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Discussion

have you dealt with this issue?

Hi

I would apprecite opinions on this from other NP's, not sure if it is something worth drawing a line in the sand about, but let's just say, it irks me.

Basically the question is: When you are hired as an NP, should you have to do more menial LPN, MA tasks, just because you can? This seems wrong and I have not experienced it at other jobs.

I am an FNP and work with several LPN's. the LPN's do pt hx and vitals, and get basic testing such as PPD and Urine tests. Once this is done, I see the patient and so a physical and write a note (paper charting). the Nurses have other duties as well, but there are not clear job duties listed (a big part of the problem)

The previous NP, who I knew from a previous job, told me that it was not part of my job to do the Hx and vitals and PPD's and that I should not do it, becasue when she had offerred to help out, she was then expected to always do it.

I saw with my own eyes that the nurses were purposefully not getting the History and vitals,

and I cant say what they were doing, but when I was training, the clinic was way behind for this reason.

Today, the employer, who is off site, told me that he met with the new clinic manager (an RN) and said that I would be expected to do RN duties as well since I am an RN, and mentioned HX and vitals. I didnt say anything but I wanted to say that that was ridiculous.

Am I right?

(To be clear: I have no problem with helping out when needed, but to hire me as an NP, and then tell me I have to work as an LPN or MA seems screwed up. )

I will be meeting with the Clinic manager and employer on Monday, it may not be a big deal, just wanted another take.

Thanks!

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    I think your role should be clear that you are a provider, not a member of the nursing and ancillary staff. I do not work in the out-patient setting, I work in an ICU. Although I'm a CCRN and know what nurses do at the bedside, I do not chart hourly vital signs, empty Foley's to record I/O's, set-up my own hemodynamic pressure lines, or give scheduled meds. I do like to help, in fact, when I have to place lines many nurses ask me what I would need as far as line kits, sterile glove size, and sterile gown. I would always say I can grab those myself as long as they are available to assist with handing stuff once I'm in sterile attire.

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    • Experts

    Agree with Juan. You should have clear cut job duties. I work output dialysis for the most part. I do not work FOR the dialysis company but rather the nephrology practice. I do not provide pt care, I direct it. If something out of the ordinary occurs I do lend a hand. During a code I don't do CPR but rather run the code and assign tasks. A's an APN my duties more closely align with the MD. Can I do a manual BP, yep, can I do CPR, yep. But A's a rule I don't. As to histories, I do prefer to do my own, as my line of questioning is probably focused in a different direction. You need role clarification. I would point out too that in order for you to be the most productive nursing staff needs to step up and help...

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    I am the sole NP in a tiny clinic. Yes, I do 'RN or MA' type tasks. Why? Because there's no one else there to do them. We are training a new MA, but she's not comfortable with anything over a fingerstick yet. And that's fine, cause she busts her hiney to do as much as she can to help me.

    The OM can draw blood, but she is usually only there a half day anymore (a rant for another day). So, since I'm the one who will get the earful from Doc if bloods aren't done, it's me or nobody.

    That being said, if there's someone there that should be doing these tasks and is not doing them, then no. I would inform the bigwigs of that fact, you are not hired as an RN, you are an NP. If you were to assist with these tasks to help, that should be appreciated, not expected.

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    • Experts

    Here's something your management should understand. The most expensive person, i.e., the providers, should have as few menial tasks as possible so they can be face-to-face with a patient (and making money). My vitals are done for me by RNs, as well as med reconciliation's (I double check), social workers do the social history (which is important to me but doesn't need to be done by me). Does your management want you be be able to see, for example, 20 patients a day or 24? Hit them with the money card.

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    I agree with zenman. Just had a similiar situation come up this week. In the psych clinic, no injections are given. I think this is very strange because I left an agency that administered a lot of injections. The reason why we dont is there is no nurse. Well, one of the docs felt I should be able to give his patient a haldol dec injection because I was a NP. Luckily the Medical Director does not view me as an extender and stated I was not giving any injections. We need to hire lpns. Have I given injections...yes...would I give injections...yes but not as a regularly scheduled duty. I asked him (the doc) if he knew how to give injections? He said I offended him, but he sends the patient to his family doctor to get the injection!!! It gets worse...we have an CNS who works as a therapist and they felt she should give the injections as she did in the past...so CNSs are less??? I think not. She did not speak up, but I did. Yes we are RNs who are trained in advanced practice. It's funny to have other people in different professions get upset when NPs/ CNSs prefer not to give injections. Counselors and Clinical social workers arent asked to work as case workers. I do my own vitals as the last lpn was horrid and everyone essentially had the same vitals.

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    • Author

    hi thanks for your responses!

    it's nice to hear a few different scenarios that illustrate the same point. I think it's about respect and ignorance lol.

    I filled in at a different clinic yesterday, where I don't usually work, and had an experienced LPN

    who was fabulous and had things ready for me to sign etc when I came in, but I realized the overriding

    feeling I got was that she had respect for my position and was trying to help me. I realized it wasnt

    something I felt a lot of at the other clinics. I asked her if she felt that the NP should be doing the Hx, etc and she said

    that the only time that had ever happened was when they were behind and her and the NP would do 2 at the same time and then she would take over once the NP could see the patient. makes sense to me.

    I have seen this on other posts on this forum as well where anyone from MA's to LPN's, RN's whatever,

    especially if they are in Nursing school, or NP school or thinking of going to school, think that they are just as "Good" as an NP and that they are just not appreciated.Sometimes they are very valuable employees from an office manager standpoint, and they are praised for "running the show", but due to ego issues, they then think they are the most important person in the clinic.

    (actually I have seen posts here where the NP was forced to quit because the Doctor would not fire a rude MA or office manager, so sometimes they are right)

    One time at an urgent care clinic (at a different place) the MA was bandaging a patients arm and I said something to the patient such as " You're in good hands, she's the best", and she responded by saying, "yea, I could be the NP, I just need a few more classes". I think she believed it.

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    You cant make the company/practice much money if all you doing is vitals and labs all day. I've had to do 'RN' work because my RN was out sick and I didnt want to have to make more work for the other nurses already busting their humps. But I definitely wasnt given injections or medi-sets. Set limits and if they dont respond leave.

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    One time at an urgent care clinic (at a different place) the MA was bandaging a patients arm and I said something to the patient such as " You're in good hands, she's the best", and she responded by saying, "yea, I could be the NP, I just need a few more classes". I think she believed it.

    I almost spit out my coffee when I read this one. It's like me saying I can take your gallbladder out, all I need is a few more classes. Some people have no clue.

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