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NP's answering to Nursing Management?

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ohiosam2 ohiosam2 (New) New

I am wondering if anyone has any experience with this. I have been an NP in my area for a few years now and I am very familiar with practice at other hospitals. I currently work in an ER. There are both NP's and PA's in the ER. We work under physician management. As far as I know, the other hospitals in the area also work under the physician management teams. Recently there was a very big discussion going on in the hospital. It seems that the nursing management felt that they should be in charge of both PA's and NP's. Fortunately, the hospital physicians absolutely refused to allow this. I was shocked. I do not feel a nurse manager should be dictating practice to those who are advanced providers. During the discussion, nursing stated that many hospitals around the United States are putting their NP's and PA's under nursing management instead of the physicians. Is anyone out there under nursing right now? If so, are you having difficulties with this arrangement?

Jules A, MSN

Specializes in Family Nurse Practitioner.

I think the differentiation is whether NPs are considered nursing staff or medical staff. I won't work as nursing staff although there is only one hospital in this area who does it that way and they are very cheap, go figure. If I was a PA there would be no way I'd even consider this foolish notion. What exactly is their end game I wonder?

PG2018

Specializes in Outpatient Psychiatry.

Where I live a physician group was contracted to work area ERs. They also provided FNPs and PAs for ERs. Recently, I've noticed the hospitals have ads posted for FNPs to work the ERs. The hospital already employees the hospitalists so maybe they'll fall under medical oversight. It wouldn't surprise me to find RN managers trying to direct them. The "board" of nursing already has LPNs and RNs directing NPs. Stupid really.

Jules A, MSN

Specializes in Family Nurse Practitioner.

Admin, Maybe consider merging this into the same thread in the NP section?

Your regulatory body is your state board of Registered Nursing, and the laws/regulations governing your practice are to be found on your state BORN web site, is this not true? You are a nurse with advanced training, but you are not a doctor, so why is it inappropriate that a nurse manager should head your practice?

Nursing managers do not practice medicine. Our manager now is a physician who offers us a resource and recommendations on how we practice and how best to practice Emergency Medicine. He reviews our charts and will offer constructive criticism and praise for the way we practice and will assist us in education if there is something we are lacking. A nurse manager cannot offer this kind of support or management. Our physician management also has quality indicators that are directly applicable to our practice as providers. Nursing management would have no idea which quality metrics to monitor as they are experts in nursing practice and not medicine. I think a colleague of mine summed it up nicely. We are providers. We are no longer nurses. We need to have other providers managing our practice because what we do is very different than nursing. I will say this too. The statement was made by nursing management that if they would like to manage NPs so that we could assist with the nursing role when we are not busy. I would love to have a day in the ER when I am not busy. I sit down for 4 hours every day to chart on the multitude of patients I have seen that day. Nursing considers this "doing nothing" because they see us sitting in front of a computer. They would like for us to help out with the nursing role on our down time? That is not my role any longer. This is an example of how a nurse manager does not understand the NP role because they are not an advanced practice nurse.

Jules A, MSN

Specializes in Family Nurse Practitioner.

Nursing managers do not practice medicine. Our manager now is a physician who offers us a resource and recommendations on how we practice and how best to practice Emergency Medicine. He reviews our charts and will offer constructive criticism and praise for the way we practice and will assist us in education if there is something we are lacking. A nurse manager cannot offer this kind of support or management. Our physician management also has quality indicators that are directly applicable to our practice as providers. Nursing management would have no idea which quality metrics to monitor as they are experts in nursing practice and not medicine. I think a colleague of mine summed it up nicely. We are providers. We are no longer nurses. We need to have other providers managing our practice because what we do is very different than nursing. I will say this too. The statement was made by nursing management that if they would like to manage NPs so that we could assist with the nursing role when we are not busy. I would love to have a day in the ER when I am not busy. I sit down for 4 hours every day to chart on the multitude of patients I have seen that day. Nursing considers this "doing nothing" because they see us sitting in front of a computer. They would like for us to help out with the nursing role on our down time? That is not my role any longer. This is an example of how a nurse manager does not understand the NP role because they are not an advanced practice nurse.

Oh so its that familiar slippery slope. YeahhhhhNO. Not even cracking the door to something that will have me doing duties my physician colleagues aren't. Good for you and your peers for recognizing it for what it is and nipping it in the bud unlike what I have seen in the past where NPs are so smugly co-dependent they will do anything to feel needed or because they don't have the stones to push back.

Psychcns

Specializes in Psychiatric Nursing. Has 30 years experience.

You would think nurse managers were busy enough without overseeing providers. I could imagine higher management seeing it as efficient but I can't see why nurse managers would want it. The example above is to have NPs cross train as RNs which doesn't make sense either. I could imagine upper management wanting more "productivity" from physicians. When I work locums I have had nurse managers sign my time sheet but there was always some kind of accountability to a physician.

Nursing managers do not practice medicine. Our manager now is a physician who offers us a resource and recommendations on how we practice and how best to practice Emergency Medicine. He reviews our charts and will offer constructive criticism and praise for the way we practice and will assist us in education if there is something we are lacking. A nurse manager cannot offer this kind of support or management. Our physician management also has quality indicators that are directly applicable to our practice as providers. Nursing management would have no idea which quality metrics to monitor as they are experts in nursing practice and not medicine. I think a colleague of mine summed it up nicely. We are providers. We are no longer nurses. We need to have other providers managing our practice because what we do is very different than nursing. I will say this too. The statement was made by nursing management that if they would like to manage NPs so that we could assist with the nursing role when we are not busy. I would love to have a day in the ER when I am not busy. I sit down for 4 hours every day to chart on the multitude of patients I have seen that day. Nursing considers this "doing nothing" because they see us sitting in front of a computer. They would like for us to help out with the nursing role on our down time? That is not my role any longer. This is an example of how a nurse manager does not understand the NP role because they are not an advanced practice nurse.

Your scope of practice is dictated by what your state board of Registered Nursing permits in regard to Nurse Practitioner practice, is that not so? You may be a provider, but you are still a nurse.

I understand why you don't want to have to perform the duties of RN's, but that is a separate issue.

Psychcns

Specializes in Psychiatric Nursing. Has 30 years experience.

As a psychiatric provider I have the same role expectations as a psychiatrist. Yes, we are regulated by our state BON, and we are usually credentialed as part of the medical staff.

As a psychiatric provider I have the same role expectations as a psychiatrist. Yes, we are regulated by our state BON, and we are usually credentialed as part of the medical staff.

I don't know your scope of practice, but I assume you assess patients, develop a plan of care, and can order some medications and treatments/interventions, monitor their effect, and revise the plan of care as needed within your scope of practice. But you don't have the same level of responsibility or accountability as a psychiatrist as you are not trained as a psychiatrist. A psychiatrist is still ultimately responsible for the care of the patient.

Edited by Susie2310

Psychcns

Specializes in Psychiatric Nursing. Has 30 years experience.

The places I have worked inpatient, one time a psychiatrist was listed as the attending. Otherwise I am. For outpatient sometimes I have a collaborator and sometimes I dont. I thought in independent practice states I am responsible for my own practice. Even in collaborative practice states I am responsible for my practice. Do you have a different understanding? What state? One time. I had a psychiatrist read my charts and it felt like micro managing and was not helpful. I consult with psychiatrists. How are you seeing the accountability of a psychiatrist as different from mine when it is often the same role.

Jules A, MSN

Specializes in Family Nurse Practitioner.

The places I have worked inpatient, one time a psychiatrist was listed as the attending. Otherwise I am. For outpatient sometimes I have a collaborator and sometimes I dont. I thought in independent practice states I am responsible for my own practice. Even in collaborative practice states I am responsible for my practice. Do you have a different understanding? What state? One time. I had a psychiatrist read my charts and it felt like micro managing and was not helpful. I consult with psychiatrists. How are you seeing the accountability of a psychiatrist as different from mine when it is often the same role.

My experience is similar. I have admitting privileges with my own patient load and outpatient I also see my patients without any collaboration required. No other provider interacts with my patients. While I can't do ECT like psychiatrists can there are only two hospitals where I work who offer that treatment option anyway. I'd imagine my medical directors are indirectly responsible for all their employees both physicians and NPs but our duties are identical. Sadly my knowledge is less than the psychiatrists I work with but my responsibilities are the same.

BirkieGirl

Has 25 years experience.

I have to agree with Jules- no provider should be managed by a nurse manager. They are two VERY different roles. that's not even up for debate. THIS WOULD NOT BE A DEBATE IF A PA OR PHYSICIAN WERE TOLD THEY HAD TO BE MANAGED BY A NURSE MANAGER!!!!! And yes, although a NP is still a nurse first , their current role is as a provider. I worked in a practice were NPs left in droves because the practice originally had a physician in charge of them, then changed it to a nurse manager a year later. four of five NPs resigned the next day, the fifth one left the following month.

Psychcns

Specializes in Psychiatric Nursing. Has 30 years experience.

The other thing to consider is "what do you mean by managed?" In the chain of command, I understand that nurse managers are responsible for their staff. There is no way a nurse manager could or should be responsible for the work of a provider. However there many be ways of conceiving "managing" that allows providers to treat patients. And if nurse managers take on managing providers, it should be all providers, and they would have to figure out how to partner with physicians.

catsmeow1972, BSN, RN

Specializes in OR. Has 15 years experience.

There are three problems i see right off with the premise of "NPs are nurses and can be managed by Nurse Managers." First, an NP is an advanced practice degree...ie: an MSN or higher., with further specialization/training in their chosen focus. The majority of "Nurse Managers, if they have an MSN (yes, i know, nowadays in any sizable facility, most do), it is likely in management, clinical leader, etc. Very rarely do you see a person in a nurse manager role whose Master's concentration was acute care or family practice. Second, the "well they could help out in the nursing role when they are not busy." is preposterous. The only place I have ever seen NPs in a role where they are in a facility for a shift length amount of time is in the ER. This sounds to me like an effort to blend roles to avoid actually having to hire more staff, ala the do-more-with-less mentality. Third, the physician takes the ultimate responsibility for the decisions of the APRN. Were i that physician, i am managing my own advanced practice/mid-level providers, thank you. (I am not including the independent practitioners...different ball of wax there.)

For the record, i am neither a nurse manager nor an APRN/PA. This is just my observation, from the staff nurse point of view.

I am trying to understand this concept and must be missing something. Do many providers work directly for the facility? I have worked as an RN in the past and the providers were not employed by the facility. As a brand new NP again I am employed by a provider group that has privileges within several hospitals. So the concept of a nurse manager being over a provider is just not making any sense. We do not have the same function.. Maybe I am missing something in this construct.

Jules A, MSN

Specializes in Family Nurse Practitioner.

I am trying to understand this concept and must be missing something. Do many providers work directly for the facility? I have worked as an RN in the past and the providers were not employed by the facility. As a brand new NP again I am employed by a provider group that has privileges within several hospitals. So the concept of a nurse manager being over a provider is just not making any sense. We do not have the same function.. Maybe I am missing something in this construct.

At the three hospitals where I have privileges the psychiatrists and NPs are employees of the hospital's medical staff. I wish we were part of a provider group.