There seem to be many questions in regards to if FNP can work in an inpatient role. This is especially interesting in regards to if they can work in an ICU and provide ICU level care to patients. While I am far from an expert in anything in life, I would like to provide a post for some discussion since I have read quite a few of these posts with the above stated question as the main focus.
I currently work in a medium sized rural facility. Around 360 Beds. We have two ICU. One is a CV unit, the other is the general run of the mill ICU for everything non-cardiac related. Most of our work is done in the regular ICU, since the cardiologist manage most of the stuff in their unit, but we do get consulted for many issues in their CVU, but this is for another topic.
As an FNP hospitalist†or whatever you want to call it, we do only inpatient care. This ranges from your simple chest pain rule outs that probably didn't need to be admitted, all the way down to patients with septic shock, on the vent, surgical icu patients, etc. Usually we do the admitting at night. Our shift is from 6 pm to 6 am. We are usually the only provider in the hospital from around 11-5 am, unless there is an emergency surgery, stat cath, or a central line needs placed in the er or on the floor. This excludes the ER physician, who runs a fair share of the codes at night, but not all.
We admit, provide orders, and call the shots on our ICU patients. Of course we have pulmonology back up for complicated vents and surgeons for surgical related problems. We also have the regular sub specialties including cardiology, nephrology, ortho, etc. But they are all sleeping, and have all the local clinic group patients to care for also. Us as the hospital group also get the benefit of specialists, but we are there, so we are usually the first line for non-obvious problems that would go to the specialist.
We do everything except intubate or put in lines.
Were we trained for this in fnp school. Nope.
Did we work as an ICU nurse before this. I didint, the other guy did.
Do we manage, Yup.
Are we smarter than the average person. Nope.
How do we do it?
We got trained for a few months after school and picked up some high quality texts off of amazon.
Should we have been ACNP- probably, but we didn't know we wanted to do this in school. would their be a benefit in going back for an ACNP cert. Probably not much besides learning to intubate better and put in lines, chest tubes and such.
But we can take seminars or train with the physicians at the hospital for this.
If i knew i wanted to do this forever I would have gotten a critical care program instead, but we didin't, but we were needed.
Do we feel competent in our position- Yes.
Is there more we could learn- of course, but our current knowledge base gets us through the night. Maybe if we were on the critical care team it would be different, but again, at night we are the critical care team. If the care of the patient was in our hands 24.7 this might be a different story, but in our case, the FNP cert, along with some extra training and self-directed study has gotten us a long way.
If I were birthing a baby I would actually prefer an NP with L&D experience as an RN over an MD that had a 6 week rotation.
Yeah I might agree if by chance it was a NP with actual L& D experience but not without which is more along the lines of the initial scenario of a NP without experience in the acute care setting working in ICU.
Yeah I might agree if by chance it was a NP with actual L& D experience but not without which is more along the lines of the initial scenario of a NP without experience in the acute care setting working in ICU.
I agree with that. If the OP had no ICU experience and limited training/support than it was a dicey scenario to start. It likely is much better now but that doesn't change the start.
It was a pretty difficult scenario at the beginning. Its mostly pretty easy now with a few here and there things. I might have to call my attending once every couple months or so. I am starting in the clinic soon and I am sure that will be more difficult for me than this current job, even though I went to school for clinic based work.
Job experience makes so much more difference than formal education it seems.
I do much better with OJT than formal education. However if there is a certification available you might want to consider getting it. It legitimizes your role and like others are saying it probably is the future. Maybe the hospital would pay for you or maybe the ANCC has some portfolio certification you could get.
I have been an FNP for over 10 years and have been working in hospitalist work for the majority of that time. I have also gone back and now passed the AGACNP exam. This is my perspective/opinion and it's going to differ from some on here. I graduated from a highly ranked FNP program. Did it prepare me for acute care? Very little, that is not what it was intended to do. I didn't even realize how much it had not until I was deep into my post master's. FNP and AGACNP training are very different. Now should guidelines of who can practice where be based on setting alone? No. There are some hospitalized patients that are appropriate for the FNP to manage but these are low acuity patients that could almost be manged in an outpatient setting, not unstable patients or ICU patients. Again, I understood this better after having been through both training settings and having to examine the consensus model. I practiced as an FNP in the hospital for a long time but ultimately didn't want to anymore, I felt like many hospitalized patients were outside of what is considered the scope of practice for an FNP and this could be easily capitalized upon in litagation. As more states move toward independent NP practice this will likely become a bigger issue.
I won't be in hospital setting for more than a couple more years. Otherwise I probably would go get the cert for more legal protection. Ina. Fairly short period of time once we get flooded with nps they will probably be stricter on what specialty practices where.
Specializes in Emergency Nursing, Critical Care Nursing.
As an RN, I've worked ER for 6 years and critical care for 9. As a newly graduated FNP, I have accepted a job as a hospitalist/intensivist. I DO plan on returning for post-master's certs in acute care, but there is duality in my intention for doing so: a) consensus concerns, and b) depth of knowledge base. I'm thinking there is a fairly steep curve between someone who has had relevant experience as an RN and a nurse who enters advanced practice, never having practiced as a nurse (yes, this happens in some programs).
I am motivated enough like the OP to self-study in the interim with said high quality texts (please share the list) that enrich my knowledge as a nurse practitioner in the hospital/acute care setting.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
This topic came up twice in the recent AANP National Conference. One was via a Podium Presentation by 2 faculty members of a well-established and recognized FNP program. The presentation was also attended by a representative of NONPF (National Association of Nurse Practitioner Faculties). The other session was for an Open Forum for the Acute Care Specialty Group created within AANP. It was an open discussion that got heated especially with this topic brought up.
The jist of the sessions revolve around the fact that with the Consensus Model and NONPF's documents outlining separate Primary Care and Acute Care competencies, NP's should practice within their training. Setting may be irrelevant but the acuity of patients cared for matter a lot whichever setting it may be. The podium presentation was also part of "Legal Issues in NP practice" and the conversation quickly segway'd into the legal risks one can be taking when working in a field one isn't formally trained under.
Both FNP faculty members and the NONPF representative were clear in saying that they discourage FNP's from practicing with high acuity patients and the same goes for ACNP's in primary care roles. Unfortunately, even though ACNP certification has been around since 1995 the reality is that only 50% of NP's who care for high acuity patients in hospitals are trained as ACNP's. The other issue is the fact that there are many gray areas in the acute care vs primary care debate. A lot of specialties in medicine cross the spectrum of wellness to critical illness.
The other issue is the fact that there are primary care trained NP's who have been in practice in acute care settings for over 20 years, many of whom started long before acute care training was even available. These NP's may be better poised to defend their position at a time when a "grandfathering clause" may be invoked. A number of attendees who are primary care trained but work in acute care also decried the fact that there were no acute care training programs that were feasibly close to where they lived so they were left with little option.
At the moment, make sure you check with your state BON whether scope of practice can be an issue. If you have access to PubMed, there is literature on which states define SOP based on the NP's certification, which ones are ambiguous, and which ones do not define it at all. These numbers will likely change in the future as NCSBN attempts to formalize and homogenize SOP language across the states.
Specializes in Vascular Neurology and Neurocritical Care.
Yes this is similar to a thread that many of us participated in not long ago if remember right, but I digress. Many states are issuing position statements on matters such as these.
Juan has brought up some great points, this will definitely become more of an issue over the next several years. The training between AGACNP and FNP is vastly different and if NPs are going to be successful in moving toward more independent practice in all areas of the country it will become important to make sure that we are practicing within the scope that we are educated for.
Jules A, MSN
8,864 Posts
Yeah I might agree if by chance it was a NP with actual L& D experience but not without which is more along the lines of the initial scenario of a NP without experience in the acute care setting working in ICU.