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?

[ohmg]

In most states, NPs can practice independently. Having non NPs manage you likely introduces risk. Good for you having physicians that have their heads on straight. I'd be damned as an NP to have a BSN 'managing' me...

[idialyze, BSN, RN]

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?

Why such hostility about NPs, sour grapes?

[BostonFNP, APRN]

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?

What state do you live in?

Why couldn't a good CNA not be capable of following the scope of practice for an RN in managing you?

[Susie2310]

Why such hostility about NPs, sour grapes?

Since you made the above comment, I will reply. No hostility; I am concerned about the standard of care. We have two classes of health care. Some patients receive their care from physicians with many years of education and training, and some receive their care from NP's, with a small fraction of the education and training of a physician. According to a poster above, there isn't a scope of practice for NP's in his state, and NP's are allowed to do what they feel trained and competent doing. I am grateful that I live in a state where physicians have strongly opposed independent NP practice, and where the BON has not allowed independent NP practice.

[BostonFNP, APRN]

No hostility; I am concerned about the standard of care. We have two classes of health care. Some patients receive their care from physicians with many years of education and training, and some receive their care from NP's, with a small fraction of the education and training of a physician.

Because the outcomes are definitely better for physicians! Am I right? Awesome!

Clearly, whether you want to admit it here or not, you have some tremendous bias. I have yet to see you post any data though, why is that?

[PG2018]

Since you made the above comment, I will reply. No hostility; I am concerned about the standard of care. We have two classes of health care. Some patients receive their care from physicians with many years of education and training, and some receive their care from NP's, with a small fraction of the education and training of a physician. According to a poster above, there isn't a scope of practice for NP's in his state, and NP's are allowed to do what they feel trained and competent doing. I am grateful that I live in a state where physicians have strongly opposed independent NP practice, and where the BON has not allowed independent NP practice.

The physician scope isn't delineated either. No one has a document telling them what to or what not to do. Neither medicine nor nursing are algorithms. So you feel a RN can manage NPS because of our condensed training?

[scubadude]

It is entirely inappropriate to be managed by "nurse managers". Just because the same board licenses us in many states does not mean that an RN is qualified to supervise or manage us. The argument of being accountable to the BON does not make management by an RN appropriate. If I was called to the BON and asked why I rx'd a particular med would an answer of "my manager, she's an RN and she told me to" me acceptable? It would be 10x worse if the same answer was given to a jury or malpractice attorney. Now if I looked at my note and see that I consulted with Dr X who is my manager, and said that I rx'd something, how does it sound? See the difference?

Many states have a law prohibiting the "corporate practice of medicine". Essentially it requires a physician to own a clinic. As an RN you couldn't go out and open a clinic and just hire a Dr to work there. This is because you do not have the privileges to diagnose and treat, nor would the entity you created to open your clinic and thus you do not have the knowledge base to supervise a provider.

Period. End of story.

This argument is similar to what I have with my toddlers. I have the knowledge and do not need to argue the fact. Accept it and deal with it. An RN is not qualified to manage or supervise NP's, PA's, MD's or DO's. State laws in half of states have established this and it is punishable by incarceration in some cases.

[CraigB-RN, MSN, RN]

An RN is not qualified to manage or supervise NP's, PA's, MD's or DO's. State laws in half of states have established this and it is punishable by incarceration in some cases.

Can you do me a favor and reference those laws.

The issue is going to be different in each facility and it's important to be comparing apples to apples. As a CNO i had direct oversite of the ED. This meant I handle administrative functions. I also ensured that everyone was meeting the standards the hospital had set up through the Medcial Staff and the Board. There were certain things that all clinicians had to do, MD, DO, NP, PA. I handled all the QI and credentialling, etc. When a specific clinical question came up, it was forwarded to both the ED director who was an MD and in general the Chief of Staff for review and I took action based on their recomendations. This was the same for any clinician.

In every state I"ve worked in I was qualified to manage and supervise clinicians. I wasn't however qualified to dictate medcial practice. But I could enforce standards that had been set.

p.s. the last time I checked most hosptial administrators weren't MD and they have a certain amount of supervisory/management responsibilities, including HR functions.

p.s.s. It also depends on who's hiring and that is a completly seperate issue. In once facility NP (including CRNA's) were hired by the nuring department. In another facility they were hired by the medcial staff or in some cases either the hospitlaist or the ED group.

[Cowboyardee]

Since you made the above comment, I will reply. No hostility; I am concerned about the standard of care. We have two classes of health care. Some patients receive their care from physicians with many years of education and training, and some receive their care from NP's, with a small fraction of the education and training of a physician. According to a poster above, there isn't a scope of practice for NP's in his state, and NP's are allowed to do what they feel trained and competent doing. I am grateful that I live in a state where physicians have strongly opposed independent NP practice, and where the BON has not allowed independent NP practice.

I don't understand.

In the above post you're talking about standards of care and your concern for whether NPs should be allowed to practice independently given the disparity between NP and MD training. In other posts in this thread you are arguing that there's no problem with NPs being overseen by nursing management.

Don't these two positions seem contradictory to you? Do you think RNs' standard of care would be unaffected if our direct oversight came from CNAs?

[Susie2310]

Can you do me a favor and reference those laws.

The issue is going to be different in each facility and it's important to be comparing apples to apples. As a CNO i had direct oversite of the ED. This meant I handle administrative functions. I also ensured that everyone was meeting the standards the hospital had set up through the Medcial Staff and the Board. There were certain things that all clinicians had to do, MD, DO, NP, PA. I handled all the QI and credentialling, etc. When a specific clinical question came up, it was forwarded to both the ED director who was an MD and in general the Chief of Staff for review and I took action based on their recomendations. This was the same for any clinician.

In every state I"ve worked in I was qualified to manage and supervise clinicians. I wasn't however qualified to dictate medcial practice. But I could enforce standards that had been set.

p.s. the last time I checked most hosptial administrators weren't MD and they have a certain amount of supervisory/management responsibilities, including HR functions.

p.s.s. It also depends on who's hiring and that is a completly seperate issue. In once facility NP (including CRNA's) were hired by the nuring department. In another facility they were hired by the medcial staff or in some cases either the hospitlaist or the ED group.

Your post reminded me of the fact that a local ED Manager was an RN.

[Susie2310]

I don't understand.

In the above post you're talking about standards of care and your concern for whether NPs should be allowed to practice independently given the disparity between NP and MD training. In other posts in this thread you are arguing that there's no problem with NPs being overseen by nursing management.

Don't these two positions seem contradictory to you? Do you think RNs' standard of care would be unaffected if our direct oversight came from CNAs?

See CraigB-RN's post and my post below.

[Flaring]

Deleted