Need Advice: Starting a CC NP job...

Advanced Practice Columnist / Guide · Nov 2, 2015

1) My employer doesn't feel it necessary for me to go back for a post-masters in AGACNP, but I have applied and am planning to do this in January. Most probably at Jacksonville University which isn't far from me. Would this benefit me or am I just in professional student mode.

Physicians don't really understand the peculiarities of NP training. For some, an NP is an NP and it doesn't matter what particular program the NP completed. While this may have worked in your advantage in terms of getting hired, you should proceed with caution. As its stands, there are specific differences in NP training from acute care to primary care and it is a fact we can not deny.

Many states have not caught up with regulating our practice based on our training and chances are your state does not have written regulations on Adult Primary Care NP's working in an ICU setting. However, you are responsible for your actions as an individual provider and should a problem arise in your day to day management of critically ill patients, your competency may be questioned. This may happen in a dire situation such as a litigation where you were not even at fault but your name is on the record as one of the providers.

Your RN experience will not protect you - you were not a provider in the ICU. The physicians won't be able to vouch for you - they did not know the difference between acute care and primary care tracks and NP's do not typically practice under physicians as stated in state practice acts. The absence of regulation in the state practice act may not protect you either as in such a situation, national standards may be applied. Nowadays, most ICU groups only hire ACNP's or AG-ACNP's. That is the standard and critical care literature refer to ACNP's in studies pertaining to NP's in the ICU.

That in mind, the choice to pursue additional acute care training is up to you. Your an adult and you should be able to weigh the pros and cons.

2) I'm beginning a new role in the same unit in-which I have worked as a floor nurse. I foresee some growing pains, but how would you guys best address this? I have many friends and good relationships with the nursing and medical staff, but this will be a new role. How did you guys make that transition?

I work with an ICU group composed of almost 20 ACNP's. Some of us worked as RN's in the same unit we now work in as NP's. The transition for those who worked as RN's in the unit has been smooth from what I've observed. I think part of that is the culture of our unit where the CCNP role is well accepted and valued by the nursing staff. I also feel that clinical competence and the ability to collaborate in a manner that shows mutual respect for each other's role make a big difference.

3) I'm looking for FCCS courses to take with the SCCM. Any other courses you guys would recommend?

FCCS would be a good course to attend but not necessary. I found it as a good review course. SCCM also offers other courses such as Bedside Ultrasound in Critical Care which is helpful. If you have a chance, attend the SCCM Annual Congress.

4) I live in South Florida. I have not talked salary yet, but the group is paying for malpractice insurance, my credentialing, etc. I've been an RN for five years with the last three in critical care. This is my first job as an NP. I am unsure how to broach the subject of salary as I really have never been aggressive about this at any level of nursing.

I am unfortunately unable to answer this as I live in a different part of the country. However, discuss billing especially in terms of procedures you will be allowed to perform and emphasize how this can contribute to revenue. That should be enough to convince the group of your value and that your pay should be commensurate.