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I am an FNP working for a surgical service. I do not have my RNFA so I do not assist in the OR. I love my job. I am currently in a post-graduate certificate program for FNPs who want to be AGACNPs. In 2012 the AACN put out a consensus statement regarding the scope of practice of APRNs. It's hard to argue with the main premise, that the population you practice with should match your certification and your certification should match your education.At this time, hospitals in my area are no longer hiring FNPs to work in acute care settings, and surgery is considered an acute care setting. However, they aren't firing the ones who are already here, like me. But when an FNP leaves they're replaced with an AGACNP or a PA.In my state, FNPs can no longer be supervised by a surgeon or physician working in acute care, so no new grad FNPs could be hired to a surgical service anyway.Check with your state's board of nursing-- but every year that passes more and more states start following the consensus statement guidelines. It may depend on where you live, but you'd likely find it difficult to work with a surgical service as an FNP. I do know some FNPs who work for outpatient offices for urology or hematology, with the idea being that patients seen in the office are stable patients being seen for a chronic condition. Could an FNP with an RNFA then go to the hospital with a surgeon and assist? Based on the reply above it certainly looks like that is the case in some places, but you would need to be prepared for the landscape to change even while you're in school. When I was hired 6 years ago for a surgical service, most of the NPs on that service were FNPs. Some have moved to other jobs, some have gone to get their AGACNP certification. I'm one of the few left, and as I said, no more will be hired for surgical services from here on out.

Hello, I am seeking some help regarding finding criteria for discharge or step-down from ICU to a non-critical care unit. I have hit up the usual suspects for nursing research, but I haven't found what I'm looking for yet. In brief, a family friend is hospitalized in an ICU and was recently transferred from a large hospital to a smaller one. The staff at the smaller hospital is telling his family that he'll probably be moved to a regular semi-private room on a non-critical care unit within a few days. He does have a trach, no speaking valve, and while he is conscious at times he is not able to perform intentional movements as would be needed to operate a call bell. He has been off a vent for 1 week, and needs suction several times per day. (Also has vac dressing, PICC, and a PEG). While I've never worked in an ICU I have worked in a step-down unit with constant visual contact with up to 8 patients, and a med-surg floor focused on trauma and neuro. I would never have imagined taking a patient who could not speak or signal for help and putting them into a normal closed room, but that seems to be what his family is being told. I know hospitals and ICUs differ, but there must be a set of guidelines or criteria for moving a patient from ICU to step-down, or from ICU straight to a med-surg floor. I no longer work in a hospital so I don't have access to the in-house guidelines that I used to. Any help in terms of finding articles or even a sample set of guidelines would be most helpful. He was all ready to be moved earlier today when his wife told the charge nurse that she was not happy with the prospect of her husband being on a med-surg floor, so he's in place for another day. Thanks very much.