Employment Contract Critique Nurse Practitioner

APRN Employment Contract Critique

Introduction

An employment contract is defined as the agreement between an employee and an employer on the basis of their employment relationship. Contracts may be temporal, permanent or independent. When nurse practitioners are looking for employment, they search for positions that best suit their skills, abilities and experience (Brodie, 2011). After a nurse practitioner has been interviewed and has been offered a job, then the most important part becomes about nurse practitioner contract negotiation. Bargaining for salary is one of the crucial parts of the negotiation because it is the first step to achieving personal and career goals. The responsibility of a family nurse practitioner (FNP) is to provide primary medical care to patients - from children to adults. The essay aims at providing a critique of a sample nurse practitioner employment contract (included in the appendices section). The critique will major on various factors including compensation, bonuses, on call time, vacation, restriction to competition, expectations on number of patients to see daily, expectations on the non-clinical work they should do, support services that should be offered to NP, travel compensation, mileage, time off reasons for termination and others.

APRN Employment Contract Critique

Scope of services to be performed and population

A nurse practitioner deals with a wide range of health services to both children and adults. The services include the diagnosis and management of acute and chronic health problems.

Compensation

Compensation in this case is money given to a NP for the services they offer to a hospital or medical center. A nurse practitioner should receive an average wage of $111,375 without the inclusion of overtime and bonuses. However, the average salary is also dependent on the years of experience. In the United States a nurse practitioner at the entry level will be paid an approximate of $97,000 for one year. Nurse practitioners with three to nine of years of experience earn approximately from $110,000 to $119,000. However, as a result of the nature of their profession, skills and their need in the society, they should at no point be paid below $90,000 annually. The salary may however range from hospital to hospital. Top medical firms for nurse practitioners in the United States include Signify Health which pay their NP’s $492,455 annually and UCLA Health which pays their NP’s $180,406 annually (Dillon, & Hoyson 2014). The employment contract should ensure that the salaries for nurse practitioner is nothing below that of an entry level.

One of the positive elements of compensation in the highlighted employment contract is that nurse practitioners will be paid biweekly. This is very crucial because as a result of the Covid-19 pandemic, it cushions employees from the detrimental effects of a downturn in economic activity.

Travel Compensation

Nurse practitioners, especially family nurse practitioners who take their time to go to families and take care of their health needs, need to be paid for the time they spend travelling for work assignments. Transportation is the responsibility of the employee. However, the company is required to provide travel expenses when the NP is out of town or has attended conferences on behalf of the firm. The travel compensation acts as an overtime payment and the NP is required to fill in overtime payments to ensure they are captured and see to it that there are no problems on disbursements.

Gas/ Mileage

This is part of travel compensation. It is the NP’s responsibility to take care of their transportation costs. However, if the NP is sent on a mission outside the hospital, then the firm needs to take care of the associated costs. This is instrumental because such an arrangement is not in the NPS’s budget. The NP is required to fill a form to be compensated for the gas they have spent. The NP is required to have receipts as evidence of the extra gas used.

On call time

On call responsibility of a NP is to ensure that patients continue to be treated and that they are on their medication despite the physician being away. On call time enables the nurse to receive instructions from the physician on patients that were on treatment. On call responsibilities should, however, not affect the NP’s working hours. Despite on call time, the NP has the right to work only within their shift hours and leave for their homes. Any additional time they spent in the hospital even on call time with the physician should be regarded as overtime. Furthermore, nurse practitioners should always ensure that they are reachable during call time to ensure efficiency when treating patients.

Bonuses

Most of the time, bonuses are not guaranteed. NPs should be evaluated after every six months. The evaluation is dependent upon multiple performance factors. Nurse practitioners who perform well could receive a bonus. A move of this nature is meant to promote performance and increase morale. In the present scenario, the employment contract would need to provide a clear view of the amount of money that nurse practitioners may earn as bonuses when they perform to a certain level. Such information is important because it promotes fairness and equality throughout the entire process (Dillon & Hoyson 2014).

Duration of Employment

The NP’s contract of employment shows that NPs should be employed for one year, but then then there are options for renewal on a periodic basis. Today, many people are employed on the basis of temporary contracts and they are renewed based on performance. The nurse practitioner is also supposed to work from 8:00 am to 4:30 pm. Any extra hours past these should be paid when there is clear consent from the human resource department.

How the Agreement Can be Altered or Updated

One of the instances which the agreement could be altered is when a nurse practitioner is unwell and therefore, they cannot attend to patients. On normal occasions, a nurse practitioner has leave days in the working calendar. They are given a maximum of four sick leave days. However, there are illnesses that could require the nurse practitioner to stay for a month or more on bed rest prior to resumption. At this point, it is the employer’s responsibility to embrace measures to advance the employee’s well-being. The employer may choose to pay the employee half the salary.

Responsibility for maintaining and paying for credentials

Nurse practitioners are required to renew their licenses when due. In any case they do not renew the licenses, they could be terminated from work. Nurse practitioners may be able to maintain their certifications and credentials by ensuring that set calendar dates for renewal. In essence, nurse practitioners are also required to pay prescriptive fees for the relevant documentation. Copies of the documentation should be kept on file for verification. If the nurse practitioner do not comply with laws related to credentials maintenance and payment, they may not have any other leverage to support them.

Benefits and Vacation Time

Nurse practitioners have benefits - including vacations and insurance. Such benefits are supposed to act as motivators for nurse practitioners to be competent in their field. When the practitioners are employed in their first year, they are given a vacation of two weeks but as they continue working for their employer for longer, they are likely to have one or two months’ vacation. However, the contract agreement does not include the employee’s family in vacations. Although they may be costly, I am of the opinion that an employee may need to spend their free time with their family – which could involve travelling. This helps ease work-related pressure and crucial details on the same should have, therefore, been a prominent aspect of the contract. There may also be need to ensure that nurse practitioners receive optical, visual, and general insurance.

Time off and expenses for continuing education

The nurse practitioner should have time off - depending on their shift and emergencies at the hospital. The employer is more than willing to ensure that the nurse practitioners continue with their education – which would have a positive impact on the ability of nurse practitioners to offer quality services.

Restriction on Competition

Every employment contracts routinely have non-compete clauses (Bellot, Valdez, Altdoerffer, Quiaoit, Bronzell-Wynder & Cunningham, 2017). In this case, the employer urges the nurse practitioner not to take up employment within a 50-mile radius when and if the contracted is terminated. The good thing about the non-compete clause is that it is clearly defined and only works for two years. This means that regardless of a nurse practitioners’ decision to dissolve the agreement, they may still get back and serve the same clients after two years. The employer has the right to file a complaint against the nurse practitioner in case they do not follow the set agreement on the non-compete clause.

Reasons for termination

The nurse practitioner has the right to terminate the contract for their own reasons. However, they may need to give the employer a 60-day notice to prepare other nurse practitioners to take the position. Moreover, the firm may also terminate the contract for clearly defined reasons. I am of the opinion that a thirty-day notice before termination would be sufficient and not overly restrictive.

Extent of support service to be offered to the NP

A nurse practitioner has many responsibilities especially when it comes to supporting the physician (Buppert, 2020). To make work easier, the nurse practitioner also needs support from subordinate staff. The need for collaboration has been highlighted in this case. The contract does not, however, show the full extent of support for the nurse practitioner. I am of the opinion that specific factors relating to administrative support, empowerment initiatives, etc. ought to have been highlighted. When nurse practitioners are empowered, they may be more confident in executing the employer’s care plan.

Expectations regarding the number of patients seen per day

The contract does not provide a given number of patients to be seen every day. It is not easy to estimate the number of patients that may come to a hospital but it is important to give a number estimate to the same so as to assess expected workload.

Expectations regarding non-clinical work to be done by NP

The contract has established that nurse practitioners may be sent to represent the firm in conferences. The advantage of the non-clinical work is that this could be considered an avenue for networking and knowledge enhancement.

Release to the NP of the NPs quality performance as measured by health plan auditors

It is the employer’s responsibility to ensure that nurse practitioners who performed well are promoted. Promotions in a firm act as a form of motivation.

Conclusion

The essay presents a critique of the employment contract of a nurse practitioner. Various aspects of the same have been addressed. Amongst other things, the critique emphasizes the need to support nurse practitioners so as to promote their performance and enable them meet their obligations to patients.

References

Bellot, J., Valdez, B., Altdoerffer, K., Quiaoit, Y., Bronzell-Wynder, T., & Cunningham, P. (2017). Does contracting with managed care organizations remain a barrier for nurse practitioners? Nurse Economics, 35(2), 57-63.

Brodie, D. (2011). How relational is the employment contract? Industrial Law Journal, 40(3), 232-253.

Buppert, C., 2020. Nurse practitioner's business practice and legal guide. Jones & Bartlett Learning.

Dillon, D., & Hoyson, P. M. (2014). Beginning employment: a guide for the new nurse practitioner. The Journal for Nurse Practitioners, 10(1), 55-59.

Dillon, D., & Hoyson, P. M. (2014). Beginning employment: a guide for the new nurse practitioner. The Journal for Nurse Practitioners, 10(1), 55-59.

Appendices

Nurse Practitioner Employment Contract

EMPLOYMENT CONTRACT AGREEMENT BETWEEN THE FOLLOWING PARTIES:

EMPLOYER:

The following party shall here in be referred to as “Corporation”

EMPLOYEE:

The following party shall here in be referred to as “EMPLOYEE “or “NP”

TERMS OF EMPLOYMENT

DURATION

The contract duration is for one year with option for renewal for five (5) years thereafter.

COMPENSATION

Salary:

The contracted position will be paid at a Salary rate of $_________ per year.

The contract will be renewed the sixth month after 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.

TERMINATION

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 either 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 a 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 which 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 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 corporation divert, coerce, or recruit patients involved in the medical practice of corporation. For the two-year period after termination of the contractual agreement with the corporation, the NP will refrain from treatment of all patients seen at corporation either individually or collectively, unless otherwise agreed to by corporation in writing.

PERFORMANCE EVALUATION

Annual performance evaluation of the NP shall be given for the purpose of improvement of the NP performance in the work place. This evaluation shall include but not limited to the review 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 creation of an annual plan regarding professional goals for the upcoming year.

ON CALL RESPONSIBILITIES

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 hour a day, 7 day 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 of 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 is 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:

HOURS

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 any 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 one 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 the expectation that the hours worked reflect full time employment and may require more than 40 hours. Those hours worked beyond a 40-hour work week 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.

HOLIDAYS

Paid time off for all salaried employees include the following days which are not compulated as vacation.

1. NEW YEAR’S DAY

1. MEMORIAL DAY

1. JULY 4 TH (Except when it occurs on a Saturday or Sunday then the holiday will be observed on either Friday or Monday)

1. LABOR DAY

1. THANKSGIVING DAY AND THE DAY AFTER (2004- 11-26-04 FRIDAY)

1. CHRISTMAS EVE

1. CHRISTMAS DAY

1. HALF A DAY- NEW YEAR’S EVE

SICK LEAVE

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 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.

VACATION

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.

Third year of employment the addition of a third week of vacation will accrue.

Fifth year of employment the addition of a 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.

PERSONAL LEAVE

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 patient care and does not pose a significant burden to the daily operation of the corporation.

CONTINUING EDUCATION

The corporation is committed to the continuation of educational endeavors within the realm of Pain Management. The corporation will schedule the 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 at one week for the purpose of Continuing Medical Education.

PROFESSIONAL MEMBERSHIPS

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 require documentation for the requested organization including the nature of the membership and associated fees.