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What are the legal ramifications for an NP hired as an NP, but who is to function as an RN due to an RN shortage?

Thursday July 3, 2014
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Question:

Dear Donna,

I was hired as a palliative care NP. Due to RN shortages in the visiting nurse role, I have been told I will begin seeing patients in their home. I will function as an RN in this role, not as an NP. What are the legal ramifications if any?

NP Asked To Work As RN

Dear Donna replies:

Dear NP Asked To Work As RN,

It is challenging to respond to your question without knowing all the details but what you present is troubling for several reasons. If you were just recently hired as an NP, why all of a sudden does your employer realize they need more RNs and not an NP? Are they changing your title and reducing your salary too? Or are you just being asked to temporarily fill in, in addition to your NP duties? Did you sign an employment contract to work as an NP? And what will happen to the NP position for which you were hired? Will it be eliminated, put on hold, someone else hired to fill the role?

An NP generally can work as an RN as long as their RN license is valid, and they have met all state requirements to keep their license current. When any nurse works in a role lower/more narrow than her highest license, there are issues related to role confusion (for yourself and your patients), insurance and liability. This is where it gets tricky. You are held legally and otherwise accountable to your highest license regardless of the role you work in but must represent yourself accurately in the role you will hold plus practice in that limited scope. I wonder if your employer has asked an NP to work as an RN before and if they are aware of the potential challenges.

I would speak to a nurse attorney first to fully understand the ramifications and potential pit-falls for you. You also should contact your state chapter of the American Association of Nurse Practitioners (www.aanp.org) for additional information, advice and support. If you don't already belong, join and become active. This is exactly the type of situation when your professional associations can be your best allies and resources.

Here's something else to think about: I'm sure you have to get a certain number of clinical hours working as an NP to renew your license and/or certification so this potential job title/role change is a concern for this reason as well.

You, and only you, are in charge of your career. Just because your employer says you have to do this, doesn't mean you don't have options. You can try explaining to them the reasons why you won't/can't do this (back it up with info from AANP and/or a nurse attorney) realizing you may be out looking for work again if you do. Or, your employer might realize the potential liability issues to them and you, and they will have a change of heart about changing your role from NP to RN.

Sometimes you have to take a stand and even educate your employer (in a diplomatic way). While things might not turn out as you like, there is always a chance it will work in your favor if you are proactive rather than passive. You'll never know if you don't try. Most importantly in this situation, protect yourself, your licenses and certifications.

Best wishes,
Donna


Donna Cardillo, RN, MA, well-known career guru, is Nurse.com’s “Dear Donna” and author of “Your First Year as a Nurse: Making the Transition from Total Novice to Successful Professional” and “The ULTIMATE Career Guide for Nurses: Practical Advice for Thriving at Every Stage of Your Career.” Information about the books is available at www.Nurse.com/CE/7010 and www.Nurse.com/CE/7250, respectively. To ask Donna your question, go to www.Nurse.com/Asktheexperts/Deardonna. Find a “Dear Donna” seminar near you: Call 800-866-0919 or visit http://www. Nurse.com/Events.