Is the advanced practice nurse a part of the medical or the nursing staffing or both?

As the role has been defined and implemented, the nurse hospitalist tends to work with both staffs (11). Combining the unique education and nursing skills, the hospitalist not only diagnoses, but often provides direct care for his/her patients. Thus, there should be language within the collective bargaining agreement that clarifies who directs and supervises nurse practitioner practice as well as who evaluates their practices.

Many collective bargaining agreements have career ladders which tend to place nurse practitioners in the upper mid-level for entry to the top levels as experienced NPs. These levels should be adjusted to promotion and wage increase potential comparable to RN managers. The NP who chooses to work bedside should not be penalized for clinical practice, especially when that practice benefits the hospital (12).