ER NP's/RN's

[Nelly, FNP]

Hello everyone! I was wondering if anyone could tell me the main differences between an ER NP and the RN. What added responsibilities/priveledges does the NP have in the ED? Also, is it true that they don't make much more than the RN? Any info would help. Thanks

[MAGIK GIRL]

if i am not mistaken, the np in an er functions like a pa. they see pts and present to the docs. they write scrits as well.

[FNP grrl]

i'll be starting in the fast track of an ER as an FNP soon. i have worked as an RN for years in the ER. i also work as an FNP in an urgent care. the roles are very different. as an FNP, i have more in common with the docs in the ER & urgent care than i do the RNs.

in urgent care, i work side-by-side w/ a doc. we each pick up charts & go in to see the next patient pretty much identically. i always consult w/ the MD any time the pt is very sick or very complicated or if i simply need some more in-depth medical information.

i am not required to present patients to the docs...it is my judgment whether or not to consult with them. once i got past the beginning stage in the urgent care, i consulted less & less. there are whole shifts now when i don't really discuss any of my patients w/ them. we work as colleagues. the docs co-sign all the midlevels' charts in that setting (PAs & NPs). in my state, PAs must always be countersigned, while NPs don't have to be countersigned after an initial time period passes.

i can write any RX that docs can in this state- ie, NPs here have full prescriptive authority, including narcs. this varies from state to state however.

NPs and PAs get a full history, examine/work up a patient, write orders, interpret tests, write Rx and make medical diagnoses just like docs do. all of that is outside the RN scope of practice. i am not saying RNs don't order & interpret tests 'cause we all know they do!! i'm still an RN- i haven't forgotten. ER nurses are especially independent as we all also know. however, legally speaking, the RN cannot give medical orders or make a medical diagnosis.

NPs and PAs also do more invasive procedures than RNs usually do. in my fast track/ urgent care setting, that means suturing, I&Ds, pelvics, reducing fractures & dislocations, digital blocks, etc. some NPs & PAs assist in surgery, put in chest tubes & central lines, intubate, etc. just depends on the setting.

in the fast track job, i will be seeing patients (alone) that were triaged specifically to fast track- they are supposed to meet certain criteria to go to fast track in the first place- not a perfect system of course. all depends on who is triaging & how busy the rest of the ER is. the docs are nearby & i can consult whenever i need to.

$$wise, i will be making quite a bit more as an NP that i did as an RN- plus productivity bonuses. of course, i never worked a lot of overtime as an RN either. and i never worked in a place where there was a severe RN shortage- so i am sure there are some travel/agency RNs in certain areas who will be making more per hour than i do. and ER pays better than, say, the health department. but overall NP salaries ARE higher than RN salaries.

the thing that i love about NPs is that they practice medicine with a nursing framework.

[TinyNurse, RN]

nice post FNP, even though we use PAs in our ED and not NPs, I understand the scope a whole lot more.

best of luck in your new job!

xo Jen

[FNP grrl]

thanks jen! i should also say that in my urgent care job, PAs & NPs work the same position. in my ER job, there are only docs & NPs. not sure why.

[RNin92]

Originally posted by FNP grrl

i'll be starting in the fast track of an ER as an FNP soon. i have worked as an RN for years in the ER. i also work as an FNP in an urgent care. the roles are very different. as an FNP, i have more in common with the docs in the ER & urgent care than i do the RNs.

in urgent care, i work side-by-side w/ a doc. we each pick up charts & go in to see the next patient pretty much identically. i always consult w/ the MD any time the pt is very sick or very complicated or if i simply need some more in-depth medical information.

i am not required to present patients to the docs...it is my judgment whether or not to consult with them. once i got past the beginning stage in the urgent care, i consulted less & less. there are whole shifts now when i don't really discuss any of my patients w/ them. we work as colleagues. the docs co-sign all the midlevels' charts in that setting (PAs & NPs). in my state, PAs must always be countersigned, while NPs don't have to be countersigned after an initial time period passes.

i can write any RX that docs can in this state- ie, NPs here have full prescriptive authority, including narcs. this varies from state to state however.

NPs and PAs get a full history, examine/work up a patient, write orders, interpret tests, write Rx and make medical diagnoses just like docs do. all of that is outside the RN scope of practice. i am not saying RNs don't order & interpret tests 'cause we all know they do!! i'm still an RN- i haven't forgotten. ER nurses are especially independent as we all also know. however, legally speaking, the RN cannot give medical orders or make a medical diagnosis.

NPs and PAs also do more invasive procedures than RNs usually do. in my fast track/ urgent care setting, that means suturing, I&Ds, pelvics, reducing fractures & dislocations, digital blocks, etc. some NPs & PAs assist in surgery, put in chest tubes & central lines, intubate, etc. just depends on the setting.

in the fast track job, i will be seeing patients (alone) that were triaged specifically to fast track- they are supposed to meet certain criteria to go to fast track in the first place- not a perfect system of course. all depends on who is triaging & how busy the rest of the ER is. the docs are nearby & i can consult whenever i need to.

$$wise, i will be making quite a bit more as an NP that i did as an RN- plus productivity bonuses. of course, i never worked a lot of overtime as an RN either. and i never worked in a place where there was a severe RN shortage- so i am sure there are some travel/agency RNs in certain areas who will be making more per hour than i do. and ER pays better than, say, the health department. but overall NP salaries ARE higher than RN salaries.

the thing that i love about NPs is that they practice medicine with a nursing framework.

the beauty of your post is that NPs function INDEPENDENTLY...they do NOT need to present to the docs like the PAs do!! Kind of makes you wonder why the PAs make significantly more than the NPs do. Ahhh...the all omnipotent AMA.

:devil: