Ok, so I'm soon an FNP... what about a DNP in acute care?

[yellow finch]

Now that I'm wrapping up my final semester as a FNP student, I'm realiy wanting to work in the ER/ICU.

What are my options?

I've looked into Acute Care DNP. Is that a good direction to go in a few years?

I just resigned from my ICU job this week. Will this affect my ability to enter any prorgrams?

[Hekate]

Now that I'm completing my program, there is little opportunity to round through the hospital as the FNP program I'm in forces me to complete hours primarily within a Family Practice/Internal Medicine office. I've also discovered that the office bores me to no end and I can't see myself working in one.

So far, I know of a couple of hospitals that hire mid-levels in the ER but they are mainly PAs. *sigh* Time to change that. :)

As for my FNP program, yes, I feel (on the whole) ready to practice. I've also put out the word to a specific group that I'm available to round, as a RN, with the MDs in order to learn the job better. It may not be my first choice for employment in the ned, but it will be excellent experience.

Any further questions? I'm happy to answer them!

Hello Yellow Finch,

One of my colleagues graduated from the FNP program (university of Michigan-flint) about 7 months ago and got hired by a group of Neuro surgeons. They are training her for first assist on all neuro procedures, trained her to read cat scans, insert ICP drains/monitor etc....

She works with her conterpart to cover the group needs-He is a PA and they do exactly the same job.

I think safe to say that she never considered a career in a PCP office even though she went for the FNP program. She seems thrilled with her role!

I suppose each hospital has their own guidelines about the role that a NP plays within the hospital, but my understanding is that the surgeons who hired her through the hospital in the first place (she is considered to be employed by the hospital,not by the surgeon's group, but for their needs) are the ones deciding of her responsabilities and training her accordingly. They obviously want someone who could be on call for them and cover all neuro traumas, able to read images and call them once she judges the surgeon's presence to be required. Until then, she still has a lot of autonomy in decision making as well as performing invasive procedures. If the surgeon needs to come in, she will assist him in the ER, OR or ICU. On a daily basis, she also rounds with them and scrubs in for elective and emergency procedures.

I just thought you might find her experience interesting and hope it will open new prospects to you.

Keep us posted on your progress

J-

[ANPFNPGNP]

Hello Yellow Finch,

One of my colleagues graduated from the FNP program (university of Michigan-flint) about 7 months ago and got hired by a group of Neuro surgeons. They are training her for first assist on all neuro procedures, trained her to read cat scans, insert ICP drains/monitor etc....

She works with her conterpart to cover the group needs-He is a PA and they do exactly the same job.

I think safe to say that she never considered a career in a PCP office even though she went for the FNP program. She seems thrilled with her role!

I suppose each hospital has their own guidelines about the role that a NP plays within the hospital, but my understanding is that the surgeons who hired her through the hospital in the first place (she is considered to be employed by the hospital,not by the surgeon's group, but for their needs) are the ones deciding of her responsabilities and training her accordingly. They obviously want someone who could be on call for them and cover all neuro traumas, able to read images and call them once she judges the surgeon's presence to be required. Until then, she still has a lot of autonomy in decision making as well as performing invasive procedures. If the surgeon needs to come in, she will assist him in the ER, OR or ICU. On a daily basis, she also rounds with them and scrubs in for elective and emergency procedures.

I just thought you might find her experience interesting and hope it will open new prospects to you.

Keep us posted on your progress

J-

I wanted to work as a first assist, but was very disappointed that TX won't allow me to do it unless I get certified as a first assist...no easy feat! I wonder if NP's can bill as a first assist, even though they aren't certified as one b/c PA's can.

Also, I've been offered a job in the ER fast track and I'm starting within the next month. The ER's where I live are packed with NP's and there are very few PA's, so things are better in other parts of the country. I had to have 2 years of urgent care experience in order to be considered for the job...ER RN experience is not considered, only midlevel experience.

[jeepgirl, LPN, NP]

Hello Yellow Finch,

One of my colleagues graduated from the FNP program (university of Michigan-flint) about 7 months ago and got hired by a group of Neuro surgeons. They are training her for first assist on all neuro procedures, trained her to read cat scans, insert ICP drains/monitor etc....

She works with her conterpart to cover the group needs-He is a PA and they do exactly the same job.

i feel like i know nothing about neuro - but, are NP's supposed to be doing invasive stuff like some of the things listed (i'm not really worried about first assist as much or reading CT scans, but I am a little about the inserting the ICP monitors, ect). thanks in advance for answering - it helps me learn.

i have been to a few workshops that discuss, for instance, that were pediatric np's - primary care certified who have worked in acute care. the issues was that some were hired into areas that classically used acute care pnp's, and they needed to essentially had to step back and stop the job they were doing because by the state they were in it was considered to be outside their area of practice - so it was either stop the job altogether or go back to school to get the acute care certification. which i can kind of understand in a way. we all have our scope of practice.

I think that as a new NP it is very hard for me to understand - I am a person who tends to stay very strictly within standards that have been set forth and what I know I have been formally trained on, but then again I see more and more NP's do more and more things that I would not have considered... so... where is the scope of practice?

It just seems like a very fine and sometimes wavy line and seems to be very hard to understand.

[ANPFNPGNP]

i feel like i know nothing about neuro - but, are NP's supposed to be doing invasive stuff like some of the things listed (i'm not really worried about first assist as much or reading CT scans, but I am a little about the inserting the ICP monitors, ect). thanks in advance for answering - it helps me learn.

i have been to a few workshops that discuss, for instance, that were pediatric np's - primary care certified who have worked in acute care. the issues was that some were hired into areas that classically used acute care pnp's, and they needed to essentially had to step back and stop the job they were doing because by the state they were in it was considered to be outside their area of practice - so it was either stop the job altogether or go back to school to get the acute care certification. which i can kind of understand in a way. we all have our scope of practice.

I think that as a new NP it is very hard for me to understand - I am a person who tends to stay very strictly within standards that have been set forth and what I know I have been formally trained on, but then again I see more and more NP's do more and more things that I would not have considered... so... where is the scope of practice?

It just seems like a very fine and sometimes wavy line and seems to be very hard to understand.

Only Acute Care NP's are supposed to be doing all those invasive procedures you're speaking of. Also, the certification boards clearly dictate what is within our scope of practice. For FNP's, it's clearly primary care practice. Anything else leaves the FNP open to huge liability issues.

[jeepgirl, LPN, NP]

what i have heard that people don't understand re: the scope of practice and doctors "teaching" them things is that we have to go by our scope of practice that is put forth by our certifying boards and our state. i think PA's can just do whatever the doc teaches them to do since they essentially work on their license, correct?

in my state, PA's are extremely limited (can only work and see patients when the DR is on site - NP's can be off site and still work) but i think it is way fishy that PA's can just flitter around and do whatever the doc "teaches" them to do. sorry, but i have seen some docs who are not the greatest teachers and who don't teach EBP or the rational behind the care they give. would not be a good situation in a number of cases.

does anyone know if the PA thing is completely true from what I have heard?

for instance, a NP may have a collaborative practice agreement with a doc, but if an NP screws up or goes outside the scope of practice, it still is on the NP - even if the doc trained her to do whatever it was outside the scope of practice, even if he asked her to. that is my understanding.

please, someone else chime in!

tia!

[core0]

what i have heard that people don't understand re: the scope of practice and doctors "teaching" them things is that we have to go by our scope of practice that is put forth by our certifying boards and our state. i think pa's can just do whatever the doc teaches them to do since they essentially work on their license, correct?

this is a lot more complex than you state. the scope of practice for a pa is defined by the physicians scope of practice (a pa can't do things the physician can't do) and what the physician permits them to do within that scope of practice. its icumbent on the physician-pa team to make sure that the pa is qualified to do a particular procedure. if there is a bad outcome it falls on both providers for liability (since they each have their own licenses).

in my state, pa's are extremely limited (can only work and see patients when the dr is on site - np's can be off site and still work) but i think it is way fishy that pa's can just flitter around and do whatever the doc "teaches" them to do. sorry, but i have seen some docs who are not the greatest teachers and who don't teach ebp or the rational behind the care they give. would not be a good situation in a number of cases.

unless you live in missouri this is simply not true (even in missouri the physician has to be on site 2/3 of the time and there are widely available exceptions). other states have requirements for physician oversight but there is no state that requires 100% on site supervision. as far as "flitter" around, pas undergo extensive training in surgery and medicine. this forms the basis for medical practice. these skills are further developed in the practice by the pa-physician team to address any knowledge deficitis (especially in specialty medicine). in other words the pa education forms the basis that is augmented by the practice. i am guessing like most pas we have all been exposed to good and bad teachers. you learn to take good aspects of practice and discard the bad ones. this is pretty common in medical education.

does anyone know if the pa thing is completely true from what i have heard?

for instance, a np may have a collaborative practice agreement with a doc, but if an np screws up or goes outside the scope of practice, it still is on the np - even if the doc trained her to do whatever it was outside the scope of practice, even if he asked her to. that is my understanding.

please, someone else chime in!

tia!

the np scope of practice is defined by the nursing board. the physician retains liability and may have action taken against there medical license if they direct an np outside their scope of practice. the np on the other hand can have action taken against their nursing license if they act outside their scope of practice regardless of whether the physician directs it or not. this is one of the principal differences between the np and pa professions. the scope of practice for a pa is dependent. the scope of practice for an np is independent (in most states). independent scope of practice can be an advantage but it also can be a disadvantage.

david carpenter, pa-c

[jeepgirl, LPN, NP]

The NP scope of practice is defined by the nursing board. The physician retains liability and may have action taken against there medical license if they direct an NP outside their scope of practice. The NP on the other hand can have action taken against their nursing license if they act outside their scope of practice regardless of whether the physician directs it or not. This is one of the principal differences between the NP and PA professions. The scope of practice for a PA is dependent. The scope of practice for an NP is independent (in most states). Independent scope of practice can be an advantage but it also can be a disadvantage.

David Carpenter, PA-C

So does a PA have to have additional training when switching from lets say, Cardiology to Peds? Or Surgery to OB/GYN?

Yes, I am in MO.

PA's all get the same basic training, right?

Thanks for your clarifications!!!! I really like to learn about this stuff because you know that it comes up!

[core0]

So does a PA have to have additional training when switching from lets say, Cardiology to Peds? Or Surgery to OB/GYN?

Yes, I am in MO.

PA's all get the same basic training, right?

Thanks for your clarifications!!!! I really like to learn about this stuff because you know that it comes up!

PAs get the same general training. There are some programs that emphasize one are or another such as peds or surgery or primary care. However, the minimum requirements are spelled out in fairly exquisite detail by ARC-PA.

As far as additional training when switching specialties no there is no additional training per se. What is expected is that the practice would spend more time in orientation and mentoring when switching from cardiology to peds. The other thing that helps us is that we have to recert every six years in general medicine. So that means going back and memorizing Salter-Harris Fractures and how to calculate a due date for example. I did my first recert a year ago and was suprised how much I retained.

If you are moving into a procedure rich environment there are usually courses to help. For example the medical device manufacturers put on endoscopic vein harvesting programs on a fairly regular basis for new PAs in the CVS arena. Most of the major physician specialty organizations have a course at the major conferences that covers the fundamentals of the specialty. The AAPA has been working with the major medical societies to facilitate this.

David Carpenter, PA-C