NP's with second jobs

Bonosgrrl · Aug 20, 2009

I continued to do a little per diem on the cardiac tele floor where i previously worked prior to becoming an NP. but i only did it for a little while.

It does not set you up for liability issues because when you are working as an RN you cannot be expected to perform as an NP. the scope of practice in the position as an RN is what you would follow.

Trauma Columnist · Aug 20, 2009

The liability issues is a biggie - you are held to the knowledge of an NP even though you work as an RN.

I did not work as an RN once I became an APN. However, I do work two jobs as an APN simply due to the economy and the fact that I help our family who have been laid off.

Editorial Team / Admin · Aug 20, 2009

The liability issues is a biggie - you are held to the knowledge of an NP even though you work as an RN.
I did not work as an RN once I became an APN. However, I do work two jobs as an APN simply due to the economy and the fact that I help our family who have been laid off.

traumaRUs is exactly correct. Liability issues are paramount when APNs work as RNs. You are held to the higher educative standard and can be liable if you are faced with issues that require the added knowledge of an APN.

Be careful when choosing to practice as RN with advanced education as NP.

Nacki, MSN, NP · Aug 20, 2009

traumaRUs is exactly correct. Liability issues are paramount when APNs work as RNs. You are held to the higher educative standard and can be liable if you are faced with issues that require the added knowledge of an APN.
Be careful when choosing to practice as RN with advanced education as NP.

This is what I thought. I wonder if the need for $$$ is so great that one would put their liscense in jeporady. I know of a girl who works M-F as a NP and then every other Sunday as a RN. She comes in and says she can't take care of pt. A or B because she works with them throughout the week. I just see it as blurring boundary lines between NP and RN, this doesn't include how the staff feels since she comes in and rounds w/the doc during the week, writes orders and such and then works as a RN on the weekend.

Trauma Columnist · Aug 20, 2009

Exactly. Its funny I just had a similar situation: one of my nephrology pts had a syncopal episode and darn it, came to the itsy bitsy ER where I occas work prn (as an APN). I did not take care of him but it was more for billing reasons than anything else.

Editorial Team / Admin · Aug 20, 2009

I just see it as blurring boundary lines between NP and RN

Exactly.

And, attorneys/legal authorities, will see it the same way if something should happen where the NP should have acted.

To me, it's just not worth my license.

Bonosgrrl · Aug 20, 2009

from Medscape

"From a regulatory standpoint, you are always legally entitled to work under your RN license, as long as it is current and you meet all RN requirements. However, insurers agree that someone with advanced practice training and certification needs to be insured at the 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 role validation, by keeping your job title, job description, duties, and activities crystal clear. The most conservative advice would be to avoid working in areas that share the specialty of your advanced practice focus (such as a nurse midwife working as a labor and delivery nurse). Taking such a position is asking for role confusion, and that, in turn, affects your ability to practice appropriately with your patients."

Trauma Columnist · Aug 20, 2009

Yes indeed - bottom line: don't do it....you are just asking for the lawyers to come knockin' at your door.

elkpark · Aug 20, 2009

from Medscape
"From a regulatory standpoint, you are always legally entitled to work under your RN license, as long as it is current and you meet all RN requirements. However, insurers agree that someone with advanced practice training and certification needs to be insured at the 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 role validation, by keeping your job title, job description, duties, and activities crystal clear. The most conservative advice would be to avoid working in areas that share the specialty of your advanced practice focus (such as a nurse midwife working as a labor and delivery nurse). Taking such a position is asking for role confusion, and that, in turn, affects your ability to practice appropriately with your patients."

Regardless of what "face you hold out to the public," it is well established in the courts that, if something goes wrong and you end up in court, you will be held to the standards of the highest level of education and licensure/certification you hold, regardless of what your particular job title was that day, or what role your employer was paying you to fill. Why do you think NSO is saying that "insurers agree" that you should be insured at the higher level? -- because that's the role/standard to which you're going to be held in court, and that's the level at which damages, if any, will be levied. This is what makes working in two different capacities so complicated legally/ethically, and why many employers just won't hire people to work below their level of licensure. Advanced practice nurses like to do it because it's a comparatively easy way to pick up extra cash, but it's important to recognize you're taking a chance.

One quick reference (I'm sure there are lots more out there); emphasis mine:

"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 expected 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)

[The DATA BASE /The Bulletin /Spring 1985]"

http://www.maine.gov/boardofnursing/questions/questions_general.html#practice

Smitty08 · Aug 20, 2009

Or..work in a different job at the same mastery level if you need extra $$ or experience. For example, mostly I prescribe, but I could work at a different place prescribing, doing therapy or some combo of same. That avoids the role level confusion and potential liability issues.

Nacki, MSN, NP · Aug 21, 2009

Thanks for all the responses. I thought this wasn't good practice for a NP, especially one who works as a RN in the same specialty. Thanks for your input.