NP's answering to Nursing Management?

[ohiosam2]

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]

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]

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]

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]

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.

[RunNP]

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]

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.

[traumaRUs, MSN, APRN]

Merged threads

[Susie2310]

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.

Yes, nurses are always responsible for their practice. I don't know what your BON permits in regard to your scope of practice. In my state NP's do not practice independently.

[PG2018]

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?

Because they don't understand the job and sundry issues of practicing as an independent provider.

[PG2018]

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.

This is asinine.

[PG2018]

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.

Actually if I kill my patient, it's my butt not a psychiatrist 300 miles away.

And no I don't have a plan of care. We don't do that. We examine and treat in a problem focused manner.

You sound like a nurse disgruntled by NPs.

[PG2018]

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.

I agree. Having held an administrative position in a government agency, accounting standards require someone approve time and leave, approve purchase orders, etc. If an organization wants that to be a RN it's a stupid idea but more palatable than managing practice traits, outcomes, etc.