NPs working in hospitals??

rnsrgr8t · Apr 20, 2006

Hi Elfone,

I am a Pediatric Nurse Practitioner and I work at a Pediatric Hospital in DE. I am one of 2 APN's in Urology. I am payed by my division (comes out of the division budget) and the department of Nursing. There are more than 60 employed APN's in my hospital working in all kinds of settings. I split my role between the outpatient clinic and helping cover the inpatients we have. I have my own subset of patients that I manage clinically on my own. I think there is a tremendous role for APN's in the hospital setting. We have a fellow and resident program so the need for coverage on the inpatient side is not as great. However, some of the other specialties that do not have fellows/residents, have APN's that function in their place. I hope this information helps!

sailornurse · Apr 21, 2006

You did not indicate what specialty as a NP is, so it is hard to say. Here we use FNP's in the ER to do fast track. Acute care NP's, well that's a given. Another hospital I know of has Neonatal NP's in the NICU & they respond to precipitous deliveries in the ER. CNS & NP roles are different.

aviator411, RN · Apr 23, 2006

elfone,

Bear in mind that the ultimate source of authority and control in most hospitals is not the "administration", it is the "organized medical staff".

All of the hospital administrators in three piece suits in the history of the system have never admitted a single patient to a hospital. Only the medical staff bring patients to the hospital and the $$ that come with them.

NP's have jobs in a hospital ONLY when the medical staff says they do. The administration is nothing more than a puppet for which the medical staff pulls the strings.

Your hospital is obviously controlled by people who have no intention of allowing NP's to practice there. The administrator personally would probably like nothing better than to have NP's to perform many of the duties that the local MD's hate to do but it is not usually up to him or her to make such a decision. It is the MD's who hold all the cards and there are still significant numbers of them who aren't about to relenquish any of their turf or income to another group. To these folks all nursers are to be "Stepford Nurses" ie. seen and not heard.

I'm not trying to discourage you, only to make you aware that what you propose is probably a project of much greater scope than you suggest. If you are serious and wish to persist, one of the first things you need to do is learn the history at some institutions where NP's now play a significant role. You need to learn how they overcame the initial resistance of the medical staff, etc.. Obviously it has been done before so it can be done again but be prepared to take on a major "project".

Best of luck!

Papadoc · Apr 24, 2006

elfone,
Bear in mind that the ultimate source of authority and control in most hospitals is not the "administration", it is the "organized medical staff".
All of the hospital administrators in three piece suits in the history of the system have never admitted a single patient to a hospital. Only the medical staff bring patients to the hospital and the $$ that come with them.
NP's have jobs in a hospital ONLY when the medical staff says they do. The administration is nothing more than a puppet for which the medical staff pulls the strings.
Your hospital is obviously controlled by people who have no intention of allowing NP's to practice there. The administrator personally would probably like nothing better than to have NP's to perform many of the duties that the local MD's hate to do but it is not usually up to him or her to make such a decision. It is the MD's who hold all the cards and there are still significant numbers of them who aren't about to relenquish any of their turf or income to another group. To these folks all nursers are to be "Stepford Nurses" ie. seen and not heard.
I'm not trying to discourage you, only to make you aware that what you propose is probably a project of much greater scope than you suggest. If you are serious and wish to persist, one of the first things you need to do is learn the history at some institutions where NP's now play a significant role. You need to learn how they overcame the initial resistance of the medical staff, etc.. Obviously it has been done before so it can be done again but be prepared to take on a major "project".
Best of luck!

Wow! I was under the impression that things are wise versa. I don't know how things are done in Oklahoma, but in the greater NY/NJ MBAs in piece suits arte definitely running the show. Many docs are simply sallried employees, and have no say in anything, including certain Tx protocols, and medical decisions. And that's seems to be one of the major reasons for the dissatisfaction with the medical profession, esp for the newbies.There are very few truely community hospitals, where sensus is supported by docs alone. Most places here are merging, creating these monterous corporate conglamirates where the bottom line is the way to go. HMO contracts, milking State and federal grants etc.

In the OP situation, it could be some regional thing PA vs NP. Docs want to assert their control at least at midlelvel, so NPs who are governed by BON may not be welcome.

Anyway, just keep looking. If that place doesn't want your business, take it somewhere else, where they are more appreciative. Also, ask your medical staff, may be you could join some group medical practice, and be associated with ppl who you know, and probably like.

Good Luck

pchensal · Oct 6, 2006

I work at Parkland Health and Hospital System. Women's health care nurse practitioners are utilized throughout the Ob/Gyn areas in the hospital and in the outpatient clinics.

Don't give up...think outside the box!

pchensal

Trauma Columnist · Oct 6, 2006

I worked at a large teaching hospital for 10 years in the ER. Loved every minute of it! However, they did not use mid-levels in the ER because they had a large residency program.

However, they used NPs/CNS's (in IL the role is same), for Sleep Lab, interventional radiology (CRNA to monitor sedation), ICU - day to day handling of acute needs, trauma services (to coordinate the care of trauma pt from admission to discharge), NICU (again to manage the day to day care of th patient/family), Peds ICU (to manage the off-hours care of the pt).

Hopefully this helps. It is important to think outside the box. Although I wanted to stay at this institution, it was not in the cards at the time I graduated. I am very happy with what I'm doing for now.

aviator411, RN · Oct 6, 2006

the university of michigan health system employs 136 np's at the present time. a review of the university personnel-salary schedule, which lists everyone from the president of the university to the groundskeepers (not necessarily in order of importance) including name, salary, job title, etc., gives interesting insight into the diversity of roles performed by np's.

this schedule is available on line in excel spreadsheet form and can be sorted by job title, salary, name.... at: http://apps.michigandaily.com/salary/200506.xls

np salaries range from $57,000 to $91,000 with the vast majority earning $83,657.

DaisyRN, ACNP · Oct 9, 2006

HI there elfone,

I am in the same boat! Here is my situation:

- I am in school for my ACNP and will graduate next December.

- I want to work as a hospitalist.

- I currently work in an ER with a big ER MD group, and have a great rapport.

- One of the ER doctors is married to the director of a hospitalist group.

- This director was appointed by the ER group I have worked with for 5 yrs.

- The director is interested in using me as a hospitalist.

- The hospitalist is a new role at the hospital I want to work for.

- The hospital would govern a new position such as NP as hospitalist.

- The hospital has recently started using PAs in the ER.

- Some NPs can be found in association with the hospital.

- The director told me that it would be an uphill climb, but self-creating a position for me as a hospitalist could be done.

- He said I might could get a job with his group with limited capability at first, and then allow the hospital to expand my responsibilities after learning my skill level. (THIS SEEMS RISKY to me... they might... or might not... ?)

My plan:

- Talk to larger hospitals with good reputations and similar patient census regarding their use of NPs in the hospitalist role (job description, pay, etc.)

- Keep a detailed log of my clinical experiences (which I hope to spend time with a hospitalist group)

- Create a portfolio of the above information and also AMA statements regarding NPs as hospitalists, AHA's position, ANA's, etc.

My concerns:

- The length of time it would take for me to get where I want to be.

- Whether or not the hospital would even hear me out.

- When I should start presenting this information to the hospital (I want a job when I graduate... should I start talking to the hospital board now?)

My hopes:

- That they will be receptive to the idea.

- That I will be an active participant in defining this role, responsibilities, pay, benefit, etc.

- That they recognize my value to the hospital.

So, there ya have it... if you have any other ideas, I'd be glad to hear them.

gauge14iv, MSN, APRN, NP · Oct 9, 2006

You might also talk to large physician and practice management groups - Pediatrix is one group I can think of - they use NP's in the hospitalist role, but they are hired by the physician group, not by the hospital - that might be another avenue.

Trauma Columnist · Oct 9, 2006

At least in my area, being hired by the MD practice is the way to go...more money, more responsibility, a better defined role.

ERNP · Oct 11, 2006

I agree the hospital is not the employer of choice for many. Contracting with a private group or even a management service has a much better yield in terms of income and other things of professional importance.