NURSING RESEARCH
cuka
Week5CRAssignmentAPRNEmploymentContractCritiqueRW.docx22
APRN Employment Contract Critique
Name xxx
United State University
Course xxx
Professors xxxx
Date xxx
Introduction
Family Nurse Practitioners (FNPs) are nurses who have advanced training and are usually registered. They work with other health care professionals to give care that is focused on the whole family. These types of nurses can work in a variety of clinical settings, including traditional doctor's offices and hospitals as well as private homes and clinics. They are known to lay a high focus on the need for general health promotion and prevention of infections and to provide treatment for every type of sickness that affects any community member. As these individuals seek employment, they are typically expected to negotiate an employment contract in order to prepare, investigate, and offer precise and substantial terms. For instance, these doctors should be able to articulate and explain in a professional manner why they deserve the remuneration they are requesting in relation to the anticipated earnings of their services. Consequently, this paper is a review, analysis, and evaluation of a sample FNP employment contract based on the primary aspects included in various contract types.
At JJC medical center, the FNP will help patients deal with their pain. The contract was quite ambiguous regarding the family nurse practitioner's responsibilities. The particular ages of the group receiving pain care were not specified in the contract. No information was supplied regarding the sort of analgesia, either opioid or nonopioid, that will be administered to patients. FNP play a key role in the therapy of severe pain, and it has been demonstrated that its administration reduces patients' pain and improves their ability to function (Arends et al., 2020). More detail about the nurse practitioner's duties should have been included in the agreement.
Compensations
In the state of California, the annual average salary for the position of a nurse practitioner is $ 123,111 (Salary.com, 2022). According to the contract, it is not clear how many years of experience the FNP has; nonetheless, the annual compensation that is standard for an FNP in the united states is 116,500 dollars on average (Salary.com, 2022). This contract provides compensation that is less than the state of California's typical annual pay. The contract specifies that it will be evaluated after 6 months, but it does not indicate if the salary would be increased considering the performance.
Travel, Gas, or Mileage Compensations
The contract stipulates that transportation compensation for out-of-state meetings or education will be supplied if it is necessary for the practitioner's job. Henceforth, no compensation for transportation in-state conferences or meetings. This is comparable to the perks provided by other occupations; however, some firms offer reimbursement for gas mileage over a predetermined threshold (He, 2021). Gas or mileage can be used to describe car allowances. This compensation applies when a contract permits workers to use their own vehicles, and the employer reimburses all expenses (He, 2021). The mileage compensation varies based on the number of miles driven. This type of perk has a big drawback in that it is impossible to compute the actual amount of gas spent or to create proper expenditure reports and logs (He, 2021). In addition, the cancellation procedure is not included in the contract.
On-Call Time
The contract stipulates that the FNP must be on-call at certain specified times to fill in for the physician. There is no mention in the contract regarding whether or not the service provider will receive additional compensation for being on call. When someone is required to work on-call, they typically receive additional remuneration for their time. Additionally, the provider will be required to work on the weekends, but they will not receive any additional compensation for their efforts, either for working overtime or on the weekends. This agreement does not include the benefits that are provided by other FNP jobs, such as compensation for working extra hours or being on call.
Bonuses
The payment of an annual bonus will be taken into consideration, considering the productivity, but the payment of such a bonus is not guaranteed. In the contract, the FNP's performance will be judged on how on-time, well-documented, accurate, and accountable they are.
Duration of Employment and How the Agreement can Be Altered
The length of the employment contract is set at one year, but after that period of time has passed, the provider has the opportunity to extend their contract for an additional five years. Contracts for a number of occupations that are comparable typically last for one year and include an option to extend them for an additional number of years after that. Even though the contract is only valid for one year, either party might choose to end it early if the expected requirements are not satisfied.
The agreement might be revised to include the demographic for which the provider will offer care. Additionally, the conditions of the agreement regarding reimbursement when on call, putting in overtime, as well as serving duties on the weekends should be brought up to date (Duquesne University, 2022). Additionally, the compensation is lower than the state's typical annual salary for residents of the same state. It would be beneficial to raise the compensation in order to make it more comparable to the opportunities that are now available in the nearby region.
Responsibility Credentials and Benefits
The contract stipulates that the service provider is responsible for keeping a license, as this is a condition of the position. The contract makes no mention of FNP reimbursement for license renewal. The supplier would also cover the prescribed expenses. The contract specifies that failing to keep a valid license will result in suspension or termination from the position. Compensation for license renewal, as well as prescriptive expenses, ought to have been included in the agreement since the provider needs them to carry out the tasks for which they were contracted (Duquesne University, 2022).
Time Off, Vacations, and Continuing Education
The corporation encourages continuous education and will compensate FNPs for expenses incurred in furthering their education. When necessary for further education, housing, transportation, and meals would also be supplied. In addition, compensation for professional membership fees will be granted. The fact that the company encourages its providers to participate in continuing education is significant not only because doing so is required for the renewal of the provider's license but also because doing so gives the provider the incentive to understand evidence-based recommendations, which in turn improves the quality of healthcare services which is being delivered (AANP, 2022).
Providers are paid time off for holidays like New Year's Eve as well or Christmas day. However, this paid time off is not counted toward the vacation time of the employee. In the event that a provider needs to take personal leave for any reason, that time will be subtracted from the total amount of vacation time that is available to them.
First-year employees receive 2 weeks of vacation, which increases to 3 in the third and 4 weeks in the 5th year of service. A minimum of six weeks' notice is required prior to vacation approval. This employer provides only 2 weeks of vacation in the first year is inadequate compared to similar industries. New FNPs should be given at least 3 or 4 weeks of vacation (AANP, 2022).
The employer provides health insurance, and the practitioner is authorized to select the desired health insurance plan. The provider is also covered by liability insurance; however, it would fall under the physician's policy. A provider should have occurrence-based insurance that covers them not only while they are employed but also after they have left their current position (AANP, 2022).
Restriction on Competition
The employer enforces the non-compete clause to prevent the employee from using the particular pain management skills they have gained at a neighboring competitor's facility. The goal of the competition policy is to prohibit the hospital from exposing an excessive amount of information about its operations in order to give an edge to its competitors (AHLA, n.d.). The non-compete agreement that is used by JJC health center is one of the laxest in the industry because it permits foregoing employees to work anywhere outside of a 50-mile effective range. Nevertheless, the clause permitting NPs to treat corporation-affiliated patients should be lenient. In a rule that seems unnecessary, the clause says that the NPs cannot take patients from the company and find new ones for themselves within two years after the contract ends. Patients are emotional creatures similar to everyone else and could form a favorable attachment to the NP (Arends et al., 2020). People should not be denied access to the practice of their choice, regardless of where that NP is located.
Reasons for Termination
A sad fact about a contract is that it can be dissolved if certain requirements are not satisfied by any party involved. At JJC medical term, the agreement can be dissolved for a range of reasons such as a violation of its provisions by either side, the NP's performance, the employer's financial situation, or the NP's desire to leave the practice for individual matters. If any side wishes to end the deal, they must provide a written explanation within sixty days. The rule ought not to be followed in this instance since the worker could be abandoning the job due to an unexpected emergency. However, if the employee's actions endanger the health and safety of patients, waiting 60 days to terminate the employee may be unjust to JJC health center. Failure to follow the HIPAA rules, which puts patients and employers at risk, is a serious issue that needs to be fixed right away.
The Extent of Support Service to be Offered
Organizations should endeavor to offer NPs ample chances and support. The JJC medical center offers educational seminars to further the practice of pain treatment. The company will benefit greatly from the NPs' increased knowledge since they will provide excellent care for patients. On the contrary, one could contend that financing the NP's continued education could be counterproductive, as the NP may quit after completing their degree. In this case, the employer would have endured a loss. Additionally, the organization should endeavor to provide more transportation options for employees. Most companies offer transport services for their workers (AANP, 2022).
Furthermore, extra support services should be introduced to help employees love their work and remain at their workplace (AANP, 2022). For NPs with babies and toddlers, additional amenities should include complimentary meals and a daycare center. As a result, NPs will be motivated to do their best work on a regular basis since they will feel appreciated.
Expectations of the Number of Patients to be seen Per Day
On average, it is estimated that the NP should examine 20 patients per day. Less than twenty patients per day would imply that the service is not sufficiently profitable (Weber, 2019). When designating a number, the organization should be acutely conscious of the condition of its personnel and mindful of their wellbeing. The agreement should be clear and fair when it comes to the number of patients that can be seen on a given day. The first step in determining a suitable number of patients is determining how many patients a nurse practitioner may safely manage in a day (Weber, 2019). The subsequent step is to assess how many clients can be evaluated in 9.5 hours, given logistical constraints (Weber, 2019). The JJC health center needs 9 hours of community service from Monday to Friday. In addition to this, the organization needs to consider the patients' mobility, the extent of their communication skills, and the operational configuration of the hospital.
Expectations Considering Non-Clinical Work
Non-clinical work-related tasks can be performed by NPs at their location of employment. Non-clinical roles help to achieve organizational goals (Brom et al., 2018). They could assist in clinical research. Clinical research aids the hospital in developing innovative approaches to resolving problems and enables the NP to increase their knowledge base (Brom et al., 2018). Positively, given that both parties expect to gain, this might be termed a win-win situation. On the other hand, the nurse is pressured to execute activities in which they lack experience, leading to inaccuracies. The JJC healthcare system requires NPs to provide secretarial assistance. They can also serve in administrative capacities, such as receptionist or scribe duties, or even as patient advocates or advocates for the underserved.
Quality Performance
The Practitioners should be evaluated in order to improve their performance on the job. Acknowledging and correcting NPs' shortcomings is one of the main goals of the evaluation process (Arends et al., 2020). The contract stipulates that completeness, accountability, correctness, and compliance must be considered throughout the evaluation of an NP's performance. However, the company must give all the necessary tools for the completion of these responsibilities in order to avoid being perceived as hypocritical and asking too much of the NPs. Every nurse practitioner should receive an individual answer from a health plan auditor, highlighting the areas in which they need to work on (Arends et al., 2020). Each nurse practitioner should have a clear annual plan detailing their professional goals for the future year, which auditors are responsible for ensuring they have. Overall, the method of releasing excellent performance data should be consistent and non-coercive so that NPs feel that they are an integral part of the business (Arends et al., 2020). If the NPs are handled well during the process, they will try to follow the published guidelines.
To conclude, an attorney should be brought in to analyze any and all contracts to ensure that any anomalies are found and that the deal is fair. For the price of seeking legal advice to review the contract, studies show this service can be invaluable in helping NPs better understand their contracts and help them negotiate new contracts or revise old ones. As with all NPs contracts that are unique, the second set of eyes can help ensure that both sides are getting what they want out of this agreement. This contract, too, appears to have emphasized and explored essential aspects in great depth.
References
AANP. (2022). Employment negotiations. American Association of Nurse Practitioners. https://www.aanp.org/practice/practice-management/employment-negotiations
AHLA. (n.d.). Ama-Assn.Org. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/ama-foundation/legal-operational-guide-free-medical-clinics.pdf
Arends, R., Anderson Elverson, C., Pike Keefner, T., & Mylant, M. (2020). Screening, brief intervention, and referral to treatment training for family nurse practitioner students. Journal of the American Association of Nurse Practitioners, 33(5), 375–382. https://doi.org/10.1097/JXX.0000000000000423
Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120–130. https://doi.org/10.1097/JXX.0000000000000023
Duquesne University. (2022, May 26). How to negotiate a nursing salary. Duquesne University School of Nursing. https://onlinenursing.duq.edu/blog/nurse-practitioner-contract-negotiation/
He, T. (2021, March 4). Medical mileage deduction: Everything you need to know. TripLog. https://triplogmileage.com/small-business/everything-you-need-to-know-about-the-medical-mileage-deduction/
Personal Support Worker HQ. (n.d.). Nurse practitioner salary in California explained (2022). Personalsupportworkerhq.Com. https://personalsupportworkerhq.com/california-nurse-practitioner-salary/
Salary.com. (2022). Nurse Practitioner salary in California City, CA. Salary.Com. https://www.salary.com/research/salary/benchmark/nurse-practitioner-salary/california-city-ca
Weber, D. O. (2019). How Many Patients Can a Primary Care Physician Treat? Physicianleaders.Org. https://www.physicianleaders.org/news/how-many-patients-can-primary-care-physician-treat
Appendix
Nurse Practitioner Employment Contract
EMPLOYER: JJC medical center
The contract duration is for one year with an option for renewal for five (5) years thereafter.
Salary:
The contracted position will be paid at a salary rate of $105,000 per year.
The contract will be renewed the sixth month after a review of the employee’s performance. Paychecks will be issued biweekly.
Bonuses:
The consideration of a bonus will be determined yearly based upon the assessment of the productivity, performance review, and financial status of the Corporation. There will be no guarantee of bonus payment, however, the Corporation maintains the philosophy that the value of an employee must be assessed, and the reward for the production of a job well done should be recognized with a financial reward.
The termination of this contract may be made under the following conditions.
Violation of State or Federal Law Breach of the Contract by either Party Performance of the NP
Desire to Leave the Practice for Personal Reasons Financial Considerations of the Corporation
In the event party desires to dissolve the agreement, they should provide the reason for the dissolution in writing to the other party with a minimum of 60 days’ notice. In the event an unreconcilable condition arises between the parties which cannot be resolved within this time frame, the parties may seek mediation to resolve the time parameter differences for the dissolution of the contract for employment.
Immediate termination with cause may be made if there exist any legal or material impediments to the delivery of patient care by the NP which may include conditions that would potentially jeopardize the safety of the patients or place the corporation at unexpected financial or legal risk NON-COMPETE CLAUSE
Because of the special skills and information regarding pain management which would be gained by the NP through employment, it is necessary to invoke a non-compete agreement. In the event of dissolution or termination of the contract, the following non-compete clause shall begin and remain in effect for two years. The NP shall not maintain or be employed in the Practice of Pain Management within a 50-mile radius of any of the corporation’s clinical practice locations. The NP may continue to practice in these areas; however, the total percentage of patients being seen for pain management in any subsequent practice of the NP will not exceed 10 (ten) percent. The NP shall not during the two-year period following termination of the contract with the corporation divert, coerce, or recruit patients involved in the medical practice of the corporation.
For the two-year period after termination of the contractual agreement with the corporation, the NP will refrain from the treatment of all patients seen at the corporation either individually or collectively, unless otherwise agreed to by the corporation in writing.
Annual performance evaluation of the NP shall be given for the purpose of improvement of the NP performance in the workplace. This evaluation shall include but is not limited to the review of 5% of the patient electronic medical records of the NP by the physicians of the practice for the following information:
*Completeness
*Accuracy
*Accountability
*Compliance with applicable State and Federal Guidelines regarding prescriptive issues
The second component of the evaluation will include input from co-workers regarding interoffice communication, flexibility, and overall personability.
The third component of the evaluation will include a self-assessment and the creation of an annual plan regarding professional goals for the upcoming year.
The corporation may request the availability of the NP when the Physician is out of town for the purpose of providing emergent patient assessment and referral. These On-Call scenarios should be planned with the NP. The mutual goal of maintaining 24 hours a day, 7 days a week patient care shall be considered the most important issue in the vigilance of consistent patient care. The physician shall be available for telephone consultation at all times to the NP in the event that the
NP is on-call. The Physician will provide the NP with the information necessary to contact him during these time periods.
The corporation defines the purpose of an On-Call NP as to provide emergent patient assessment and treatment only.
The calling in of Prescriptive medication has been and will continue to be deferred to a scheduled appointment, noting it is the responsibility of the patient to maintain his/her medications at an appropriate quantity through planned scheduled appointments.
ASSISTANCE: SECRETARIAL SUPPORT
The corporation will staff the offices Monday through Friday, from 8:00 am to 4:30 p.m. The duties and responsibilities of the office personnel are to maintain patient assistance at check-in, telephone handling, patient scheduling, and the direction of patient flow through the clinic day. See the delineation of office duties in the job descriptions of the following:
The hours of employment are as follows:
Monday through Friday 8:00 am to 4:30 p.m.
Saturday – hours to be arranged with mutual consent to accommodate the patient population and not paid at an additional rate. Saturday hours are only scheduled when it is deemed necessary by the President to accommodate the patient load and not as a regular event. Saturday hours will be no more than once per month and arranged with the consideration of the employee request given the request has been made is reasonable, reflecting the consideration of the office needs.
The position will be paid at a salaried rate with the expectation that the hours worked reflect full- time employment and may require more than 40 hours. Those hours worked beyond a 40-hour
workweek will not be paid at any additional rate, however, deference will be given to the NP in that overall the average workweek for the year will be 40 hours.
Paid time off for all salaried employees includes the following days which are not computed as a vacation.
1. NEW YEAR’S DAY
2. MEMORIAL DAY
3. JULY 4 TH (Except when it occurs on a Saturday or Sunday then the holiday will be observed on either Friday or Monday)
4. LABOR DAY
5. THANKSGIVING DAY AND THE DAY AFTER
6. CHRISTMAS EVE
7. CHRISTMAS DAY
8. HALF A DAY- NEW YEAR’S EVE
In the event of an acute illness, reasonable notice should be given to the employer. The primary practice physician should be contacted personally either at his home or by pager. Excessive calls concerning the use of unscheduled time off for repeated illnesses require the documentation of your Primary Care Physician. The allowable yearly maximum will be no more than 4 days. If the illness requires hospitalization, surgery, or other medical intervention requiring recovery time suggested by the Physician rendering the care he/she should convey these medical requirements to the primary practice physician in writing within one month of the planned medication intervention. More than 4 days of unscheduled time off for illness will result
in the use of paid vacation days to be used for the occurrences. When the vacation days are exhausted then reduction of benefits and /or dismissal will be reviewed on an individual basis giving consideration of the circumstances and the demands of the practice.
First-year of employment two weeks of vacation will be included in the salaried employee benefits plan.
The salary will include the vacation benefit and no additional monetary benefit will be paid. In the third year of employment, the addition of the third week of vacation will accrue.
In the fifth year of employment, the addition of the fourth week of vacation will accrue. Vacation time will be scheduled with a minimum notice of 6 weeks, the more notice given to the designee of the corporation will be greatly appreciated for the adjustment of patient and physician schedules. The vacation times request should be made in writing to the corporation and include the complete dates of your request including weekday and weekend dates. All reasonable requests will be considered, and approval of the requested vacation time will be made available to the employee within one week of submitting the written request.
Request for personal leave will be considered and vacation time will be used for the requested days off.
Request for unpaid time off may be considered if there is no significant interruption in inpatient care and does not pose a significant burden to the daily operation of the corporation.
The corporation is committed to the continuation of educational endeavors within the realm of Pain Management. The corporation will schedule educational seminars for the advancement of
the employee in the practice. Should the employee desire to attend an educational offering unrelated to the practice of Pain Management sufficient course information should be submitted to the corporation for review and approval.
The corporation will cover the cost inclusive transportation, lodging, and meals for Continuing Education for one week for the purpose of Continuing Medical Education.
Memberships to Professional organizations are not a condition of employment, however, it is expected certain key organizations and certifications should be achieved from time to time by the NP as evidence of both professional advancement and continuing education. The corporation will review memberships to such organizations and corporate funding will be allocated through an application process. Submit the required documentation for the requested organization including the nature of the membership and associated fees.
Current Indiana License is required prior to employment and will be verified by the Management. It is the responsibility of the employee to maintain his/her current Indiana License and submit a copy of the document prior to gainful employment. Failure to maintain this documentation as current will necessarily result in immediate cessation of salary and benefits until corrections are made.
Payment for Health Professions Bureau fees will be issued to this agency by the corporation.
All state and federally regulated prescriptive fees and documentation of DEA and state narcotic licenses are a condition of employment and must be submitted to the Management prior to
employment for verification. Current copies of these documents shall be kept on file for immediate review at all times.
Payment for Health Professions Bureau “Prescriptive Authority Advanced Practice Nurse” will be issued to this agency by the corporation. The following are included Prescriptive authority, controlled substances registration fees, and DEA licensure verification.
Communication devices will be supplied by the Corporation and will remain property of said Corporation for the duration of employment. The devices provided shall not be used for personal communication and shall be returned to the employer upon departing from the Corporation. It is the responsibility of the employee to maintain the equipment in good condition and report any defects, problems, or malfunction.
Repairs and replacement of the device will be the responsibility of the Corporation.
Transportation will be the responsibility of the employee. Transportation will only be provided when the employee is out of town for the purpose of attending a meeting, conference, and or education offering required by the Corporation. All receipts of the transportation will be required for reimbursement by the Corporation. Transportation should be arranged prior to the travel and an estimation of the cost and duration made at that time. When at all possible the Corporation will make these reservations and provide the information concerning the transportation prior to departure to the traveling parties.
Transportation to the satellite offices will be the responsibility of the employee. Dependable transportation is an expectation for employment.
Medical Insurance:
The employee within the financial parameters defined by the Corporation may determine the type of plan selected. The plan identified by the employee should be submitted to the Corporation for review.
The information to be submitted to the Corporation should include the type of plan, cost, and a contact person with the said insurance company.
Malpractice Insurance:
The employee will be carried on the primary physician’s Medical Malpractice Insurance for the duration of their employment. It is the option of the NP to purchase at their own expense, separate malpractice coverage.
The Following Malpractice Insurance Company should be able to answer any question you may have concerning the policy. Upon employment, the Corporation will provide a copy of the updated edition of the employee’s coverage.
The corporation will bill the Nurse Practitioner’s fees for the duration of the contractual agreement. It will be the responsibility of the employee to properly code the patient superbill on the electronic medical record computer software. Training on the system will be provided to the employee. Information Systems Security Agreement shall be signed between the employee and the Corporation.
The corporation shall maintain sole ownership of any and all patient charts, mailing lists, and electronic – computerized information concerning patient data. The use of said information
outside the practice shall be construed as a violation of the Patient’s HIPPA. rights and shall be prosecuted as such.
Promotion of the Company:
The employee shall represent the Corporation in a professional manner and as a representative of the company, the following methods of advertising may be employed for the continued promotion of our corporate philosophy.
Newspaper Advertisements Business Cards
Misc. other printed materials to promote the business for the general public.
The inclusion of the employee’s name and credentials may be used in the promotion of the Corporation.
The employee shall have the opportunity to review all material that contains his/her professional /personal identification. The employee written and/or verbal approval should be obtained in a reasonable time for the printing of the material. Objections or suggestions for the material will be given careful consideration prior to printing.
Promotion of the corporation may require the attendance of various local and regional activities. The Nurse Practitioner may be asked to participate in the activity. The coordination of such events will be made with the approval and availability of the Nurse Practitioner. The NP should make an attempt to attend these functions given ample time and space in the schedule. Weekend events should be scheduled in advance and coordinated with the NP. Weekend promotional commitments are not mandatory and will not influence the practitioner’s employment status with the corporation.
The primary physician of the practice or any designated legal physician agent of the corporation will execute a cooperative agreement for the purpose of satisfying legal requirements for the continuing practice of the NP
