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.

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?

Legally, Can I mix RN/NP roles?

Specialties NP Nursing Q/A

Updated: Dec 31, 2022

by paramedic-RN

You are reading page 2 of Legally, Can I mix RN/NP roles?

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paramedic-RN

170 Posts

1 hour ago, djmatte said:

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.

Not sure if you're referencing me but I'm not concerned about loosing my skills. That's not why I was considering helping them with their RN shortage. It's a long explanation as to why I've been considering it (I'll spare you the details) but my main concern has been the legality of it which OhioNP touched on pretty well.

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Kooky Korky, BSN, RN

5,215 Posts

On 8/31/2021 at 11:40 PM, paramedic-RN said:

Not sure if you're referencing me but I'm not concerned about loosing my skills. That's not why I was considering helping them with their RN shortage. It's a long explanation as to why I've been considering it (I'll spare you the details) but my main concern has been the legality of it which OhioNP touched on pretty well.

Loose = not tight; or "I let my dog loose";

Lose = to not win or, in this case, to not be able to maintain skills

No need to start every sentence with "so".

On 8/31/2021 at 4:50 PM, 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.

Do you introduce yourself to patients as Doctor?

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paramedic-RN

170 Posts

15 hours ago, Kooky Korky said:

Loose = not tight; or "I let my dog loose";

Lose = to not win or, in this case, to not be able to maintain skills

No need to start every sentence with "so".

Do you introduce yourself to patients as Doctor?

Hi Kooky Korky,

Of course there's no NEED to start every sentence with "so" there's no NEED to start your sentence with any particular word.

But I chose to use the word "so" in a couple sentences (didn't realize anyone was counting).

I'm curious why you felt the need to point that out? What do you get out of pointing out irrelevant things to strangers online? Are you looking to put someone down? Are you looking for confrontation? What do you get out of that? You should ask yourself

SO I could point out that your post was just filled with sentence fragments, but why would I do that? I'm not trying to get some ego fix on a nursing forum.

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DrCOVID, DNP

461 Posts

Specializes in psych/medical-surgical.

On 9/4/2021 at 9:36 PM, Kooky Korky said:

Do you introduce yourself to patients as Doctor?

Ohhh not this crap again!

YES I DO - I introduce myself as DOCTOR and explain I'm a Nurse PRACTIITONER with a DOCTORATE

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Babyboss 19, MSN, APRN

34 Posts

Specializes in in primary care pediatrics and NICU.

On 8/28/2021 at 1:39 PM, djmatte said:

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.

This is what I've ben doing for 4 years: kept my inpatient part time RN ICU job while working primary care NP 2 days a week. I make way more money in dual role vs NP job alone, with added benefit of mental break from overcommitting to either. This is not optional in all states. My state allows you to work in either role.

Legally, Can I mix RN/NP roles?

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