APRN Employment Contract Critique: Key Clauses Analyzed

Introduction

An employment contract is defined as the agreement between an employee and an employer governing the terms of their employment relationship. Contracts may be temporary, 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 offered a job, the most important step becomes contract negotiation. Bargaining for salary is one of the most crucial aspects of that process, as it is the first step toward achieving personal and career goals.

The responsibility of a family nurse practitioner (FNP) is to provide primary medical care to patients ranging from children to adults. This essay provides a critique of a sample nurse practitioner employment contract (included in the appendices). The critique addresses various factors including compensation, bonuses, on-call time, vacation, restrictions on competition, expectations regarding the number of patients seen daily, expectations regarding non-clinical work, support services to be offered to the NP, travel compensation, mileage, time off, reasons for termination, and other relevant provisions.

Compensation and Travel Reimbursement

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

Compensation in this context refers to the money paid to an NP for the services they provide to a hospital or medical center. A nurse practitioner should receive an average wage of $111,375, excluding overtime and bonuses. The average salary also depends on years of experience. In the United States, an entry-level nurse practitioner will earn approximately $97,000 per year. Nurse practitioners with three to nine years of experience earn approximately $110,000 to $119,000. Given the nature of their profession, their specialized skills, and their societal importance, they should at no point be paid below $90,000 annually. Salaries may vary from one hospital to another. Top-paying employers for nurse practitioners in the United States include Signify Health, which pays NPs $492,455 annually, and UCLA Health, which pays NPs $180,406 annually (Dillon & Hoyson, 2014). The employment contract should ensure that nurse practitioner salaries are no less than entry-level standards.

One positive element of the highlighted employment contract is that nurse practitioners will be paid biweekly. This is beneficial because, particularly in the context of economic uncertainty such as that brought on by the COVID-19 pandemic, more frequent payment helps cushion employees from financial hardship.

Nurse practitioners — especially family nurse practitioners who travel to provide care in patients' homes — need to be compensated for time spent traveling on work assignments. Transportation is generally the employee's responsibility; however, the company is required to cover travel expenses when the NP travels out of town or attends conferences on behalf of the firm. Travel compensation functions similarly to overtime payment, and the NP is required to submit the appropriate forms to ensure accurate disbursement without complications.

Gas and mileage reimbursement is part of travel compensation. While it is ordinarily the NP's responsibility to cover transportation costs, if the NP is sent on a mission outside the hospital, the firm should bear the associated costs, as such travel falls outside the NP's personal budget. The NP is required to complete a reimbursement form and retain receipts as evidence of extra fuel costs incurred.

On-Call Time, Bonuses, and Duration of Employment

The on-call responsibility of an NP is to ensure that patients continue to receive appropriate care and remain on their prescribed medications when the physician is away. On-call time allows the nurse to receive physician instructions regarding patients currently under treatment. On-call responsibilities should not, however, infringe upon the NP's standard working hours. Despite on-call obligations, the NP has the right to work only within their assigned shift and to leave at the end of it. Any additional time spent in the hospital — including on-call time — should be treated as overtime. Nurse practitioners should also ensure they remain reachable during on-call periods to support continuity and efficiency of patient care.

Bonuses are generally not guaranteed. NPs should be evaluated every six months, with evaluations based on multiple performance factors. Nurse practitioners who perform well may receive a bonus — a measure intended to promote performance and boost morale. In the present contract, it would be beneficial to clearly state the amount that an NP may earn as a bonus upon reaching a specified performance level. Such transparency promotes fairness and equality throughout the process (Dillon & Hoyson, 2014).

The NP's contract shows that the initial employment period is one year, with options for renewal on a periodic basis. Many professionals today are employed on temporary contracts that are renewed based on performance. The nurse practitioner is expected to work from 8:00 a.m. to 4:30 p.m. Any additional hours worked beyond this schedule should be compensated with the clear consent of the human resources department.

Conclusion

This paper has presented a critique of a nurse practitioner employment contract. Various aspects of the contract have been examined, including compensation, travel reimbursement, on-call responsibilities, bonuses, duration of employment, vacation and sick leave, credential maintenance, non-compete provisions, termination conditions, support services, patient load expectations, and non-clinical duties. The critique emphasizes the importance of supporting nurse practitioners in order to promote their performance and enable them to meet their obligations to patients effectively.

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.

EMPLOYMENT CONTRACT AGREEMENT BETWEEN THE FOLLOWING PARTIES:

EMPLOYER: The following party shall herein be referred to as "Corporation."
[Enter Corporation Name and Address Here]

EMPLOYEE: The following party shall herein be referred to as "EMPLOYEE" or "NP."
[Enter Name and Address of Nurse Practitioner Here]

TERMS OF EMPLOYMENT

DURATION: The contract duration is for one year with the 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 reviewed for renewal at six months based on the employee's performance. Paychecks will be issued biweekly.

Bonuses: The consideration of a bonus will be determined yearly based upon an assessment of productivity, performance review, and the financial status of the Corporation. There is no guarantee of bonus payment; however, the Corporation maintains the philosophy that the value of an employee must be assessed and that exceptional performance 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. If an irreconcilable condition arises that cannot be resolved within this time frame, the parties may seek mediation to resolve differences over the dissolution timeline.

Immediate termination with cause may occur if legal or material impediments exist to the delivery of patient care by the NP, including conditions that could potentially jeopardize patient safety or place the Corporation at unexpected financial or legal risk.

NON-COMPETE CLAUSE

Because of the special skills and information regarding pain management gained through employment, a non-compete agreement is invoked upon dissolution or termination of the contract. The clause shall remain in effect for two years. The NP shall not be employed in the practice of pain management within a 50-mile radius of any corporate clinical practice location. The NP may continue to practice in these areas; however, the total percentage of patients seen for pain management in any subsequent practice shall not exceed 10%. The NP shall not, during the two-year period following termination, divert, coerce, or recruit patients of the Corporation, and shall refrain from treating all patients previously seen at the Corporation unless otherwise agreed to in writing.

PERFORMANCE EVALUATION

An annual performance evaluation shall be conducted to support improvement in the NP's workplace performance. The evaluation shall include, but is not limited to, a review of 5% of the NP's patient electronic medical records by the physicians of the practice, examining completeness, accuracy, accountability, and compliance with applicable state and federal prescriptive guidelines. A second component will include input from co-workers regarding interoffice communication, flexibility, and overall collegiality. A third component will include a self-assessment and the creation of an annual professional goals plan 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. On-call scenarios should be planned in advance with the NP. The mutual goal of maintaining 24-hours-a-day, 7-days-a-week patient care is considered the most important priority in consistent patient care delivery. The physician shall remain available for telephone consultation at all times during any period the NP is on call.

The purpose of on-call NP coverage is to provide emergent patient assessment and treatment only. The prescribing of medications will continue to be deferred to scheduled appointments, as it is the patient's responsibility to maintain adequate medication quantities through planned visits.

ASSISTANCE: SECRETARIAL SUPPORT

The Corporation will staff the offices Monday through Friday, from 8:00 a.m. to 4:30 p.m. Office personnel are responsible for patient check-in, telephone handling, patient scheduling, and the direction of patient flow through the clinic day.

HOURS

Hours of employment are Monday through Friday, 8:00 a.m. to 4:30 p.m. Saturday hours may be arranged with mutual consent to accommodate the patient population and are not paid at an additional rate. Saturday hours are only scheduled when deemed necessary and will be no more than one per month, arranged with consideration of the employee's request, provided it is reasonable given office needs. The position is salaried with the expectation of full-time hours, which may occasionally exceed 40 hours per week. Hours beyond 40 per week will not be paid at an additional rate; however, the average workweek over the course of the year is expected to be 40 hours.

HOLIDAYS

Paid time off for all salaried employees includes the following days, which do not count against vacation time: New Year's Day, Memorial Day, July 4th (or the observed Friday or Monday if it falls on a weekend), Labor Day, Thanksgiving Day and the following Friday, Christmas Eve, Christmas Day, and New Year's Eve (half day).

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. Excessive use of unscheduled time off for repeated illnesses requires documentation from the employee's primary care physician. The allowable yearly maximum is no more than 4 sick days.

If the illness requires hospitalization, surgery, or other medical intervention, the treating physician should communicate the required recovery time in writing to the primary practice physician within one month of the planned intervention. More than 4 days of unscheduled illness-related absence will result in the use of paid vacation days. When vacation days are exhausted, reduction of benefits and/or dismissal will be reviewed on an individual basis, giving consideration to the circumstances and the demands of the practice.

VACATION

In the first year of employment, two weeks of vacation are included in the salaried employee benefits plan. No additional monetary compensation will be paid in lieu of vacation. A third week of vacation accrues in the third year of employment. A fourth week accrues in the fifth year of employment. Vacation must be requested with a minimum of six weeks' notice, submitted in writing to the Corporation with complete dates. All reasonable requests will be considered, and approval will be communicated to the employee within one week of submission.

PERSONAL LEAVE

Requests for personal leave will be considered, and vacation time will be applied to approved days off. Requests for unpaid time off may be considered if there is no significant interruption in patient care and the absence does not pose a burden to daily operations.

CONTINUING EDUCATION

The Corporation is committed to supporting continuing education within the realm of pain management. Educational seminars will be scheduled for the advancement of the employee in the practice. Should the employee wish to attend an educational offering unrelated to pain management, sufficient course information should be submitted to the Corporation for review and approval. The Corporation will cover transportation, lodging, and meals for one week of continuing medical education annually.

PROFESSIONAL MEMBERSHIPS

Memberships to professional organizations are not a condition of employment; however, key certifications and organizational memberships are expected as evidence of professional advancement and continuing education. The Corporation will review membership requests, and corporate funding may be allocated through an application process.

LICENSE RENEWAL

A current Indiana license is required prior to employment and will be verified by management. It is the employee's responsibility to maintain a current Indiana license and submit a copy prior to the commencement of employment. Failure to maintain this documentation as current will result in the immediate cessation of salary and benefits until corrections are made. Payment of Health Professions Bureau fees will be issued by the Corporation.

PRESCRIPTIVE FEES

All state and federally regulated prescriptive fees, including DEA and state narcotic licenses, are a condition of employment and must be submitted to management prior to employment for verification. Current copies of these documents shall be kept on file at all times. Payment for Health Professions Bureau "Prescriptive Authority Advanced Practice Nurse" fees will be issued by the Corporation, including prescriptive authority, controlled substances registration fees, and DEA licensure verification.

COMMUNICATION

Communication devices will be supplied by the Corporation and remain corporate property for the duration of employment. Devices shall not be used for personal communication and must be returned upon departure. The employee is responsible for maintaining equipment in good condition and reporting any defects or malfunctions. Repairs and replacements are the responsibility of the Corporation.

TRANSPORTATION

Transportation is the responsibility of the employee. The Corporation will provide transportation only when the employee travels out of town for a meeting, conference, or required educational offering. All receipts must be submitted for reimbursement. Transportation to satellite offices is the employee's responsibility. Dependable transportation is an expectation of employment.

INSURANCE

Medical Insurance: The employee may select a plan within the financial parameters defined by the Corporation, and the selected plan should be submitted for corporate review with details including plan type, cost, and a contact person at the insurance company.

Malpractice Insurance: The employee will be covered under the primary physician's medical malpractice insurance for the duration of employment. The NP may also purchase separate malpractice coverage at their own expense. Upon employment, the Corporation will provide a copy of the employee's updated coverage details.

PROFESSIONAL ISSUES

The Corporation will bill the nurse practitioner's fees for the duration of the contractual agreement. It is the employee's responsibility to properly code patient superbills on the electronic medical record system, for which training will be provided. An Information Systems Security Agreement shall be signed between the employee and the Corporation. The Corporation maintains sole ownership of all patient charts, mailing lists, and electronic patient data. Use of this information outside the practice constitutes a violation of patient HIPAA rights and will be prosecuted as such.

Promotion of the Company: The employee shall represent the Corporation professionally and may participate in promotional activities including newspaper advertisements, business cards, and other printed materials. The employee's name and credentials may be used in promotional materials, and the employee shall have the opportunity to review and provide written or verbal approval of any material bearing their professional identification. Objections or suggestions will be given careful consideration. Weekend promotional events are not mandatory and will not influence the practitioner's employment status.

COOPERATIVE AGREEMENT

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.

SIGNED:

_______________________________________      _______________________________________

MD                          Date                  FNP-C                          Date