NP still working as a bedside nurse on the side...

Oldmahubbard · Mar 18, 2019

11 hours ago, traumaRUs said:
You are held to the ASSESSMENT skills of an APRN. Believe me.

So why would any NP work as an RN, when you are required to assess but can't do anything? Sounds like a complete lose/lose proposition.

Sounds like a story behind it, too. I would love to hear.

There are many licensed NPs who work as RNs, for reasons of their own. Possibly thousands. I don't think it's a rare thing.

NPs getting into legal trouble working as RNs?

Sounds to me like an urban legend. I would like to be proven wrong.

djmatte, ADN, MSN, RN, NP · Mar 18, 2019

8 hours ago, The-DON said:
I worked with them in the ER, however it is a state by state thing. There is the option of obtaining an post grad acute care certificate as well.

ENP cert would be more appropriate after than ACNP of planning to work in the ed.

Trauma Columnist · Mar 19, 2019

12 hours ago, Oldmahubbard said:
So why would any NP work as an RN, when you are required to assess but can't do anything? Sounds like a complete lose/lose proposition.
Sounds like a story behind it, too. I would love to hear.
There are many licensed NPs who work as RNs, for reasons of their own. Possibly thousands. I don't think it's a rare thing.
NPs getting into legal trouble working as RNs?
Sounds to me like an urban legend. I would like to be proven wrong.

lol - yep there is a story behind it. I've been on my rural fire dept for many years and been an APRN for 13. I am licensed as a pre-hospital RN in IL which is how I run EMS calls.

Will make this very general but I'm sure you'll understand why I'm doing so. I ran a call with a licensed volunteer paramedic who was first on the scene. I came along a few minutes later and asked what I could do to help. The pt was on a cardiac monitor and I briefly glanced at the monitor as I did some other tasks to get the pt ready for transport. I was called a couple of weeks later by the medical director (an MD) who asked if I had looked at the monitor and I told him what I saw. In the end, there was some confusion over the rhythm and it had been charted something different than what I saw and interpreted......so I wrote an addendum to the chart, signed it and all was well....until a couple of months later when I was contacted again by the medical director to call a lawyer about the call. So, as I was talking to the lawyer and he was asking me some basic background questions, he made the comment that since I was an APRN, I was held to that standard for assessment of the patient. That it all depended on the situation but even if I couldn't "fix" the situation, I had to utilize my knowledge (as an APRN) to assess the pt at that level and if I couldn't do anything about it, I had the duty to report it to someone else who could fix it. So, yes, at least in IL, I am held to the assessment skills of an APRN with like experience.

Melissa94RN, BSN, MSN, NP · Jun 13, 2019

On 3/14/2019 at 2:09 PM, LM NY said:
I thought I can't work in the ER with an FNP. I don't want to remain in acute care full time once I get my FNP, but would love the chance to do it once in a blue. Maybe I am thinking too much about it now, when I haven't even started the FNP program. All I know is, I will always have that itch for the hospital setting, just not full time.

I actually am in the process of applying so that I can go back to school for my FNP. I am an ACNP now. Most of the ED's I know want the FNP or the ACNP/FNP dual role. The reason is the ACNP cannot see children and this is problematic in the ED setting. My background is the ER/trauma presently I am working in surgery with my ACNP. The Emergency NP certification requires the FNP. Check it out. https://www.aanpcert.org/faq-enp.

Dodongo, APRN, NP · Jun 13, 2019

2 hours ago, Melissa94RN said:
I actually am in the process of applying so that I can go back to school for my FNP. I am an ACNP now. Most of the ED's I know want the FNP or the ACNP/FNP dual role. The reason is the ACNP cannot see children and this is problematic in the ED setting. My background is the ER/trauma presently I am working in surgery with my ACNP. The Emergency NP certification requires the FNP. Check it out. https://www.aanpcert.org/faq-enp.

Creating multiple tracks for NPs has really shot us in the foot. My hospital system only hires ACNPs for inpatient (and NNPs). They had a couple FNPs that couldn't keep up and made this a requirement, in keeping with the consensus model. But ER needs peds coverage. So they were only hiring ACNP/FNP or ACNP/PNP for a while, but this was too difficult and dual prepared individuals so few, they are now only hiring PAs for the ER - system wide.

Melissa94RN, BSN, MSN, NP · Jun 13, 2019

This is sad because NP's can be a great asset to the ED setting. The consensus model has had consequences that I don't think they truly thought out fully. Most ED's though are still hiring FNP, a friend of mine new grad just got hired to the ED with her FNP, the caveat is that she will not be able to manage any critical patient unless she gets ACNP dual. If her patient condition changes, the patient is handed off to an ACNP or MD. I do think that is why there are more and more Emergency NP programs now popping up.

myoglobin, ASN, BSN, MSN · Jun 20, 2019

There are some valid reasons to keep your bedside skills:

a. If you are opening your own clinic (in an IP state) you may wish to work part time in order to be able to get health insurance from the hospital.

b. In many cases by keeping your skills you "keep your options open" to earn better money as a travel RN. In Florida FNP and PMHNP often earn no more than 80 to 100K. Travel RN's in California can earn upwards of 150K and have basic housing provided. If my SO left me or died, this could be a viable option.

c. In some cases people value social connections. My SO works from home and has no social interaction (save for me and you can imagine how much fun I am). Thus, she often misses her ICU coworkers and might benefit from "a shift" every few weeks. I myself have no friends or family outside of work and thus might find myself in a similar situation especially if I end up working from home.

d. Being held to a "higher standard" you say? Since half the doctors that chart assessments don't even come and see the patient, I would say that I would be ahead of any reasonable standard as an RN at my hospital, just by being there.

PMHNP Man, MSN, APRN, NP · Jun 24, 2019

On 3/13/2019 at 7:12 PM, LM NY said:
Not an NP yet, but didn’t ever want to lose my critical thinking or assessment skills that are more centered around acute care. I’ve heard some say “once a nurse, always a nurse”. How true is that? I have friends who are not NP’s, but have left the bedside to LTC, clinics, case management, etc. and were honest enough to tell me that they don’t feel confident enough to jump into an emergency situation if the occasion ever arises. I don’t want that to be me. I was thinking more along the lines of once an FNP, I can do one shift a month. I know it’s just wishful thinking, but it is a thought.

Something I find unsatisfactory about nursing is this ownership of "critical thinking."

If you're evaluating, diagnosing, formulating a treatment plan, and coding the encounter you're thinking critically. NPs can do it too as can army tank drivers, plumbers, lifeguards, and homeless vagrants.

Once you become a NP, you're really not going to care beans about "skills" because you'll probably never lift a finger again and touch a patient instead finding yourself a knowledge worker rather than a task master delegating most aspects of your day. The skills are overrated. Shoving tubes into people is really not something that can't be taught or coached.

Dodongo, APRN, NP · Jun 25, 2019

2 hours ago, PMHNP Man said:
Something I find unsatisfactory about nursing is this ownership of "critical thinking."
If you're evaluating, diagnosing, formulating a treatment plan, and coding the encounter you're thinking critically. NPs can do it too as can army tank drivers, plumbers, lifeguards, and homeless vagrants.
Once you become a NP, you're really not going to care beans about "skills" because you'll probably never lift a finger again and touch a patient instead finding yourself a knowledge worker rather than a task master delegating most aspects of your day. The skills are overrated. Shoving tubes into people is really not something that can't be taught or coached.

Right?? When nurses say things like that it just shows they have zero idea what "critical thinking" actually is. Haha. Diagnosing and prescribing is about as critical as thinking can get. And what skills are you afraid of losing? Nursing skills? Who cares? I could take a high schooler and teach them how to put in an IV or foley. Even during codes. Pushing meds, doing compressions, etc - I'd much rather leave that stuff to the nurses. I'll stand at the head of the bed or intubate or do a central line.

watch123 · Jun 26, 2019

This has to be a joke of a thread!

LM NY · Jul 1, 2019

On 6/26/2019 at 5:05 AM, watch123 said:
This has to be a joke of a thread!

What do you mean a joke of a thread? Did you mean the person who started the thread or the responses that came after? I started the thread and was not giggling as I was typing it. What's wrong with disagreeing these days? Why does it have to be a joke? We can't all be vanilla. There are other flavors available. If I was/am feeling a type of way about something, I have every right to post about it. If you have nothing to contribute to a thread then why even bother? Your comment seems to be more of a joke. Lately, I've been wondering why I am not visiting AN as much as I used to and I was just reminded of the reason.

JBMmom, MSN, NP · Aug 7, 2019

I work in critical care and we have a couple NPs that work per diem in our unit as staff nurses. They say that they enjoy their primary care NP roles, but still miss the activity of the floor at times. And they say the extra money helps with vacations.