Virtually Any Specialty Can Be a Fit for Working in Hospital Settings

By Stephanie Jordan
Managing Editor, Connections

One of the great things about becoming a nurse practitioner is that there are a number of options when it comes to selecting a practice area. NPs train in broader specialties than those of physicians such as 'family' and 'acute care' rather than specialty specific like 'cardiology and 'urology.' So if an NP’s degree covers a broad range of medical specialties, how do NPs get placed in a hospital setting? In a cardiology practice, for example, are family NPs, acute care NPs, or adult geriatric NPs best suited to work with these patients?

According to a 2018 AANP National Nurse Practitioner Sample Survey, 41.7 percent of full-time NPs hold hospital privileges. One such NP is CANP Tri-Valley Chapter member Jennifer T. Dixon, an NP hospitalist providing care and management to hospitalized adult patients. When asked which specialty is best suited to hospital work, Dixon says that the type is not a limiting factor.

“Family, adult, acute can all work in a hospital setting. There are no real barriers that I have seen,” says Dixon. “NPs don't have a residency program like physicians do, so we train with the physician we work with, within our scope of practice. If you are new, expect a training period and that you will probably be assigned to do simpler things at first. The hospital is often not the employer, instead we are privileged (credentialed).”

Credentialing or obtaining privileges is the process of establishing the qualifications of an individual to work in a specific environment. This generally includes a background check along with an assessment of academic and certification credentials, work history, recent continuing education, and current licensure. In most facilities, two levels of privileges exist. Full privileges allow you to admit patients yourself, make rounds on your patients and discharge them without supervision or co-signature. Nurse practitioners rarely obtain such privileges. Nurse practitioners are usually awarded associate or ancillary privileges

Dixon herself is not employed by the hospital, but rather is a Lead NP with the Regal Medical Group, one of the largest networks of physicians and specialists in Southern California.

“I am seeing more and more private physicians adding NPs to their practices and they are mentoring them into their specialties. The specialty type of NP is not as important as personality, fit, and communication skills and whether the physician believes he or she can mentor the NP,” states Dixon.

Dixon believes the influx of NPs coming into hospitals is because physicians are seeing the value that NPs can offer, like nursing knowledge and communications skills. “It becomes a great collaborative relationship,” says Dixon. “I really love what I do.”

But Dixon has had to work hard to establish herself and as a result has contributed to the reputation of NPs in the hospitals she is associated with.

“In the beginning, I had to stay strong and show what work I could do. It required a huge work ethic. I think nurses are like that. In addition to our medical training as NPs, we also develop strategies, like how to approach people, educate the families, offer end-of-life care, and provide emotional support. We have a greater ability to connect.”

Because of the nature of the hospital structure, patients are admitted only to a physician. All of Dixon’s orders and reports must be co-signed by a physician.

“We work together so closely and collaboratively,” states Dixon. “In that way the hospital setting is more immediate than the outpatient world, with less frequent physician interaction. The physician and I do our rounds together and she says to patients, ‘We are the medical team that will take care of you while you are here.’ I really enjoy the close working relationship I have with my physicians. Our cases can be very complicated, so it is really nice to have someone to talk to and collaborate with.”

Do patients accept her as an NP or do they prefer to see the physician? 

“Today people have a better understanding of what we do, but we are still on a trajectory,” admits Dixon. “People accept that I am part of a team. I don’t wear a lab coat, instead I like to wear fun, bright colors. Even still, a lot of people call me ‘Doc’ – in fact, there is no word for nurse practitioner in Spanish. They will call me ‘Doctora’ -- but I will correct them and say, No, this is what NPs do, deliver care, and connect with the family.”

Very rarely has a patient asked to see a physician instead of Dixon. But if they do, she rolls with it.

“It’s okay if they ask. They have a right to see who they want, and the physician has experience that I do not have. But it doesn’t happen often and it doesn’t bother me. I do reinforce the team, that this is our plan and that ‘we are all working together for you’. You just have to put out a ton of confidence in your knowledge and what you can offer.”

Dixon does note that she is never unprepared when working with a patient.

“I feel like I do have to be super prepared. I read everything and know everything that I can before I see the patient. If I don’t know something, I will say, ‘I don’t know. The surgeon can answer that.’ But you have to be on your game.”

What Dixon loves about being an NP in a hospital setting is the bond she makes with patients and their families. While the relationship may not last for years, it is an intense experience for the family and for her.

“To be with people at their worst moments. It’s an honor to do that, to be a part of that,” concludes Dixon.