NP's with second jobs

nursetim, NP · Aug 22, 2009

Would the same hold true were I to volunteer as a swat team medic? I was thinking about going back for my EMT then EMT-P. I figure that once I get to the P level I'm covered as I can preform all the procedures I have been trained in. Where it would get dicey is if I would be the team medic as an EMT basic and had to intubate or start a line or such. Any ideas?

elkpark · Aug 22, 2009

Would the same hold true were I to volunteer as a swat team medic? I was thinking about going back for my EMT then EMT-P. I figure that once I get to the P level I'm covered as I can preform all the procedures I have been trained in. Where it would get dicey is if I would be the team medic as an EMT basic and had to intubate or start a line or such. Any ideas?

You're right, it's v. dicey. The same principle applies in any discipline or setting -- if you end up in court, you will be held to the standards of the highest level of education and licensure/credentials you hold. The chances of that ever happening are slim, granted, and every individual has to decide individually how comfortable s/he is with the risk.

celclt · Aug 22, 2009

I have a friend who works as a RN on L&D and is a WHNP but the hours are better for her family. She was doing in hosp OB triage as a NP and clinic work but really wanted to be home with her children so RN work it is. She has really discouraged me from NP d/t politics, malpractice,pt workload.

celclt · Aug 22, 2009

Elkpark and SirI, would this vary by state? Dictated by both BON, facility, and state and/or federal regulatory code or just state BON?

What do NPs do if they are unable to find employment as a NP (market saturate) or burnout,ect? What I hear from the above is that it would be more favorable legally to work PRN as a NP than RN. I know several NPs working as RNs (including several nursing instructors in my program). Would that mean nursing students are working under her NP license, the facility is surely aware during credentialing?

elkpark · Aug 22, 2009

Elkpark and SirI, would this vary by state? Dictated by both BON, facility, and state and/or federal regulatory code or just state BON?
What do NPs do if they are unable to find employment as a NP (market saturate) or burnout,ect? What I hear from the above is that it would be more favorable legally to work PRN as a NP than RN. I know several NPs working as RNs (including several nursing instructors in my program). Would that mean nursing students are working under her NP license, the facility is surely aware during credentialing?

This issue has nothing to do with facilities or a state BON (any state BON) -- that's the point. It's the court system. Courts have repeatedly held practitioners to their highest level of education and licensure, regardless of a job title on a particular day, when it comes to client safety and outcomes. You don't get to forget or ignore what you know as an NP because you're working in a staff nurse position (RN working in a CNA position, or any other situation). If something goes wrong and you end up in court, you will be held to the standard of what a careful, prudent NP knows and would do, regardless.

Of course, lots of people do this (including me, currently :)) and chances are v. slim that you ever will end up in court, but it's important that people understand and consider the risk they're taking when entering into these situations.

celclt · Aug 22, 2009

Thanks for the info- that is concerning, but interesting. How does the court system circumnavigate the BONs deemed scope for each role? If the RN acted as a NP while hired to fulfill a RN role, would she be working outside the scope? How would that affect her licenses? Would it be 'overlooked'/reasonable bc it was an emergency?

elkpark · Aug 22, 2009

Thanks for the info- that is concerning, but interesting. How does the court system circumnavigate the BONs deemed scope for each role? If the RN acted as a NP while hired to fulfill a RN role, would she be working outside the scope? How would that affect her licenses? Would it be 'overlooked'/reasonable bc it was an emergency?

All these issues are why working outside/below your level of licensure is dicey -- there are no clear-cut, definitive answers. A lot of it depends on the circumstances.

Nacki, MSN, NP · Aug 22, 2009

Thanks for the info- that is concerning, but interesting. How does the court system circumnavigate the BONs deemed scope for each role? If the RN acted as a NP while hired to fulfill a RN role, would she be working outside the scope? How would that affect her licenses? Would it be 'overlooked'/reasonable bc it was an emergency?

Tricky, tricky...but interesting. I want to hear about this one. I still woundn't set myself up for a potential outcome like this though.

TX RN · Aug 23, 2009

My :twocents: , so take it with a grain of salt.

How does it circumvent the BON you ask?

It actually doesn't. I think the complaint must first be filed with the BON, the board investigates and if their findings conclude that the licensee actions violated the practice act then sanctions are made against their license. In a crimial court the charges will typically not be filed to the court until the board has found some negligence or deliberate action that has caused harm.

To clarify this issue let's give an example.

Nurse Betty is sued for failing to initiate MI protocols for a chest pain patient because the MD refused to order any interventions and the patient subsequently died. Charges could be filed against both the MD and Nurse Betty for gross negligence (manslaughter). However, before charges are filed by the district attorney's office some would argue that it would be prudent to allow the licensing board to investigate the complaint first. This would serve as evidence to the court in either defending or prosecuting the individual.

Now if you ask me how this works on celebrity cases, such as the Michael Jackson case,well....I'm just as curious as you are to find out.

The main issue in protecting licensure is being cognizant of the true issue at hand. The real issue here is Licensure/Certification practice guidelines VS. Institution Policy (job description and unit based policies). If you ever find yourself in between a rock and a hard place, my advice is to distinguish which of those two is driving your decision. My :twocents: again, would be to always follow practice guidelines even when they conflict with facility policy. I would rather be fired for ignoring policy than be investigated and possibly risk disciplinary action and sanctions placed on my license for ingoring practice guidelines.

:typing

elkpark · Aug 23, 2009

My , so take it with a grain of salt.
How does it circumvent the BON you ask?
It actually doesn't. I think the complaint must first be filed with the BON, the board investigates and if their findings conclude that the licensee actions violated the practice act then sanctions are made against their license. In a crimial court the charges will typically not be filed to the court until the board has found some negligence or deliberate action that has caused harm.
To clarify this issue let's give an example.
Nurse Betty is sued for failing to initiate MI protocols for a chest pain patient because the MD refused to order any interventions and the patient subsequently died. Charges could be filed against both the MD and Nurse Betty for gross negligence (manslaughter). However, before charges are filed by the district attorney's office some would argue that it would be prudent to allow the licensing board to investigate the complaint first. This would serve as evidence to the court in either defending or prosecuting the individual.
Now if you ask me how this works on celebrity cases, such as the Michael Jackson case,well....I'm just as curious as you are to find out.
The main issue in protecting licensure is being cognizant of the true issue at hand. The real issue here is Licensure/Certification practice guidelines VS. Institution Policy (job description and unit based policies). If you ever find yourself in between a rock and a hard place, my advice is to distinguish which of those two is driving your decision. My again, would be to always follow practice guidelines even when they conflict with facility policy. I would rather be fired for ignoring policy than be investigated and possibly risk disciplinary action and sanctions placed on my license for ingoring practice guidelines.
:typing

Speaking only for myself, I'm not talking about any sort of criminal or regulatory charges, but being sued for malpractice (professional negligence) in civil court. The standards of evidence and burden of proof are v. different in civil court than they are in criminal court.

Again, the chances that any of us, as nurses, will ever find ourselves being sued for malpractice are v. slim. But I think it's part of our professional responsibilities to be aware of all the legal ramifications of the choices we make and actions we take profesionally.

scrabblern, RN · Sep 27, 2009

i agree that in most cases the two roles could interfere... i was thinking if i pursued FNP, since i work as an RN in Neonatal ICU there would be little role confusion if i chose to continue working as an RN. obviously most RNs train to provide advanced practice to patient population they have experience with. however, since it is possible to pursue FNP from pretty much any specialty... if one pursued it from NICU i wonder how much liability would be held against them... simply because only NNPs are trained to deal with that specific patient population. i don't see how could anyone expect an ANP or FNP to know what treatments to prescribe to a preemie or be held to that level of practice...

JDCitizen · Sep 27, 2009

So how many states require that you be licensed as an RN and as a APRN? Here in GA if you want to practice as a APRN you have to have both.

I worked for two years after I graduated as an RN my job title was RN, I was identified as an RN and caring for patients as an RN. My training may have been higher and allowed me to identify problems that I may have not been able to previously identify... I would have had the obligation to contact the patients MD and if appropriate my supervisors to help provide proper care (RN or APRN). I did not have privileges to practice medicine in that hospital, I had no protocols to work under as an APRN in that hospital.

Also noted law is different in civil and "criminal".... Lawsuits are civil matter and anyone can have a lawsuit at anytime frivolous or otherwise… That’s why I carry malpractice insurance of my own.

Practice acts as well as the legal stuff will vary greatly from state to state and from courtroom to courtroom. What one jury finds as a negative another jury may find as a positive.. I would think one would need to know what their state laws have to say....