Reply To: NP Staffing

  • Jessica Edgar

    February 13, 2019 at 9:27 am

    When I worked at Phoenix Children’s Hospital I was one of two inpatient PNP’s.  We tried to get outpatient NP’s to help the inpatient side with weekends, vacations, etc and were met with a lot of resistance for the same concerns you mentioned. Prior to this, we had already established the hiring of two fellows out of Heme/Onc specifically for night coverage which was very helpful in terms of caring for patients and for staff support given the amount of new grad RN’s on nights.  The fellows were busy all night long covering new diagnoses, routine chemo admits and BMT patients. This was a long time coming and our patients received better care.  Their back up was year 3 residents from the program. 

    The biggest problem for us as PNP’s inpatient was the expectation we consistently stay past our shift to help with no relief, not getting our vacation approved, and having to cover both weekends and holidays. There was no work life balance.

    Jessica Edgar CPNP
    Director of Medical Affairs
    Make-A-Wish America
    Phoenix, Arizona
    ph 623-640-2264
    work 602-792-3263
    Original Message:
    Sent: 02-13-2019 08:49 AM
    From: Brandi Dach
    Subject: NP Staffing

    Good Morning!  I am the clinical manager of a mid-size oncology program.  We have 6 oncologists and 2 hematologists, 4 outpatient oncology NP’s and 1 heme NP and 5 inpatient NP’s that are doing their best to cover the inpatient hematology consult service and oncology service 24/7.  We do not have fellows, but hem/onc is a mandatory rotation in our residency program.   We are team specific, with each outpatient NP working with 1-2 MD’s, managing patients, writing orders, etc.

    We are under increasing pressure by hospital administration to provide 24/7 coverage without holes and initially thought we would be able to partner with the residency program to have 2nd year residents, who had already been through their heme/onc rotation cover nights (allowing the inpatient NP’s to cover the heme consult/oncology service 7 days/week).  We have since been told our patient population is too complicated and that this was no longer an option.  I have been asked why I have inpatient and outpatient NP’s and why they don’t all work an inpatient/outpatient/overnight rotation. I worry about continuity of care among many other things, but don’t want to be closed minded to all options- So my questions are:

    1)  Are there other programs successfully rotating their NP’s inpatient/outpatient/overnight?  If so, can you please elaborate on your rotation/roles in each location?
    2)  Are there other programs using residents overnight to cover their inpatient service?  If so, who provides their onsite back-up?

    Thanks for any insight/wisdom you all can share!


    Brandi Dach, CPNP,CPON,RN
    Nurse Practitioner/Clinical Operations Manager
    Austin, TX
    United States