In the Fall of 2016, the Ohio Board of Nursing (OBON) released an article in their e-zine, Momentum, on the scope of practice (SOP) between acute care nurse practitioners (ACNP) and primary care (ANP, AGNP, FNP, WHNP) nurse practitioners. The article provided the OBON’s interpretation on the difference between these two population-focused specialties. The crux of the discussion was the word “unstable.” The OBON interpreted that if a patient was unstable, regardless of setting, only an ACNP could manage this patient. Then, if there was a “possibility” of a patient becoming “unstable,” as in an acute care hospital, only an ACNP could care for hospital patients. Further, if the FNP who has been managing primary care, urgent and emergent patients in an Emergency Department for years and has certifications in ACLS, TCLS and competency based education in ED procedures and emergency patient management, then these facts had no bearing on the subject matter as only ACNP’s can manage “unstable” patients. In fact, the American Academy of Nurse Practitioners states in their requirements to sit for the new Emergency NP examination you must be nationally certified as a Family Nurse Practitioner (FNP). You must also have a minimum of 2,000 direct, emergency practice hours as an FNP. How is one supposed to obtain these hours, if not permitted in the ED?
OAAPN has learned that at least 12 non-ACNPs have been reported to the Ohio Board of Nursing by ANCPs for practicing outside of their scope. These complaints were lodged before the publication of the OBON’s fall 2016 Momentum. These non-ACNPs are fully credentialed and privileged at the hospital systems where they work. There is no documentation of unsafe practice.
Unfortunately, there are unintended consequences of these actions which are not going unnoticed by the rest of the health care community. Hospital administrators, physicians and non-APRNs are shaking their heads over the actions of some ACNPs. Additionally, our physician assistant colleagues are strengthening the perspective that PAs can work anywhere as long as they have a supervising physician.
OAAPN will be meeting with the staff from the OBON in February about this issue. A question that needs to be asked: Are we no longer using the APRN Decision Making Model regarding APRN Scope of Practice?