Nurse Practitioner Autonomy

LetsChill · Jun 13, 2012

I too am looking at the ACNP programs. Its too bad there is a lot of "stuff" outside of the RNs scope of practice, for which we have to rely on those with more training. That is one very good reason to pursue an advanced degree, especially in the hospital setting.

When I worked in a CVICU, there was a group of midlevel practitioners, including 3 PAs and 1 NP, who managed the everyday operations of diagnoses, treatments, minor procedures, prescriptions, and anything else we could throw at them. They were fairly independent in their decision making. Mostly, the 4 of them would consult with eachother regarding any issues encountered. The surgeons were in the OR most of the time and were only accessed in extreme circumstances or at the beginning of the day before the surgeries when they met with the PAs and NP to discuss the cases and any specific problems.

I'd say the NP has a very high level of autonomy, something I'd be very interested in. I now work with several Hospitalist NPs, who manage admissions and discharges for their group on a cardiology stepdown unit. They also take turns being on call. They meet with others in their group to discuss cases (not sure on how often this occurs). I have not heard of an instance where they have asked the MD what they should do, indicating to me that they make their own decisions nearly all the time.

That being said, NPs also must stay within their scope of practice as well, but the scope of practice is much greater than that of an RN. Do you realize that after we get our NP, we won't have to call the doctor to get a perscription for regular strength tylenol, or even to report a low urine output or a high blood pressure?! We can just fix it ourselves! :w00t: Autonomy at work.

Now, I need to go...got to work on the application essays...

sailornurse · Jun 15, 2012

There are states where NP's have completely independent practice. I think there are about 18, give or take a few. New Mexico is one of them. No physician collaboration is required. You can open your own practice.

mrmedical, ASN, BSN · Jun 15, 2012

It varies state to state, but from what I gathered midlevels in general function as a kind of "permanent resident" as far as those not in independent practice are concerned.

Advanced Practice Columnist / Guide · Jun 18, 2012

Just wanted to address the OP's question as it seemed specific to ACNP and ICU role.

I have worked in 2 states as an ICU Nurse Practitioner, one of which was Michigan, and now California. Both are not independent practice states. However, I don't think that matters as much as far as the ICU NP role. I know other ICU-based NP practices across the US and the role is very similar across the board. There are published literature on the role if you research it (PubMed is a great search site).

To explain further, I do know that all of the ICU NP's I'm familiar with across the US work in collaboration with an intensivist, officially. There may be times when the NP is alone in the ICU (night shift coverage for instance) and is the only provider in the unit. NP's do get to make many decisions at the bedside on their own. They are typically first call for patient issues (i.e., hemodynamic instabilities, abnormal labs, changes in status, cardiac rhythm changes, etc). NP's typically will act on these issues on their own and will only consult with the collaborating intensivist if the situation is too complex.

In the roles I've had, NP's also perform procedures such as central line placements, arterial line placement, intubations, and conscious sedation. I used to be a nurse practitioner in a CVICU in Detroit and we also placed chest tubes and performed bronchoscopies.