Nurse Practitioner Common SOP Scenarios
Nurse Practitioner Scope of Practice: Commonly Asked Questions
The questions below are answered based on national nursing organizations’ definitions of nurse practitioner scope of practice. Each state’s RN/APRN licensing board may have a different perspective and rules that may impact the answers provided. When considering if a task, skill, or the care of a particular patient is within one’s scope of practice, one should consider the definitions of scope of practice provided by national nursing organizations, their scope of practice as defined by their education/certification/licensure, their respective state licensing board’s practice act, rules and regulations, and state and federal laws that impact scope of practice. The answers below are considered expert opinion and do not represent legal advice. They are provided for educational purposes only and may change without prior notice. It is the responsibility of every APRN/nurse practitioner to remain updated in their knowledge of scope of practice, state board licensing practice act and rules, and state and federal laws.
Can a family nurse practitioner work in an acute care facility?
Based on the concepts that scope of practice is defined by the patient needs, not their physical location, and the nurse practitioner’s education, certification, and licensure the answer to this question is that it depends. The family nurse practitioner’s (FNP) education, certification and licensure are in the provision of primary care for stable acute and chronic illness, from birth to end of life. If the FNP will be providing care in the hospital setting that is consistent with the care they would provide in a primary care setting then it is likely within their scope of practice to work within the hospital setting.
For example, palliative care is considered an area of overlap between the primary care and acute care. If the FNP is working on a palliative care service in the inpatient setting, this is well within their scope of practice. It is also within the FNP’s scope of practice to complete discharge planning, assist with transition in care, manage subcutaneous insulin, and order nebulizers for a patient with COPD exacerbation.
Contrary to the above scenarios, an FNP should not care for a patient in the ICU who is on a ventilator and receiving vasopressor therapy. Nor should they care for a patient that has diabetic ketoacidosis who needs IV fluid resuscitation and IV insulin. The FNP is not educated, certified and licensed to care for these types of patients, therefore, the care of these patients is not within the FNP’s scope of practice. The patient’s needs in these instances requires that they are cared for by the acute care nurse practitioner (AG/Pediatric). Acute care nurse practitioners (AG/Pediatric) are educated, certified, and licensed to provide care for unstable, acutely, and critically ill patients.
Since the definition of primary care provided by NONPF defines primary care as being characterized by a long-term relationship between the patient and nurse practitioner, can a family nurse practitioner work in an urgent care center? This is not a long-term relationship.
Although patients that present to urgent care facilities do not have an established long-term relationship with the family nurse practitioner at the facility, working in an urgent care setting is within the scope of practice of the family nurse practitioner. Family nurse practitioners are educated, certified, and licensed to provide care to patients with stable acute conditions in addition to chronic disease management.
Can a family nurse practitioner work in an emergency department?
Based on the concepts that scope of practice is defined by the patient needs, not their physical location, and the nurse practitioner’s education, certification, and licensure the answer to this question is that it depends. The family nurse practitioner’s (FNP) education, certification and licensure are in the provision of primary care for stable acute and chronic illness, from birth to end of life. If the FNP will be providing care in the emergency department that is consistent with the care, they would provide in a primary care setting then it is likely within their scope of practice to work within the emergency department.
It is generally accepted that the fast-track portion of the emergency is an appropriate setting for an FNP to work as the patients typically present with stable, acute conditions. Generally, the main ED is typically not the best location for the FNP to work. Patients who present to the main ED tend to present with unstable acute issues such as acute strokes, acute coronary syndrome, respiratory distress requiring intubation, trauma or a type of shock. The FNP is not educated, certified, or licensed to provide care for these types of patients. These types of patients require the expertise of the acute care nurse practitioner (AG/Pediatric). Acute care nurse practitioners (AG/Pediatric) are educated, certified, and licensed to provide care for unstable, acutely, and critically ill patients.
In trauma and burn services, they often care for adolescents that are 14 and 15 years old. What is the youngest age for which an AGACNP may provide care?
To my knowledge, a specific age has not been identified by the national nursing organizations that define the AGACNP scope of practice. This makes this scenario very difficult to manage. The NONPF 2016 Adult Gerontology Acute Care Nurse Practitioner Competencies, provide some guidance. This document defines the role of the AGANCP to include the care of late adolescents, adults, and older adults. Late adolescence is typically thought to start at the age of 18. This may represent a reasonable starting age. Anyone who is in this scenario should check with the school from which they graduated to ask what age group they prepared them for and check with their state’s board of nursing.
As a psychiatric mental health nurse practitioner can I treat obesity?
The psychiatric mental health nurse practitioner (PMHNP) is educated, certified, and licensed to care for complex psychiatric conditions from prebirth to until death. All weight management programs should include treatment for the associated mental health conditions/symptoms that often accompany a diagnosis of obesity. The management of an obese patient’s mental health is within the PMHNP’s scope of practice. The evaluation, diagnosis, and management of the physiologic components of obesity, such as prescribing weight loss medications, is not within the PMHNP’s scope of practice.
Can a women’s health nurse practitioner provide testosterone replacement therapy for male patients?
The women’s health nurse practitioner (WHNP) is educated, certified, and licensed to provide primary care of women from puberty through older adulthood. Their scope includes the care gynecologic conditions, prenatal, antepartum, and post-partum care. In addition they may care for the sexual and reproductive health of men. It is within the WHNP’s scope of practice to provide testosterone replacement therapy for men experiencing hypogonadism.
I am an adult gerontology primary care nurse practitioner and have an oncology APRN certification. I currently work in oncology. How does this advanced APRN certification affect my scope of practice? Am I practicing out of scope?
Several national nursing organizations such as the Oncology Nursing Society, American Nephrology Nurses Association, and Gerontological Advanced Practice Nurses Association offer specialty nursing certifications. These certifications validate and recognize one’s expertise in a particular nursing specialty. They do not expand the nurse practitioner’s scope of practice as defined by their education, board certification, licensure and the respective national nursing organization that define NP scope of practice.
This type of certification shows one’s dedication to their area of specialization but is not required to practice or get licensed. Some of these specialty certifications include content in review materials and on the test that is not within the respective nurse practitioner’s scope of practice. For instance, the ONC certification may include content on the evaluation and treatment of superior vena cava syndrome or tumor lysis syndrome. These patients are considered unstable and should be cared for by an acute care nurse practitioner, not a primary care nurse practitioner, such as an adult gerontology primary care nurse practitioner (AGPCNP). The completion of this certification does not qualify the AGPCNP to provide care for patients that are unstable acute illness or are critically ill.
Any nurse practitioner that has completed advanced certification such as the one described above, should be commended on their achievement but must recognize that they must still work within the confines of their scope of practice, as defined by their education, certification, licensure and by the governing national nursing organization.
Working in subspecialty practices such as oncology is considered an area of overlap between primary and acute care. Therefore, working in oncology is within the AGPCNP scope of practice provided, they do not care for patients that are unstable or critically ill.