Working as a staff nurse when an APRN?

Trauma Columnist · May 18, 2011

The problem is the liability factor - you are held to the standard of an APRN even when working as a staff nurse.

I would love to work prn as a staff nurse but wouldn't due to the liability.

mochamonster · May 18, 2011

This is what I was afraid of. It's a shame because I'm sure I'm not the only one who is interested in more than one area. It's one of the reasons I was drawn to nursing. I haven't gotten my MSN, so I guess I may just put that off a little to enjoy working at the bedside for a while since it seems I will not be able to return to it. Thanks for your response.

flaviadsouza · May 18, 2011

Yup..I feel that when your a RN or MSN... It does make a difference, since your output will be different. You can work bedside but as a Nursing supervisor/ Head nurse/ Nurse educator etc.. It goes the way you visualize yourself...

NAURN · May 25, 2011

We have a nurse that works as an NP in one hospital and works PRN as a nurse at my hospital. It seems to work well for her and allows her to earn some extra cash.

tonet0908 · Jun 17, 2011

I'm in NY and I have been an FNP since December 2009. I'm still working as a RN-BC on the Tele unit that I've been on for the last 6 yrs and I have been working as a FNP-BC in a single physician Family Practice for the last 10 months. I don't see a big difference other than I'm a lot more tired because I'm working way more hours now. Also, I notice that I do more critical thinking on the unit than I used to do, for example, I assess my patients as if I was an NP rather than just focusing on the matter at hand which is what I have done as an RN. Before I administer meds, I also analyze them as if I was prescribing them (SE & contraindications). Everything has stayed the same at the hospital. The only thing that I've noticed which I guess is a good thing is that my RN co-workers and some of the PA's are now asking my opinion when it comes to making decisions about the patients. For exampe, a PA might ask me what meds I want to give to a pt who is having ST and intractable HTN instead of just telling me what to give or an RN will ask me things that they would normally ask an MD or PA.

So far my NP scope of practice has not been an issue. I am working as an RN in the hospital so I guess I'm still held under that scope of practice. My Nurse Mgr doesn't treat me any differently from the other RN's. I still sign my name with RN-BC at the hospital and FNP-BC at the office. I know alot of other NPs that are still doing bedside nursing, some of them are not even practising as NPs. So you can do both in NY, I don't know about other states.

mochamonster · Jun 18, 2011

The only thing that I've noticed which I guess is a good thing is that my RN co-workers and some of the PA's are now asking my opinion when it comes to making decisions about the patients. For exampe, a PA might ask me what meds I want to give to a pt who is having ST and intractable HTN instead of just telling me what to give or an RN will ask me things that they would normally ask an MD or PA.

This is the exact thing I was concerned about. Since they are treating you as an NP and not an RN by asking your opinion and making decisions based on that NP opinion, are you not "practicing" as an NP when you are working as an RN? Also, conversely if something were to happen to your patient as an RN that you could resolve as an NP and you did not act, legally wouldn't you be held to that standard even if your employer requires that you only act as an RN?

I've heard opinions from both sides, on here and in person. I suppose it just comes down to how much professional risk you are willing to take when working as an RN. Thanks for your input. I find this scenario to be quite interesting.

tonet0908 · Jun 18, 2011

This is the exact thing I was concerned about. Since they are treating you as an NP and not an RN by asking your opinion and making decisions based on that NP opinion, are you not "practicing" as an NP when you are working as an RN? Also, conversely if something were to happen to your patient as an RN that you could resolve as an NP and you did not act, legally wouldn't you be held to that standard even if your employer requires that you only act as an RN?
I've heard opinions from both sides, on here and in person. I suppose it just comes down to how much professional risk you are willing to take when working as an RN. Thanks for your input. I find this scenario to be quite interesting.

I guess in a sense they are treating me as an NP but I think its because me and these particular individuals are friends, we've been working together for the last 6 yrs and they ask me just as if we were having a conversation about any old thing. There are 2 other RNs on my unit who are NP's as well and I never heard them asking them the same quetions because I guess because I am the more easy going, approachable one.

Also, I guess I might be practising as an NP while working as an RN only because of the decisions I make with my patients. I just feel more efficeint for example, I have the same 6 patient assignment that the other nurses have. If one of my patients starts to go into resp distress, based on RN experience and NP training, I will know to do vitals, including O2 Sat and Blood glucose, give at least 40 mg of Lasix IV push if theres crackles and put the patient on a NR etc. I will do all of this before I call the MD who at my instituiton will be happy when he/she comes and will ask me what I did and put in the orders for me. As an RN, I remember, I would have just checked the BP, Pulse, and O2 Sat and paged the MD or PA, not knowing what else to do.

So, I say all this to say that being an NP and working as an RN has helped me to be more efficient and opened my eyes more so I can pay attention to my patients S&S. No, at the institution where I work at I'm working as an RN so the mgrs treat me as one, if I get in trouble while there,I will get in trouble as an RN,not an NP. Only my coworker friends ask me NP things. Maybe its just to see how much I know, who knows.

mochamonster · Jun 18, 2011

Thanks for your response tonet. I appreciate hearing what it is like for an APRN who does work at the bedside. It seems like this arrangement works really well for you and your patients benefit from your added knowledge.

I know I want to continue my education, but I want to expand my options in doing so, not limit them.

tonet0908 · Jun 18, 2011

Thanks for your response tonet. I appreciate hearing what it is like for an APRN who does work at the bedside. It seems like this arrangement works really well for you and your patients benefit from your added knowledge.
I know I want to continue my education, but I want to expand my options in doing so, not limit them.

Your welcome, anytime. I love working bedside, that's why I haven't left. I'm still full time on the unit and parttime (2 days/wk) at the office. Also, I get all my benefits including health insurance and 100% education reimbursement from the hospital and just an hrly salary from the office so why would I leave the hospital?

Yes, you can definitely work wherever you want providing they are willing to hire a new grad. It was very hard for me to find an NP job because they were looking for NP experience, they didn't seem to care that I was an RN for 5 yrs already.