Is the NP role in hospitals changing?

[Therese_RN]

I have been an RN for four years. I am beginning to seriously think about going to NP school. I have been looking into different FNP and PNP programs in my area. I met with a professor in an FNP program this week and she mentioned that hospitals are really moving away from hiring NPs without the label of "acute" in their title/degree program. I have seen on certification websites that there are now separate certifications for acute care and primary care PNPs and Adult/Gerontology NPs. I am trying to figure out which program is best for me and don't want to limit myself or make myself less marketable to an employer in the future by only studying acute or primary care. Has anyone in the field noticed a shift in hiring trends by hospitals that only want acute care NPs and not FNPs? As a PNP would I be more likely to get a hospital job than as an FNP (not necessarily concerning the population I would work with but just the title of FNP being more primary care focused)? Any information would be appreciated!

[Dodongo, APRN, NP]

This has been addressed in other threads. In a nutshell, yes, hospital systems are beginning to exhibit hiring preferences. The academic institutions in my area advertise specifically for ACNPs, however, many FNPs are working in the hospital setting because they've been there for many years. Within 10 years or so I imagine that BONs will limit FNP to outpatient and ACNP to inpatient (with some cross over) for a few reasons, the largest of them being: the push for (more) independent practice, the consensus model and the proliferation of ACNP programs.

[Corey Narry, MSN, RN, NP]

I think it's time to retire the thinking that one type of NP program is more marketable than the other and that one type of NP track trains you to do everything. The truth is, there is a specific purpose for each of the NP tracks we have and that is: primary care vs acute care with specific population foci in each of these tracks. There was a time when FNP's were prevalent in acute care practices the reason being acute care tracks were relatively new and less common in many areas of the country. We now have a fair amount of acute care programs with some even accessible via distance option.

At the end of the day, the question you ask yourself is "were you trained appropriately in your NP program for the type of practice you are embarking on?" If the answer is no, "would there have been a more appropriate NP track that could have prepared you for the role?". You can invoke the fact that your collaborating physician "trained you", "vouched for you", "collaborated with you" but at the end of the day, would this physician still "vouch for you" when things go wrong and a mistake is made and a finger is being pointed at you for that mistake. In a sense, it's good risk management practice to stick to what you are trained to perform in your role as an NP.

[Jules A, MSN]

You can invoke the fact that your collaborating physician "trained you", "vouched for you", "collaborated with you" but at the end of the day, would this physician still "vouch for you" when things go wrong and a mistake is made and a finger is being pointed at you for that mistake. In a sense, it's good risk management practice to stick to what you are trained to perform in your role as an NP.

To answer your question a resounding NO.

And in addition to good risk management practice I'd also add being formally trained and boarded in your specialty is just the sensible and ethical thing to do.

[Skippingtowork]

Do not limit yourself. There are programs that educate and train you for both family practice primary care and acute adult/gerontology care. I believe you have to be boarded in both if in a state which requires board certification. This way you can practice both in the hospital and the clinic. If you do just acute you are not trained for primary care. If you do primary care, you can follow your patients in the hospital under you physician superisor. Most NPs seeing patients in the hospital are not hospitalists. Patients can always be turned over to a hospitalist if needed, but if your supervising physician is following his own patients in the hospital, you can too because you are working under that MD. If you are in a specialist field, you definitely can go to the hospital, as a consultant. The hospitalist role, especially for more acute conditions is very different from managing someone with a stable condition. Get both and stay flexible. Also, even those who only plan to do primary care should be going to the hospital for training. It's quite an eye opener and makes you a better clinician.

[TicTok411]

If I were starting school today I would look for a dual ACNP/FNP track to cover all my bases. However, in some parts of the country the consensus model is where some states are heading. But it will take many years for it to reach all 50 states - look how different the states treat the NP practice, its all fragmented where we all have different levels of independence and heck we all have different titles.

I work in a rural area where over 95% of the hospital NPs are either family or adult. I have met less than a handful of ACNPs in the area. If ever the rules change here everyone will be grandfathered in.

I find it curious that I could move to Texas tomorrow and be told I cannot work in the acute care setting. Reason number 3897 to stay the heck of that state.

[babyNP., APRN]

It reminds me of family practice docs (in an urban setting- rural I can understand more) who do OB. If you want to do OB care and delivery babies, I really feel that you need to go be an obstetrician (or become a CNM).

OP, if you want to do both, you should get dual certified so that you are doing the best for your patients. To answer your question, yes with the consensus model coming along, you should be practicing within the area in which you are trained. And to be frank- doesn't it make sense? Why would a primary care doctor work in the ICU? It shouldn't be any different for NPs.

[Skippingtowork]

"Acute" only means hospital. It does not mean intensive care, although ICU falls under the umbrella. Most hospital patients are not in the intensive care and can be managed by someone without extensive formal training and who is working under an MD. In most states NPs are not admitting to the hospital so are not working independently. Dual role is the best path.