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You are here: Home / Archives for APRN

Nurses As Independent Contractors

February 6, 2020 by LORIE A BROWN, R.N., M.N., J.D. 3 Comments

A new law went into effect in California last month regulating “gig” labor.  The legislation was aimed at companies such as Uber and Lyft which inappropriately classify their drivers as independent contractors.  The hope was that if they were to be labeled “employees,” they would be entitled to regular employment benefits such as minimum wage, sick pay and insurance benefits.  However, the unintended consequence is that this could affect registered nurses, certified registered nurses, anesthetists and nurse practitioners.

This legislation came from an April 2018 California Supreme Court ruling that independent contractors must be free to perform their work as they choose and it must be in a different line of work from the contracting company and the independent contractor must operate their own business.

Here, nurses, CRNAs and NPs are not allowed to work as they wish but must conform to the hospital’s policies and procedures while working in the same line of work as the company contracting their services.

The legislation requires an ABC test which the independent contractor must:

  1. Be free from the hiring entity’s control;
  2. Do work which is “outside the usual course of the hiring entity’s business”; and
  3. Be established in a trade similar to the work being performed.

If nurses work as independent contractors, they’re working within the course of company’s usual business.  So, they would fail Part B of the test.

The upsides of the law are that nurses who lack the ability to get benefits can unionize and receive legal protection and health insurance now will be able to have those benefits provided.

Although California’s new law is stronger than many similar laws, 20 states have already implemented the ABC test in one form or another.  Therefore, if you take away that this pertains only to the Golden State, you must think again.

There are many pros and cons to being an independent contractor versus an employee.  As an independent contractor, you usually can work when you want, make more money and have more write offs than would a traditional employee such as anything that can be considered as a business expense if you are contracting as a business.

The downside to being an independent contractor is that the hospital does not pay their share of taxes which, of course, means you will owe more taxes.

That notwithstanding, having a nicer paycheck upfront certainly is helpful.

Be very careful if you are working as an independent contractor and should have been an employee. This considers your status as misclassified as an independent contractor rather than properly as an employee. There are serious consequences such as owing back taxes to the state and federal governments which could include penalties.

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Filed Under: Employment, Newsletter, Workplace Issues Tagged With: APRN, benefits, business, business owner, CNA, CRNA, employee, Gig Labor, Independent Contractors, legislation, nurses, tax penalties, taxes, union, unionize

Keeping Your Nurse Practitioner License Safe

November 27, 2019 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

Recently I attended the Nursing Service Organization Annual Summit where they discussed the results of their annual statistical analysis of claims against nurse practitioners.  They look at things such as area of practice, resultant injuries, alleged breaches in the standard of care and on their license protection claims.

Here are some of the risk management strategies that they recommended.

  1. Professionalism is the key. Nurse practitioners have an amazing way of developing a great rapport with their patients.  Establishing the rapport and complying with your employer’s standards, policies and procedures is a great step in reducing your risk as a nurse practitioner.
  2. You will “live and die” by your documentation. Therefore, document, document, document!  It is important to note in your chart your reasons for your clinical decision making process and rationale.  If your reasoning is supported in the chart, that goes a long way to protect you.  There has never an attorney who has said, “I wish they didn’t document so much.”  It has always been: “I wish they would have documented more!”
  3. Additionally, it is important to document all discussions, consultations, clinical information along with the risk benefits and alternatives to treatment options. If you hand out any educational materials, that also should be noted.
  4. If the patient it is not compliant, it is important to note that fact in the medical record. You should also document any efforts you have made to encourage compliance.  Simply stating that the patient was noncompliant is not enough.  As a health care professional, you have a duty to warn the patient of the risks of their noncompliance and the benefits of their being compliant.
  5. You do not have to provide care to patients who are not compliant. If you have concerns about continuing to provide care to a noncompliant patient, bring that concern to your employer’s attention and consider terminating the care for that patient.  Unlike nursing, as a nurse practitioner, we can somewhat choose our patients.  If you have a concern that a patient may sue you or is not compliant, you can discontinue services by giving them 30 days notice and send the letter by certified mail.  You are required to provide emergency care for the 30 days, and it is helpful to refer them for other care.

Do you have any suggestions for other risk management strategies?  I’d like to read them in the comments below.

 

 

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Filed Under: Employment, License Protection, Newsletter, Workplace Issues Tagged With: APRN, documentation, license protection, Lorie Brown, medical record, noncompliant, NP, NSO, Nurse Practitioners, nurses, patients, policy and procedures, Risk Management, standards

Lorie Brown Interviews Kathleen Russell of the National Council of State Boards of Nursing

September 13, 2018 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

Lorie Brown, R.N., M.N., J.D. interviews Kathleen Russell, J.D., M.N., R.N., Senior Policy Advisor, Nursing Regulation of the National Counsel of State Boards of Nursing. Some of the topics include their mission and members, their new Welcome to the Nursing Profession Booklet and video, the nurses’ license and discipline database, Nursys.com, and the e-Notify service as well as the continuing education courses they provide on www.LearningExt.com.

The e-Notify service will notify you in advance when your license(s) need to be renewed and if any disciplinary action has been filed against your license(s). This is a great option for any nurses that are licensed in multiple states.

They also discuss the full practice authority initiative for Advance Practice Nurses – nurse practitioners, nurse midwives, clinical nurse specialists and nurse anesthetists – at the website: www.NursingAmerica.org.

Ms. Russell also introduces their brand new website at www.NCSBN.org and invites all nurses to check out all of their resources.

Lastly, they discuss their article on National Nursing Guidelines for Medical Marijuana that was published in the Journal of Nursing Regulation.

09/14/2018 Edit: Find the New Nurse Welcome Booklet at https://www.ncsbn.org/12096.htm.

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Filed Under: Employment, License Protection, Newsletter, Workplace Issues Tagged With: advanced practice nursing, APRN, board of nursing, clinical nurse specialists, continuing education, Kathleen Russell, Lorie Brown, midwives, NCSBN, new nurses, nurse, nurse anesthetists, nursing, nursing board, Nursys.com

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