What do hospital NPs do?

[JerseyGir1]

Hi. I'm currently in an accel BSN program and was also accepted to the Master's program in which I can pick any NP specialty when the time comes. I went into this almost whole-heartedly thinking I wanted to become an FNP and work in primary care clinics/group practices. Now that I am getting exposure to the hospital setting during undergraduate clinicals, I kind of like the environment. I sometimes see NPs on my floor but I can't exactly tell what their role is. Is it likely that most of them are ACNPs? I'm trying to get an idea of what a hospital NP would do as compared to an RN, and compared to a physician... and also how they collaborate with each.

My second question is... If I go for the ACNP (or another hospital specialty) and after a few years decide I want to move to primary care/family practice, is it easy to get post-masters certification as an FNP?

[Corey Narry, MSN, RN, NP]

Hi. I'm currently in an accel BSN program and was also accepted to the Master's program in which I can pick any NP specialty when the time comes. I went into this almost whole-heartedly thinking I wanted to become an FNP and work in primary care clinics/group practices. Now that I am getting exposure to the hospital setting during undergraduate clinicals, I kind of like the environment. I sometimes see NPs on my floor but I can't exactly tell what their role is. Is it likely that most of them are ACNPs? I'm trying to get an idea of what a hospital NP would do as compared to an RN, and compared to a physician... and also how they collaborate with each.

My second question is... If I go for the ACNP (or another hospital specialty) and after a few years decide I want to move to primary care/family practice, is it easy to get post-masters certification as an FNP?

Not knowing exactly where you're located at (except for the fact that you're probably from Jersey :)), there's no way for anyone to say for certain whether the NP's in the hospital you are referring to are primarily ACNP's. As have been pointed out in other threads, different locations vary as far as which types of NP's work in particular settings such as hospitals. By role definition, Acute Care Nurse Practitioners are trained to provide care to patients with chronic as well acute and critical illnesses. The age of the patient population served is limited depending on whether the NP is trained as an Adult ACNP or Pediatric ACNP.

Many hospital NP's you see are likely employed in different practice arrangements. Some are hired by private practices in a variety of specialties and are credentialed to see patients in the hospital. Some are hired by the hospitals as employees. Some are probably rounding in the hospital but also have duties in the clinic setting. I am an adult ACNP hired by the hospital and work exclusively in the hospital. I work primarily in the ICU but also cross-cover the step-down and general patient care units on occasion. Our role includes rounding with the ICU medical team composed of an intensivist, sometimes an ICU fellow, a resident on ICU rotation, and the attending physician who is the primary service for the patients we see. It is a big team but this is the nature of critical care medicine as the patients have very high acuity.

The NP's assess the patients and participate in planning the medical care of each patient with the team during rounds. NP's have the auotomony to write orders for medications, including IV pressors and inotropes. We perform invasive procedures such as bronchoscopies, invasive lines, and thoracostomy tube placements. Each patient admitted to the ICU is seen in consultation with the primary service that initially had the patient. In our case, the primary service is cardiothoracic surgery. The NP's write the consultation when the patient gets admitted. Discharges out of the ICU are decided as a team but the NP writes the discharge orders and discharge summary. We communicate the plan of care to patients, families, and nurses.

The resident has a similar role. However, because the residents are coming in fresh to an ICU rotation, many times the NP's are their resource for day to day ICU routines. Some come to the rotation with strong ICU skills but some don't. Hospital practice for NP's differ in that there is a bigger necessity for collaboration with attending physicians especially with our patient acuity. Througout the day, unstable patient's exam can change and in some instances, we do need to collaborate with physicians in changing the plan of care. Our hospital requires all our notes to be signed with an attestation by the attending intensivist each 24-hour period although our services are billed using insurance guidelines.

I hope my role was stated clear enough for you to understand it. I may have written it in such a way that it is difficult to picture how our day goes. But don't hesitate to ask of you have any other questions about hospital practice. Regarding you last question, post MSN programs for ACNP's that prepare them to sit for the FNP exam are widespread. I have not personally explored them in detail and have no idea how long they take. Since you are interested in the DNP degree as well, an issue was brought up in a previous thread regarding how one becomes a FNP after finishing an ACNP when the DNP does become a mandatory requirement. This is another layer of the DNP that has not been answered. I'm sorry I couldn't find that thread though.

[JerseyGir1]

That was really great information... and yes, it was very clear. Thanks for taking to time to respond!