Private practice NP question

Goldenfox · Nov 24, 2015

Do you have dual US/Canadian citizenship or a US permanent resident card? I believe that that would be the first consideration for getting a license. Or you may be able to do it with some type of visa sponsorship...not sure about that part. As long as you have certification and the appropriate state license you can work in a private practice anywhere. If, however, by 'private practice' you actually mean independent practice then that varies from state to state. Depends of what type of NP enterprise you have in mind. Even though some states give full practice autonomy there are certain things that the board of nursing may not permit you to do.

cat101 · Nov 24, 2015

Thank you for your reply. I don't have a particular plan in mind, I have to research what the visa requirements are first. I am afraid, I will be told that I need an employer in order to work in the US. I am not a resident or citizen of the US.

P.S: Having a good employer might be good enough, but it is more risky and not what would make me go for NP.

sadiemae1123 · Nov 24, 2015

It might depend on how you structure the business when you set it up. It might work if you consider yourself the employee of the business that owns the practice.

cat101 · Nov 25, 2015

Thank you. One more question: What kind of skills would make me more marketable? Is it really saturated for FNP? I was attracted to psychiatry a lot, but turns out no equivalent to this degree in Canada,, so if I go this route and do not land a good visa, it will be a waste, as I would not be able to work as a Psych NP or any other NP here.

Can an FNP work mostly in psych? Like, providing therapy and titrating medications, or it is legally required to graduate from the Mental Health NP programs?

Goldenfox · Nov 25, 2015

Have you given any thought to attending a brick and mortar NP school in the USA? I think it would be easier for you to get a US employer to sponsor you that way after you graduate. You should look into that.

FNP may seem saturated in many coastal cities but there are jobs popping up all the time in the interior parts of the USA, and some of them pay better too. A lot of nurses are going to online NP schools now but what people don't pay attention to is the horrible attrition rates at many of these schools. Many of the students are looking for easy, and they fail and flunk out. Employers also look at where you get your education and I can imagine that they would sooner pick somebody who went to a reputable school as opposed to somebody who went to a fly by night school. The truth is that many of these schools are just pumping out grads but they don't present students with real challenges. I'm not knocking all online schools, but some of them are degree mills.

The result is that some NP graduates are poorly prepared for the job, and the physician who interviews them for their first job can easily tell. Most of them don't want to hire people who they have to teach everything that they should have learned in school; therefore, the biggest challenge that new grad NPs face is not so much the glut, but the lack of experience and good diagnostic skills.

Psych is not simply optional for an FNP. Psych is its own discipline. It is a very different program from the FNP program, and the board certification exam that you take at the end is also different. You need the psych np license to work with those types of patients. They get specialized training on how to manage those patients and the psych meds. The FNP programs only scratch the surface of that. My NP program had a psych component but it wasn't anything like what psych NPs get in their program. Psych patients can be very unstable. They need the specialized management. The FNP can manage their medical issues, but the psych stuff---no.

sadiemae1123 · Nov 25, 2015

Working with a primarily psychiatric patient population as an FNP will largely depend on the state practice act, in terms of legality.

You should also keep in mind that most FNP programs don't focus on psychiatric issues beyond easily treatable depression and anxiety cases that often present to the primary care provider for treatment.

Complex diagnosis and in depth study of psychiatric pharmacology aren't covered in depth in an FNP program.

Unless you have a strong background in psych or an employer willing to provide an extensive and thorough orientation, you would probably be ill prepared for dealing with the type of complicated issues most psych patients have.

cat101 · Nov 25, 2015

I do agree with everything that Goldenfox and the previous poster said.

I wanted to mention though, that the Canadian Universities are much better in terms of not giving away NP degrees to random people who never stepped a foot in a hospital or health care setting. Actually, the program is strictly regulated by the provinces and offered only in "brick and mortar" universities, with a few exceptions of some universities offering some theory courses online, but we are talking schools like University of Toronto, offering some of the mandatory theory courses online. Otherwise, admission requirements are 3 years full time RN practice for all schools, high GPA and references. As a matter of fact, I would trust a Canadian NP more for these reasons. I think in the US it has turned more into a business than education at most schools, some of which are not even legitimate.

Curriculum is also mandatory for all universities here and again regulated by the province I live in. So, basically everyone will take the same courses, as the program is centrally regulated. Clinical sites might slightly differ, but most are arranged by the schools as well and most are at big institutions.

I personally have 5 years RN experience, mostly surgical, general medicine and a bit of psychiatry. I understand better now that psych NPs are different than Family NP s in the US.

I have looked into US schools. What stopped me from applying to a reputable US university (my GPA is 3.9) was the uncertainty in clinical site arrangements.

And the high out of province cost for most of them. My tuition will be much lower at a reputable Canadian Uni and they are supposed to arrange clinicals as well. Might not be my first preference of site or specialty, in term of clinical placements, but I will never be in a position where my graduation would be delayed due to inability to find a preceptor and clinical site.

It will be a huge mess for a Canadian at US University to find out that they are not eligible for clinical placements in this state, or to be delayed due to inability to find them on their own.

Thank you for the replies though, they are really appreciated.

greygooseuria · Nov 25, 2015

You're better off going to school in Canada to become an NP and then working as an NP there, to be honest.

First, you'll have to have an employer sponsor you for a work visa here once you are an NP, and they have to prove that there isn't a qualified US grad to hire before they hire you. I have a friend that is Canadian and working as an NP here without visa sponsorship as she went to a US school, and she's having her own nightmares trying to remain in the states.

Second, IF you get the work visa, you'll have to work for a while before you can open your own practice. That will require capital and going somewhere where you can build a patient population.

Advanced Practice Columnist / Guide · Nov 25, 2015

Two issues if you go to a program in Canada:

1. Are you eligible for national certification in the US? Looks like AANP allows Canadian NP program grads to sit for their FNP and AGNP exams as long as the program has accreditation (by a national nursing organization). ANCC (for FNP, AGNP, and PMHNP ceritification) did not specify whether they allow Canadians to take their exams.

https://www.aanpcert.org/ptistore/resource/documents/2013%20CandidateRenewalHandbook%20-Rev%2011%2025%202013%20forNCCA(FINAL).pdf

Family Nurse Practitioner Certification Eligibility Criteria

2. Are you eligible to work in the US as a Canadian citizen? there are Canadian NP's and RN's in the US working under the NAFTA agreement. Canadians are not required to apply for a visa. In many cases, a letter from the employer detailing your job responsibilities is enough (and you are licensed and certified as an RN/NP in the US). You will have to find an employer or business partner (if working as an independent provider) to start the process. You may not be able to do this as a sole owner of a practice (as that meets criteria as self employed).

TN NAFTA Professionals | USCIS

Only the second issue applies if you go to a program in the US.

Do you have a US RN license? you will need that prior to starting clinicals in a US-based NP program.

In the US, the independent practice states (including DC) for NP's are:

Pacific Coast: HI, WA, OR

West: MT, ID, WY, CO, NM, NV, AZ

Middle: ND, NE, MN, IA

Northeast: ME, NH, VT, CT, RI, MD

The nation's capital (DC) is also an independent practice jurisdiction

Goldenfox · Nov 26, 2015

there are Canadian NP's and RN's in the US working under the NAFTA agreement. Canadians are not required to apply for a visa.

Thanks for clarifying that. The way someone had explained it to me in the past is that the NAFTA agreement applies to RNs of any specialty; but NPs and physicians who use it are limited to working in research or academia, not clinical patient care. The person who told me this is a Canadian NP who said she never used to have an issue with coming to the US to work as an RN but when she tried to come over as an NP the CBP turned her back and told her to get a H1-B visa. Perhaps there was some other detail specific to her situation.

Advanced Practice Columnist / Guide · Nov 26, 2015

Goldenfox,

Actually, only RN's are included in the NAFTA list. However, NP's are also RN's and this may have been one way Canadian NP's manage to work here. It depends on how the role is identified in the letter from the employer. I do know of a few Canadian NP's who've had issues. One I know must continue to work as an RN per diem because her NAFTA letter is from a facility that employs her as an RN. She went to NP school in the US.

Professions Covered by NAFTA | Ottawa, Canada - Embassy of the United States