Carolyn Buppert, MSN, JD

Disclosures

January 31, 2017

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Question

Can an APRN Take a Job as an RN?

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

An advanced practice registered nurse (APRN) wants to know whether she can work as a staff registered nurse (RN) on an occasional or as-needed basis. For example, a staff nurse earns a master's degree and becomes certified as a nurse practitioner or clinical nurse specialist but can't find a job and must continue working as a staff nurse.

My advice is that the APRN is also an RN and can work at either level. When working as an RN, your scope of practice is limited to what your state authorizes an RN to do. You may carry out orders from a physician or other APRN, but you may not perform any service that requires an order, unless someone else who has that expanded authority places the order. For example, while working as an RN, you would not be authorized to diagnose illnesses or prescribe or order medication—even aspirin. If, when hired as an RN, you go outside the RN scope of practice, you could be charged with exceeding scope of practice, because, even though you have the credentials for APRN practice, you don't have the required collaborative arrangement, which is necessary in your state for advanced practice.

What you will need to be careful of, when working as an RN, is making sure that you don't act on your instincts to manage a patient yourself. You may know that a patient needs more or less medication, but you can't make that change without an order from a physician or APRN who has the necessary collaborative agreement.

And don't get caught up in diagnosing and treating colleagues. For example, if a colleague is pretty sure that she has a urinary tract infection and doesn't have time to visit her primary care provider, don't write her a prescription for an antibiotic. Why? Because even though you have the expertise to do that, you don't have the legal authority if you are in a state that mandates physician collaboration for advanced practice.

One more thing: Just because APRNs have advanced education doesn't mean that they are qualified to take RN-level jobs. If you have experience as an RN on a dialysis unit, then you should be qualified to continue in that area after becoming an APRN. But don't take an RN job that requires specialized experience when you have none, unless the employer is willing to provide the necessary education and preceptorship training.

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