I'm jealous that you graduate soon. It feels like forever before I'm done!

christvs, DNP, RN, NP · Dec 19, 2007

Thank you pinoy and yellow finch for all your advice. I really appreciate it. :) I did one of my clinicals in a small ER (my preceptor let me handle some of the urgent care cases myself with help) so I know I would like urgent care. But I know I feel more strongly about internal medicine and cardiology and really think I would prefer to spend time with hospitalized patients....I would especially want to follow them from admission to discharge regardless of the setting I end up working in, because I think it's so difficult to manage patients who you really don't know! I've seen this happen time and time again as an RN on my med/surg/tele unit-the poor covering night float intern and/or hospitalist night intern have no idea a lot of the time what to tell us, and I don't blame them really, because a lot of the time they haven't even seen the patient when they have so many patients they are cross covering. A little scary. Anyhow, we'll see how my cardiology clinical goes this semester. I wish I could get some internal medicine NP experience too. I think I'm going to ask to follow around a hospitalist for a couple of days this semester just to see more.

Trauma Columnist · Dec 19, 2007

I live in central IL and in two of the hospitals where I work, hospitalists rule the roost - they admit easily 75% of the patients. In the ICUs, the intensivist calls the shots. The hospitalist practices all have APNs working with them and all seem very happy with the outcome and division of labor.