Inpatient vs. Outpatient Challenges Faced by FNPs

Family nurse practitioners play an essential role in today’s health care environment, leveraging their advanced skill sets to serve patients across the clinical spectrum. Like most medical professionals, FNPs work in both inpatient and outpatient settings, each of which comes with distinct challenges and opportunities. Registered nurses intending to pursue an FNP career track should familiarize themselves with both of these clinical environments, along with the various competencies needed to function effectively in these domains.

Understanding Inpatient Care

An estimated 21% of practicing FNPs work in inpatient facilities, according to the American Association of Nurse Practitioners’ latest practice setting survey, conducted in 2014. These clinical sites support patients who require overnight hospitalization for treatment or observation. Here, FNPs often collaborate with attending physicians and other staff to serve patients in need of significant health intervention. However, a good number — approximately 40%, according to research published in 2014 in the Journal of Hospital Medicine — work autonomously in these facilities, carrying out essential clinical duties with great independence. What might this work entail?

In the formalized paired rounding model where FNPs work directly with doctors and split patient panels, these advanced practice professionals conduct daily visits, organize specialty consults, manage discharge activities and address billing, the Society of Hospital Medicine reported in 2017. In other cases, FNPs are assigned to observational units or relatively stable patients. Here, they can still act with great autonomy but do not have such heavy patient demands. Some inpatient health care operations assign FNPs to admissions, where they can get patients comfortable and prepare them for diagnostics, lab tests or procedures.

Understanding Outpatient Care

More than 42% of FNPs work in outpatient health care environments, the AANP’s practice setting survey from 2014 revealed. Such facilities center on medical services that do not necessitate hospitalization and can be administered during single visits. The nontraditional approach to health care has increased in popularity over the past decade due to the emergence of patient-centered care strategies and associated Medicare billing requirements, according to analysts for Deloitte in 2018. Additionally, the development of cutting-edge, minimally invasive treatments has supported the rise of outpatient care as a viable alternative to the inpatient approach.

FNPs have and continue to be involved in the ascent of outpatient services. The clinical duties associated with this work resemble those of inpatient FNP operations.

Grasping The Challenges

On the surface, it would seem that FNPs are able to navigate and find professional success in both inpatient and outpatient facilities. But this is not always the case, according to information from the SHM published in 2014.

A number of longstanding administrative requirements restrict FNP autonomy in inpatient and outpatient care settings. For example, Medicare dictates that attending physicians sign off on home care orders, an obvious roadblock to advanced-practice nurses who oversee patient discharge activities. Additionally, some clinics, hospitals and private practices maintain internal bylaws that restrict FNP functionality. These impediments, combined with the presence of old state legislation restricting FNP practice authority, can pose serious challenges to these medical professionals. On top of these functional complications, FNPs encounter a number of clinical issues stemming from higher rates of acuity. Without top-of-the-line education, it can be hard to capably care for modern patients, many of whom suffer from serious conditions.

Cultivating The Right Skill Set

While the above challenges certainly pose significant problems for FNPs, few allow such roadblocks to derail their work. How? By equipping themselves with the experience and skills they need to see success in the field via master’s degree programs. Nearly 98% of the nearly 150,000 FNPs working in the U.S. hold graduate degrees, according to research from the AANP. In short, graduate degrees are prerequisites for health care professionals intending to enter the FNP field. There are numerous programs available to aspiring FNPs. However, the online Master of Science in Nursing – Family Nurse Practitioner program at Bradley University has a unique offering.

Here at Bradley, registered nurses cultivate the skills they need to function as FNPs in both inpatient and outpatient settings. The degree track centers on nearly two dozen courses designed to help prepare future FNPs. Students start with core classes covering a variety of different subject areas:

  • In Statistical Procedures, aspiring advanced-practice nurses dissect key statistical analysis procedures and workflows, lending them the evidence-based mindset they need to do good work in today’s data-driven health care environment.
  • Advanced Pathophysiology touches on the biological investigation methods and theories that underpin modern patient diagnostic work, essential duties for FNPs no matter the clinical setting.
  • During Nursing Theories: Analysis and Development, students engage with theoretical models that define modern advanced nursing practice.
  • Leadership in the Health Care Delivery System addresses how FNPs can propel care quality improvement via their work with patients and colleagues.
  • Over the course of Legal and Ethical Issues in Health Care, ascendant FNPs grapple with the various external complications that come with delivering care in the 21st century.
  • Evidence-Based Practice takes on some of the overarching research utilization theories driving the modern medical arena.
  • In Advanced Health Assessment, future FNPs learn how to examine and collect data used in holistic health assessment of persons throughout the lifespan and deploy them as part of effective treatment plans.
  • Because technological literacy is essential to success in the FNP role, Health Informatics offers an overview of common health care IT.
  • Students enrolled in Health Care Policy develop an understanding of the wide-reaching legislation and regulation that drives clinical operations.
  • Advanced Pharmacology, which unfolds over two sessions, addresses mission-critical prescription distribution strategies — a key functional area for FNPs with prescriptive authority.

In addition to these core courses, aspiring FNPs enrolled in the online MSN-FNP program at Bradley University navigate five preceptor-guided clinical practicums that enable them to sharpen their skills by treating real patients. The degree track ultimately closes with a research-based capstone wherein students study and assess major issues affecting modern health care delivery.

In all, the educational experience offered at Bradley University can prepare FNPs for work in both inpatient and outpatient environments, giving them the opportunity to develop transformative clinical skill sets. Are you interested in enrolling in the online MSN-FNP program? Connect with Bradley University today.



AANP – What’s a Nurse Practitioner (NP)?

The Journal of Hospital Medicine – Nurse Practitioner and Physician Assistant Scope of Practice

The Hospitalist – The Role of NPs and PAs in Hospital Medicine Programs

Deloitte – Growth in Outpatient Care