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.

[djmatte, ADN, 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.

I guess the moral of the story is to not own the facility you do your procedures at. You start to see cutting corners to improve profits as a rational decision. It's like a DJ deciding to own a club. You try to do both things, but when the money starts to slip, you decide to sacrifice your treasured house music for some crappy mainstream hip hop. And eventually you are just left with a bad overall product with nobody respecting you.

[babatee, MSN, RN]

Talk to your employer and start looking for a new job.

[aprnKate]

this whole situation is just real bad news. I really do hope you seek another job that is appropriate for your NP role.

[Crush]

One way to not get too stressed with wondering about a bad reference is to keep your evaluation ready as proof. I had to do that in the past. I warned the place I applied to that I would get a bad reference but I gave them a copy of my last 2 evaluations that showed I had good reviews.

[bgxyrnf, MSN, RN]

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.

Agreed in principle and I would certainly encourage actively job hunting, networking, etc, but finding a job at the present time is likely to be complicated by being a newbie only a few months (I think) into their first job.

The reality is that most people can't simply resign without something else lined up and employment history titled as an NP at least helps get the application past the HR screening people/software where the OP may have the opportunity to dazzle in person.

[BlondieMSNRN]

Absolutely not. Any potential employer who is worth it will understand that this isn't a good fit and wont look down on you for leaving. You shouldn't be expected to stay in a role that doesn't allow for growth and doesn't utilize you as an NP. One of the good things about a terrible NP job is it allows one to know what the red flags are of potential ones. Always ask to shadow any potential ones, have your contract nailed down, and be as honest as you can without badmouthing the current place. Most importantly, move on.

[sweet sunshine]

Doctor really needs RN for the job, but wants you to be the RN with script writing authorization for opioids so he doesn't have to write them.

[ghillbert, MSN, NP]

Repeat after me:

"No."

Find a new job. If worried he would give a bad reference, get your evaluations on paper and keep a copy. Then write "references available on request" on your CV and don't list his name. If interviewed elsewhere, you can explain. It's not unusual; as someone who hires staff, it's common people don't want their current employer to know they are looking elsewhere. Get references from clinical preceptors, professors etc who can speak to your characteristics. If he is so petty and cheap, he won't give a good reference regardless whether you quit now or later. Do you have in writing regarding repayment of relocation expenses?

[Kooky Korky, BSN, RN]

I think I hear the doctor saying "Here's the knife".

[Adam18]

I'm so thankful for all the replies that I have been getting. To answer some of your questions. It is written in my contract that I have to pay back my re-location if I leave before 2 years. I am working in a state where NP's are completely independent. whatever mistake I make falls all on me and me only. I have already started looking for a new job. The evaluation idea is clever! I hadn't thought of that. Sadly, I have not received one evaluation since I've started. This place feels like a complete dictatorship sometimes. We haven't even had one clinic meeting. The doc changes rules at the drop of a hat and doesn't inform all of his employees at once so no one ever knows what's going on. I never know I did something wrong until I hear him on the phone telling a patient that he'll have to have a talk with me about this or that and the discussion never happens. I'll probably have to draft up my own eval and have them fill it out. I also have not received my raise after my 6 month probationary period and without proper explanation except for not seeing enough patients and not finishing my notes fast enough. Keep in mind I have no dictation device, transcription service, or scribe, and all my notes are hand-typed. The NP and doc have it though. I have complained about this. I also see more patients than the doc's senior NP on average. I was in the process of scheduling a meeting with them to discuss why I am deserving of the raise and have typed up a long grievance letter where I also included suggestions on how to make the clinic more efficient. This is getting ridiculous, and I should have left a long time ago but since this is my first job in a specialty I have always wanted, I have been swallowing my pride. I hope this isn't happening to other new grads out there. I can't tell you how many patients have confided in me that they would rather see an NP than a doc because we're more thorough and careful and better at explaining. I'm proud that nurses have such a powerful lobbying group and continue fighting for what is deserved. I'm no longer going to be a pawn in this nonsense.

[Adam18]

The doctor has yet to train me as a first assist, because he can't afford to pay me my salary and have me at the hospitals assisting in the bigger surgeries with him when he already has someone to assist. He says that he needs me in the clinic, but My training was expedited to help out as an ambulatory Surgery RN. I'm becoming more upset every minute that I think about this. The opportunity to first assist is a huge reason why I was sold on the job while interviewing. I have moved hundreds of miles away from friends and family.

[NurseMoneyTalk]

I don't know about the state you live in but I do know after talking to the Board of Nursing where I reside ghat they said in a legal situation they would hold that person to the highest level of their licensure. So for example even though you are working as a RN you have a APRN therefore you would be judged as the latter.

There is so much ambiguity in this scenario. It also appears that you are being taken advantage of from what I understand. I would either talk to management or start making other arrangements.