"Ask NE GAPNA Members" Question

As someone who is a certified Adult NP from AANP and gerontological NP from ANCC, the option to combine both into the new Adult/Gerontological NP is not open to me. Since I occasionally have patients less than 65 yrs old in my nursing homes, I will have to continue to recertify with both organizations. I think at least one of the organizations should be willing to accept my other certification.

I worry that there will be legal scope of practice issues with the new distinction of primary care vs acute care in the future and that this distinction will severely limit employment opportunities in various practice settings. Will an Adult-Gero Primary Care NP be employable in a hospital setting or will an Adult-Gero Acute Care NP be employable in SNF? I currently work in a sub-acute setting - is that primary care or acute care? I'm concerned that the confusion with this may lead to PAs being employed over NPs to eliminate this issue for employers. There is also much concern about the grandfathered in GNP or ANP maintaining certification if they move state to state or if they have a long lapse in employment (possibly to raise young children or to care for an ill family member) that would not qualify them for recertification without testing. It also saddens me that Geriatrics is no longer recognized as an individual specialty worthy of standing alone. Susan, you bring up another issue which is that there are multiple certifying organizations for APRNs. Other professionals, such as physicians or lawyers do not have choices in the board that certifies them. It seems that in a "Consensus Model" a consensus on one certifying body would make things less convoluted.

I still have faith that experience, continuing education and active clinical hours in a specialty will support any primary care into acute and vice-versa. With independence in APRN practice (hopefully!), we will be accountable for our boundaries, skill and competency, so employment decisions must be made on the same playing field. My practice in dementia is based on my neurology background (CNRN), experience in Neuro-trauma ICU and continuing education in cognitive impairment & behavioral psychiatry. There is no certification in dementia, LTC or many other niche NP practices.
Interesting I just transferred my Adult NP-BC AACN (with GNP-BC) into AGPCP-BC, but I feel compelled to keep my GNP-BC. Still am on the fence, as it is expensive. What are other NPs doing?

I also am maintaining my GNP-BC in addition to the new AGPCNP-BC...I have hope that someday nursing will recognize that gerontology/geriatrics is its own specialty. I know many practitioners who are letting the ANP-BC go, but keeping the GNP-BC in addition to the AGPCNP-BC for that same reason.

I am a recruiter of Psych NP/CNSs and find it so difficult to find Psych NPs interested in the Geri population. I was hoping you can shed some light onto why this may be.
-Diana Cohen Connerty

Diana,
Speaking for myself there are two reasons: I don't want to restrict myself to just one aspect of care, and I don't want to be giving recommendations, I want to order what needs to be done
Susan

I am keeping my GNP, of course, since I cannot combine my certifications and I work in geriatrics. I would like to drop my ANP but I do have some younger disabled patients and so I will keep it too

I decided to keep my GNP:)
Susan, I would definitely keep the Adult certification as who knows what Medicare/Medicaid will do in the future in credentialing and reimbursement. I agree Diana, it is difficult to find any Mental Health APRNs. Have you tried the AAGP or APNA (both have career postings)? Locally in SECT, there are a few MH APRNs who bill insurances, but not enough for our referral needs. (This is a great incentive to allow APRNs to practice to their full scope!) What do the mental health, geri-psych or LTC APRNs feel about the direction of psychiatric care for our aging population? Are there ways to incentivize and increase numbers among CNSs and NPs to meet the competencies and provide geriatric psych-mental health at home, & in offices and LTC?

I think a lack of interest in the geriatric population is across the board in primary care. It is a dying speciality with MDs, and it occured with APRNs as well (low numbers enrolling in APRN gero programs and the general lack of APRNs to provide care for the aging population) and was part of the incentive to combine the Adult and Gero specialties. I think the same occurs in the psych community. Also, in my area at least, many of the psych NP jobs that require geri interest/expertise are in snfs, and I think there are many practitioners (and many in the general population) who flat out do not enjoy being in that setting. Having said that, I do know a few FNPs and ANPs who gave up primary care to work as geri psych APRN consultants (without the official psych certification) because the reimbursement/pay was so much higher than what they received in primary care.