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.
Specializes in Internal Medicine, Geriatric Medicine.
As a new Adult Nurse Practitioner, I worked as a hospitalist. It was the most amazing learning experience and it has carried forward into getting the second job and the DNP program. I was able to take everything I'd learned about interpreting results and how to explain them to panicked families into my current office-based position. Now I'll be working in long term complex care and managing a broad range of illnesses. My MSN program didn't have acute care as part of it, but the foundation for managing acute patients was there. I chose the ANP before the AGACNP or AGPCNP was actually even announced. I didn't want to limit myself to just acute care or just primary care. Turns out I don't need to. I can do either. And for the record, in NYS, they don't recognize the new certification. If you have AGACNP, you're licensed as an Acute Care Nurse Practitioner. If you have AGPCNP, you're licensed as an ANP. If you want the recognition for the geriatric piece, they're making people go get the post-Masters in just geriatrics. That's what happened to a colleague of mine.
They did not have an ACNP program near me when I decided to return to school for my FNP. I believe I would have gone that route or even the dual ACNP/FNP route, but programs have changed since then and added more options. My RN background was deeply involved with critical care care and there was a learning curve when my boots hit the ground in an ICU. As a nurse you may think you know but as a provider you are required to know and that can be scary at times. I have been working pulmonary/Critical Care for almost 4 years now and I am seeing and managing patients in the ICU. I intubate, place lines, manage vents and run codes. My practice physicians know I will ask for their help/advice when I need it and we seem to work well that way.
I probably will take the post masters acute care program, but at this point I am not sure I will gain much from the program.
I probably will take the post masters acute care program, but at this point I am not sure I will gain much from the program.
Very cool, it sounds like you are a bad ass! The reason, imo, to get the the acute care BC is to protect yourself should you ever be sued and also possibly give yourself more employment options in the future. My state's bon and hospitals are now requiring we work within the scope of our certification so there isn't as much leeway.
Very cool, it sounds like you are a bad ass! The reason, imo, to get the the acute care BC is to protect yourself should you ever be sued and also possibly give yourself more employment options in the future. My state's bon and hospitals are now requiring we work within the scope of our certification so there isn't as much leeway.
No I am the farthest thing from a bad ass! I just benefited from one on one training by a brilliant specialist who brought me along slowly and forced me to learn and grow. There is no way an NP program could come close to the education I received over the last four years. If I had the option to sit for the boards ACNP boards I have no doubt I would ace it.
IsabelK
174 Posts
As a new Adult Nurse Practitioner, I worked as a hospitalist. It was the most amazing learning experience and it has carried forward into getting the second job and the DNP program. I was able to take everything I'd learned about interpreting results and how to explain them to panicked families into my current office-based position. Now I'll be working in long term complex care and managing a broad range of illnesses. My MSN program didn't have acute care as part of it, but the foundation for managing acute patients was there. I chose the ANP before the AGACNP or AGPCNP was actually even announced. I didn't want to limit myself to just acute care or just primary care. Turns out I don't need to. I can do either. And for the record, in NYS, they don't recognize the new certification. If you have AGACNP, you're licensed as an Acute Care Nurse Practitioner. If you have AGPCNP, you're licensed as an ANP. If you want the recognition for the geriatric piece, they're making people go get the post-Masters in just geriatrics. That's what happened to a colleague of mine.