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Discussion

NP being forced to work as RN

Hello, I am a Palliative Care and Hospice NP. My Palliative Care census has fallen quite low, so I was asked to fill in and help the Hospice nurses out. I thought this meant, if there was a need for a PRN visit or something. But now they are trying to get me to do admissions (I have not been trained to do so), and to fill in for vacations. They wanted me to take call (for less than I make now), but I refused.

(I make my NP salary while providing case management nursing care)

My question isn't one of "I don't want to do this", because I realize they need to justify having me (but they actually HAVE to have me).

But legally...Can this be problematic? My partner quit over this and she is under the impression that this goes against CMS, but I'm not sure I understand the verbage properly.

Any advice would be greatly appreciated.

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    • Experts

    I see the same problem for you. Either take the easy way out by resigning, (since they probably won't listen to you and change the setup), or take the time to get an official reading on the rules. If you can satisfy yourself about the advisability of this policy, then it is still up to you whether or not you want to work in this manner.

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    • Experts

    There are a bunch of existing threads here about advanced practice nurses working "below" their level of licensure, as staff nurses. Apparently, there are a few states in which the BON rules/regs specifically disallow this. Most states don't have any regulatory restriction on it. There are some legal considerations you need to understand. But (unless you're in one of the states that prohibits it) it's up to you whether you're comfortable with it or not.

    How is it that you think this "goes against CMS"?

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    • Experts

    If your BON doesn't have objections I would approach it based on your feelings for the practice. If you really enjoy working there and want to pitch in when the census is low that's cool. For me unless I had a real strong bond to the facility and my team I probably would resign if they didn't change this requirement because it can be a slippery slope and imo I always cringe when NPs get all martyr-ish and do stuff because it pads their codependent nature and "who else will do it if I don't?".

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    I would actually disagree that working case management as an NP would necessarily be "below" your licensure. Since a lot of case management is dealing with MDs and NPs to write prescriptions and refills and develop medical solutions to symptom management, presumably you would be doing this at every visit. There is a different question as to whether you should or want to do this work, but I don't think there would be an issue with the BON.

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    • Author

    My partner was reading the CMS policies regarding NPs in hospice, and she misread it..I looked it up. What it means is that you can't do RN work and bill as an NP. Either way, I went to school to be an NP. I don't mind pitching in...but covering for vacations etc, is ridiculous in my opinion. Particularly since they only have a 27 patient census and 3 RNs to cover....and a contigent and on call RN to cover. It's hardly necessary. But I also understand that them paying me to not work because I have no patients, does t make sense.

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    • Experts

    It sounds like you answered your own question. As a general rule I try not to do "ridiculous" things. :) We are professionals and aren't "forced" to do anything. Since you aren't happy with this requirement I'd start looking for another job. Good luck!

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    • Author

    Yes, you're right. There are so many other things going on as well. I am not treated as a professional. I answer to an RN, who has clearly stated that anyone could do my job, if they had the initials after their name. She makes me call in every morning and report what my plan for the day is. This wouldn't be a big deal but it was done punitively, and simply because our professional judgment was questioned by her. She doesn't have the qualifications to question my judgment. Any way, a lot of issues going on that have driven the rest of the Palliative team away. Now I'm the only one left. Resume is out there...just waiting for the right fit for me

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    • Author

    Tammy G, I do not act as an NP in any way during these visits. And if I want to a prescription changed...I call their attending. I do not write orders. In fact, if I needed something changed, I have no idea how to even do this. I followed ab RN for two days...3 months ago. I'm not saying it's beneath me to work as an RN, I'm saying that I went to school to be an NP.

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    I'm glad you got that out of your system. But, you do have a long way to go before you achieve your vision of a perfect world.

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    You are still an APRN for these patients and will be held to the same standards.

    Many APRNs provide "lowly" RN care for their patients.

    You are being paid so either accept the check or leave for another job.

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    It sounds to me as if the RN you are "answering" to has a chip on her shoulder. No, not everyone can do what you do if they have the initials after their name. Those initials are hard to get and aren't handed out like candy. That alone would tell me that I am not valued. I understand that you are in a niche profession and it can be hard to find something else. Depending on where you are, I would consider a palliative care position in a hospital or another county nearby. It isn't a matter of feeling that the work is below you, but you earned your degree to do something different. This job simply wants your initials on their forms and doesn't value what you bring to them. Run, run away.

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