States restricting FNPs rounding on inpatients

[Adenium]

Hi all,

I've been following this forum for a couple years now, since I started contemplating a career change into nursing. Recently, making my decision on a Master's program, I've even been reading back through all the old threads to help solidify my decision. Many hours of NP land!!

Some things are still clear as mud, mainly how much choosing FNP/ANP will restrict someone hoping to mainly work in an outpatient specialty office but who MAY be asked to round on inpatients. In my area I'll be OK, but I'm not sure where I'll end up living later in life. Not too excited about going back for a post-master's while working a full-time NP job, unless I really have to. I'm hoping to do outpt cardiology, but have applied for the FNP so I can have other options when looking for jobs.

I know from the zillion posts that Texas is really cracking down on FNPs for this. I'm in CT, and most of the cardiology office NPs I've seen are FNP/ANP. Many are hospitalists. Some perform the ACNP function in the ICU. Some are ACNPs and we do have local programs producing them so it's not a shortage issue for the hospitals. What's more, in asking these ANP/FNPs they'd never heard of all these restrictions going on in other areas.

My question is, since many people just write in "well, in my area they're starting to come down on this...or I've heard of this being an issue in some places....."

WHERE are these geographical areas other than Texas? Where is the FNP/ANP being restricted and to what extent?

1) Sees outpatient and inpatient

2) Sees outpatients ONLY

3) Not only restricted to outpatients, but only general PRIMARY care outpatients, no outpatient specialty offices

A lot of NPs have written that they have training to specialize, whereas FNP/ANP don't. But if you do clinical rotations and take a job doing similar, aren't you covered? Are people talking about specializing inside the hospital, or outside?

Sorry it's long-winded. It kills me that nursing is so all over the place and we have to guess on the best path, but given where I am I'm not switching to PA instead. Onward and upward! Thanks for all your help in the many threads already touching on this as well as what anyone adds in here!

[NPinWCH]

I'm in Ohio. So far there is no hard and fast rule, just a reccomendation from the BON and it only pertains to non ACNPs working in INPATIENT settings.

FNPs call round on their own patients who are admitted, but they are discouraged from working in specialty inpatient units such as ICUs. FNPs do work in ERs here though. There are some FNPs in hospitalist specialty working mostly on general med-surg units, usually in a hospitalist group.

There is also some discussion about ACNPs not working in primary care areas, but again no rule, just suggestions that it probably isn't appropriate based on school/training.

As far as specialty outpt areas go, I have not seen anything limiting either ACNP or FNP practice in those areas and I still see plenty of both in cardiology, pulmonology, urology/nephrology and derm offices. Both often doing rounds on inpatients as well.

So basically, it looks like they want FNPs in primary care and ACNP in specialty and inpatient areas, but outpatient specialty seems open to both. Rounding on your own patients seems to be okay for both.

[Adenium]

Oh how I hope this is how it plays out. Thanks for your input.

[Annaiya, NP]

The lines aren't clear and I don't know that they ever will be, or at least not for a long time yet, because all of this stuff is in flux. TX (from what I have been able to gather from the BoN website) does not say that FNP cannot work inpatient. Instead it says that an NP must have formal education and appropriate experience in something in order for it to be within their scope of practice. As far as I know, FNP programs do not offer classroom education on invasive procedures like CVLs, chest tubes, etc. This is why an FNP working in an ICU would be working outside their scope of practice. Just learning the procedure on the job is not enough. However, they might be alright in an ED if their job description doesn't include any invasive procedures. But these rules are specifically not specific, so if an issues comes up on whether you are within your scope of practice, you will have to argue each specific case. IMO, it comes down to really knowing the BoN laws and regulations for your state and keeping up to date on any changes. Go with the specialty you want to do now, and don't worry about what might change. There is no way to predict how things will be in 10 years, so just cross that bridge when you get to it.

[sailornurse]

i'm in ohio. so far there is no hard and fast rule, just a reccomendation from the bon and it only pertains to non acnps working in inpatient settings.

fnps call round on their own patients who are admitted, but they are discouraged from working in specialty inpatient units such as icus. fnps do work in ers here though. there are some fnps in hospitalist specialty working mostly on general med-surg units, usually in a hospitalist group.

there is also some discussion about acnps not working in primary care areas, but again no rule, just suggestions that it probably isn't appropriate based on school/training.

as far as specialty outpt areas go, i have not seen anything limiting either acnp or fnp practice in those areas and i still see plenty of both in cardiology, pulmonology, urology/nephrology and derm offices. both often doing rounds on inpatients as well.

so basically, it looks like they want fnps in primary care and acnp in specialty and inpatient areas, but outpatient specialty seems open to both. rounding on your own patients seems to be okay for both.

ditto all the above for new mexico!!!

sailornurse, msn, fnp:o

[nomadcrna, DNP, CRNA, NP]

You can receive education and training (as the board requires) after you graduate. The board does not require that this "education and training" be during your initial NP education. There are many programs that you can attend to get this training.

The lines aren't clear and I don't know that they ever will be, or at least not for a long time yet, because all of this stuff is in flux. TX (from what I have been able to gather from the BoN website) does not say that FNP cannot work inpatient. Instead it says that an NP must have formal education and appropriate experience in something in order for it to be within their scope of practice. As far as I know, FNP programs do not offer classroom education on invasive procedures like CVLs, chest tubes, etc. This is why an FNP working in an ICU would be working outside their scope of practice. Just learning the procedure on the job is not enough. However, they might be alright in an ED if their job description doesn't include any invasive procedures. But these rules are specifically not specific, so if an issues comes up on whether you are within your scope of practice, you will have to argue each specific case. IMO, it comes down to really knowing the BoN laws and regulations for your state and keeping up to date on any changes. Go with the specialty you want to do now, and don't worry about what might change. There is no way to predict how things will be in 10 years, so just cross that bridge when you get to it.

[Dr. Tammy, FNP/GNP-C]

Check out the Pearson report. Here in California, there is no difference. NP's are certified by the board as NP's--not with any specialization or practice location restriction (outpatient versus inpatient).

[Annaiya, NP]

You can receive education and training (as the board requires) after you graduate. The board does not require that this "education and training" be during your initial NP education. There are many programs that you can attend to get this training.

I agree, I'm just not sure if the TX BoN has stated if that would qualify in their eyes. Like I said, I think a lot of this is speculation at this point.

[nomadcrna, DNP, CRNA, NP]

This is what the Texas Board states. Have you read what they say?

I also have not read anything about them restricting practice, if anything they are moving towards the model by the consensus and Pearson report as Dr. Tammy stated.

[core0]

This is what the Texas Board states. Have you read what they say?

I also have not read anything about them restricting practice, if anything they are moving towards the model by the consensus and Pearson report as Dr. Tammy stated.

Q: I am authorized to practice in a particular specialty area. I want to expand my scope of practice to include a second specialty area. (Examples of this situation include but are not limited to: adult health expanding to include pediatrics, family practice expanding to include care of patients with complex psychiatric pathologies, and primary care expanding to include acute/critical care). Can I do this by completing continuing education activities specific to the specialty and working with another advanced practice nurse authorized in that specialty or a physician?

A: There are finite limits to expanding one's scope of practice without completing additional formal education and obtaining the requisite authorization to practice in the additional role and/or specialty from the BON. When incorporating a new patient care activity or procedure into one's individual scope of practice, the board expects the advanced practice nurse to verify that the activity or procedure is consistent with the professional scope of practice for the authorized role and specialty and permitted by laws and regulations in effect at the time. For example, a women's health nurse practitioner or nurse-midwife who wishes to incorporate performance of colposcopies in his/her practice may do so without obtaining an additional authorization to practice from the BON because this activity is consistent with the professional scope of practice for those roles.

If the activity is not consistent with the professional scope of practice for the authorized role and specialty, additional formal education and authorization from the BON in the second role and/or specialty is required. For example, an advanced practice nurse who is authorized to practice in gerontological nursing wishes to provide advanced practice nursing care to all adult patients. In order to do so, he/she must complete education that will prepare him/her in an advanced practice role and specialty that encompasses advanced practice nursing care of adults of all ages. Rule 221.4© requires that this additional education meet the curricular requirements outlined in Rule 221.3, relating to advanced practice nursing education. After completing the additional formal education, you must obtain national certification in the additional role and specialty as well as authorization to practice in the particular role and specialty from the BON before you begin practicing in the additional specialty or role.

From here:

http://www.bon.state.tx.us/practice/apn-scopeofpractice.html

[NPinWCH]

Ohio is exactly like core0 says. I'm an FNP. If I want to practice as an ACNP, I must obtain a post masters certification to do so.

Granted, as an FNP I can practice in the same roles as a PNP, ANP, WHNP and GNP,but only because my formal education covered caring for those age groups. I am able to do some of the work of an ACNP, MHNP or NNP, but there is no way I could practice to the full extent of their license, and no matter what care I am providing, I can't call myself anything other than an FNP.

There is some overlap between certain specialties. Like FNP and ACNP or CNM and WHNP, but we do not replace each other. While a CNM can do pretty much everything the WHNP can do, the WHNP cannot do all the CNM can do. The FNP can't do all the ACNP can do and then again, the ACNP can't see peds so they can't do all the FNP can either.

On the job training does not replace formal education. To do the job the BON in Ohio says you must be certified to do that job.

[globalRN]

in my part of the world, FNP is restricted to family practice either hospital based(inpatients) or outpatient clinics. Specialty areas are the scope of the Adult Nurse Practitioner which covers every specialty(excluding kids and babes)

I met the criteria for both licences so can work in either family practice or a specialty area.

However, I would never apply to an area that I am not familiar with or have the NP skillset: ICU, CCU, ortho, renal etc.

I am quite comfortable working adult hem/onc, adult internal medicine inpatient and adult family practice inpatient. Since I have never worked full scope family medicine in a clinic...that is an area that I would not choose to work in unless I had a burning need and the time to get clinically updated.