Nurse Practitioner roles in California and Florida

Gator FNP · Jun 30, 2009

I live/work in Florida. FNPs can work in hospitals, some are part of hospitalist groups, trauma group, nephrology. Many options exist. The only problem with working in Florida is no controlled substance prescribing. We are only one of two states w/o.

JMM21 · Jun 30, 2009

Thanks for the info!!

pacooper · Jul 1, 2009

Gator FNP, that's great, I live in Georgia about to go into an Adult NP school...what is the other state that does not allow NPs to prescribe controlled substances?

morganvibes · Jul 1, 2009

The other state that doesn't allow NP's to prescribe controlled substances is Georgia, sorry!

I am still thinking about moving to FL, but the NP situation is unfortunate.

We need to pressure these states to get into the new century.

Dr. Tammy, FNP/GNP-C · Jul 1, 2009

We need to pressure these states to get into the new century.

There first needs to be a consensus among nurse practitioners. Many practicing NP's, including my preceptor subscribe to the notion that NP's practice medicine and not advance nursing. Until this thought process changes and we take ownership over the process by which we provide care, we as a profession will be relegated to a technician status which the corresponding practice will be designated by an outside profession--that is--dictated exclusively by medicine.

psychonaut · Jul 1, 2009

Many practicing NP's, including my preceptor subscribe to the notion that NP's practice medicine and not advance nursing.

What does this tell you?

It tells me that those who are actual practitioners in the profession have a clear idea of what it is they do.

Also, if this perspective has won prescribing rights in 48/50 states, why a change just to win over the last two?

To my view, APN-related lobbying for expanded practice rights has been very successful over the last 45-ish years. The trend appears to be a continuing expansion of practice. The only thing I see as a potential threat to this expansion is the entire DNP issue; seems APN practice expansion could have stayed "under the radar" for a time longer. However, probably won't make a huge difference in the long run, the APN lobby has proven itself quite effective in securing expanded scopes for its constituents.

Sorry for going OT here, I won't belabor the point further. This topic is one I enjoy discussing, especially with Tammy, as she represents a firmly held view that is both in opposition to many APNs (by her own admission above), and very much in accordance with what is offered by what may be called the "Ivory Tower" of nursing (from my own readings of academic nursing leaders).

Gator FNP · Jul 1, 2009

Just a quick FYI, FL has been fighting for full prescriptive rights x 15 years. I thought we might be close this year, but no success again.

morganvibes · Jul 1, 2009

I really like Florida and don't mind joining the battle, I'm very much into politics.

As a new grad I'm not sure I want to begin my career by biting the hands that feed me (i.e. Physicians in FL).

Are you involved?

SandBetweenMyToes, BSN, RN · Jul 3, 2009

I too, have dreams of practicing in Florida simply because I love it there, regardless of their status with NP's. I can see myself being involved in the education/lobbying process as well. My question is to those who practice there now: Is there a certain region or cities that are more progressive overall (notwithstanding the prescribing issues common to the state as a whole)? I really love the Space Coast but wonder if it is more progressive in college towns, military areas, or perhaps on the southern gulf side? Any insight form those in the know is appreciated!

Dr. Tammy, FNP/GNP-C · Jul 4, 2009

What does this tell you?
It tells me that those who are actual practitioners in the profession have a clear idea of what it is they do.
Also, if this perspective has won prescribing rights in 48/50 states, why a change just to win over the last two?
To my view, APN-related lobbying for expanded practice rights has been very successful over the last 45-ish years. The trend appears to be a continuing expansion of practice. The only thing I see as a potential threat to this expansion is the entire DNP issue; seems APN practice expansion could have stayed "under the radar" for a time longer. However, probably won't make a huge difference in the long run, the APN lobby has proven itself quite effective in securing expanded scopes for its constituents.
Sorry for going OT here, I won't belabor the point further. This topic is one I enjoy discussing, especially with Tammy, as she represents a firmly held view that is both in opposition to many APNs (by her own admission above), and very much in accordance with what is offered by what may be called the "Ivory Tower" of nursing (from my own readings of academic nursing leaders).

What does this tell me? It tells me that there is a disassociation between advanced nursing practice and the models and processes by which graduate level advanced practice nurses are trained, prepared and licensed. As a consequence, advanced practice nurses who subscribe to the notion they are truly practicing medicine in their practice and not advanced practice nursing must, and can only function, as technicians of the medicine-based model--similar to how paramedics operate. Therefore, advanced practice nurses, under this system of beliefs will never have complete discretion over advancement, professional growth--similar to how paramedics function--total discretion related to scope of practice is dictated by physicians.

Fortunately, however, the failed medical-model based health care system (as evidenced by the health care crisis) which currently directs, guides and informs virtually every component of the health care industry is dwindling fast in favor with individuals, families and communities. I see this every day in my practice. As an example, when my patients tell me "you're the best doctor I have ever had" I take an extra five minutes at the end and explain the fundamental differences between nursing and medicine and the process of nursing that I use to direct assessment and care.

As far as representing the "Ivory Tower", I appreciate that you consider my thoughts inline with major nursing leadership, but I don't subscribe to your mischaracterization. Loretta Ford, a good friend of mine, never imagined that medicine would attempt to hijack advanced nursing practice when she invented the nurse practitioner role some 35 years ago. Although I do not believe in the Mundinger's contention that NP's need to be brought into the fold of medicine by passing a physician-based exam prepared by a physician-based organization, I do believe that Physician representation from AMA is clearly rooted in ego and greed. This is evidenced by their previous resolutions that do nothing more than harm the profession of advanced nursing.

Fortunately, the powers of the AMA have done little to quash advancement of the advanced practice role as evidenced by the growing number of states where NP's operate independently in the sense of practice. You correctly correlate this to our powerful lobby, but the lobby is only as powerful as its membership. This is why it is critically important for all NP's to actively participate in their state and local NP associations. If it wasn't for these organizations, I suppose nurses would still be standing up when a physician entered the room.

NurseKitten, MSN, RN · Jul 4, 2009

Most physicians around here (North Florida) have either an ARNP or PA. They practice in the office and in the hospital - it's just as common to see the trauma orthopedic surgeon's ARNP rounding on the post op patients as it is to see him...and the orders are equally as effective. :)

Northeastern Florida has 4 schools churning out ARNP's, so the market's pretty saturated - one of the reasons I changed from FNP to CRNA - so look either in the southern part of the state or panhandle, e.g. west of Marianna.

Good luck. :)