NP restrictions

[DD214_DOC]

This is for my wife, who is contemplating becoming a NP in Women's Health.

I'm not sure how the mid-level stuff works. Could a women's health NP work under the license of a family doc? I don't know if they HAVE to work under an OB/Gyn or what, or could the WHNP take care of the Gyn stuff a family doc would see?

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[deleted6669]

if she wants to go the np route then fnp(family nurse practitioner) is a much more flexible option as an fnp can see kids and adults(male and female) and work in primary care or urgent care settings.an fnp can do anything a women's health np can do but a womens health np can do obgyn only. no kids. no male pts.
as far as supervision goes it varies by state of practice.

 

[core0]

if she wants to go the np route then fnp(family nurse practitioner) is a much more flexible option as an fnp can see kids and adults(male and female) and work in primary care or urgent care settings.an fnp can do anything a women's health np can do but a womens health np can do obgyn only. no kids. no male pts.
as far as supervision goes it varies by state of practice.

Take a look at this article. It does a nice job of explaining NP scope of practice and why the FP WHNP thing won't work.

http://www.medscape.com/viewarticle/506277_1

David Carpenter, PA-C

 

[deleted6669]

Take a look at this article. It does a nice job of explaining NP scope of practice and why the FP WHNP thing won't work.

http://www.medscape.com/viewarticle/506277_1

David Carpenter, PA-C

YOUR LINK REQUIRES A MEMBERSHIP....
if the gist of the article is that an fnp can't do women's health then it is not accurate.I know lots of fnp's who work in gyn and at planned parenthood, etc

 

[primadonna22274]

Hey E, just so you know, medscape is totally FREE.
I've had it since PA school and I like it. It's not Up-to-date or MDConsult but it has its own niche.
L.

YOUR LINK REQUIRES A MEMBERSHIP....
if the gist of the article is that an fnp can't do women's health then it is not accurate.I know lots of fnp's who work in gyn and at planned parenthood, etc

 

[core0]

YOUR LINK REQUIRES A MEMBERSHIP....
if the gist of the article is that an fnp can't do women's health then it is not accurate.I know lots of fnp's who work in gyn and at planned parenthood, etc

You're asking the wrong question. The question is not are FNP's working in gyn, but according to nursing should they be. This is the interesting debate that appears to be going on between those who teach and those who work in field. The academic perspective seems to be if you were not trained as a nurse practitioner in that field then you should not be working in that field. Since there is a Women's health NP then they should be occupying this niche. Here is an example from the article mentioned (which has free registration):

"I am a psychiatric mental health NP (PMHNP), working in a VA health system. My patients wait a long time to see their primary care provider. Can I treat a rash that I see and prescribe hydrocortisone? Does it make a difference if this medication is over the counter?

The answer is a qualified perhaps. Do you have clinical and didactic training in your preparation, including physical assessment, to evaluate the differential diagnosis of the rash? Are you familiar with all of the medications the patient is taking as well as other health conditions such as liver disease? What type of follow-up visit and examination can you offer this patient if the rash is not getting better? Is the rash secondary to a condition that you are treating such as a reaction to medications you have prescribed? If so, treatment may be appropriate in the context of your care of the patient. However, since you are not available or designated as this person's provider for their other medical conditions, it would be difficult to identify on what basis you have chosen to treat (and feel yourself qualified to treat) some conditions and not others.

There have been several licensing disciplinary cases related to both FNPs treating mental health conditions and PMHNPs treating primary care conditions. In the case of the FNPs, many were not licensed or clinically trained to differentially diagnose beyond the very basic self-limited mental health conditions, yet had prescribed medications such as antipsychotics or had mistakenly given selective serotonin reuptake inhibitors to patients with mood disorders who they thought had simple self-limited depression. Lack of access to mental health providers (or primary providers) may be an issue, but it does not change the requirement to get your patient to the most appropriate provider to coordinate their care. For the PMHNP, coordinating or initiating treatment for primary care conditions without the knowledge of a primary care provider can be a significant area of risk to the patient and to your license."

Contrast this with the reality - if you are not treating bipolar disorder in primary care you are probably in the minority. From the PA perspective it is an interesting concept - that you are limited by your certification, function, and job type - as opposed to limitations imposed by your supervising physician. Notice the emphasis on clincal and didactic training. Contrast this with the mentor relationship where the PA function evolves with the job and function.

David Carpenter, PA-C

 

[DNP student]

YOUR LINK REQUIRES A MEMBERSHIP....
if the gist of the article is that an fnp can't do women's health then it is not accurate.I know lots of fnp's who work in gyn and at planned parenthood, etc

The statement was "WHNP cannot work in FP, but FNP can work in ob/gyn."

 

[DD214_DOC]

Well, that sucks, as I'm certainly not going into OB/Gyn. I'm obviously not going to influence my wife to do something she doesn't want to do, so maybe I'll hope I start/join some type of combined practice, clinic, whatever that has OBs around.

 

[core0]

The statement was "WHNP cannot work in FP, but FNP can work in ob/gyn."

And my statement stands. Is a FNP trained for the entire spectrum of OB/GYN? The nursing answer seems to be that since there is a different specialty that covers that then no they can't. Specifically there are conditions that FP farm out to OB such as high risk, fetal testing etc. So if you do not have that didactic training then you are outside of your scope of practice. In a situation such as planned parenthood where there is a subset practiced (depends on the planned parenthood) this may be possible (many Planned Parenthood clinics are manned by FP docs).

David Carpenter, PA-C

 

[DNP student]

And my statement stands. Is a FNP trained for the entire spectrum of OB/GYN? The nursing answer seems to be that since there is a different specialty that covers that then no they can't. Specifically there are conditions that FP farm out to OB such as high risk, fetal testing etc. So if you do not have that didactic training then you are outside of your scope of practice. In a situation such as planned parenthood where there is a subset practiced (depends on the planned parenthood) this may be possible (many Planned Parenthood clinics are manned by FP docs).

David Carpenter, PA-C

Actually, many (I don't know about all) FNP programs spend class and clinical time in OB/Gyn. However, WHNP's spend little or no time in FP.

 

[deleted6669]

Actually, many (I don't know about all) FNP programs spend class and clinical time in OB/Gyn. However, WHNP's spend little or no time in FP.

I guess the question is does fnp go as in depth into obgyn as a whnp?
are there things that a whnp might learn that an fnp does not like endometrial biopsies or management of high risk ob pts?

as a pa student I did 200 hrs of obgyn to include gyn clinic,fetal monitoring, labor and delivery, c-sections, hysts, tubal ligations, colposcopy,etc but never did endometrial biopsies or inserted norplants.
on my er rotations I managed common urgent/emergent obgyn complaints like pain/bleeding in preganancy, dysfunctional uterine bleeding, vag d/c, etc but do not do things like place iud's, etc that a pa or np who works full time in obgyn might do.I assume my experience is similar to what an fnp might learn. above and beyond this what does a whnp do?

 

[DNP student]

I guess the question is does fnp go as in depth into obgyn as a whnp?
are there things that a whnp might learn that an fnp does not like endometrial biopsies or management of high risk ob pts?

as a pa student I did 200 hrs of obgyn to include gyn clinic,fetal monitoring, labor and delivery, c-sections, hysts, tubal ligations, colposcopy,etc but never did endometrial biopsies or inserted norplants.
on my er rotations I managed common urgent/emergent obgyn complaints like pain/bleeding in preganancy, dysfunctional uterine bleeding, vag d/c, etc but do not do things like place iud's, etc that a pa or np who works full time in obgyn might do.I assume my experience is similar to what an fnp might learn. above and beyond this what does a whnp do?

Of course a WHNP would go more in depth about womens health than an FNP and be more qualified. I really don't know a WHNP, most nurses do the midwifery route instead. I just know that some FNP programs have ob/gyn rotations.