Full time NP position requires you to cover RN duties at times?

JALEXSHOE · Jul 20, 2007

This is a tough one.

I will give you the best advice I can come up with off the top of my head. Know that it is JUST advice and worth exactly what you paid for it, which is most likely nothing, lol.

What does your job description state? What are your duties? Is she right in asking you to help? It gets very sticky here. You state you are inactive and then you state that she is asking you to cover when they are busy (is it just busy or overloaded?).

Ok, what does your state's nurse practice act state? Some states would see this as under your title, and some would see it as you acting out of your scope, because you were employed in a different role. Again, this question isn't one to be answered with conjecture, you would really need to investigate to make sure you are not breaking any rules. This investigation should take place on both the employer and state level.

For example, I have known paramedics who were also nurses. In the hospital, when they are nurses, they cannot do some of the things they do as paramedics (like EJ lines) because the job description does not cover them. This sets them up for risk of loss of their licensure and both the employer and themselves up for liability.

Once you have this information, you will be better armed to talk with your supervisor about this. If you do decide to approach her with this, make sure you are constructive and positive. Be willing to state facts without emotion, and have alternatives suggested. Approach this like it is something you want to resolve and fix. Be willing to state that wish to help, but you want to make sure...yada, yada, yada... But be prepared, that if she continues, you can follow your grievance policy or you might want to seek another position if the environment is not what you want it to be.

How do the other nurses act when you are put in this role? Are there other nurse practitioners where you work, are they treated the same? What are their views?

Another way to approach this, is if it is acceptable under the guidelines above, then instead of being inactive, find ways to be active within your own role. There are some people that are of a mind that "idle hands are the devil's handiwork," and if that is the reason, well the only thing that will fix it is productivity. So don't give her a reason to send you to work.

Good luck!

Selke · Jul 21, 2007

Why is this administrator giving you evaluations? You aren't a nurse there. Shouldn't the MDs, if anyone, be evaluating your work? Does she evaluate the MDs?

What does your contract state? Are RN duties included in your contract? If not, then you are under no obligation to work as a nurse. You are a primary care provider, an APRN, NOT a nurse.

Are there other APRNs at your facility? If so I would ask them if they are expected to be a "back up RN". I would also bring this up with the MDs. I think this is highly inappropriate of this administrator and she's trying to use you to fix her scheduling or MA/RN staffing problems, and/or appease the MAs/RNs who are resentful of APRNs. (Yeah, I suspect there are other issues going on here ....)

Are you a member of an APRN professional organization? Is there one in your state? Can you contact your representative and discuss this with them?

Good luck getting this straightened out.

DucatiNP · Jul 24, 2007

Why is this administrator giving you evaluations? You aren't a nurse there. Shouldn't the MDs, if anyone, be evaluating your work? Does she evaluate the MDs?
What does your contract state? Are RN duties included in your contract? If not, then you are under no obligation to work as a nurse. You are a primary care provider, an APRN, NOT a nurse.
Are there other APRNs at your facility? If so I would ask them if they are expected to be a "back up RN". I would also bring this up with the MDs. I think this is highly inappropriate of this administrator and she's trying to use you to fix her scheduling or MA/RN staffing problems, and/or appease the MAs/RNs who are resentful of APRNs. (Yeah, I suspect there are other issues going on here ....)
Are you a member of an APRN professional organization? Is there one in your state? Can you contact your representative and discuss this with them?
Good luck getting this straightened out.

She evaluates me because I'm the main healthcare provider at my anticoagulation clinic, the MD is just available for consult by phone. I also get evaluated by the MD.

RN duties are not in my contract. But 'working cooperatively with other health team members' is in my contract.

"I are a primary care provider, an APRN, NOT a nurse."

I really want to say this to my boss/administrator who happens to be an RN, but how? (I have some ideas but other views help)

1) be constructive and positive.

2) be willing to state facts without emotion

3) have alternatives suggested.

4) approach this like it is something you want to resolve and fix.

5) Be willing to state that wish to help, but you want to make sure...yada, yada, yada...

(Thanks Jal)

Selke · Jul 25, 2007

She evaluates me because I'm the main healthcare provider at my anticoagulation clinic, the MD is just available for consult by phone. I also get evaluated by the MD.
RN duties are not in my contract. But 'working cooperatively with other health team members' is in my contract.
"I are a primary care provider, an APRN, NOT a nurse."
I really want to say this to my boss/administrator who happens to be an RN, but how? (I have some ideas but other views help)
1) be constructive and positive.
2) be willing to state facts without emotion
3) have alternatives suggested.
4) approach this like it is something you want to resolve and fix.
5) Be willing to state that wish to help, but you want to make sure...yada, yada, yada...
(Thanks Jal)

Some of these are good suggestions. I would still contact my local or state APRN group and try to find out how others handle this and your legal rights to refuse RN work. I'd think it would set a bad precedent for you to start "helping out" the MAs/RNs in the clinic; they will come to just see you as a glorified nurse and expect you to fill in whenever THEY feel you should, and the administrator will see you as a quick fix for her staffing issues. I wonder about interpreting the "working cooperatively with others" as filling the RNs role, vs working well with other team members? This seems to be a slippery slope ... are you the first APRN in this facility? If not, I wonder if this came up with others before you. Staffing the RNs/MAs isn't your responsibility to help the administrator resolve; it's her job. That's just how I see it. I don't have experience with this situation and would like to hear from other APRNs who might read this, too .... let us know how it works out.

DucatiNP · Jul 25, 2007

Some of these are good suggestions. I would still contact my local or state APRN group and try to find out how others handle this and your legal rights to refuse RN work. I'd think it would set a bad precedent for you to start "helping out" the MAs/RNs in the clinic; they will come to just see you as a glorified nurse and expect you to fill in whenever THEY feel you should, and the administrator will see you as a quick fix for her staffing issues. I wonder about interpreting the "working cooperatively with others" as filling the RNs role, vs working well with other team members? This seems to be a slippery slope ... are you the first APRN in this facility? If not, I wonder if this came up with others before you. Staffing the RNs/MAs isn't your responsibility to help the administrator resolve; it's her job. That's just how I see it. I don't have experience with this situation and would like to hear from other APRNs who might read this, too .... let us know how it works out.

Thanks Selke,

1) I'd think it would set a bad precedent for you to start "helping out" the MAs/RNs in the clinic; they will come to just see you as a glorified nurse and expect you to fill in whenever THEY feel you should, and the administrator will see you as a quick fix for her staffing issues.

The precedent has already been done. My administrator already expects me and the other NP to do MA stuff when we don't have one. My administrator makes sure the ENT surgeon and pediatricians will always have an MA or actually have an RN do their MA work. The NP's always get the short end staffing.

2) First APRN in this facility?

I'm the 2nd APRN in this facility, the 1st one is a GYN NP. And she doesn't mind doing whatever the boss says (shes been there for 27 years and shes going for 30).

3) I wonder about interpreting the "working cooperatively with others" as filling the RNs role, vs working well with other team members?

I have a feeling since she wrote the job description, and she cuts the paychecks, she gets to interpret it.

4) Staffing the RNs/MAs isn't your responsibility to help the administrator resolve; it's her job. That's just how I see it.

That's how I see it too, I would like to tell her that.

5) I don't have experience with this situation and would like to hear from other APRNs who might read this, too ....

That's why I posted this here, hopefully I'll have more views / wisdom from NP's with experience.

jer_sd · Jul 25, 2007

I approach this on a diffrent manner, I will help with RN duties in my department (radiology). If the nurse is off I will sedate patients for procedures (and bill the CPT codes), help out with IVs and other RN type duties.

However I have reminded the office manager and staff that I am held to NP standard of care not RN or MA standard of care and this limits my actions since I need to make sure there is appropriate follow through for patients and concerns (For example I can't just dip a urine and chart the results I need to make sure the patient is treated for a UTI) This increased lability makes it impractical for me to be a true replacement for an RN.

I believe that I am part of a health care team so I help out, if it gets too much RN role I always have patients I need to call back, charts to sign off ect not to avoid RN work but even if i do not have a patient waiting to see me there is still work to be done.

Jeremy

DucatiNP · Jul 25, 2007

However I have reminded the office manager and staff that I am held to NP standard of care not RN or MA standard of care and this limits my actions since I need to make sure there is appropriate follow through for patients and concerns (For example I can't just dip a urine and chart the results I need to make sure the patient is treated for a UTI) This increased lability makes it impractical for me to be a true replacement for an RN.
I believe that I am part of a health care team so I help out, if it gets too much RN role I always have patients I need to call back, charts to sign off ect not to avoid RN work but even if i do not have a patient waiting to see me there is still work to be done.
Jeremy

Great point, I am held to the NP standard of care! I was trying to put that into words when (without warning) the admin RN had me 'watch' / orient to the advice nurse position.

I said to my administrator, "You know, I CAN do the workup for the problem presented to me."

She said, "just watch the advice nurse, this isn't an orientation or anything."

I'm thinking, (then why am I watching).

Come to think of it, when I called the patient with the advice nurse for a follow up lab (for another doctor), I signed with an NP behind my name. Now I'm nervous that I did something wrong.

Thanks so much for posting! This board is so great, you all are really helping me out.

NeuroNP · Jul 25, 2007

I'm not an NP yet, so this is just my personal opinion...

I think there is a difference between "helping out" and working as a nurse. When I worked in the ER, we had a doc who was an ER nurse for several years before going to med school. He "helped out" a lot. When the nurse was busy, he dipped his own urine, sometimes he'd start his own IVs or draw his own labs. But he never worked as a nurse. He never took an assignment. He never once came in on a day he wasn't staffing and worked an assignment as a nurse, no matter how short-handed we were. And no one asked him to. Because, he was a doctor now.

My thought is, why should you be asked to do something that is not your job anymore just because it used to be? Again, I'm not saying don't be helpful and have the "that's not my job" attitude. But there's a big difference in helping out and working a shift as a backup RN. I'm not clear which it is that you're being asked to do. My impression is that they want you to, for example, on Mondays work as an RN and NOT an NP.

Maybe you should ask your administrator, since she's ALSO an RN, to pick up some shifts to "help out"?

SuesquatchRN, BSN, RN · Jul 25, 2007

If not, then you are under no obligation to work as a nurse. You are a primary care provider, an APRN, NOT a nurse.

Huh?

Advanced practice registered NURSE.

I object to the implication that this nurse is somehow not a nurse because she's a primary care provider. A regular old floor nurse, no, but a nurse none-the-less.

Trauma Columnist · Jul 25, 2007

The difference is the standard that you are held to. I would love to pick up shifts in the ER. However, as an APN I am held to that standard and its not safe then for me to work as a staff nurse. I do not mind helping out and do so frequently. I am very aware and proud that I am a NURSE, be it staff nurse, charge nurse or APN.

My only concern (and I'm thinking its shared with the OP) is that I am held to a higher standard.

JALEXSHOE · Jul 25, 2007

Yes, I agree. I wouldn't be adverse to helping out (I will always be a nurse), but I do worry that they put you in an unfair situation if they are having you work on a level where your license and current role would conflict with the role they transfer you to in high census. As an ARNP, you have a higher level of expectation of care. You need to contact your state boards supervisors and ask them many of your questions.

You mentioned, the other ARNP is doing this with no complaints whatsoever, so I don't know how much you will change, in that current environment, especially if she has been there 27 years and is still gleefully doing it. They have her example, and they seem to have set this as the standard.

You could probably print articles or legal statutes that you might be able to research and present them to her or the supervising physician correlated with specific instances where you feel that you may have been put in a precarious position. From what you have stated here, I rather doubt you may effect much change with this approach. It SOUNDS like this is what they expect and enforcing your rights will probably not make a comfortable environment for you.

If this is how they roll though, then you might be better served making the best of it, and looking for another job while you still feel you can get a decent reference. It depends on so many factors. You can't make people do the right thing. And not all places do things the right way, some unknowingly, for the sake of convenience.

Maybe, they aren't doing any wrong at all, maybe it is just not your cup of tea or the kind of job you want... We all have things we want and ways we want to practice. Shakespeare says to, " To thine own self be true."

All in all, it hasn't sounded like this is a "love your job just not all the people environment." Maybe you haven't found it yet. This could be a sign you need to be looking for it, lol. Sometimes, things happen, because someone somewhere has been sending us signs, and we who are so caught up in our everyday lives, just do not see them, until we get run over by them.