FNP in acute inpatient specialty role

  1. I am starting as a new NP in a specialized ICU role.

    I am concerned that many of the nursing staff, having been on this unit for 15-20 years, are more knowledgeable in this specialized area of practice than I will be, yet I know I will be responsible to provide leadership within the department. Said nurses on unit are reputed to be a 'tough bunch'.

    In addition, I look younger than my age.

    Has anyone else had a similar experience? Any insights to share?

    Wanting to start on this unit without inadvertantly communicating to potential bullies that I am the soup du jour... I have been told that at times I appear to lack confidence and am too soft-spoken. I do not want this set of nurses to have idea that I will assist them or do nursing tasks that they would do for other providers when asked. (I do want nurses to get off Facebook to page a specialist for me, for example, and not tell me where to find the phone number).

    Thanks,
    Julia
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    About Julia77

    Joined: Feb '14; Posts: 74; Likes: 37

    18 Comments

  3. by   Dodongo
    You should be concerned that you're practicing outside of your scope and training...
  4. by   KeepinitrealCCRN
    be opened minded and listen to what they have to say since they will know more than you.
  5. by   traumaRUs
    FNP in ICU is out of scope of your practice. Doesn't matter if the hospital will hire you, you are the one responsible for your own practice.

    As to be being soft-spoken and looking young, conduct yourself professionally and there will be no problems. Don't borrow trouble.
  6. by   djmatte
    Aside from the dead horse beating, my first question would be do you have any ICU experience as an RN? This to me can make or break the relationships you form with your new colleagues. Having an understanding and respect for their jobs, roles, and abilities is very important.

    Also have a very good idea going in of what your expectations/roles are. Make sure you are being utilized to be an APRN and not just there to fill in with patient care when their backs are against the wall. If you aren't being employed to be their line-supervisor (I'm presuming you aren't), keep that in mind through your practice when interacting with these colleagues.
  7. by   Julia77
    Thanks for sharing your thoughts. djmatte, I completely understand and respect the RN role, and yes, I have experience in ICU, although not in this specific type of unit.

    I have noticed that some RN's will willingly do certain tasks when asked by more senior NP colleagues and by attending physicians, and some of these same RNs will continue to Facebook on their phones and redirect me to do these identical tasks when I ask for assistance ('you can look up the number in that book over there" in response to a request to page a specialist for me) and ask me to solve problems that when I was in an ICU RN role, I would have solved myself.

    In past positions, I have assisted RN's with turning and positioning patients, so I could assess skin, and I know other providers did not do this, and then the expectation became that I would assist with full bed changes, even on days when short staffing was not an issue. I did address this by assisting until I was able to complete my assessment, and then excusing myself and telling the nurse I would get someone to come help them from the nurses' station, with the rest of the bed change.

    My perception is that I have previously been too friendly, too willing to help out, and this has somehow contributed to an expectation that I would help with nursing tasks, which ended up contributing to a time management issues for me. It is not the expectation of the employer that I assist with nursing tasks. I am not sure I have communicated the scenario and question here optimally, but if other NP's have had similar situations with insights about this type of scenario, I would appreciate hearing thoughts on successfully addressing this. Julia
  8. by   ACNP-Ray
    The hospital I was working at last year hired an FNP as my opposite on the night shift. I did 7 on and then she took the next 7 nights. I can tell you only what the ICU nurses said to me while I was there. She wasn't an ICU nurse before she started her FNP program and she was ill prepared to take care of the patients we admitted into the ICU. Codes with her tended to be disasters and the ER doc would usually have to take over in those situations because she didn't have the needed experience to deal with it even though it was a small country(out in the boonies) ICU. Now on the med/surg floor she did alright but she had no business being anywhere near that ICU....So find out who your charge nurses are and LISTEN to them. If they want levophed, don't second guess them and give them an order for dopamine. At the same time read all the material you can find on ICU patient management if you still decide to take this position.
  9. by   Wuzzie
    ICU experience doesn't matter if she's functioning outside of her scope of practice.
  10. by   djmatte
    Quote from Wuzzie
    ICU experience doesn't matter if she's functioning outside of her scope of practice.
    And beating a dead horse doesn't matter if the licensing state or the employer isn't willing to clearly define scope of practice. She has the job. She's going to work there. She's asking for advice...not your condescension.
  11. by   Dodongo
    Quote from ACNP-Ray
    The hospital I was working at last year hired an FNP as my opposite on the night shift. I did 7 on and then she took the next 7 nights. I can tell you only what the ICU nurses said to me while I was there. She wasn't an ICU nurse before she started her FNP program and she was ill prepared to take care of the patients we admitted into the ICU. Codes with her tended to be disasters and the ER doc would usually have to take over in those situations because she didn't have the needed experience to deal with it even though it was a small country(out in the boonies) ICU. Now on the med/surg floor she did alright but she had no business being anywhere near that ICU....So find out who your charge nurses are and LISTEN to them. If they want levophed, don't second guess them and give them an order for dopamine. At the same time read all the material you can find on ICU patient management if you still decide to take this position.
    This is why I so dislike NPs practicing in areas they weren't trained for in school. Prior RN experience shouldn't matter. It makes all NPs look incompetent. For some reason it's only FNPs that do this. Other specialty NPs stay in their own lanes.
  12. by   Wuzzie
    Quote from djmatte
    And beating a dead horse doesn't matter if the licensing state or the employer isn't willing to clearly define scope of practice. She has the job. She's going to work there. She's asking for advice...not your condescension.
    Who's being condescending? Certainly not me. She needs to protect her license.
  13. by   Dodongo
    Quote from djmatte
    And beating a dead horse doesn't matter if the licensing state or the employer isn't willing to clearly define scope of practice. She has the job. She's going to work there. She's asking for advice...not your condescension.
    My advice is to find a job she is educated and trained to do.
  14. by   djmatte
    Quote from Wuzzie
    Who's being condescending? Certainly not me. She needs to protect her license.
    Certainly you are. It's condescending telling her what she does or doesn't *need* to do. I can't speak for her state, but the Ohio Attorney General released an opinion last year on this topic that if the state BoN doesn't have an official and legislated opinion on scope of practice, then there is nothing preventing FNPs from filling that role. I imagine many states would have the same opinion. If her state has that view, then she really isn't risking her license in any way. She was asking very specific questions regarding the interaction with ICU level coworkers...not your opinion on what she chooses to do with her license.

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