Does Anyone Actually Know How NPs are Allowed to Practice?

I'm at a pharmacology conference in Chicago this week with a friend and former NP school classmate. My friend, Ann, is a family nurse practitioner who has been working in a cardiology practice for the past six years. Ann is pretty much an amazing and inspiring NP. Within cardiology, she has honed her skills in electrophysiology and does all things palpitations, pacemakers, and defibrillators

This week between Chicago eats, shopping, and of course conferencing, Ann and I have had some serious conversations about scope of practice. She is nervous that as a family nurse practitioner, specializing in cardiology is in a gray scope of practice area for her. Is she practicing within the bounds of her specialty?

To address her concerns, Ann has looked into a few options to ensure the security of her career:

  1. DNP - While this is becoming more popular among NPs, it wouldn't affect Ann's scope of practice or address her specialty concerns at this point. 
  2. Post-Master's - Ann could obtain her acute care nurse practitioner degree addressing her concern that cardiology is outside of the realm of the FNP's scope of practice
  3. Cardiology Certification - A few mom and pop 'certifications' have cropped up in recent years to formalize specialty training for nurse practitioners. This could potentially address Ann's anxiety, although these certifications are arbitrarily created and not necessarily backed by larger certifying bodies. 
  4. Do Nothing - Ann can continue practicing in cardiology until (if ever) a new rule or regulation addresses this scope of practice conundrum

What's the right answer to Ann's problem? No one really knows! 

Ann isn't alone in her scope of practice questioning. Recently, I received an email from a MidlevelU reader in a similar situation. It reads: 

"I have been a family nurse practitioner (FNP) with a MSN since 1987. I am new to Florida. I was referred to you by the Florida Board of Nursing with a scope of practice issue. Most recently, from 2001 to 2014, I had been practicing psychiatry as a FNP. This was in a different state and no problems occurred. My question is whether practicing in specialties other than family practice is an option in the State of Florida? Per the Florida BON, they do not address this issue. There is nothing written, no precedent."

If the Florida Board of Nursing doesn't know the answer to questions about their own scope of practice regulations then who does?! 

The waters are muddied when it comes to scope of practice for nurse practitioners, especially those working in specialties. Specialty designations for nurse practitioners are much broader than those for physicians, for example, which make it unclear where boundaries lie. Can a family nurse practitioner work in the inpatient setting? What about the emergency department - where acute care and family practice intersect? If acute care nurse practitioners must be the NPs in the emergency department setting, then they would need to be dual certified in order to treat patients of all ages. Is this really a practical approach to ED staffing? The questions go on and on with a number of nurse practitioners anxious about the future of their careers. One change to rules or regulations could affect the clinical foundation they've worked so hard to build. 

While we can't know for sure how or if this issue will be addressed, I have a few predications. First, nurse practitioner designations will continue to become more specialized. This will eventually clear up boundaries between specialties and make nurse practitioners' distinctions readily apparent. We already see this with the creation of specialized certification exams like those for emergency NPs

Second, regulatory bodies will begin to address the issue. It's in the profession and the public's best interest to keep nurse practitioners in practice. So, we can expect that NPs currently practicing will be 'grandfathered in' under any new rules. This has happened in the past, for example, with physicians. Before the creation of emergency medicine residencies, family doctors were the ones staffing emergency departments. When EM residencies became required for physicians in the emergency department, family docs working in the ED were allowed to continue to practice in the setting. Changes issued by regulatory bodies occur slowly and with forewarning so nurse practitioners affected will have time to adapt. New changes should not make it so that you as an NP suddenly wake up one morning out of a job.

Do you have scope of practice questions about your nurse practitioner career?

 

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