Women's Health vs Family NP

Nursing Students NP Students

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Hello,

I am in a post-BSN to DNP program...When I applied, I applied for the Women's Health DNP which is where my interests are. That very year the school eliminated their Women's Health Program and I was accepted instead into the Family NP Program.

I have heard that the program you are in determines the license exam you sit for (adult NP Program=adult NP licensing exam) and that you have to practice according to the license you receive (adult NP license=adult nurse practitioner). I have also heard stories about NPs who were licensed as adult NPs and wanted to practice women's health and had to work a certain amount of hours in adult health to maintain their license. I have been trying to find answers for weeks, as I am reluctant to continue much further in my program until this is confirmed (I completed first year). My advisor said that I could practice women's health with a family license (which I knew) but she could not confirm whether, if I am licensed in family practice, I will need to also work in family practice to maintain my license.

I just really need to know if I will have to work as a Family NP in order to maintain my license, or if I can work exclusively in women's health with a family NP license. Please help!

Thanks!

Kim

Specializes in Pediatrics, High-Risk L&D, Antepartum, L.

It's a system where the majority of OB cases are managed by primary care providers......

It's a completely different population, training...hey if that article works for you so be it.

We have specialists for a reason.

Specializes in Adult Internal Medicine.

It's a completely different population, training...hey if that article works for you so be it.

We have specialists for a reason.

And despite our specialists Cuba has a lower neonatal mortality rate than we do.

Specialists play an important role, when indicated. Part of moving Into the advanced practice role is learning when data trumps personal experience and when a patient is within your scope and outside your scope.

Specializes in Anesthesia, Pain, Emergency Medicine.

Well the peer reviewed studies say that the FPs have as good of outcomes as OBs do. Those are the facts.

You should know that YOUR anecdotal "life experiences" mean nothing.

Sorry, those are the facts.

Specializes in Anesthesia, Pain, Emergency Medicine.

Is your grad school not teaching you properly? Seriously, it is a valid study. Find something to refute it. Even ACOG is pro FP perinatal care.

And if you are so aware about evidence you would know that something from 1995 isn't very impressive.
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
Well the peer reviewed studies say that the FPs have as good of outcomes as OBs do. Those are the facts.

You should know that YOUR anecdotal "life experiences" mean nothing.

Sorry, those are the facts.

"Facts" that I have yet to see...

Jory, appreciate your enthusiasm, but you are spreading misconceptions. You are speaking to issues that are above your education and experience level, and sadly, you were led astray by other individuals.

As for the first statement, it is entirely acceptable for an FNP to follow a woman through her entire pregnancy, in fact her entire lifespan. FNPs are educated on prenatal care and lactation, and the national board exams test the FNP on these subjects, providing verification of competence in these arenas for entry to practice.

As for your second statement, also false. The majority of FNPs work in primary not speciality care.

Enthusiasm is a great thing, but if it gets you over your head, it can become problematic.

Again...your lack of reading my original post is showing.

I never made a statement of where FNP's mostly worked...you did, not me...you. So please don't correct me on comments I never made to start with...I don't think it's appropriate to make it up as we go along.

The comment made by the prenatal care WAS LISTED AS A MERE EXAMPLE of the example WE were given of HOW it was going to change IN THE NEAR FUTURE.

Your limited experience is really showing.

Just because you have not seen it, does not make it fact.

Below is what is called evidence based medicine. You will become proficient in EBM if you further your education. The reason i seem offended is that I'm tired of non-APN coming in here and giving their "opinion" or what "they heard".

BTW, it is individual states that dictate how we practice.

First, I would like to point out you are a CRNA, not an FNP. So I would wager that you are making generalizations on things that you don't have the education nor experience level to speak on either.

By the way..I asked one of the surgeons (that has been at our facility for over 20 years) if GP's ever performed surgery at our facility (which is a very large hospital system) on the off chance that I could be wrong (and you correct) and might be commonplace somewhere else. She actually didn't answer me...laughter, was the response that I got, followed by, "Not if we are smart." If that tells you anything about the qualifications of a GP doing surgery.

I understand what evidenced based medicine is...apparently what you don't understand is how to read my original post.

So what do you say now? So who does not understand what various specialties do?

Family Practice IS a specialty.

Yes and no...and as a CRNA, I don't really think that you have education and the background to speak on that either, considering that isn't even what your educational background is in.

Some other surgeries that I have personally done anesthesia for(by family practice) include c-sections, hemorrhoids, appendectomy, vasectomy, tubal ligation, circumcisions.

I bet you will really foam at the mouth when I tell you that there are FNPs that do colonoscopies!

No, this would surprise me at all. However, I personally wouldn't allow an FNP to do this. It's hysterical how you think you are the only knowledgeable person in the room.

Oh my

I even do minor surgical procedures as a FNP.

Are you a CRNA or an FNP? Hmmmm...starting to doubt if you have either credential. After all, if you post it on the internet, that makes it so, right?

Outcomes of cesarean sections p... [J Am Board Fam Pract. 1995 Mar-Apr] - PubMed - NCBI

Cesarean Delivery in Family Medicine (Position Paper) -- AAFP Policies -- AAFP

J Am Board Fam Pract. 1995 Mar-Apr;8(2):81-90.

Outcomes of cesarean sections performed by family physicians and the training they received: a 15-year retrospective study.

Deutchman M, Connor P, Gobbo R, FitzSimmons R.

Source

Department of Family Medicine, University of Tennessee, Memphis, USA.

Abstract

BACKGROUND:

Family physicians are the major or sole providers of Cesarean section services in many communities. Approximately 2800 family physicians provide Cesarean section services in communities of all sizes across the country.

METHODS:

The outcomes of all Cesarean sections performed at two rural hospitals during a 10- to 15-year period were examined and compared with standard quality-outcome criteria published in the medical literature. Outcome criteria included rates of various surgical complications, use of blood transfusion, infant Apgar scores, and length of postoperative hospital stay. Other descriptive data were examined including patient demographics, operating time, anesthesia type, and choice of incision. Statistical analysis consisted of chi-squares, odds ratios, and stepwise multiple regression.

RESULTS:

Five hundred sixty-three Cesarean sections were performed by 12 residency-trained family physicians, 68 by general practitioners, 70 by general surgeons, and 9 by obstetrician-gynecologists. Family physicians met or surpassed the referenced standards in all measures examined. The number of Cesarean sections each physician performed while in residency training was also examined. The average number of in-training Cesarean sections was 46, ranging from 25 to 100.

CONCLUSIONS:

The results of this study support the ability of family physicians to provide Cesarean section services based on a wide range of training backgrounds and variable numbers of procedures done in training.

OVERVIEW AND PURPOSE

Obstetric care for patients is an integral part of many family physicians' scope of practice and remains an important component of family medicine residency training.1,2 An American Academy of Family Physicians (AAFP)/American College of Obstetricians and Gynecologists (ACOG) Joint Statement asserts that access to high-quality maternity care is an important public health concern in the United States.3 A cooperative and collaborative relationship among obstetricians, family physicians, and nurse midwives is essential for provision of high-quality care for pregnant women. The most important objective must be the highest standard of care regardless of specialty.

Family physicians provide substantial perinatal care in this country, especially to rural and underserved populations, delivering 100% of the babies in some geographic areas. Obstetric services provided by family physicians have declined in the past decade, with only 23% providing deliveries and fewer than 10% providing prenatal visits.4,5 The Future of Family Medicine Project first outlined the broad spectrum of services that family physicians will be expected to provide to renew the specialty and meet the needs of patients and society.6 Comprehensive accessible care is further described in the more recent Patient-Centered Medical Home (PCMH) model promoted by the AAFP and other organizations.7 Operative deliveries and other advanced perinatal services are ideally suited for this model of comprehensive care, which involves extended or more advanced services.

Several factors contribute to current and future demand for routine and advanced maternity care services by family physicians. To provide the appropriate access to care that all women deserve,2 the following must be considered: Rural areas rely on comprehensive perinatal care provided by family physicians, including cesarean delivery.8,9 A high percentage of family physicians in rural areas provide obstetric care (e.g., 46% in the West North Central United States).5

  • The cost of medical malpractice insurance has continued to increase and remains a major factor in obstetrician/gynecologist's career dissatisfaction.10
  • Obstetricians increasingly are choosing subspecialty careers, dropping obstetrics from their practices, retiring early, or practicing in areas that are already well served.11-13
  • Cesarean delivery rates in this country are at an all time high of more than 31.1% of all deliveries, having risen 50% over the past decade.14,15

Cesarean delivery is one of the most common surgical procedures. According to the CDC approximately 1.3 million cesarean deliveries are performed in the United States annually. Despite the use of risk assessment systems and protocols, the need for cesarean delivery can arise suddenly and unpredictably during the course of labor. An essential component of modern perinatal care is the prompt availability of surgical intervention without the need to transport the patient.

Provision of cesarean delivery by well trained family physicians augments services available to women, in some places providing additional options for care, and in other places providing a service that would not otherwise be available. Regardless of specialty, there should be shared common standards of perinatal care. Quality patient care requires that all physicians practice within their ability as determined by training, experience, and current competence.3Given that many family physicians currently perform cesarean deliveries and many continue to be trained for this service, it is important that there be a common understanding of the place for cesarean delivery as part of a family physician's scope of practice and as part of the health care delivery system.

This document should serve as a resource for family physicians who are training for and planning to include cesarean delivery in their practice. It also will assist hospital and health plan credentialing committee members and administrators, obstetricians, midwives, nurses, and other clinical staff to understand the role of family physicians in providing cesarean delivery in their practice of medicine.

SECTION II - SCOPE OF PRACTICE FOR FAMILY PHYSICIANS

Family medicine is a specialty based on comprehensive care encompassing a breadth of medical services. Family physicians practice among diverse populations and in geographically varied, often remote, settings. Family physicians choose their personal scope of practice based on their experiences in training, practice interests, and the needs of their practice populations. Broadly speaking, the following indicate the extent to which cesarean delivery is within the current scope of family medicine practice:

  • A joint AAFP/ACOG statement recommended core educational guidelines, and a joint statement on hospital privileges affirms that surgical delivery is within the scope of family practice.1,3
  • About 4.3% of active AAFP members, or 4,000 family physicians, perform cesarean delivery. In predominantly rural areas, such as the West North Central region of the United States, an average of 15.3% of family physicians perform cesarean deliveries.16
  • Among family medicine residencies, 55% provide cesarean delivery training.17
  • Nationally, about 25 family medicine fellowships in obstetrics exist, many of which specifically seek to train family physicians to perform cesarean delivery independently.18
  • More than 2,000 U.S. family physicians have hospital privileges to perform cesarean delivery.19

Published data document that cesarean delivery care provided by family physicians in active practice or in training can meet or exceed national standards for maternal and infant outcomes.19-21 In addition, there is some evidence that women who receive their perinatal care from family physicians have lower cesarean delivery rates than patients cared for by obstetrician/gynecologists.21,22 This is important for social and financial reasons and because surgical delivery carries a significantly increased risk of maternal morbidity and mortality over lady partsl delivery. There is much written on the indications for cesarean delivery, but the indications most commonly given are listed in the Appendix, Table 1.15,19,53

And, this article was supposed to impress me how? I am sure that at backwoods hospitals,this may be a necessary evil. It's not necessary here and I work at a very large facility and there are NO GENERAL PRACTICE PHYSICIANS that have surgical privileges.

I don't really know what your problem is, but you apparently have too much time on your hands.

I stated, from the beginning, that the scope of practice with regards to women's health performed by FNP's was getting ready to change...I WAS CLEAR that I wasn't sure of the details..I listed the ONE example we were given...I WAS CLEAR that I didn't have a source...I WAS CLEAR that I thought the year was 2015, but wasn't sure...I WAS VERY CLEAR. This was stated by a professor that is very highly regarded in the field...I seriously doubt she would be spreading false rumors. I seriously doubt, if the entire curriculum would be changing, on a rumor.

I simply AND APPROPRIATELY stated that if it were me..I would call to check. Why are you so intimidated by that? Because someone knew something that you apparently didn't?

You are not even an FNP and if you are, a poorly informed one. I don't see how you practice with such a poor attitude...that is probably why you work in surgery because you don't need people skills when your victims are asleep.

A very sad world we come to in nursing, when this kind of attitude is a textbook example of everything that is wrong in nursing. Instead of having an open discussion, you have some holier than thou person coming in and attacking.

If you had simply ASKED, "JORY...that is interesting...do you think you can get us more information on that?"

Do you know how I would have responded? ABSOLUTELY!!!

Because that is the type of nurse that I am...I'm sorry it's not the type you are. The profession has enough bullies in it...they don't need more of them.

Specializes in Nephrology, Cardiology, ER, ICU.

Okay everybody, lets step back and rethink this......

Here is the link to the AACN Consensus Model practice model:

http://www.aacn.nche.edu/membership/members-only/presentations/2013/13spring/Thompkins.pdf

Looks like what you are looking for is on slide 5.

The consensus model, as its rolled out state by state, will show to everyone what the scope of practice will be.

Specializes in Anesthesia, Pain, Emergency Medicine.

Ok really, so peer reviewed scientific studies are not facts?

Ok then. I'm done.

"Facts" that I have yet to see...
Specializes in Anesthesia, Pain, Emergency Medicine.

Don't forget. The consensus model means nothing unless EACH state passes it. My state is passing most of it but seeing as FNPs cover many rural ERs and inpatient care, they are choosing their wording carefully.

Okay everybody, lets step back and rethink this......

Here is the link to the AACN Consensus Model practice model:

http://www.aacn.nche.edu/membership/members-only/presentations/2013/13spring/Thompkins.pdf

Looks like what you are looking for is on slide 5.

The consensus model, as its rolled out state by state, will show to everyone what the scope of practice will be.

Specializes in Anesthesia, Pain, Emergency Medicine.

Nice attack. :) To bad much of it is false.

Backwoods hospitals? I won't even respond to that. Way to silly.

Family practice physicians are NOT GP physicians. GP physicians used to be allowed to practice after their internship year when they did not do a residency.

Family practice physicians ARE specialists.

So who is changing the FNP scope, you do realize that it is the individual states that dictate practice? So, just because there is a consensus model, does not mean each state will adopt it.

Women's health, which we are discussing, is a part of primary care. Do you really think most rural areas have either OB or WHNPs? Once again, limited experience on your part.

Lastly, yes I am an FNP as well as a CRNA. Nothing else in that paragraph needs to be addressed. When you can't argue the facts, out come the personal attacks, WTG.

There is no reason to take this discussion to personal attacks.

Now you see I have no personal attacks in my post. My statements are also backed up with fact.

If you want to discuss something, don't use hearsay as in " I heard " this. You can keep repeating that it was your instructors and they are qualified but that still does not make it fact.

Post references, as I did. I notice you did not try to refute them except with "I talked to a surgeon".

So, just to be clear. The consensus model does not change your scope of practice unless the state you are in changes its current practice laws to reflect it.

http://www.nacns.org/docs/NACNSConsensusModel.pdf

States are not Implementing the Full Model – Resulting in Apparent Loss of

Consistency

At the beginning of 2012, 19 statesi

have indicated plans for beginning work to

implement this model have not implemented the full model. Due to many

circumstances, these states have elected to select portions of the Model that work for

them. This is contrary to the intent of passing the full Model as drafted. The more

states that pass this model in a piecemeal manner may result in problematic variations

between states. It is unclear at this point if these new variations will have an

unforeseen impact on APRN roles including the CNS role.

And, this article was supposed to impress me how? I am sure that at backwoods hospitals,this may be a necessary evil. It's not necessary here and I work at a very large facility and there are NO GENERAL PRACTICE PHYSICIANS that have surgical privileges.

I stated, from the beginning, that the scope of practice with regards to women's health performed by FNP's was getting ready to change...I WAS CLEAR that I wasn't sure of the details.

You are not even an FNP and if you are, a poorly informed one. I don't see how you practice with such a poor attitude...that is probably why you work in surgery because you don't need people skills when your victims are asleep.

Specializes in Nephrology, Cardiology, ER, ICU.

Nomad - agree facts are needed in order to support views or opinions. Im all for that. I am fully aware that the Consensus Model is just that....a model and certainly not the end all of APRN practice. However, it seems to be on the NCSBN bandwagon. I neither support nor disagree with it, just providing info so others will know what is being discussed by the suits that govern our practice as APRNs.

Like you, as an APRN, I know its easy for those that are not APRNs, to come and give opinions that may or may not be true. We try to be respectful of all opinions here at AN.

The main discourse here seems that there is some disagreement among some professors that may be giving wrong info to students.

To the students - I always advise you to get involved with your states APRN organization. In the US, our practice is governed by our states with input from other organizations like AACN and NCSBN.

Too many cooks.....

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