Dear CNO

I’m an NP who works in public health. Recently, I was offered a casual Registered Nurse (RN) position in a local doctor’s office. I’d like to take this job, but before I do so, I’d like to check—am I allowed to work as an RN with an NP registration?

Thanks for the question! First of all, congratulations on the job opportunity, that’s wonderful.

It is common for nurses to work in different roles than the ones they are registered for, and CNO does not restrict this. Doing so comes with particular rules and accountabilities, so let’s walk through those.

It is up to the employer to determine whether it is acceptable for an NP to work in a role of another registration. That means you should check with the employer first and determine the scope and responsibilities of the role, as there may be policies that you need to be aware of.

If the employer policies allow working in a different role than you are registered for, then you can proceed! But there are still important accountabilities to uphold.

One of those is that when a nurse accepts a position in a different role, the nurse is expected to fulfil only the requirements of the position’s job description. This includes

• knowing and performing within the limits of the role

• having the knowledge, skill and judgement to recognize when the client’s condition deviates from the norm

As a nurse, you have other accountabilities too.

Sometimes emergency situations may arise outside the scope of the role for which you are hired. What’s important to remember in this situation is your primary accountability is to the client. In the case of an emergency and you are the only NP present, you must identify, assess and respond to the emergency at the level of your NP preparation. In emergencies where there are no other NPs, you remain accountable to the responsibilities of your registration even if you are working in a different role.

Additionally, you are responsible to identify yourself in documentation and to clients in a manner that reflects your registration. This means, because you are registered as an NP, then you must continue to identify yourself as an NP when introducing yourself or documenting, regardless of the role you are taking on in this job. You can read more on title use in our Ask Practice explanation Title use when working in different roles.

Again, congratulations on the job offer and we hope this helps you get started.

All the best,
Cindy Lee, RN, MN, CHE Advanced Practice Consultant

Further reading: Nurses working in different roles

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