NP's answering to Nursing Management?

Specialties NP

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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?

Specializes in Outpatient Psychiatry.
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.

Yet you seem to talk with a great deal of generalization. A nurse manager needs to manage people working AS nurses or staff working FOR nurses. Regardless of your misunderstanding, a NP nor any other advanced practice nurse (e.g. CRNA or CNM) is neither working AS a nurse or FOR a nurse. We're working in a circumscribed role above and beyond your limited perceptions. By your same ridiculous logic, the OR nurse manager should oversee the CRNAs and AAs. It just doesn't work and seems only like a nurse's power struggle.

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Yet you seem to talk with a great deal of generalization. A nurse manager needs to manage people working AS nurses or staff working FOR nurses. Regardless of your misunderstanding, a NP nor any other advanced practice nurse (e.g. CRNA or CNM) is neither working AS a nurse or FOR a nurse. We're working in a circumscribed role above and beyond your limited perceptions. By your same ridiculous logic, the OR nurse manager should oversee the CRNAs and AAs. It just doesn't work and seems only like a nurse's power struggle.

A NP is still a nurse, correct? Where is your scope of practice specified, and where are the rules and regulations regarding your practice? Are they not on your state board of nursing web site? You sound very defensive. Remember that different states have different laws regarding NP practice.

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Specializes in Cardiology nurse practitioner.

I just left a position that was managed this way. We had an assigned "supervising physician", who was on paper only.,but my position was managed by the supervisor of case management.

She couldn't grasp the concept that I wasn't a nurse. She would text me to drop by and do "welfare checks" on patients. She expected me to do my own auth for DME, therapy, etc., after I wrote the order for it.

She wanted me to cover the "other nurses", when they went out on vacation or called in.

And, she thought I should talk to the PCP before I ordered anything. Then, she told the nurses it was ok to ignore my orders and ask the PCP if they had concerns. This effectively undermined my position.

No freaking way. I was out of there.

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A NP is still a nurse, correct? Where is your scope of practice specified, and where are the rules and regulations regarding your practice? Are they not on your state board of nursing web site? You sound very defensive. Remember that different states have different laws regarding NP practice.

A NP holds a RN license in addition to an NP license. We do not work as nurses but as providers and in such we hold a scope of practice that exceeds that of an RN. I think the issue with the concept of a RN manager being in a supervising role to an NP is that they do not understand the scope of practice and the issues that relate to it.

How would an RN feel about being supervised by an LPN or better yet a CNA. It is not reasonable. The best interest of the patient is not best served by inadequate supervision.

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Specializes in Outpatient Psychiatry.
A NP is still a nurse, correct? Where is your scope of practice specified, and where are the rules and regulations regarding your practice? Are they not on your state board of nursing web site? You sound very defensive. Remember that different states have different laws regarding NP practice.

I'm indeed defensive of our position as NPs. You as a RN do not understand our scope. You're not qualified to supervise me. No RN is. The board of nursing and word "nurse" are irrelevant here. We have an added credential that we work with, and that's why we are NPs and you or any other RN without that credential cannot dictate our practice. Say you worked for me, which is possible, I could supervise you because my scope involves directing your actions and ordering your practice. If I hired a LPN to supervise you, you'd have a tantrum.

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Specializes in Adult Internal Medicine.

I am credentialed as medical staff and managed by the CMO. I did interview for a job once where the NP performance reviews fell to the nursing manager. She was pretty upfrotn about that fact she just spoke with 4 colleagues and used their impression for her review because she had no experience with the role. The one benefit to this was that NPs were part of the nursing union and the salaries/benefits were outstanding.

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If manager means someone who can directly fire you, then no, it does not make sense to have a nurse manager in charge of an NP. This sounds like some bizarre power play by the nursing department.

However, administrators of service lines who control operational budgets are typically RNs and carry pretty significant clout. In a hospital, you only matter if you are making money (Providers) or controlling a lot of money (Senior Administrators).

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I had a friend who worked as an NP with a hospitalist group and she had a nursing director over the group. As I understood it the nurse dir was responsible for the placing of request for locums and acting as a go between the hospital admin/families and the provider group. She had no real authority over the providers. She was more their glorified secretary.

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Specializes in Outpatient Psychiatry.
In a hospital, you only matter if you are making money (Providers) or controlling a lot of money (Senior Administrators).

I had privy once of overhearing a RN complain to a COO about having to pay for lunch in the hospital cafeteria while doctors (PAs and NPs also) didn't have to and the hospital stocked their lounge with sweet snacks, energy drinks, Starbucks drinks, etc.

The short reply of the COO was to the effect of "because if buying them a $7 lunch or $3 drink is going to make them happier the hospital will do nothing but profit."

Nurse was royally ticked. I thought " wow, what a good idea!" Conversely, I was always the guy who thought a company paying for a staff coffee pot was a bad idea.

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A NP holds a RN license in addition to an NP license. We do not work as nurses but as providers and in such we hold a scope of practice that exceeds that of an RN. I think the issue with the concept of a RN manager being in a supervising role to an NP is that they do not understand the scope of practice and the issues that relate to it.

How would an RN feel about being supervised by an LPN or better yet a CNA. It is not reasonable. The best interest of the patient is not best served by inadequate supervision.

Your scope of practice as a NP, and the relevant laws/regulations, are provided on your state Board of Registered Nursing web site, and your state Board of Registered Nursing has regulatory authority over your practice as a NP, is that not true? If this is not the case, please say so. Yes, you work as a provider due to having taken advanced nursing courses, but as a NP you are still a nurse.

You are licensed as an RN and a NP by virtue of your education and training. If a patient complains about your care to your state Board of Registered Nursing, it is they who will investigate the complaint, and it is they who will discipline your license if necessary. My point is that all of the above does not make it inappropriate that you should have a nurse manager as long as physicians have input into care that is provided, which undoubtedly they will. Do the physicians you work with know the scope of your practice as an NP and the relevant laws/regulations as they are described on your state Board of Nursing web site? Why would a good non NP nurse manager not be capable of following the specified scope of NP practice and other laws/regulations in managing you?

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Specializes in Outpatient Psychiatry.
Your scope of practice as a NP, and the relevant laws/regulations, are provided on your state Board of Registered Nursing web site, and your state Board of Registered Nursing has regulatory authority over your practice as a NP, is that not true? If this is not the case, please say so. Yes, you work as a provider due to having taken advanced nursing courses, but as a NP you are still a nurse.

You are licensed as an RN and a NP by virtue of your education and training. If a patient complains about your care to your state Board of Registered Nursing, it is they who will investigate the complaint, and it is they who will discipline your license if necessary. My point is that all of the above does not make it inappropriate that you should have a nurse manager as long as physicians have input into care that is provided, which undoubtedly they will. Do the physicians you work with know the scope of your practice as an NP and the relevant laws/regulations as they are described on your state Board of Nursing web site? Why would a good non NP nurse manager not be capable of following the specified scope of NP practice and other laws/regulations in managing you?

We don't typically have a defined scope. My state licensure and national certification reads to do what I'm trained and feel competent doing. How is Daisy Duck, RN going to know that? Doctors don't know our scope either, but they can rightfully supervise the practice because they area a higher trained provider and more analogous to our role as NPs.

For your argument, if a NP wants a job tending to call lights on a floor somewhere then so be it. Let the local unit manager have at them.

Your board of nursing mantra is totally parallel to the root. No, nurse managers should not manage NPs solely based on the verbiage of the NP's title.

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Specializes in Psychiatric Nursing.

Nurse managers often have a lot of different disciplines reporting to them. NPs should be grouped with other providers in terms of reporting. Makes no sense for providers to cross train as staff nurses. If all providers are reporting to a nurse administrator, that is fine. But it seems some places are expecting NPs to be NPs and staff nurses as one job description. If an NP has that much down time the position should be eliminated.

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