FIND NP PROGRAMS
FIND NP PROGRAMS
Can an NP Work as an RN – (PROS VS. CONS)
Written By: Lauren Jacobson MS, RN, WHNP-BC
Creating your unique work structure in the nursing field is one of its main selling points. Maybe you are a registered nurse (RN) who is considering becoming a nurse practitioner (NP), but you love your RN work and do not want to fully give that up. Perhaps you are looking to complement your current work life as an RN with something that gives you a bit more autonomy, challenges your clinical intellect in a new way, and impacts patients differently. You may be an NP already and be wondering if you can pick up some shifts on the side as a nurse to get different experience or earn a little money ("both" is an acceptable answer). If you are a nursing school candidate and wonder what your future in the nursing profession could look like, you might be finding yourself reading this article. Regardless of what brought you here, you are probably wondering “can an NP work as an RN?" While the quick, direct, and largely unhelpful answer is "yes"...there are first several things you should consider and be aware of.
Some considerations are practical and legal and will not only help you protect patients but also yourself. Some of these considerations are general regardless of what state you practice in, and others may be state specific. Here we review the top 7 pros and cons of an NP working as an RN and some of the major things you should consider.
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CAN AN NP LEGALLY WORK AS AN RN?
As mentioned in the introduction, generally NPs can work as RNs. However, first, you must have a valid RN license… luckily for you, you cannot have an NP license without this. In some states, your RN licensure is tied directly to your NP license. For example, in Massachusetts, you must renew your RN and NP license every two years, on your birthday, on even-numbered years (someone must have had fun coming up with this method…). You cannot renew your NP license without also renewing your RN license. Meaning, you have to be licensed as an RN in the state of MA to work as an NP there. Thereby, while you are a licensed NP, you at least will always have an RN license in that state. Now, what does that mean for working across state borders?
CAN AN NP LEGALLY WORK AS AN RN IN ALL THE STATES?
Chances are that if you are working as an RN already, you are familiar with some of the nuances of the nursing system in the US. You need to pass your NCLEX exam
, then you can apply for licensure as a nurse in one or more states. If you are already an NP in one state though, and you want to work in another as an RN, that is possible…as long as you are licensed as an RN in that state. Being an NP does not magically grant you the ability to work as an RN anywhere you want.
Now, here enters the nurse licensure compact (NLC)
. The NLC increases nurses' ability to practice in some states if they are already licensed in a certain state. The NLC has been growing for years and has taken on new importance with the COVID-19 pandemic. With the pandemic, nurses were being recruited across state borders to meet the demand. The NLC helped make that possible. The NLC only applies to RN licensure though, not NPs. Confused? Me too. So let's use some examples to work out if you can legally work as an RN in all states.
The short answer is no. You have to have RN licensure in a state to work there, or you have to have a multistate license
through the NLC. Since not all states are involved in the NLC, if you TRULY wanted to be able to work as an RN in every state, you would need the multistate license, and then licensure in every state not covered by it. Again, while the NCLEX exam is national, nursing licensure is not.
Let's take New Hampshire (NH) for example. You are a licensed NH RN and NP. NH is not enormous and it does border Massachusetts (MA), Vermont (VT), and Maine (ME). So it would be geographically possible to work occasionally in a surrounding state if you are looking to supplement your income. You find a position in VT that would allow you to pick up some extra shifts. You can either apply for a multistate license through your board of nursing (BON)
or apply for a nursing license directly with the VT BON. One of these two things needs to happen though before you can practice in VT. Since VT is a part of the NLC, you might as well apply for a multistate license that would give you access to working as a nurse (including via telehealth)
in all NLC states. MA however has pending NLC legislation. In this case, you would have to still apply for direct licensure with the MA BON as a multistate license would not work.
IS IT COMMON FOR NPS TO WORK AS RNS?
It is common for NPs to work as RNs. Not only will a quick internet search tell you this, but I can tell you from personal experience that it is true. One of the biggest advantages of an NP working as an RN is that you will earn even more money per hour or shift working per diem as an RN than you would while working full-time as an RN. This is one of the many reasons it is common for NPs to work as RNs. Some NPs worked many years as an RN before transitioning to an NP. Often, they liked the work they did or the skills they used and may not want to give that up.
It's also no secret that student debt
accumulates for nursing students (whether you're an RN, NP, or both). I knew many NPs (myself included) who supplemented their full-time NP income with a few extra RN shifts per month. A friend of mine is a Family Nurse Practitioner (FNP)
. She worked Monday through Friday in occupational health from around 9 a.m. to 5 p.m. as an NP. Approximately two times per month she would pick up shifts at the hospital working on a medical-surgical floor as an RN. With this strategy, she was able to put the extra money she made as an RN toward her monthly student debt payments.
TOP CONS OF AN NP WORKING AS AN RN
The following are the top 7 disadvantages of an NP working as an RN.
CON #1: Scope of practice
If you are already in your nursing career you probably know a bit about the differences in the scope of practice
for RNs and NPs. NPs are trained at a higher level and therefore have a broader scope of practice. This means that (depending on specific training) NPs can order and interpret diagnostic tests and images, diagnose patients, prescribe medication, and perform procedures. Depending on the state they may need little to no physician oversight to do this.
RNs however, always have to work under a physician, NP, or physician's assistant (PA). RNs cannot order tests or diagnose patients. They also cannot prescribe medication. RNs play a crucial role in caring for patients. In short, they are responsible for assessing patient medical status, implementing care plans, administering treatment plans ordered by physicians, NPs, or PAs, and they perform life resuscitation procedures when required.
One of the cons of an NP working as an RN in terms of scopes of practice is mixing them up. If you are accustomed to working with an NP scope of practice, you may be tempted to provide a higher level of care to patients than what you are legally allowed to do within your RN job. This is a disadvantage to you at the basic level because, well it's confusing! As an RN caring for a patient, you may be needing to make a rapid clinical decision, and it may not be clear to you where your scope of practice begins or ends in that situation. This can lead to at minimum some delay in care implementation, confusion for the patient, and a bit of self-doubt. On a more serious level, this can lead to liability issues which are one of the next disadvantages of an NP working as an RN.
CON #2: Liability and standard of care
As an NP who prescribes medication, and autonomously makes healthcare decisions with patients you are likely aware of the need for malpractice insurance
and various liability issues you can run into. As an RN who is also licensed as an NP this liability area can feel a bit gray…and in some ways it is. One of the cons of an NP working as an RN is that in the event of a patient injury or death, you may be held to your highest standard of care- which would be that of an NP.
However, as stated in con number 1, you may also have the urge in day-to-day clinical activities to provide a higher level of care than what you are permitted to do working under your RN license. Ultimately, this is a risk you may have to accept if you plan to work as both an NP and RN, and should also discuss it with prospective employers.
CON #3: Varying shifts
One of the appeals to working as an NP is the potential for stable working hours. RNs may also have predictable and stable schedules depending on their practice environment, but it is more common for them to have shift work that varies at times. If you are planning to work as an NP and an RN, you may be giving up some of this stability by throwing in longer (12 hours), irregular, and/or weekend and night shifts into the mix. Depending on the benefits you are getting from working as an NP and an RN this “con” may be negligible for you.
CON #4: Autonomy
As an RN you will have less autonomy than you do as an NP. This may be a frustrating and difficult adjustment if you are juggling the two roles regularly. It may feel unnecessary and time-consuming to have to wait for orders from other NPs, PAs, or physicians when in your other job as an NP, you can do this yourself. It also may be that you disagree with the plan of care for a patient. While as an RN you are your patient's advocate and can speak up for what you think would be most beneficial for them, you will not be able to make treatment plan decisions.
CON #5: Fatigue
While NPs may have a certain level of comfort due to the lifestyle around their work, your schedule working as an RN may not afford you this. If you work on a hospital floor, you are likely to have a more fast-paced and physical environment than what you are used to as an NP. Doing this on top of your NP work can contribute to fatigue.
CON #6: Respect
Nurses are often praised publicly as being the backbone of the healthcare system and the most trusted profession
. This does not always translate into the workplace. Respect from colleagues, the institution where you work, and your patients may be individualized and depend on the work culture. However, in practice, many nurses have had experiences like hearing "but you're just a nurse" from colleagues or patients, which can leave them feeling devalued. This is an unfortunate and unfair reality for some.
Experiencing this as an RN may contrast with your experience as an NP. While NPs can get a dose of this prejudice from time to time, it can be less than what RNs experience. When you are interviewing for your RN position, try to get a feel for the work culture and the level of respect and support you will get from colleagues and supervisors.
CON #7: Burnout
People in caregiving professions are notorious for giving…and sometimes giving a bit too much. Call this the double-edged sword of a work of passion. You love it, you give it everything you have, you burn out, you slow down, you miss it, and you repeat the cycle. The advantages of an NP working as an RN may entice you, but be cautious about how and why you do this. The pros must outweigh the cons.
Your life is not your career, and stress is what drives many patients to poor health outcomes you find them in. Healthcare professionals are amongst the most likely professional groups to experience burnout
. One of the biggest disadvantages of an NP working as an RN is the increased risk of burnout.
TOP PROS OF AN NP WORKING AS AN RN
The following are the top 7 advantages of an NP working as an RN.
PRO #1: Income
One of the top pros of an NP working as an RN is earning more money. While most of us didn’t go into the field to make the big bucks, we likely came out of school with a lot of debt. Picking up a few extra shifts as an RN can help pay it off or help you save money for something else. Depending on the state, city, and clinical field you work in as an RN, you can earn between $40 to $65 per hour
. If your RN job is not your primary job, you will be earning per diem rates. These are usually a lot higher than if you were a full-time RN with all the benefits.
PRO #2: Skills
One of the pros of an NP working as an RN is new skill development and skill maintenance. Chances are that if you are an NP or are thinking of becoming one, the excitement of learning new clinical skills is a motivator. NP skills can be quite different from RN skills though.
For example, I worked as an occupational health nurse per diem while I was doing my direct entry masters in nursing program
. I had never worked as an RN before this, so my nursing skills were limited to what I had learned on my clinical rotations. When I got my first job after graduating as a Women’s Health NP (WHNP)
, I still wanted to expand my nursing skills. I picked up some side RN jobs in women's health and psychiatry and learned new skills like IV management, ultrasonography, psychiatric medication administration, management, and de-escalation techniques.
Alternatively, if you have worked as an RN for a long time, you may not want to risk losing all the clinical skills you have gained. Working as an RN while you are an NP can help keep those skills sharp.
PRO #3: Patient population
Sometimes it can be nice to have more variety in the types of patients you see. Particularly if you are an NP who works with a very specific patient population (like women's health or neonatal), you may want to change things up a bit. By working as an RN while you are an NP you can get more satisfaction from seeing different patient populations with different clinical needs.
PRO #4: Experience
Depending on where you are in your career development and personal life, you may have a clear idea of what you want and when, or you might still be figuring it out. Either is ok, I think I will forever be in a state of "figuring it out" and for me that keeps things fun. Working as both an NP and an RN can boost your CV and give you experiences in clinical areas that you might be considering transitioning to.
For example, if you're working as an FNP in a primary care practice, but you are curious about working in the Emergency Department or working more with children than you do at your current position, you can get new experience. One way to carefully test out your interests without having too much responsibility and liability risks are to apply for a part-time RN position in different departments. If you don't have prior experience, it may be challenging to get a part-time position in the emergency department or on a pediatric floor, since you will need training and onboarding. An in-between step here could be to try out working as an RN in urgent care or an outpatient pediatric clinic.
PRO #5: Variety
Having spent years exploring different types of work in healthcare and talking with friends in a variety of professional fields, I am pretty sure everyone gets bored sometimes. There can be a level of monotony in any job. Working as an RN while you work as an NP can change this up a bit and help break this cycle. I know when I was working primarily outpatient, I would get bored sometimes, or I craved more physical work. Picking up some weekend shifts in a more fast-paced environment helped me feel more excited about my work while getting all of the other benefits I've discussed here.
PRO #6: Networking
It can seem all sunshine and rainbows at the start of your career. You might be looking at your new NP job and thinking you will stay there forever, and maybe you will. You have fabulous colleagues, it pays well, you are learning, and feel supported by your employer…but you don't know what you don't know. Sometimes working as an RN while working as an NP can end up helping you out down the road. A huge part of having a successful career in any field is building your network. By working elsewhere as an RN while you are in your NP role, you will be able to network with other healthcare professionals and employers. This will also mean that you have more potential references.
PRO #7: Stress management
Nursing is a high-stress field. We know this. As an NP one stressor you may have is knowing that you have higher liability and standard of care with your patients. As a new NP, or if you are in an environment without much support, this can weigh on you. It's not common that many NPs can financially afford to work part-time without additional income. One option here can be to work as an RN a few days a week and work as an NP on the other days. This may allow you to have a few days with fewer or different types of responsibility and stress depending on the RN role you choose.
For example, during COVID in 2020 I was furloughed 2 days a week from my outpatient WHNP job. The other three days I was working from home. Until I was sent to work in a testing center those other two days, I picked up some shifts at the psychiatric residential treatment facility for adolescent boys where I would work on the weekend. This position was very low-key. During most of my days there I would just pass medications and hang out with the kids in their recreation room playing games or watching movies unless there was a clinical issue.
SHOULD AN NP WORK AS AN RN – MY FINAL THOUGHTS
So, can an NP work as an RN? YES. Maybe a better question though is- SHOULD an NP work as an RN? I think this is a very personal decision and depends on what your goals, values, and needs are. It can certainly be a great way to increase skills, network, earn more money, and keep your work life exciting and balanced. You can also run an increased risk of burning out or mixing up your scope of practice and thus risk liability issues. Regardless of your motivations or hesitations about working as both an RN and an NP, you have to be aware of the potential benefits and risks. Hopefully, this article on the top 7 pros and cons of an NP working as an RN helps you make an informed decision.
Lauren Jacobson MS, RN, WHNP-BC
Lauren Jacobson is a registered nurse and women’s health nurse practitioner who is passionate about global health and gender-based violence prevention. She is Editor and an Advisory Board Member for the Global Nursing Caucus and volunteers with Physicians for Human Rights as a medical evaluator for asylum seekers.