New NP regulations for MD, PA, NJ

[abass211]

I heard today that MD/PA/NJ have passed a new law that states that a NP must practice in the field they are certified in. Meaning that if you obtain an FNP you must work in family medicine, i.e. not in the hospital/ER, etc. Has anyone else heard this or knows if other states are changing the NP laws. Or where I can go to find out more information on this - what each states regulations are??

Was thinking about going back for FNP, however if I would not be able to work in an ER and limited to a a doctors office, this could be a big hiccup.

Thanks :)

[meandragonbrett]

Maybe you should start by checking the websites of the BON or BOM? That would be a good start.

[HeatherFNP]

I live in the NJ/NYC area & have not heard of this. Where did you hear of this information?

[Annaiya, NP]

There have been other discussion about this topic on these forums. There are several other states that have already gone in this direction, but the exact details are not worked out yet. If you are considering NP school, you might to make sure you get the specialty that fits where you want to work.

[mbuchanan2107]

I've heard rumors that they want to make this a federal thing and some states are doing this. BUT, they are having a hard time coming up with how to regulate or enforce it. Some hospitals/doctors offices will state they want....Ex. ER wants an ACNP, but offices are ok with FNPs. I did hear that specialty offices "should" be manned by ACNPs and not FNPs since FNPs don't have the "advanced" knowledge. I think it depends on your background and your willingness to learn personally..... so I have not heard anything formal on any of this, just rumors.

[abass211]

Heather - I heard this from a friend who just graduated from ACNP @ jefferson in philly. From what he said it has always been the practice for maryland. But is now going to start being implemented for PA and NJ.

[t2krookie]

One wonders if the same specialty expectations are being placed on other practitioners? Generalist beginings or no.

[CCRNDiva, BSN, RN]

One wonders if the same specialty expectations are being placed on other practitioners? Generalist beginings or no.

At my facility, all practitioners must be credentialed for the specific services they are allowed to provide. They are required to submit documentation to prove their training received to perform said services. Also, all pts admitted to our ICU must have a physician that is credentialed as a level I (admit to the unit as a sole provider) consulted. All of our gen/vas. and cardiothoracic surgeons, cardiologists, nephrologists and most of our IM and hospitalists are level I's. The other docs can still round on their pts and write orders in the ICU as long as they are credentialed at the hospital. Most of our hospitalists can manage the vent for 48 hrs before consulting our intesivists/pulmonologists. Ususally if the patient is tubed longer than overnight, our intensivists are consulted (our cardiothoracic surgeons manage their own vents unless they are having trouble weaning off the vent).

I think this is a good thing. I've loved the FP docs I've had but if I were in renal failure, I want a nephrologist; in resp. failure, I want an intensivist and if I have an MI I definitely want a cardiologist. Why? Because they have received specific training to manage those conditions. It doesn't mean that I didn't trust my FP; it just means that I would need someone to care for me that is trained to care for those critical illnesses.

[Lovanurse]

Yup, this is true for PA. Google Consenses Model of Advanced Practice Nursing. The law is changing in 2012 however, you can still see your own patients in the hospital. Just no critical care. That will reserved for the ACNP.

[nomadcrna, DNP, CRNA, NP]

It is hospital credentialing that decides who they let in the ICU. Remember credentialing and law are different beasts. The hospital can always make things more strict then the state law.

Can you provide a link for the law change in PA? That is usually a good thing to reference the "proof" so to speak. :)

[Lovanurse]

A hard copy of the Consenses Model was provided for me. If interested, google it...or dont...wait and see. They are really tryin to prevent say...a WHNP from practicing primary care when they have a hard time finding a job. The state borad of nursing will propose the question " At what point in your educational training did you learn -------".

[nomadcrna, DNP, CRNA, NP]

I have a copy, thanks. We were discussing working in the ICU as a NP. I could be wrong but it seems to me that the consensus model is moving away from being stuck in a narrowly defined practice. In fact, I don't even see the ACNP mentioned. If I were "king" I would have ALL NPs do a broad based generalist education as the PA model has. Then avenues to "specialize". The consensus model is close though and I"m totally in favor of it.

I wanted evidence of the law change in PA. I'm not trying to be offensive but I don't simply believe what I see on the internet without some evidence. Do you have any that shows PA is changing the law to delineate who can see patients in the ICU? Simply quoting the coming consensus model is not evidence.

From the consensus model.....

The types are listed below. As you can see, there are no specialties, just population foci. The specialties are another tier.

In this APRN model of regulation there are four roles: certified registered nurse anesthetist

(CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse

practitioner (CNP). These four roles are given the title of advanced practice registered nurse

(APRN). APRNs are educated in one of the four roles and in at least one of six population

foci: family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women's

health/gender-related or psych/mental health.

The consensus model was not developed to prevent a practitioner from practicing outside their training. The states already do a good job of that. They want to standardized across the many states, see below.

I'm all for the consensus model. As you can see by my cut and paste. There is a difference between Licensure and Specialty. For example, it gives the Adult NP who wants to specialize in palliative care. Or for instance, a FNP who wants to specialize in neuro, ER or the hospitalist role.

* Certification for specialty may include exam, portfolio, peer review, etc.

** Certification for licensure will be psychometrically sound and legally defensible examination

be an accredited certifying program,

Currently, there is no uniform model of

regulation of APRNs across the states. Each state independently determines the APRN legal

scope of practice, the roles that are recognized, the criteria for entry-into advanced practice

and the certification examinations accepted for entry-level competence assessment. This has

created a significant barrier for APRNs to easily move from state to state and has decreased

access to care for patients.

Diagram 1: APRN Regulatory Model

Under this APRN Regulatory Model, there are four roles: certified registered nurse anesthetist (CRNA),

certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). These

four roles are given the title of advanced practice registered nurse (APRN). APRNs are educated in one of the

four roles and in at least one of six population foci: family/individual across the lifespan, adult-gerontology,

neonatal, pediatrics, women's health/gender-related or psych/mental health. Individuals will be licensed as

independent practitioners for practice at the level of one of the four APRN roles within at least one of the six

identified population foci. Education, certification, and licensure of an individual must be congruent in terms of

role and population foci. APRNs may specialize but they can not be licensed solely within a specialty area.

Specialties can provide depth in one's practice within the established population foci.