Questions for APRNs

Trauma Columnist · Feb 5, 2019

I'll take a stab at a few of these before I head out the door.

What was the educational preparation for your APRN role?

MSN in management and leadership, plus an adult CNS post-MSN cert and a pediatric CNS as a post-MSN cert

Some studies indicate APRNs do not feel fully prepared to practice upon completion of their APRN education, did you feel fully prepared for your role as an APRN after graduation? If not, about how long did it take before you felt prepared to perform at the top of your licensure?

I was an experienced RN with 10 years in a level 1 ED, 1 year adult ICU and 1 year peds ICU experience. I went into a specialty, nephrology where I had no experience. Because credentialing takes awhile, I was extremely fortunate to have approx 4-5 months of orientation. This was split between didactic lectures from the MDs to hands-on experience with seasoned MDs and NPs.

Do you have a sub-specialty (acute care NP, pediatric NP, etc)? If so, what training did you receive for your sub-specialty?

Hmmm...not sure what you mean by this? Acute care NP, Peds NP are all certifications - there is no generalist NP that I know of unless you mean FNP?

Did you take the certifying exam in your role? What was that process?

In almost all states (I believe the exceptions are IN and CA) you MUST take a certification exam in order to be licensed. I practice in IL and yes, I took two certification exams in order to be licensed as an APN. The process is individual to each state but usually involves your school sending transcripts to the certification board, you making an appt to take the test,, take the test and then forward the results to your BON.

What did it take to be credentialed for your role?

Well, credentialing can take a LONG time - I was credentialed at three hospital systems, two dialysis companies and multiple insurance companies. It took approximately 5 months to be fully credentialed

How long have you been in advanced practice?

12.5 years

Provide a brief history of the roles you’ve held as an APRN including your current role.

12 years in nephrology and 6 months in heart failure

How can an administrator or educator assist you to perform your role?

An administrator needs to be on their toes with regards to billing, what to document, etc. Health care is a business and in my opinion the administrator should be an MSN/MBA prepared person.

In your opinion, what is the biggest mistake leaders make when supporting other professionals such as APRNs?

Hmmm....your leader should be a nurse as to your clinical practice. However, you should have a business leader too who looks at your bottom line.

What challenges have you encountered in your APRN role?

Lots of challenges:

noncompliant pts

MDs that don't wish to work with APRNs (fortunately, this was over 10 years ago and I've noticed a huge change re: MD attitudes - much improved)

sometimes pt load/numbers/acuity is very high

many times you are the endpoint to care - it carries a huge responsibility and liability

Best wishes - hope this helped

Advanced Practice Columnist / Guide · Feb 5, 2019

I always feel reluctant to engage in these types of threads as someone who went through grad school myself and had to also write papers as an assignment. I was old school I guess, as I actually set an appointment to meet with practicing nurse practitioners in the area, mini tape recorder in my hand, while I interviewed them for a paper.

However, I know not everyone is in a similar circumstance and sometimes it's easier seek help online. I do feel that some perspectives are lost in the translation when one doesn't have that face to face interaction. Having said that, I want to answer some of the questions as they are relevant especially since the OP is coming from an administration background.

Some of the questions have standard answers. Yes, NP's have graduate education (MS/MSN or DNP) and yes, NP's are required to be nationally certified (ANCC, AANP, PNCB, NCC, AACN) in majority of states expect for a couple with some stipulations. All NP's are not the same, we have specialty educations (FNP, AGPCNP, AGACNP, PNPAC, PNPPC, WHNP, NNP, and FPMHNP). That kind of info, you can find easily.

From an administration standpoint, we NP's (and CNS's in some states) should be viewed not only in terms of our revenue contribution but also in ways we can improve overall patient care quality. NP's should be represented with a seat on the table in terms of how system-wide decisions are made with on-boarding, credentialing, training, and enhancing our practice in the organization. There has been a trend to have a leader or manager who is also an APN advocating for all the APN's in the organization separate from the physicians' group.

There's been a lot of talk about new NP's being unprepared to practice. This is a discussion that needs its own thread as we have seen on allnurses in the past. Poor educational standards aside, bottomline is we all need to be nurtured, mentored, trained in specific specialty related skills just like a junior attending physicians fresh out of training. I welcome on-boarding with a period of probation not to shed light on the shortcoming of our training but for the benefit of patient safety.

I'm an advocate of team-oriented approach to care with both physician and NP working alongside each other but that's only because of the practice I've been in which does warrant that high level of medical care and oversight given the patient population. On the other hand, I've seen NP's be successful in primary care and other specialties as independent providers.

BTW, I'm an Adult ACNP (ANCC cert since 2004) with 14 years of experience 90% of which is in Adult Critical Care.

Trauma Columnist · Feb 5, 2019

Moved to student NP forum

JBMmom, MSN, NP · Feb 8, 2019

On 2/5/2019 at 10:57 AM, juan de la cruz said:
I always feel reluctant to engage in these types of threads as someone who went through grad school myself and had to also write papers as an assignment. I was old school I guess, as I actually set an appointment to meet with practicing nurse practitioners in the area, mini tape recorder in my hand, while I interviewed them for a paper.
However, I know not everyone is in a similar circumstance and sometimes it's easier seek help online. I do feel that some perspectives are lost in the translation when one doesn't have that face to face interaction. Having said that, I want to answer some of the questions as they are relevant especially since the OP is coming from an administration background.
Some of the questions have standard answers. Yes, NP's have graduate education (MS/MSN or DNP) and yes, NP's are required to be nationally certified (ANCC, AANP, PNCB, NCC, AACN) in majority of states expect for a couple with some stipulations. All NP's are not the same, we have specialty educations (FNP, AGPCNP, AGACNP, PNPAC, PNPPC, WHNP, NNP, and FPMHNP). That kind of info, you can find easily.
From an administration standpoint, we NP's (and CNS's in some states) should be viewed not only in terms of our revenue contribution but also in ways we can improve overall patient care quality. NP's should be represented with a seat on the table in terms of how system-wide decisions are made with on-boarding, credentialing, training, and enhancing our practice in the organization. There has been a trend to have a leader or manager who is also an APN advocating for all the APN's in the organization separate from the physicians' group.
There's been a lot of talk about new NP's being unprepared to practice. This is a discussion that needs its own thread as we have seen on allnurses in the past. Poor educational standards aside, bottomline is we all need to be nurtured, mentored, trained in specific specialty related skills just like a junior attending physicians fresh out of training. I welcome on-boarding with a period of probation not to shed light on the shortcoming of our training but for the benefit of patient safety.
I'm an advocate of team-oriented approach to care with both physician and NP working alongside each other but that's only because of the practice I've been in which does warrant that high level of medical care and oversight given the patient population. On the other hand, I've seen NP's be successful in primary care and other specialties as independent providers.
BTW, I'm an Adult ACNP (ANCC cert since 2004) with 14 years of experience 90% of which is in Adult Critical Care.

Not my original question, but I appreciate reading your response, very well put. I know that as a current student, I have some concerns and reservations about my own preparation when I'm done with school. Your point about an on-board period to support training rather than focus on deficiencies is an excellent one. I hope to find a supportive environment when I'm done with my own training so I can practice safely and competently. I don't think anyone's goal is to be a poor provider, they're just working with the opportunities they have available. Thank you for your feedback.