Hired as a PNP, forced to work as an RN

Specialties NP

Published

So I was hired as a PNP at a pediatric urgent care. Then COVID happened. I have never been trained to work as an RN at an Urgent Care clinic... but they are forcing me to work as an RN. Are they allowed to do that? I have spoken up about not being OK with this... all that has bought me is a meeting with the director about meeting their standards of behavior. When I talked to my manager, the response was "at this time we need RNs more than we need providers." Let it also be known that 2 new doctors were hired in December. They start this month meanwhile our doctors and myself are not getting our hours as providers. What do you think?

Are you willing to relocate?

1 Votes

I wish.... it's not possible at this time.

1 Votes
Specializes in NICU.

If the clinic comes first, I would ask if the doctors are expected to act as medical assistants as well...

7 Votes
Specializes in Psychiatry.

Well shouldn't they value your career as well, the establishment should have a policy and procedure manual stating what the rules are regarding this. I would contact your state NP organization about it and talk it over with them. It sounds like they could care less about NP providers.

3 Votes
Specializes in DHSc, PA-C.

Doubtful a company has a procedure manual stating NPs can't do work that is beneath them. They can have you empty the trash and mop the floor if they wanted. They could have just laid you off, but instead kept you on. Being that you already work at this urgent care, what is the argument about not being trained? I worked in many urgent cares and wouldn't need any formal training to pick up nursing duties in a place I already work. Agree that if they are short, then both NPs and Physicians should pitch in with nursing/MA duties. Being that your an NP, and by default an RN, then nursing duties fall under your scope of practice. Your state organization can't do anything about it.

The liability issue mentioned...does anyone have a case in which an NP working as an RN got sued because s/he didn't do something that they would of as an NP, but didn't because they were working as an RN. I'm just trying to figure that out. If you're working as an RN you don't have privileges to perform NP duties right? I am trained to do things from working in prior specialties that I am not allowed to do now because I'm not credentialed to do so.

3 Votes

You are nothing more to them than a warm body with a license.....

2 Votes
6 hours ago, DizzyJ DHSc PA-C said:

Doubtful a company has a procedure manual stating NPs can't do work that is beneath them. They can have you empty the trash and mop the floor if they wanted. They could have just laid you off, but instead kept you on. Being that you already work at this urgent care, what is the argument about not being trained? I worked in many urgent cares and wouldn't need any formal training to pick up nursing duties in a place I already work. Agree that if they are short, then both NPs and Physicians should pitch in with nursing/MA duties. Being that your an NP, and by default an RN, then nursing duties fall under your scope of practice. Your state organization can't do anything about it.

The liability issue mentioned...does anyone have a case in which an NP working as an RN got sued because s/he didn't do something that they would of as an NP, but didn't because they were working as an RN. I'm just trying to figure that out. If you're working as an RN you don't have privileges to perform NP duties right? I am trained to do things from working in prior specialties that I am not allowed to do now because I'm not credentialed to do so.

The cases are extremely thin simply because most healthcare facilities understand the conundrum. In my state, your scope of practice is determined by the employer’s policies - but your responsibilities are at your level of licensing - the state can absolutely enforce that.

So, accepting a “bad” order from another provider - and carrying it out according to company policy - doesn’t mean you’re not responsible for the outcome. If the standard for an RN is “the average new-grad RN should know xyz”.. The standard for a NP might well be “the average new-grad NP should know xyz”.

The opportunity for mayhem is substantial in the case of a missed diagnosis- especially since a provider “working as an RN” likely wouldn’t have the benefit of all the information the ordering provider had.

BON’s are experts at 20/20 hindsight, as are attorneys.

3 Votes

Well Dizzy thanks for asking instead of assuming you know anything about the situation. RN: triage, assessment, meds, documentation, discharge education is all fine and dandy. But the RN is also a supervisor position.

I am credentialed and have privileges and have been working as an NP here since Jan. Then covid happened. I did telemedicine from April to June due to low census in the UC. This is my 1st job. Nowhere in my contract does it say that I am expected to work as an RN

We don't even use the same EMR template. There were checks in the procedure room they do daily that weren't done because I didn't know they did them and noone told me about them. Some lady came with meds yesterday. Do I log them somewhere or just stick them in the cabinet? Why does it say we have 50 face shields in the inventory but they're nowhere to be found. Do they have a different spot for them that I don't know about? Oh....and I'm not supposed to chart the phone calls I make to give parents results in the phone call tab? Oh I didn't know because no one told me. I was a neonatal/pediatric CCT RN for the last 6 years.... being and RN doesn't automatically make you able to do any RN job anywhere.

Oh and when it gets busy they'd also like me to be logged into 2 computers. One as an RN and one as an NP so I can triage, assess, examine, treat and discharge as an RN on one computer and an NP on the other computer.

I've emptied the trash as and NP...

I've discharged, I've cleaned rooms, I've medicated its not the work being "beneath" me. It's the fact that when the RN that puts her 2 weeks in asks to be per diem they say no... because they have good ol me to fall back on. I was not hired to do this and am the only NP here and the only provider that is being asked to do this.

2 Votes
On 8/11/2020 at 3:50 AM, caliotter3 said:

Do you feel strongly enough about this to resign? I would go along with the plan if they had not hired the new doctors, but they are flaunting that their excuse to you is a crock. It bears serous reflection about other ways they will treat you in the future. Can your career take a resignation on principle?

Agreed with this post and the other poster. Start looking for a new job and walk. This place stinks. You even have a good story as to why you are leaving before a year - COVID caused decreased visits and RN leaving resulted in your role being changed completely and you are looking for an NP role.

3 Votes
Specializes in Retired.

But there is still the mortgage to pay........If you can't leave, I think I would rather work as an RN only so that you are never in the position of being logged in two computers simultaneously. Let the Md's be forced to absorb the NP's job. Not perfect solution but you can give them a taste of their own medicine. Throw the problem back into their laps.

3 Votes

When I read about being logged into two computers at once, each for its own role, my first thought was “how exciting “. I could also see an open bottle of liquor near each for stabilization of thought processes before making entries. This situation is making you open to errors that you don’t need from your first NP job. Good luck with that job hunt. Meanwhile work as slowly as necessary to insure you don’t get confused and make mistakes.

6 Votes

I did it a couple of times and then refused to do it anymore.

4 Votes
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