When is Accepting a PRN Position a Conflict of Interest?

A reader emailed me an interesting question yesterday (thank you!) which I thought deserved a blog post dedicated to the topic. This particular ThriveAP reader is considering accepting a PRN position in addition to her regular full time gig and was concerned that working for another company in a similar, competing, clinical environment could be unethical. As nurse practitioners, many of us find ourselves with similar questions.

Picking up a few shifts on the side can contribute significantly to an NP’s income and is a great was to make some extra cash. But, taking on a PRN position isn’t worth jeopardizing your full time job. So, when it accepting a PRN position OK and when should you say ‘no’ to picking up shifts outside of your regular employment? Here are a few things to consider. 

Contractual Stipulations

Some employers prefer that nurse practitioners work exclusively for their company. This stipulation, known as a ‘moonlighting policy’, is outlined in the NP’s employment agreement. Before accepting a PRN position, review your contract closely for a moonlighting policy.

Moonlighting policies may state that you cannot work in a position outside of your primary job regardless of the circumstances, or they may take a more lenient approach. Some moonlighting policies prevent nurse practitioners from taking on extra work that could interfere with the responsibilities of the primary job. The policy may require that the nurse practitioner get prior approval for any outside employment. Or, an employment agreement may prohibit the NP from working with a competing entity. Know the ins and outs of your contract.

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Requirements of the PRN Commitment

It’s tempting to assume that because a PRN job is a ‘when necessary’ position that your secondary job will be as flexible as you need it to be. Many employers, however require that PRN nurse practitioners work a minimum number of hours each week or month. It can be difficult to master EMR systems and keep up with policy changes if you rarely work. Employers make sure NPs keep up and ensure they have adequate staffing by outlining PRN requirements. Make sure your primary position and proposed PRN requirements will be possible to fulfill.

Can You Accommodate Both Positions

Juggling multiple jobs and multiple employers can be a hassle. If either your primary or PRN job has a sporadic schedule, this can create a logistical nightmare. Don’t forget to consider on-call duties and other administrative responsibilities in thinking through the decision. Decide if you can realistically work two jobs without getting burnt out. Taking a day off here and there is necessary to keep you sane. Make sure you will have time for friends, family, and extracurricular activities if you pursue additional employment. Taking on too many responsibilities will leave you stressed and your PRN job will likely end on a sour note.

Is There a Conflict of Interest?

Hospitals, clinics, and other healthcare facilities are businesses. So, working as a nurse practitioner for two different employers could be a major conflict of interest. For NPs working in acute care settings seeing patients with episodic problems such as urgent care clinics and emergency departments this is less of a consideration. Nurse practitioners with longer term patient relationships may draw loyal patients away from their primary employer by accepting an outside position.

Consider how closely your primary employer competes with your prospective PRN employer. Are the two companies located in the same area? Do they treat the same patient populations? If accepting a PRN position could have negative impact on your primary employer, forgo the job.

Working PRN can expand your clinical skill set and provide an added source of income but the decision to take on an additional position must be weighed carefully.


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