NPs more likely to be laid off than RNs?

allnurses Guide · Feb 7, 2009

I'm not sure what kind of answers you're expecting. Were they underperforming? Were there too many in the department? It's not really possible to tell who will be laid off. Sure, NPs cost more than RNs, but usually they bill, which is more valuable to the hospital bottom line than an RN.

zahryia, LPN · Feb 8, 2009

I'm not sure what kind of answers you're expecting. Were they underperforming? Were there too many in the department? It's not really possible to tell who will be laid off. Sure, NPs cost more than RNs, but usually they bill, which is more valuable to the hospital bottom line than an RN.

I think she wants to know if this is a trend and/or if people have seen this happen in their hospital. It's a fair question.

Advanced Practice Columnist / Guide · Feb 8, 2009

Agree with above. You'll have to look into specific circumstances and/or employment conditions. Typically, NP's are under medical services and not under the nursing department but as you well know, RN's are under nursing. Salary allocations are obviously from two different budgetary sources as far as the two disciplines. Also the revenue generating ability of the NP does carry weight as ghillbert pointed out. I'm wondering with the NP's being gone, who's taken over their role? RN's can not write orders for medical management on their own even in the ICU. Were the NP's eliminated so that RN's can call attendings directly and get verbal orders both during the day and night shift? Did they increase the number of on-call residents who cover the ICU? I highly doubt that this is the case as graduate medical education for house officers or residents is funded externally and slots are not usually increased that easily. There is also a limit on resident work hours so a hospital can not put a resident on call all the time.

Advanced Practice Columnist / Guide · Feb 8, 2009

So to answer the question, no, I've never seen NP's being laid off as part of staffing cuts but it probably has happened somewhere. I am aware of hiring freezes in some hospitals for clinical positions including those for NP's. I've also seen hospitals where a nurse pracititoner has left their position for another job but the position vacated was not replaced with a new NP, rather, responsibilities previously held by the NP who left were merged with an existing role of another NP.

allnurses Guide · Feb 8, 2009

I think she wants to know if this is a trend and/or if people have seen this happen in their hospital. It's a fair question.

I assume Joe is a male . He did not ask for people's experience with this, but asked "are NPs more likely to be laid off than RNs"? I agree that it's a fair question, I just don't think there's an easy answer as there are too many variables.

core0 · Feb 8, 2009

I've seen some NP positions that were essentially for Physician convenience. Things like D/C planning or management of patients for the private practice physicians - ie things that can't be billed for. I wonder as time get tougher if these positions will be eliminated. You also can see this in private practice. If the overall number of patients decreases then there is less work and less money coming in. You can't fire a partner so if you are going to cut headcount its either the non-partner physicians or the NPPs. In the OPs case without knowing what type of position or practice it was its hard to know if its a trend.

David Carpenter, PA-C

Trauma Columnist · Feb 8, 2009

Another issue to consider is the reimbursement rate. I work in a large nephrology practice and CMS decreased our reimbursement for dialysis patient visits by 5%. That translates to money lost in the practice.

ANPFNPGNP · Feb 8, 2009

I was doing a clinical at the local PICU and the RN there said that several NPs on their team had been laid off. To the best of my knowledge this particular institution has not laid off RNs or instituted a hiring freeze. Though they have laid off some nurse managers.
So, are you therefore significantly more likely to be laid off as an NP? It would seem that a hospital could do without its NPs more easily than it could do without its floor RNs.

Comparing RN's to NP's is like comparing apples to oranges. Our job description is VERY different from that of RN's.

About 7 years ago, I did some travel nursing and I worked in a NYC hospital. I was surprised to see the hospital had several NP's working in the hospital and also in their outpatient clinics. I went to dinner with one of the hospital supervisors one night and I told her I was very interested in becoming a NP. I specifically remember her telling me that those were the first jobs to go and it was much "safer" being a RN, because they always needed them. Now, it's important to realize that there are a LOT of foreign doctors working in NYC, plus a lot of physician's want to live in the Big Apple, so there may well be an oversupply of them. On the other hand, it really seems to make sense, economically, to have NP's doing the same work for less money, so it confuses me.

One thing I do know is that a lot of hospitals hire more CRNA's than anesthesiologists. I know an anesthesiologist who encouraged his son to become a CRNA, because the trend is to replace the higher paid anesthesiologists with CRNA's. Why pay an anesthesiologist $400,000 a year, when you can get 2-3 CRNA's for the same amount of money? Under the new administration, I really think there will be changes in the way the health care system is run...I can see it being a very positive thing for NP's in the future.

Trauma Columnist · Feb 8, 2009

I hope you are right about the trend for NPs.

westcoastgirl · Feb 9, 2009

Speaking only from personal experience, in an outpatient setting perhaps it is easier to quickly gauge the cost vs. revenue of a NP (or PA or MD for that matter) employed by a practice, than to zoom in on a specific RN whose daily activities, while documented, are really not the fodder for productivity reports.

Unfortunately I do personally know a few NPs who got laid off, not at my workplace but other practices. here a very experienced PA is under scrutiny not for lack of clinical skill but productivity (slow relative to the new quotas), and quite certainly the top of any layoff list in management's mind. On the other hand several chronically terrible RNs are still here, the RN manager does not have the skill or will to get rid of them. The cutbacks for them ended up being applied to the entire group, all hours cut whether good or not-so-good RN.

ANPFNPGNP · Feb 9, 2009

Speaking only from personal experience, in an outpatient setting perhaps it is easier to quickly gauge the cost vs. revenue of a NP (or PA or MD for that matter) employed by a practice, than to zoom in on a specific RN whose daily activities, while documented, are really not the fodder for productivity reports.
Unfortunately I do personally know a few NPs who got laid off, not at my workplace but other practices. here a very experienced PA is under scrutiny not for lack of clinical skill but productivity (slow relative to the new quotas), and quite certainly the top of any layoff list in management's mind. On the other hand several chronically terrible RNs are still here, the RN manager does not have the skill or will to get rid of them. The cutbacks for them ended up being applied to the entire group, all hours cut whether good or not-so-good RN.

It's not just NP's/PA's who are under scrutiny, it's doctors as well. I trained at a large clinic that employed 8 family docs and 6 IM docs. That clinic is notorious for running off doctors who are under performing.

At one of the urgent care clinics where I work, my boss has fired several residents, simply because they can't move patients fast enough. It's sad, because those residents are extremely thorough, etc. On the other hand, reality means that the business has to make money and you can't do that on 1 patient every 30 minutes. One resident actually saw one patient per HOUR and people were leaving in droves because of the wait...he lasted 2 shifts.