Bouncing Back To The Bedside

NP To RN… Should You Do It?

One year after my first Nurse Practitioner job, I found myself burnt out, frustrated and struggling to make ends meet. So, I quit. A month later, I got a phone call from my old nursing registry with an offer I couldn’t refuse. 

The decision was an immediate ‘Yes!’ Going back to the bedside as an RN was never in my grand plan after becoming an NP. I was offered significantly more money than I was making working as a Pediatric Nurse Practitioner at a private pediatric practice with no benefits. There were many perks that went along with the RN job which included: 12 hour shifts 3 days a week instead of working 8 hours 5 days a week, getting paid time and a half after 8 hours of work time, healthcare benefits, and a stipend that paid my mortgage. My commute to work was also a slight improvement. Though, the ‘gig’ was a temporary deal lasting only 3 months. It was a perfect amount of time for me to take a break from the NP role, make some money, and figure out my next career move. 

In my 15-year career as a Nurse Practitioner, I have bounced back to the RN role at least 3 times. The second time was when I was offered a job working as an RN consultant for a pharmaceutical company. Though the pay was lower than my NP rate, the perks of work travel, a company car, gas card, quarterly bonus pay and flexible work schedule once again made my decision an immediate “Yes!” I saw it as an opportunity to learn and experience something new. 

The third time, I was offered a temporary gig working as a studio nurse at a Hollywood movie and television studio. Working on set was a role I would never experience as a nurse practitioner, and the studios are only blocks away from my home. Of course, it was a “yes” decision, and again I broadened my horizons, learned lot’s of new things and met interesting people. 

NP’s Going Back To The Bedside During COVID-19

Per Facebook chat groups, many Nurse Practitioners took advantage of the COVID-19 pandemic crisis opportunity to work as an RN on the frontlines. One NP reported “It was a nice break. Felt good getting over time pay again.” Another stated, “I’m thankful for the opportunity to go back to bedside nursing as an RN during this COVID crisis. Although, I would not want to leave my NP hospitalist position to be an RN full time again.” 

COVID-19 brought with it a flurry of job furloughs for many Nurse Practitioners. The CARES Act signed into law a 2 trillion-dollar relief fund, economic relief and public healthcare package which also increased the need for more nurses at the bedside. Hospitals and staffing companies recruited nurses to work on the frontlines paired with robust salaries and accommodations. 

Some travel companies were offering bedside RN’s $10,000 per week with added sign on bonuses. Petitions were even being circulated so that the AANP (American Academy Of Nurse Practitioners) should  strengthen the bedside numbers by having Nurse Practitioner act as bedside nurses during this crisis. The hospitals are now offering much higher pay to recruit nurses due to overproduction of NPs and many RNs leaving the bedside to pursue a NP degree

But, would you go back to the bedside working as a Registered Nurse after working as a Nurse Practitioner? 

Ask yourself this question: Are you happy with your current Nurse Practitioner position? 

Several Nurse Practitioners on FB chat sites were having regrets leaving the bedside. One NP stated that she had to take out several loans to pay for her college tuition and NP program. She further stated she felt the pay from NP to RN was the same in her state of residence, and that she was having difficulty finding a job as a Nurse Practitioner. 

The transition from the RN role to the NP role can be a difficult one. The Nurse Practitioner role comes with more responsibility. In some cases, you may be the main provider in your practice setting. 

Changes in schedule going from 12-hour shifts, 3 days a week to 8 hours 5 days a week may also cause conflict. Charting at home, working longer than 40 hours and not getting paid overtime were common complaints from new nurse practitioners on the FB chat. 

Some new NP’s may even experience an identity crisis aka “Imposter Syndrome,” thinking that they have to be “more professional” as a nurse practitioner than they were as an RN. All the factors above can cause increased stress and anxiety leading to job dissatisfaction. 

What Are The Legalities Of Bouncing Back To The Bedside?

It may not be possible in some states to work as a Nurse Practitioner and RN, or to fluctuate in between both roles. For example, one Nurse Practitioner on a FB chat group stated: “The Kentucky Board of registered Nursing was against it.” In most states working in both roles is legal and approved as long as you are working with in your scope of practice and following your employers policy. 

Another NP wrote that he considered going back to bedside nursing for better work-life balance but was told “he would not be able to work at the organization because going back to the RN role ‘muddies the waters,’ and added, “This is a complex situation with overlapping concerns related to benefit structure, dual employment and licensure. However, from a practice perspective we worry about the professional boundaries that a dual licensure would present surrounding practice. We would question how the clinician would stay in the scope of an RN role versus NP role. We would not support having the employee be in the dual RN role but would encourage the employee to fully embrace their NP role.”

If you are considering going back to the bedside as an RN, it’s a good idea to consult your malpractice insurance and make them aware of the switch. It’s also a good idea to consult your states board of Registered Nursing before accepting a position. 

“Thank You COVID. I held onto my per diem Labor and Delivery job just in case. Well, just in case happened with COVID and I got furloughed from my NP job” responded a Nurse Practitioner on a FB chat site. Several Nurse Practitioners continue to work as RN’s at the bedside either on a part time or a per diem basis. Extra money, different skill set, and the social environment were some of the reasons that NP’s gave on the FB chat group for keeping a bedside RN job. 

Besides better work schedules, pay, and work life balance, the benefits of going back to the bedside as a Nurse Practitioner include: 

  • Enhanced assessment skills
  • Improved critical thinking
  • Improved leadership skills
  • A higher level of patient advocacy

Going From Love To Hate

“I loved my ICU RN job, but I hated my Geriatric Outpatient Clinic job.” Responded an NP on a Facebook chat group. Another NP responded “Couldn’t do it. Never really enjoyed the bedside, and I would have to take a huge pay cut to go back. Wouldn’t want to do it physically either. The heaviest thing I want to lift is my coffee mug. “Life is too short to ‘hate’ what you do in your work life. 

The pause that COVID-19 has brought to the world has allowed many to go internal and look at their life and how they are living it. Your personal identity should never be corelated with your career. Yes, it’s a part of you, but not your soul essence. If you are thinking about making a change and going back to the bedside in an RN role, the best thing to do is to assess your quality of life and set your ego aside. The beauty of the nursing profession is that it offers much fluidity and the ability to bounce back to the bedside if one feels the need to. 

References 

https://www.nurse.com/blog/2014/07/09/what-is-the-liability-for-an-np-functioning-as-an-rn/?fbclid=IwAR054HZ88LTqnb7HgN9sXVMrdc4_VsD1Hd48vOsay-I__z2Ho_CYZDv7C8w

https://www.reddit.com/r/nursepractitioner/comments/cg44ml/anyone_hate_np_and_go_back_to_bedside/

https://www.facebook.com/groups/nursepractitioner/permalink/10164229749215473

De Milt DG, Fitzpatrick JJ, Sister Rita McNulty. Nurse practitioners’ job satisfaction and intent to leave current positions, the nursing profession, and the nurse practitioner role as a direct care provider. J Am Acad Nurse Pract. 2011 Jan;23(1):42-50. doi: 10.1111/j.1745-7599.2010.00570.x. Epub 2010 Nov 5. PMID: 21208333.

https://www.youtube.com/watch?v=wovAmOoKQ4c

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4323084/

https://voice.ons.org/advocacy/how-the-cares-act-and-other-covid-19-laws-affect-nursing-and-health-care

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