RN acting as a Mid-Level provider

[xstraz98]

At a hospital here in Michigan there is an associates degree registered nurse who is not a hospital employee. They are employed by a physicians group to act as a mid-level provider in the hospital. How does one work as a mid-level without an advanced practice degree? They write orders and see consults. I cannot find much regarding this type of situation and would appreciate some input from the community.

Chris.

[Otessa, BSN, RN]

I have seen this and personally, I wouldn't put myself in that position for legal purposes. They are sometimes called Nurse Clinicians.

otessa

[LuxCalidaNP]

This is totally illegal. Regardless of the years logged as an experienced RN, unless this RN is using standing orders or has her own (don't know how this would work) DEA #, this is 100% illegal, and shortchanges APNs of all types.

I would inquire, and it seems sketchy, PLEASE let your state Board of Nursing know!!!

Best of Luck!

[RN1982]

I want to know how you know they only have an ADN? And my guess about the not being a hospital employee isn't all that true. They probably got hired through the hospital specifically for that physicians group. The hospital where I work hires APNs or Nurse Clinicians for physicians groups all the time.

[meandragonbrett]

There are RNs that round on a routine basis on a selected group of patients for physicians. This is not something that is illegal. Many facilities credential these providers as "physician extenders" They are able to round on inpatients, write orders in conjunction with physician collaboration, etc.

[Otessa, BSN, RN]

There are RNs that round on a routine basis on a selected group of patients for physicians. This is not something that is illegal. Many facilities credential these providers as "physician extenders" They are able to round on inpatients, write orders in conjunction with physician collaboration, etc.

That is what I have seen. There are standing orders, etc. but there are a lot of judgement calls being made on the MD's behalf. I would be quite uncomfortable in that role.

otessa

[xstraz98]

I want to know how you know they only have an ADN? And my guess about the not being a hospital employee isn't all that true. They probably got hired through the hospital specifically for that physicians group. The hospital where I work hires APNs or Nurse Clinicians for physicians groups all the time.

I have known this person for several years. That is how I know they are an ADN. They are NOT a hospital employee as I stated before. The physicians group is under contract and they bring their own mid-level staff.

[Sandwitch883RN]

I've never heard of this before. Althought, I have only worked in community hospitals. I think anyone who works in a scope of practice, legal or not, that they haven't gone to school for is a slap in the face for those who have the advanced degree. Why work you butt off to obtain an advanced degree when you can go this route? It negates all of the hard work of the ANP. I wouldn't wan't an RN without an advanced degree writing orders for myself or my family, standing order or not.

[cookienay]

We have these physician extenders as well. They are RNs who see patients, write orders as directed by their physician, and do initial dictation. The physicians then do a follow up with the patients, review what the extender has documented, does his/her assessment and completes dictation. the extenders are typically in close communication with the physicians. They are not acting as a mid-level provider because they are not the ones diagnosing or treating. It is not illegal because they are not claiming to be physicians or NPs, nor do they sign prescriptions. Everything they do is under the direction of their employing physician. This allows the physican to keep on schedule with rounds, procedures, and office hours. Hospitals vary in their policies with regard to the physician extenders. Some hospitals require mid-level providers, some require RNs. Like I said, this is how it works at my facility. Hope this info helps.

[GilaRRT]

So, similar to a paramedic working under a set of protocols and a physicians license? Curious concept for the hospital environment however. I worked in a mid level like role in Afghanistan; however, my official title per my Afghan work visa was, "doctors assistant." Therefore, I was not working under my RN license or EMT credential per-say, even though my job title while in Dubai was Flight Nurse/Intermediate Life Support Paramedic.

With that, I was aggressive about involving our doctors as much as possible, and I had a doctor review all of my charts. However, I could not see such a system working in the US without advanced level education and licensure.

[JomoNurse]

any patient that would go to an RN as their primary medical advisor is off their rocker. RNs are not trained to provide medical advice.

[meandragonbrett]

Some of you folks are way off base. Here's an example that I can provide of what commonly is the arrangement.

Lots of interventionalists and proceduralists have RN-Physician Extenders. The role of these people are to do pre-procedure teaching, assessment, documentation, writing pre-procedure/post procedure orders at the direction of the interventionalist. These RNs are NOT practicing as APN. While it may appear they are doing this and that...everything must be co-signed by the LIP they are working with. This does NOT alleviate the LIP from rounding on their patients and writing/adding to the notes written by the physician extender. By having the physician extender, it allows the provider to be in the procedural suites which increases their productivity. The physician extenders are constantly on the phone and talking face to face with the providers throughout the day. It's not like the physician extender is at one hospital and the physician is at another hospital 20 minutes away. They are generally there together...two people doing the work of one.

It's no different than a physician's nurse rounding on the patients early in the morning and the physician coming by after office hours, surgery hours, etc. This helps to create an ease in work flow. Electrolytes can be replaced before the afternoon, diagnostics can be reviewed, etc. Work smarter not harder!

And for those that say they wouldn't be comfortable working under protocols and standing orders....don't obtain a position in an ICU.