Quote from Bonosgrrl
"From a regulatory standpoint, you are always legally entitled to work under your RN license, as long as it is current and you meet all RN requirements. However, insurers agree that someone with advanced practice training and certification needs to be insured at the higher level, regardless of position. See the NSO newsletter answering this topic at: http://www.nso.com/newsletters/advisor/2000/np/npra5.php#qa
Role validation is a large component of scope. If you take such a job, you will need to ensure that the role validation of the RN, rather than that of the NP, is the face you hold out to the public.
The setting where you are employed can also help match your role validation, by keeping your job title, job description, duties, and activities crystal clear. The most conservative advice would be to avoid working in areas that share
the specialty of your advanced practice focus (such as a nurse midwife working as a labor and delivery nurse). Taking such a position is asking for role confusion, and that, in turn, affects your ability to practice appropriately with your patients."
Regardless of what "face you hold out to the public," it is well established in the courts that, if something goes wrong and you end up in court, you will be held to the standards of the highest level of education and licensure/certification you hold, regardless of what your particular job title was that day, or what role your employer was paying you to fill. Why do you think NSO is saying that "insurers agree" that you should be insured at the higher level? -- because that's the role/standard to which you're going to be held in court
, and that's the level at which damages, if any, will be levied. This is what makes working in two different capacities so complicated legally/ethically, and why many employers just won't hire people to work below their level of licensure. Advanced practice nurses like to do it because it's a comparatively easy way to pick up extra cash, but it's important to recognize you're taking a chance.
One quick reference (I'm sure there are lots more out there); emphasis mine:
"Practice Below Level of Licensure
A licensed person who agrees to be employed in a position which requires less knowledge and skill than that for which s/he is prepared may find several problems:
1. S/he may be expected to perform at the level for which s/he has been prepared even though classified at a lesser level; and
2. S/he will be held to the standard expected of the higher licensure level should legal problems occur in that health care facility, no matter what the job classification.
The practice of employing licensed individuals to work below their level of preparation, as defined in the LAW REGULATING THE PRACTICE OF NURSING, places that licensed nurse in potential legal jeopardy and is of serious concern to the Board. (1985)
[The DATA BASE /The Bulletin /Spring 1985]"