I would like to know if any of you are seeing this trend where physicians are hiring registered nurses to function in the capacity of an Advanced practice nurse. I know of several situations where a registered nurse is hired by a provider to round on patients and write orders as if they were advanced practice clinicians when in reality they are not.
Please respond with input or personal experience with this problem
I've worked with protocol based orders before - the RN can write orders for labs, meds, treatments, etc IF and only if following a protocol, as others have said. No one represents as an APRN. :) We did it for chronic disease management (DM, HTN) and at one place the nurses could RX for UTI's as well - based on a strict protocol.
The only thing I can think of similar to what you describe was: main WOCN in an LTACH setting (an LPN but absolute wound care genius) rounding and writing wound care "orders." However, the wound MD cosigned them all, so she wasn't really excercising prescriptive authority she didn't have.
If they are misrepresenting their credentials, writing independant Rx's (meaning, not based off of protocols), or making medical dx's, that would be a huge issue.
Is that truly what is happening? Or is it like the PPs have described?
Specializes in BNAT instructor, ICU, Hospice,triage.
As a hospice nurse we text our doctor and get orders all of the time, just because you don't see or hear them, doesn't mean they have not gotten verbal orders. I used to work for a general surgeon and he would tell me what to order before I got to the hospital after I assessed them and called or text him.
Specializes in Medical-Surgical/Float Pool/Stepdown.
My hospital has a newer RN role that supports the night shift hospitalist. They field all of the pages and help with admits, etc throughout the night. The hospitalist is in house and always available and they are suppose to be working off of protocols eventually.
The biggest issue I have with this is that my hospital does not pay APP's what they should so they have a hard time with retention, especially for nightshift which really would not employ that many APP's.. It is just another way of protecting the budget which in a way I do understand but it also blurts the lines of scope of practice. Almost (almost) like how MD's uses the role of MA's in my opinion (I repeat, in my opinion). NOT a fan. Pay people what they're worth and we should get better patient outcomes, shorter stays, and less expense over the long run...but what do I know. Did I mention that it's a pay cut to go from the floor into this role? Yet another reason why I'm holding off on dropping a ton of money and time into an NP program in my already saturated area!
Specializes in Nurse Leader specializing in Labor & Delivery.
Whose NPI/DEA number and name is on the script?
I am just really surprised by that, that seems way out of the scope.
Yeah, I'm wondering that too, and I'm wondering if we're misunderstanding/talking about two different things? Like maybe she means calling in medications to pharmacy under the physician's name, rather than physically writing out a script. I've physically written out a script (for azithromycin, for a patient who comes in for chlamydia treatment) a few times just to save the provider time, but they still have to sign it themselves before it can be given to/used by the patient.
Yeah, I'm wondering that too, and I'm wondering if we're misunderstanding/talking about two different things? Like maybe she means calling in medications to pharmacy under the physician's name, rather than physically writing out a script. I've physically written out a script (for azithromycin, for a patient who comes in for chlamydia treatment) a few times just to save the provider time, but they still have to sign it themselves before it can be given to/used by the patient.
Yeah, even calling in a script under a prescriber's name is shaky ground even if a verbal was given for it.
It would seem that the practice described by OP is becoming more common. My organization recently enacted tightened rules & regs to ensure that it was maintained within legal and professional licensure boundaries. Case in point: acute care nurses calling physician; "office" nurse (not APRN) is answering calls for physician after hours; "office" nurse calls back in
Same situation with physician 'rounding' nurses ... gathering information & entering information into EMRs for their employers. If everything is not covered under SDMOs (standing delegated medical orders), the nurse is practicing medicine without a license. Also, all physician-employed nurses must be credentialed appropriately via medical staff processes. This process must include an assessment of the nurse's competence to perform those tasks.
Yeppers - the new requirements created quite a storm among the physicians. They have to do more work now. The physician-employed nurses (not APRNs) are miffed because they feel like they have been 'demoted'.
Specializes in Nurse Leader specializing in Labor & Delivery.
Yeah, even calling in a script under a prescriber's name is shaky ground even if a verbal was given for it.
How so? Nurses do it all the time. Nothing legally shaky about it whatsoever, as long as they're working off a protocol or order of some kind. I do it multiple times a day in my job in the clinic, and did it all the time as well in OB triage.
Yet another reason why I'm holding off on dropping a ton of money and time into an NP program in my already saturated area!
featherzRN, MSN
1,012 Posts
I've worked with protocol based orders before - the RN can write orders for labs, meds, treatments, etc IF and only if following a protocol, as others have said. No one represents as an APRN. :) We did it for chronic disease management (DM, HTN) and at one place the nurses could RX for UTI's as well - based on a strict protocol.