Those of you who are ACNP working as hospitalists...

[mmcmarsh]

I am meeting with someone from our corporation this week to discuss the possibility of joining our hospitalist group after graduation. We recently had our first ACNP hired for the group about 6 months ago...and she is already gone. The man I am meeting with described their first experiences with an ACNP in the hospitalist group as "challenging".

For those of you who function in this role...what have been the challenges for you? Can you describe a day for you at work? How is your patient load? Is it the same as the physicians? What is your call like and do you work alone or is there always a physician from the group present in the hospital?

Any insight would be appreciated as I'm trying my best to be prepared and cover all of my bases.

[Corey Narry, MSN, RN, NP]

I've briefly done some moonlighting with a hospitalist-type role as an NP. I called the role "hospitalist-type" because I was not part of a group of hospitalist physicians. Rather, I was employed by the hospital as part of a group of NP's and PA's who work under Internal Medicine and round/co-manage patients with a private practice internists group who admit patients to the hospital. This physician group does not function as hospitalists in it's pure sense as they do have an out-patient primary care practice as well and do not spend the whole day in the hospital. There is at least one attending internist in the group who rounds in the hospital during the morning who is basically on call for the whole week. The physicians follow a 7-day on 7-day off call schedule. The NP's and PA's follow a three 12-hour shifts a week schedule (both nights and days covered).

The patient load (18-24 patients) is split among the 3 NP's and PA's as evenly as possible while the physician basically rounds on all the patients in the morning. The biggest bulk of the role is admissions, discharges, coordinating tests and procedures, and following up on consults. The NP's and PA's typically pre-round when they arrive in the morning to check on overnight events, vitals, labs, and such and then present to the physician on rounds and determine a plan. The rest of the day, the NP's and PA's do their own thing in managing the patients, answer nurses calls for concers, get called into the ER or floor for an admission, discharge patients, etc. The nightshift is pretty much devoted to covering the service for admissions.

What I've observed among NP's is that there's variability in comfort level in making clinical decisions among their ranks as some have more experience in one aspect of medicine over another. Some tend to focus a lot on one aspect of care than the others do. The PA's pretty much follow a resident-like approach. The service has worked pretty well despite this but I didn't hang around long enough to know what the staff turn over was like.

[Corey Narry, MSN, RN, NP]

BTW, here's an article worth reading which may answer some of your concerns: http://www.todayshospitalist.com/index.php?b=articles_read&cnt=35

[HHRNurse]

Thanks for that article Juan, it was most interesting!