NP's answering to Nursing Management?

Jules A, MSN · Oct 23, 2016

I think the differentiation is whether NPs are considered nursing staff or medical staff. I won't work as nursing staff although there is only one hospital in this area who does it that way and they are very cheap, go figure. If I was a PA there would be no way I'd even consider this foolish notion. What exactly is their end game I wonder?

PG2018 · Oct 23, 2016

Where I live a physician group was contracted to work area ERs. They also provided FNPs and PAs for ERs. Recently, I've noticed the hospitals have ads posted for FNPs to work the ERs. The hospital already employees the hospitalists so maybe they'll fall under medical oversight. It wouldn't surprise me to find RN managers trying to direct them. The "board" of nursing already has LPNs and RNs directing NPs. Stupid really.

Jules A, MSN · Oct 23, 2016

Admin, Maybe consider merging this into the same thread in the NP section?

Susie2310 · Oct 23, 2016

Your regulatory body is your state board of Registered Nursing, and the laws/regulations governing your practice are to be found on your state BORN web site, is this not true? You are a nurse with advanced training, but you are not a doctor, so why is it inappropriate that a nurse manager should head your practice?

ohiosam2 · Oct 23, 2016

Nursing managers do not practice medicine. Our manager now is a physician who offers us a resource and recommendations on how we practice and how best to practice Emergency Medicine. He reviews our charts and will offer constructive criticism and praise for the way we practice and will assist us in education if there is something we are lacking. A nurse manager cannot offer this kind of support or management. Our physician management also has quality indicators that are directly applicable to our practice as providers. Nursing management would have no idea which quality metrics to monitor as they are experts in nursing practice and not medicine. I think a colleague of mine summed it up nicely. We are providers. We are no longer nurses. We need to have other providers managing our practice because what we do is very different than nursing. I will say this too. The statement was made by nursing management that if they would like to manage NPs so that we could assist with the nursing role when we are not busy. I would love to have a day in the ER when I am not busy. I sit down for 4 hours every day to chart on the multitude of patients I have seen that day. Nursing considers this "doing nothing" because they see us sitting in front of a computer. They would like for us to help out with the nursing role on our down time? That is not my role any longer. This is an example of how a nurse manager does not understand the NP role because they are not an advanced practice nurse.

Jules A, MSN · Oct 23, 2016

Nursing managers do not practice medicine. Our manager now is a physician who offers us a resource and recommendations on how we practice and how best to practice Emergency Medicine. He reviews our charts and will offer constructive criticism and praise for the way we practice and will assist us in education if there is something we are lacking. A nurse manager cannot offer this kind of support or management. Our physician management also has quality indicators that are directly applicable to our practice as providers. Nursing management would have no idea which quality metrics to monitor as they are experts in nursing practice and not medicine. I think a colleague of mine summed it up nicely. We are providers. We are no longer nurses. We need to have other providers managing our practice because what we do is very different than nursing. I will say this too. The statement was made by nursing management that if they would like to manage NPs so that we could assist with the nursing role when we are not busy. I would love to have a day in the ER when I am not busy. I sit down for 4 hours every day to chart on the multitude of patients I have seen that day. Nursing considers this "doing nothing" because they see us sitting in front of a computer. They would like for us to help out with the nursing role on our down time? That is not my role any longer. This is an example of how a nurse manager does not understand the NP role because they are not an advanced practice nurse.

Oh so its that familiar slippery slope. YeahhhhhNO. Not even cracking the door to something that will have me doing duties my physician colleagues aren't. Good for you and your peers for recognizing it for what it is and nipping it in the bud unlike what I have seen in the past where NPs are so smugly co-dependent they will do anything to feel needed or because they don't have the stones to push back.

Psychcns · Oct 23, 2016

You would think nurse managers were busy enough without overseeing providers. I could imagine higher management seeing it as efficient but I can't see why nurse managers would want it. The example above is to have NPs cross train as RNs which doesn't make sense either. I could imagine upper management wanting more "productivity" from physicians. When I work locums I have had nurse managers sign my time sheet but there was always some kind of accountability to a physician.

Susie2310 · Oct 23, 2016

Nursing managers do not practice medicine. Our manager now is a physician who offers us a resource and recommendations on how we practice and how best to practice Emergency Medicine. He reviews our charts and will offer constructive criticism and praise for the way we practice and will assist us in education if there is something we are lacking. A nurse manager cannot offer this kind of support or management. Our physician management also has quality indicators that are directly applicable to our practice as providers. Nursing management would have no idea which quality metrics to monitor as they are experts in nursing practice and not medicine. I think a colleague of mine summed it up nicely. We are providers. We are no longer nurses. We need to have other providers managing our practice because what we do is very different than nursing. I will say this too. The statement was made by nursing management that if they would like to manage NPs so that we could assist with the nursing role when we are not busy. I would love to have a day in the ER when I am not busy. I sit down for 4 hours every day to chart on the multitude of patients I have seen that day. Nursing considers this "doing nothing" because they see us sitting in front of a computer. They would like for us to help out with the nursing role on our down time? That is not my role any longer. This is an example of how a nurse manager does not understand the NP role because they are not an advanced practice nurse.

Your scope of practice is dictated by what your state board of Registered Nursing permits in regard to Nurse Practitioner practice, is that not so? You may be a provider, but you are still a nurse.

I understand why you don't want to have to perform the duties of RN's, but that is a separate issue.

Psychcns · Oct 23, 2016

As a psychiatric provider I have the same role expectations as a psychiatrist. Yes, we are regulated by our state BON, and we are usually credentialed as part of the medical staff.

Susie2310 · Oct 23, 2016

As a psychiatric provider I have the same role expectations as a psychiatrist. Yes, we are regulated by our state BON, and we are usually credentialed as part of the medical staff.

I don't know your scope of practice, but I assume you assess patients, develop a plan of care, and can order some medications and treatments/interventions, monitor their effect, and revise the plan of care as needed within your scope of practice. But you don't have the same level of responsibility or accountability as a psychiatrist as you are not trained as a psychiatrist. A psychiatrist is still ultimately responsible for the care of the patient.

Psychcns · Oct 23, 2016

The places I have worked inpatient, one time a psychiatrist was listed as the attending. Otherwise I am. For outpatient sometimes I have a collaborator and sometimes I dont. I thought in independent practice states I am responsible for my own practice. Even in collaborative practice states I am responsible for my practice. Do you have a different understanding? What state? One time. I had a psychiatrist read my charts and it felt like micro managing and was not helpful. I consult with psychiatrists. How are you seeing the accountability of a psychiatrist as different from mine when it is often the same role.