**IMPORTANT** changes to licensure for FNPs working in acute care
This announcement has 2 attachments:
I have attached the files about the changes the Georgia Board of Nurse Examiners enacted starting January 2015. If you have further questions, the email for our two speakers at the Chapter meeting last night are:
Dr. Kate Moore, director of Acute NP program Emory: firstname.lastname@example.org
Dr. Jennifer Adamski, member of the Advanced Practice Committee, Georgia Board of Nurse Examiners: email@example.com
What is the bottom line? The Georgia Board of Nursing posted in some fine print under "position statements" on their website in March 2015 some new rules that they are back-dating to January 2015 (see attachment). This was in response to the "Consensus Model" issued in 2008 (see second attachment) by a group of national certifying bodies, and recommended for every State to adopt. Only 10 States so far are fully aligned with this consensus model; the rest are in varying stages of adjusting regulations and legislation affecting advanced practice nurses, but the changes appear to be inevitable and have now come to Georgia.
The Georgia Board of Nurse Examiner's statement applies only to nurse practitioners who are NOT certified in acute care, but are working with one of the following "acute" patient population groups:
1) Any medical specialty (cardiology, neurology, oncology, sleep medicine, pain management, weight loss clinics, dermatology, research, etc.) If in doubt about whether your practice is truly primary care, ask "could this facility qualify as a medical home?" If the answer is yes, you are safe. If no, then you may have some trouble the next time you come up for renewal of your national certification, because your practice hours will not be in your certification area (family practice). Since all but four States require national certification to be licensed (including Georgia), you will not be able to renew your license in 2 years. Also, the Board of Medicine will not likely accept any new protocol you submit for a practice outside your area of certification.
2) Doing hospital rounds (even if you work in a family practice or internal medicine office most of the day) - the hospital environment is considered acute care, and FNPs will no longer be considered qualified to work there.
3) Working as a hospitalist, in an emergency room, or other acute setting such as short-term rehab facilities that treat patients recovering from "acute" problems such as MI, fracture, etc. Long-term care facilities (nursing homes) would be considered a "medical home" focused on wellness, health promotion, and primary care, so they fall under the family practice model. A free-standing urgent care is also under the family practice designation.
Many Family NPs, Adult NPs, Women's Health NPs, and Psych-Mental Health NPs working in hospitals or specialty practices will be affected by this change, as they are considered to be certified only as primary care providers. Of course, the BON position statement does not give a date, but we have been warned that it is coming, when these NPs will no longer be licensed to work in acute care without: 1) going back to graduate school to complete a certification in acute care (9-12 credit hours), 2) passing the Acute Care NP certification exam, then 3) maintaining that ACNP certification. Of course, you will then lose your FNP certification, unless you have enough hours in family practice from a second job or volunteer work to meet the practice hours requirement. So the days of the flexibility of the FNP role are over, sadly. You must now pick a population to treat: primary or acute.
Pediatric and Adult-Gerontological NPs are now certified by ANCC in either acute or primary care, and will have to practice in the setting for which they are certified. Even the Emergency NP program at Emory is an FNP, not an acute role, so they will be limited to treating patients in the fast-track of the E.R., that is, no trauma and no patients ill enough to be admitted. CRNAs, neonatal NPs, nurse midwives, and CNSs will continue to be considered acute care providers.
Currently we know of only three Universities in Georgia that are offering an Acute Care NP post-master's certificate program to family, adult, or pediatric NPs who want to continue working in an acute setting: Emory in Atlanta (private school, expensive), Georgia Regents in Augusta (less expensive), and Armstrong State in Savannah (only offers Adult-Gerontology Acute Care, but cheapest tuition). Emory tells us they will arrange all preceptors for you, but I'm not sure if the other Universities will do so - best to ask. Several online programs are also available, but you will have to find your own preceptors, which we all know can be difficult. Those NPs working in acute care right now might want to notify their employers of the new requirements, and ask for tuition reimbursement (and the cost of the acute care certifying exam offered by ANCC, which is $395 for non-members).
Many of our members asked, why do this to FNPs who have been practicing for decades in acute and specialty populations, when they have done so with competence, and no one can point to bad patient care outcomes? The answer given was that, with these more specific requirements on APRN certification, we can gain clout with physician groups, hospitals, and legislators to justify practicing to the full extent of our education, i.e. independent practice, full prescriptive authority, and recognition/compensation by insurers (no guarantees of course). This change will certainly lead to many NPs changing to lesser-paying family practice jobs, choosing to move away to less restrictive States, or spending their time and money on more education and certification. It will also make physician assistants more attractive to employers, as PAs practice under a physician's license instead of their own, and don't have all the restrictions and complications NPs in Georgia face with their licensure. Still, the consensus decision has been made by the national NP certification Boards, and practicing NPs have no say in the matter. Since certification is renewed every 5 years, being "grandfathered in" does not seem likely either. We certainly hope that this difficult change proves to be for the best in the long run, and accomplishes the goal of increased respect and autonomy for our profession.
Feel free to leave comments and please contact Dr. Moore or Dr. Adamski if you have any further questions.
Julie Hannah, FNP-C, VP Gwinnett/Forsyth Chapter