NP being used as an RN

[Adam18]

I was hired to work as a nurse practitioner in an outpatient clinic/ambulatory surgery center. The nurses were going to be let go, and I was asked to serve as the OR and pre-op post-op holding nurse on days that there is surgery in an effort to cut costs. I will also be writing scripts for the patient's to take home after surgery. After the surgeries of the day are over, I'm expected to see patients as an NP until the clinic closes. This was not included in my contract, and I will be getting my same yearly salary instead of a hourly salary. Sometimes, the surgeries run hours past closing and there has been no mention of compensation for the additional hours. I'm also concerned about any legal aspects of serving in both roles and the confusion that it may bring to the patients. Have any of your employers ever used you in a dual role to cut costs? What do you think about this? I appreciate the responses.

[Workitinurfava, BSN, RN]

I can't say that I haven't ever seen nurse's get used by dingo jobs they shouldn't be, but the things they are asking you to do are way too risky. Honestly I would not be shocked if doctors try to make this the norm in the future. Don't help foster the chance for it to occur one day, get out of there.

[djmatte, ADN, MSN, RN, NP]

Preop and recovery are very specialized nursing roles that you aren't prepared for as a nurse practitioner. Unless you have that specific background, there's no amount of training another mid level or md can provide you that will suffice. I would leave in a heartbeat even with my recovery background. I have no problem incorporating my previous knowledge of pain management or post op knowledge into the care of my patients. It can greatly help when they are anticipating surgery. But sure AF won't be doing the job I used to do after all that school. He needs to take a look his business model because he either hired one too many NPs or he needs to boost production to justify the staff.

[SpankedInPittsburgh, DNP, RN]

Yeah once you accept this role it becomes the norm. It sounds like you are working in a place that is trying to squeeze the dime as hard as they can. Tell them you negotiated your salary on the terms and conditions as outlined in your original negotiation and they have added duties without adjusting compensation. This is unacceptable really on all levels. Look for a new position that will value your contributions as an NP & not jack of all trades

[NurseVal93]

I'm happy to know that I wasn't ridiculous in thinking the same as you all have. This is a difficult situation because there is only one doctor and he is the sole owner of the center/clinic, 2 of us mid levels. The other has been with him over 15 years. They haven't been able to hold down a second NP in all those years. There is 1 MA, 1 office manager, 1 medical trascriptionist, 1 receptionist, and that's it. The last medical transcriptionist was also doing billing/coding and serving as MA checking in patients when the MA was out. She was MA and transcribing for all 3 of us providers and was fired because she Refused to serve as a scribe for the doc on top of what she was already doing. There is one Pre-op, one OR, and one post-op Rn. The same day surgeries are all simple ortho surgeries. In the pre-op RN role, I would have to start an IV, fluids, EKG, check if the consents are complete and all the pre-op paper work then in the OR, help the doctor scrub in and out and document the surgery. There are about 5 patients only a day. During post-op role, I have to explain home care instructions, Write the prescriptions for the pain medicine, vital signs, discarge Home paperwork. I don't know if this makes it any better. On top of that, I was urged to send the other nurses home as soon as I felt confident to do these tasks all on my own. It seems like I'm left to do the dirty work that the office manager should be doing. The nurses shouldn't be disposable.

Yeahhhh.. no. So they're trying to use you as a second NP AND an RN.. There are only 2 nurses there you and the other NP. They should hire an RN, that is completely ridiculous that they refuse to. Anything above an MA's scope of practice would fall on you; which would be a LOT.

UNACCEPTABLE. I'm so sorry you're going through this, best of luck in your job search friend.

[CardiacDork, MSN, RN]

On your shoulders falls the burden of defining the future practice of APRNs. Discusss these matters with the physician then find another position. To stay is to hurt both RNs and NPs. Taking away work from valauable and trained RNs in the respective roles, as well as NPs by utilizing for purposes for which they are not intended for.

[bgxyrnf, MSN, RN]

Thanks for the quick responses. This is my first job as a new graduate. How would I go about looking for a new job without my current employers knowing or getting called. I want to make sure that I have something nailed down before I quit. I would also have to pay them my relocation allowance if I quit this soon. They would also probably blackball me if any future employer called. I feel like they do not care about my professional growth. I moved because of the opportunity to first-assist and they keep saying that they cannot afford for me to leave the clinic and stop seeing patients to scrub-in. They already have another provider assisting. I have talked to them before about having Dragon or some dictation device to finish my notes faster and they have refused because they did not want to pay for another Dragon certificate. Everything that I keep bringing up falls on deaf ears. I feel trapped, abused, and have been depressed about this.

They sound like a bunch of cheap-@$$ bastards that will continue on with their behavior to maximize their profits at the expense of their employees (and probably patients, too). Their plan to "let the nurses go" was the first major indicator.

My advice is continue playing nice until you garner enough experience to get hired elsewhere.

[CKPM2RN, ASN, EMT-P]

Wait. "The nurses (multiple) were going to be let go"? So you (one person) are to replace multiple persons responsible for the pre and post op care, intake, follow up, etc? How is that safe? Did the NP degree make a superhuman with multiple eyes in the back of the head and another set of arms? How is this safe?

This is a huge problem in my eyes.

[aprnKate]

They sound like a bunch of cheap-@$$ bastards that will continue on with their behavior to maximize their profits at the expense of their employees (and probably patients, too). Their plan to "let the nurses go" was the first major indicator.

My advice is continue playing nice until you garner enough experience to get hired elsewhere.

Experience? He/she is not getting the NP experience at all by choosing to stay. Play nice and direct yes but I wouldn't stay for a RN experience unless of course you just want the RN role.

[Corey Narry, MSN, RN, NP]

I would look for another job and not worry about what feedback your current employer may give to a prospective employer. You only have 1 year there, that's not a lot of experience at this point for a future employer to give weight to. Let this be a lesson for being smart the next time around. BTW, was there even a contract and was the role specifically addressed in that contract? Was there a formal job description that was signed by both parties? If this is a state that requires a collaborative agreement, does this breach in role delineation clearly violate that legal document? you may actually have a leg to stand on as far as going against them if they continue to ignore your demands.

[Dodongo, APRN, NP]

You need to remember that as a NP you are a revenue generator, unlike a RN. A MD or PA would never do anything like this (not that they could act as RNs but you get my point here). They act as providers. Too many NPs hold onto the "nursing" part of their title. You are a practitioner. A provider. You should absolutely not be taken advantage of like you are in this situation.

Do not spend a second longer in this job than you must. Find a job where there is clear delineation between NPs and RNs.

Situations like this bring the profession down as a whole.

[djmatte, ADN, MSN, RN, NP]

I wouldn't be entirely against this if sold to me in the right light and under the right circumstances. If the provider worked both clinic and surgery hours and wanted their other providers to provide ancillary support. Much like some surgeons do with their PAs in and around surgery. But in this case, the role you will undertake isn't something you have experience in (from my understanding).

[Corey Narry, MSN, RN, NP]

Well, problem is that it's a surgical practice in what seems like an ambulatory surgery clinic. Billing is limited here, the surgeon bills for a global fee and no other provider can bill for anything except for the first assist (which the OP isn't even doing since another provider is doing it). That global fee can apply to even post-op follow up eleven days later after a minor surgery. The OP is being used for paperwork compliance...scripts, intake, discharge teaching, notes (that can't be billed anyway), and such. Could an RN (or even LVN) do these? sure except for writing the notes and prescriptions which the surgeon could do if he doesn't really need an NP.