Job Contract

Running head: APRN Contract

APRN Contract

APRN Contract

Week 5: APRN Employment Contract Group Critique

As a new graduate nurse practitioner, it is vital that when taking an offer for a position, a contract is clearly established. This is to ensure that the nurse practitioner is receiving what is in his or her best interest while embarking on this new scope of practice. In fact, components of the contract or said agreement between the nurse practitioner and employer have been found to get quite complicated; therefore, the appropriate clarification and negotiation may even prompt the consideration of obtaining an attorney (Cleveland & Knoblauch, 2018). With these challenges in mind, it would be all the more important that the various categories of the employment contract are reviewed carefully before agreement to the position. We will be critiquing as well as analyzing the contract we have obtained from nurse practitioner Eva Kim as seen in Appendix A. All personal information in the contract was excluded for the consideration of privacy.

Scope of Services and Population

With regards to the scope of services to be performed, this entails that the nurse practitioner conducts all duties that are deemed reasonable and are under the scope of practice in the state of New York (Appendix A). This was clarified in more depth in Exhibit A of the contract (Appendix A). Under this section, it explains that the position requires services such as consultation, direct patient care, collaboration, referral, as well as coordination (Appendix A). In the event that it is necessary, direct care would involve clinical tasks like vaccinations or even phlebotomy (Appendix A). It is expected that a typical work week consists of 40 hours per week (Appendix A). In comparison, it is interesting to note that a survey done by the University of California found that nurse practitioners had an average work week of 34 to 35 hours each week with very little on call or overtime if any (California Employment Development Department, 2022). The population being cared for are pediatric patients, which range from infancy all the way up to the adolescent years (Appendix A). According to the National Association of Pediatric Nurse Practitioners (NAPNAP), the historic defined the age range for the pediatric population cared for can range from birth all the way up to 21 years old (Heuer et al., 2019).

Compensation 

In terms of compensation, the rate per hour is clearly defined at $64 an hour (Appendix A). When comparing this rate to the national average, it is higher than the national average of $55.05 per hour (U.S. Bureau of Labor Statistics, 2021). Although this is the case, the metropolitan region of Los Angeles, Anaheim, and Long Beach, California top the annual mean wage at about $142,770 in comparison to New York’s annual mean wage of $133,380 (U.S. Bureau of Labor Statistics, 2021). This contract provided in Appendix A did not elaborate on the specific areas of travel compensation, gas or mileage, cancellations, on call time, or bonuses. The only thing close to travel compensation is that the contract mentions that there is no compensation given for relocation (Appendix A). 

Employment Duration

As for the duration of employment, it is a two year contract with an automatic renewal of one year (Appendix A). Although this is the case, either the employer or employee can end the agreement within a period of 30 days written notice in advance (Appendix A). 

Alteration of the Agreement 

Keeping in mind the alteration or updating of the agreement, it is laid out in section 15 of the contract (Appendix A). As a matter of fact, it states that it can only be changed or altered with the mutual agreement and permission of both sides (Appendix A). 

Credentials Responsibility

Listed under the employee benefits section, the details in relation to the licensure are provided (Appendix A). With regards to the paying for credentials, the employer is responsible for covering the full costs of licensure as well as DE (Appendix A). This is certainly a positive side to this job position. As it is not clearly stated here, it could be assumed that the nurse practitioner would have to maintain the required credentials in order to remain compliant. 

Benefits

As with all job opportunities, it is only right to consider the benefits that are tied to the position. When discussing vacation time, a period of two weeks is to be given and all major holidays are to be off as well (Appendix A). It is clearly stated that paid time off is to be 17 days (Appendix A). When it comes to continuing education, CME, or conferences, an allowance of up to $1,000 is to be provided (Appendix A). This is a great benefit as continuing education promotes lifelong education and even advances nursing professionalism overall (Agyepong & Okyere, 2020). With these benefits in mind, it is interesting to note that generally speaking, experienced nurse practitioners tend to favor benefits such as shorter shifts, less employee costs for health insurance, as well as higher employer matching plans for retirement (Staebler & Bissinger, 2017).

Competition Restrictions

Competition restrictions or non-compete agreements are contracts between the employer and employee that prohibit the employee from working with another competitor or becoming a competitor. The contract usually states a practice that the employee is not allowed to work with. Some contracts also state a mile radius and years that the former employee could not work. An excellent example of employers with this clause in their contracts is aesthetic clinics. Clinics like these prohibit former employees from practicing in an identical niche clinic within 25-50 miles for at least two years. This will prevent any clients from going with the employee and avoid sharing trade secrets. The contract below does not show any non-compete clause (Appendix A).

Termination

The initial term of the contract is two years and will be renewed every one after that. The contract states that either the employer or the employee may terminate the contract provided there is a 30 days advance written notice to the other party. The contract also states that the Nurse Practitioner can be terminated at any time if there is any breach of contract or obligations outlined in the Health Insurance Portability and Accountability Act (Appendix A). The termination clause is straightforward and very common in a lot of workplaces. 

Support Services

The example contract did not provide any information about support services for the nurse practitioner (Appendix A). The support staff is usually medical assistants, office staff, licensed practical nurses, and sometimes registered nurses. Some clinics provide support staff such as medical assistants rooming in patients, checking their vital signs, administering intramuscular medications, and making follow-up calls to patients (Rimmer, 2019). Some clinics also have office staff managing the clinic inventory, reviewing patients’ insurance, and day-to-day operations (Rimmer, 2019). A good support staff is beneficial to the nurse practitioner, especially if the provider is expected to see at least 20-30 patients per day. 

Expectations on Patients Seen

The contract states that the Nurse Practitioner is responsible for seeing at least 20-30 patients a day (Appendix A). The required patient per day is standard in a primary care clinic, especially in a pediatric clinic. The clinic where I did my pediatric rotation has a Nurse Practitioner, and he sees 20-25 patients per day. The only thing I will ask is administration time, where I can catch up with charting and take care of administrative duties. 

Non-Clinical Work Expectations

Exhibit A showed a sample of a non-clinical work expectation for the nurse practitioner. This is sometimes called an admin time, where the nurse practitioner is provided time to chart and perform non-clinical duties. The administrative expectation for the nurse practitioner was not provided in the contract but was written in the job description instead (Appendix A).

Performance

Annual performance review or evaluation of the nurse practitioner usually is done to improve the performance of the nurse practitioner in the workplace (Kleinpell & Kapu, 2017). Nurse practitioner performance is usually evaluated on several levels such as productivity, utilization, and patient satisfaction. The sample contract did not provide any information on how the nurse practitioner will be evaluated. 

Conclusion

To summarize, the contract presented is direct but needs additional information, such as the non-compete clause and the support staff. Information such as these should be written in the contract to avoid future misunderstandings. As new nurse practitioners, we can utilize the help of lawyers to help us read the fine prints of the contract. Reviewing the contract thoroughly prevents any misunderstanding between the employer and the employee. Furthermore, this will leave a positive impact on factors such as patient safety, nursing practice, as well as healthcare quality in general.

References

Agyepong, E., & Okyere, E. (2020). Analysis of the concept continuing education in nursing 

education. Journal of Education and Educational Development, 5(1), 96–107. 

http://jmsnew.iobmresearch.com/index.php/joeed/article/view/149

California Employment Development Department. (2022). California occupational guides. 

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https://www.labormarketinfo.edd.ca.gov/OccGuides/Detail.aspx?Soccode=291171&

geography=0604000111#:~:text=According%20to%20a%202010%20survey,working%2

0overtime%20or%20on%20call. 

Cleveland, K. A., & Knoblauch, D. J. (2018). Ensuring a return on your professional investment. 

The Nurse Practitioner, 43(10), 14–17. 

https://doi.org/10.1097/01.npr.0000545003.53382.d8 

Heuer, B., Hunter, J. M., Hatton, A., Lee, A., Lofgren, M., Reyes, I., & Keesing, H. (2019). 

NAPNAP position statement on age parameters for pediatric nurse practitioner practice. 

Journal of Pediatric Health Care, 33(2), A9–A11. 

https://doi.org/10.1016/j.pedhc.2018.10.007 

Kleinpell, R., & Kapu, A. (2017). Quality measures for nurse practitioner practice evaluation. 

Journal of the American Association of Nurse Practitioners. Retrieved March 28, 2022, 

from https://pubmed.ncbi.nlm.nih.gov/28649737/

Rimmer, A. (2019). Primary care will not meet demand unless practices take on more clinical 

support staff, say experts. The BMJ. Retrieved March 28, 2022, from 

https://www.bmj.com/content/364/bmj.l1299.full 

Staebler, S., & Bissinger, R. (2017). 2016 neonatal nurse practitioner workforce survey. 

Advances in Neonatal Care, 17(5), 331–336. 

https://doi.org/10.1097/anc.0000000000000433

U.S. Bureau of Labor Statistics. (2021, March 31). 29-1171 nurse practitioners. Retrieved March 

18, 2022, from https://www.bls.gov/oes/current/oes291171.htm