NP working PRN as Rn

Specialties NP

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Have any of ya'll work as RN while you are NP? Have you had any problems? I recently started working as a PRN RN on a med/surg floor 2 shifts a month and I must say I am really enjoying it.

Interesting! Do you ever feel frustrated that you need to call and get an order for something that you could normally order yourself?

I only work on Sat 7A to 7P and I really like it, MY NP job is M-F 7:30-4P and my NP job is wonderful but I like being a RN now.

No, I don't get frustrated at all. The NP job has a lot on your shoulder and the RN job is my physical but not on my shoulder.

Specializes in Nephrology, Cardiology, ER, ICU.

Read your personal malpractice policy. (You have one right?). You are held to the standard of care that an NP would provide.

For instance I'm licensed and volunteer as a pre hospital RN on my rural fire dept. Although we do not operate as an Advanced

Life Support ambulance, my assessment skills are held to the standard of an APRN.

Specializes in FNP, ONP.

No, I haven't and I would not. Talk about liability! You do realize as a licensed APP you have the same responsibility even if working below your licensure?

I have seen this question before with responses indicating that an NP would increase their liability by working as an RN and that you are held to the highest standard of care. Can anyone cite a source for this? It seems to me that if you are working as an RN in a clearly defined role then you would be held to that standard of care. For example, you are working on a med/surg floor at a hospital where you are not credentialed as an NP and your patient has chest pain. You assess the patient and report your clinical findings to the MD or NPP and document this. The MD then makes a decision to adjust the medical plan accordingly. You are not in a position to legally write orders, interpret tests, call a consultant, etc, in your capacity as an RN at that facility. What else can you do? I don't think there could be any accountability from a legal standpoint (just my opinion) if there is a mistake on account of the medical provider as long as you are meeting the standard of care as an RN.

I was able to find this article which addresses this topic (http://www.medscape.org/viewarticle/506277_7). It suggests that one can always legally work as an RN but you should be very clear that there is no role confusion and that you are not portraying yourself as an NP. It also says that most insurers will require coverage at the highest level of certification or licensure.

Specializes in Nephrology, Cardiology, ER, ICU.

I am a family NP (FNP) and am wondering if I can work as a non-advanced practice RN at a local nursing home? I plan tofunction as any other RN. Would I be held to higher liability standards?

From a regulatory standpoint, you are always legally entitled to work under your RN license, as long as it is current and you meet allRN requirements. However, insurers agree that someone with advanced practice training and certification needs to be insured atthe higher level, regardless of position. See the NSO newsletter answering this topic at:http://www.nso.com/newsletters/advisor/2000/np/npra5.php#qa.

Role validation is a large component of scope. If you take such a job, you will need to ensure that the role validation of the RN,rather than that of the NP, is the face you hold out to the public. The setting where you are employed can also help match your rolevalidation, by keeping your job title, job description, duties, and activities crystal clear. The most conservative advice would be toavoid working in areas that share the specialty of your advanced practice focus (such as a nurse midwife working as a labor anddelivery nurse). Taking such a position is asking for role confusion, and that, in turn, affects your ability to practice appropriately withyour patients.

http://www.oregon.gov/osbn/pdfs/kleinmedscapearticle.pdf

I have seen this question before with responses indicating that an NP would increase their liability by working as an RN and that you are held to the highest standard of care. Can anyone cite a source for this? It seems to me that if you are working as an RN in a clearly defined role then you would be held to that standard of care. For example, you are working on a med/surg floor at a hospital where you are not credentialed as an NP and your patient has chest pain. You assess the patient and report your clinical findings to the MD or NPP and document this. The MD then makes a decision to adjust the medical plan accordingly. You are not in a position to legally write orders, interpret tests, call a consultant, etc, in your capacity as an RN at that facility. What else can you do? I don't think there could be any accountability from a legal standpoint (just my opinion) if there is a mistake on account of the medical provider as long as you are meeting the standard of care as an RN.

I was able to find this article which addresses this topic (http://www.medscape.org/viewarticle/506277_7). It suggests that one can always legally work as an RN but you should be very clear that there is no role confusion and that you are not portraying yourself as an NP. It also says that most insurers will require coverage at the highest level of certification or licensure.

Here are some sample statements from various BONs on this topic, that I was able to find in a quick Google search. There is no mystery about this. The reason why this is a dicey thing to do is that, while the employer holds you to the scope of the position in which you're working (generalist RN), if anything goes pear-shaped enough to end up in court or in front of the BON, the courts (and BONs) will hold you to the standards of your highest level of education and licensure.

New York:Can a Registered Professional Nurse (RN) or Licensed Practical Nurse (LPN) work in a position that is below his/her level of licensure?

Answer: Yes. A licensed nurse may work in a position that he/she has the training to do and that is within his/her scope of practice. RNs have the training to perform LPN, Certified Nurses Aid and Home Care Aid functions and therefore could accept a work identified for these levels. An LPN has the training to perform Certified Nurses Aid and Home Care Aid functions, and could accept work identified for either of these positions. However, the nurse that does so would still be required to act prudently based on his/her educational preparation and would be held to that standard.

http://www.op.nysed.gov/prof/nurse/nursepracticefaq.htm

Wisconsin:

IF I HAVE AN RN LICENSE, BUT CAN ONLY FIND WORK AS AN LPN OR CNA, IS IT ACCEPTABLE FOR ME TO WORK IN A POSITION BELOW MY LEVEL OF LICENSURE UNTIL I CAN FIND OTHER WORK? THE SAME WITH AN LPN WORKING AS A CNA?

The Board of Nursing does not regulate CNAs, so questions regarding the practice of CNAs should be addressed to the Wisconsin Department of Health Services. It is important to note that while working at a lower level, you may be held to a higher standard of care due to advanced education, training and experience. Also, you must hold the credential for the profession in which you work.

http://dsps.wi.gov/Documents/Board%20Services/Position%20Statements/Registered%20Nurse.pdf

　

North Carolina:Can a LPN or RN work in a position that is below his/her level of licensure?

A licensed nurse may accept and work in a position that he/she has the training to do and that is within his/her scope of practice. A RN has the training to perform LPN and NA functions and therefore could accept a position identified for either of these levels. However, the nurse that does so would still be required to act prudently based on his/her educational preparation and would be held to that standard.

http://www.ncbon.com/dcp/i/nursing-practice-faq--nursing-practice

Iowa:Q. Can a LPN or RN work in a position that is below the level of his/her licensure?

A. There are no laws or Iowa Board of Nursing rules that prohibit a licensed nurse from working in a position that is below the level of his or her licensure. However, the board has previously determined that the nurse who does so is held to the highest level of his or her education. If a nurse is working in a position lower than the nurse's licensure and fails to act prudently based on education preparation, the nurse's license would be subject to sanction by the board.

http://nursing.iowa.gov/faq/practice.html#b1

　

Maine:Practice Below Level of Licensure

A licensed person who agrees to be employed in a position which requires less knowledge and skill than that for which s/he is prepared may find several problems:

1. S/he may be expected to perform at the level for which s/he has been prepared even though classified at a lesser level; and

2. S/he will be held to the standard expe cted of the higher licensure level should legal problems occur in that health care facility, no matter what the job classification.

The practice of employing licensed individuals to work below their level of preparation, as defined in the LAW REGULATING THE PRACTICE OF NURSING, places that licensed nurse in potential legal jeopardy and is of serious concern to the Board. (1985)http://www.maine.gov/boardofnursing/questions/questions_general.htm

Thank you both Trauma and Elkpark for your response. It does appear that many BON's have a stance on this issue including my home state. So if you are held to the standard of your education as an NP how would this translate into actual practice as an RN? You still would be unable to diagnose, prescribe, or write orders while working in the capacity of an RN. In my state, the NP practice is very specifically tied to your job and supervising MD. So I technically would not have "approval" to practice as an NP if I were to take a regular RN job and no longer held NP employment. I imagine that this differs greatly in states that grant an independent NP license with autonomous practice. It's an interesting topic.

Specializes in Nephrology, Cardiology, ER, ICU.

What I have been told by a nurse lawyer is that my assessment skills, my advanced pharmacology and pathophys knowledge is what must be used when I work as an RN. To this end, I am extremely careful how I document when volunteer as an RN. I go over each and every word two/three times to ensure that it is complete and reflects my advanced knowledge.

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