Legally, Can I mix RN/NP roles?

Specialties NP Nursing Q/A

I work at a place where I was originally employed as an RN and then when I became and NP I was hired for that role as well.

I mostly work in my NP role but will occasionally work a shift as an RN there.

Now I know those roles cannot mix for example I know I can't clock in as an RN and then be ordering labs or adjusting meds because in that moment I'm working as an RN, not an NP.

However what about switching throughout the day, is that allowed? For instance let says I come in in the morning to do infusions strictly as an RN (it's an infusion clinic) but then I have two medical intakes mid-day (where I then step into my NP role) and then at the end of the day I have a couple infusions strictly as an RN.

I've already told my employer I would like to get NP rate across the board and just do infusions as an NP but I lost that argument so now I'm here deciding if it's legally okay to be going back and forth in my roles throughout the day. 

My employer is not requiring this but is offering the option if I want more hours.

17 Answers

Specializes in Adult Gerontology.

I do not introduce myself as doctor I introduce myself as a nurse practitioner. In Ohio we have to have a collaborative physician so I will usually say full name and then say I am the Doctors NP. I currently work for our medical director so I say I’m the medical directors NP. The issue with working as both an NP and an RN with the same patient in the same practice is multifaceted. 1. Scope of practice; an NP can diagnose, order diagnostics, admit to certain levels of care, prescribe, order equipment, order therapies etc. A nurse cannot do these things they are outside the nursing scope of practice. 2. Malpractice; many malpractice insurers will not cover an NP (or doctor or PA) who is working in a different lane clinically. Malpractice policies are very specific to the role you are performing. Further, if you are functioning as an RN and there is an issue with the orders or diagnosis etc that falls under Doctor or NP role and, as a nurse you cannot change it, in a court of law you could still be held to account for the orders/diagnosis of others as the courts will say you can’t unknow what you know 3. When practicing as an RN in the same setting where you are an NP there is role bleeding whether or not anyone wants to admit it. You may be there as a nurse, but you will have the knowledge of what should be ordered prescribed etc. so you can get in trouble with your nursing license for functioning as an NP when you were working as an RN. 4. CMS (Medicare and Medicaid); if you work with the same patients, in the same setting, at the same time (and they will consider on the same shift the same time) your organization cannot bill for both services. Now you might say well nursing isn’t coded and billed for it is part of the overall package but that is often not the case. And if you are on shift as an RN, switch over do some NP stuff (like intake admission) and then back to RN the place where the double billing will come in is when they bill for the services you provided as an NP. And double billing is Medicare fraud don’t for a second think it isn’t. Home health and home hospice NPs can get in a world of trouble in this way if they are coding in their payroll and documenting both an NP and nursing visit to the same patient on the same day. Just don’t do it, it’s legally sketchy, it’s role diminishment, it’s complicated for all involved and the only upside is it saves the employer a little bit of money when paying you at the RN rate. Why would anyone want to agree to that? 

Specializes in psych/medical-surgical.

Legally? Sure of course. You are always an RN if you are an NP. Can't be an NP without RN. RN license is TIED to NP license.

But uhh... practically? What the hell... why would you wanna split the two? You should be an NP all the time, and do RN tasks!!

Specializes in Occupational Health.

I wouldn't even consider it. Tell them to hire an RN and pick up extra hours as an NP somewhere else.

Specializes in Psych/Mental Health.
On 8/25/2021 at 8:49 PM, paramedic-RN said:

My concern is flip-flopping on that third day, so for instance if I did a medical intake in the morning as an NP and then the next hour did an infusion as an RN. 

Contact your state board of nursing and/or . They should be able to give you some insight.

Specializes in Adult Gerontology.

You need to check with your state board. In Ohio the board greatly frowns upon having a dual RN and NP role with the same patients; because the patient will identify with your NP role and have expectations of receiving that level of care when clinically engaged with you and per the board, you can’t unknow what you know, so even if you are practicing as an RN your NP knowledge will slip into the practice. They encourage us to not practice below our full scope.  The other issue is coverage and claims, because the court may also hold you to the higher practice level even when you are working as an RN. It sounds to me like your employer is trying to nickel and dime you find a better gig. These people are cheap and could be putting both your licenses at unnecessary risk.

On that third day do not flip flop between roles throughout the day. If you are there as an RN stay in that lane don’t let them pressure you into “ putting on a different hat” to do the intake then changing out the hat. My current employers DON kept trying to get me to do this to make up for her RN shortages. She also asked me on more than one occasion to go back and code in my payroll an RN code on the same visit I was seeing the patient as an NP. I refused on the grounds that I would not help her commit Medicare fraud. Which it is, it’s Medicare fraud to bill for two different service levels on the same visit. Move on or set better boundaries this employer does not have your best interests at heart. And they do not respect your role as an NP. 

If anything, the best way to avoid a conflict is to perform one job at a completely different facility where you are not credentialed as an NP.  that way you literally won’t be allowed to work to your full licensure. Either way I still find the idea ridiculous. 

Specializes in Vascular Neurology and Neurocritical Care.

Agree this is absurd. Don't even think about it. And how confusing it must be for fellow staff RNs who can't keep straight what role you're performing in, and now throw in being an RN and NP in same day! Nonsense. Agree with another poster, go get another job at another facility where there will be no role confusion.

5 hours ago, Neuro Guy NP said:

Agree this is absurd. Don't even think about it. And how confusing it must be for fellow staff RNs who can't keep straight what role you're performing in, and now throw in being an RN and NP in same day! Nonsense. Agree with another poster, go get another job at another facility where there will be no role confusion.

The persistent “I don’t want to lose my skills” is nauseating at best and career diminishing at worst.  It indicates a lack of commitment to a truly new career path and lack of interest or true interest in developing new stills that are necessary to succeed as a provider.  If people truly cherished those skills, they wouldn’t (and probably shouldn’t) have moved on to advance practice. 

10 hours ago, Kooky Korky said:

Do you introduce yourself to patients as Doctor?

Some states he legally can. But that’s not the point really.  They point is in role confusion both in terms of patient and staff expectations. As a credentialed clinician we work in the same capacity as many doctors or other doctorate level clinicians. We see similar acuity patients, and often share the same patient load and panels. If authorized the title of doctor, there should be no specific issue using it.  On the other hand, if you’re credentialed as an APP in the same hospital you work as an RN, this is where the bigger confusion and blurred lines may exist. As noted earlier, it can set clinicians, colleagues, and patients up for problems if the role is in any way not understood at each interaction.  Not worth the hassle or risk. 

On 8/23/2021 at 1:13 PM, paramedic-RN said:

So I work at a place where I was originally employed as an RN and then when I became and NP I was hired for that role as well.

So I mostly work in my NP role but will occasionally work a shift as an RN there.

Now I know those roles cannot mix for example I know I can't clock in as an RN and then be ordering labs or adjusting meds because in that moment I'm working as an RN, not an NP.

However what about switching throughout the day, is that allowed? For instance let says I come in in the morning to do infusions strictly as an RN (it's an infusion clinic) but then I have two medical intakes mid-day (where I then step into my NP role) and then at the end of the day I have a couple infusions strictly as an RN.

I've already told my employer I would like to get NP rate across the board and just do infusions as an NP but I lost that argument so now I'm here deciding if it's legally okay to be going back and forth in my roles throughout the day. 

My employer is not requiring this but is offering the option if I want more hours.

You are doing a disservice to yourself (and really to the profession). Quit working as a RN and only do the NP role. Moonlight somewhere else if you need the money. Why would they pay you as a NP, when your willing to get paid at a lower rate? 

Specializes in Occupational Health.

Why would you not just work as an NP and, if necessary, perform RN functions/duties as needed?

I do work as an NP two days per week at the clinic but they've offered that if I want more hours I can have them but it's for a nurse position doing infusions. In other words I could pick up a third day as strictly an RN. 

Their argument is that it's not justified for them to paying an NP to do an RN job when an NP is not required for that job. 

Which I understand, I don't fully agree but as I mentioned I lost that argument. 

My concern is flip-flopping on that third day, so for instance if I did a medical intake in the morning as an NP and then the next hour did an infusion as an RN. 

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