Barbara Sadler: Nurse Practitioner Employment Contract Review

A Nurse Practitioner (NP) is an Advanced Practice Registered Nurse who has additional responsibilities for administering patient care than Registered Nurse (RNs).
Typical Responsibilities of a Nurse Practitioner Include:
• Diagnosing and treating acute illnesses, injuries and infections
• Writing prescriptions for medications, including their dosage and frequency
• Ordering and conducting diagnostic tests, like electrocardiograms (EKGs) and x-rays
• Teaching patients about managing their health, make recommendations and design treatment plans
• Examining and recording patient medical histories, symptoms and diagnoses
• Providing guidance to patients about medications, side effects and interactions

The nurse practitioner profession can be a highly rewarding career with plenty of opportunities to help others and take on a much needed role in the health care industry. Nurse practitioners have a lot of options these days from where they work to what they focus on. By helping to prevent disease and promote healthy living, Nurse Practitioners are referred to as true Partners in Health In fact, Nurse Practitioners continue to move outside of the commonly considered work places and besides Doctor’s offices and hospitals may be found in schools and clinics, birthing centers and even provide in home health care services.
Furthermore, an Employment Agreement also known as Employment Contract is a document by which employers and their employees define their roles and obligations at the beginning of an employment relationship. They are a pervasive and obligatory part of nearly all business and legal transactions. Well drafted contracts help to enumerate the responsibilities of the involved parties, divide liabilities, protect legal rights, and insure future relationship statuses. These touchstones are even more crucial when applying their roles to the case of a Nurse Practitioner employed by a hospital, medical group, or other health care provider. While contract drafting and negotiation can be a long and arduous process, legal representation is a must in order to ensure that your rights are being protected. A Nurse Practitioner should not enter into any contract without having the agreement reviewed by legal counsel.
There is simply too much at risk for a Nurse Practitioner to take contract matters into their own hands. In addition to the specific professional implications, contract terms can significantly impact a nurse practitioner’s family, lifestyle, and future. There are many important contract terms and clauses which can present complex and diverse issues for any nurse practitioner, including:
• Non-compete clauses
• Damages
• Indemnification
• Verbal guarantees
• Insurance statements
Additionally, often times the most influential terms and clauses in any employment contract are the ones that are not present. With the advent of productivity based employment agreements it is imperative that any Nurse Practitioner have an employment agreement reviewed before it is executed.
New residents, attending physicians, Doctors entering into their first employment contract or established physicians looking for new employment can all benefit from a thorough contract review. By employing an experienced attorney for your representation, you can insure that you will be able to fully understand the extensive and complex wording included in your contract. By having a full and complete understanding of the contract, you will be in a better position to make your own decision on whether or not you want to enter into the agreement which will affect your career life for years to come.

The financial benefits gained from having your contract reviewed and negotiated by an experienced healthcare attorney far outweigh the costs associated with a review. You are a valuable resource, and you should be treated and respected as such.
Common dangers associated with not having your employment agreement reviewed are:
• Inadequate professional liability and tail coverage
• Misidentifying negative terms
• Not enough paid-time-off (PTO) or Vacation time
• Provisions that violate Stark and the Anti-Kickback Statutes and Regulations
• Unfair restrictive covenants (non-competes)
• Unfavorable call schedules
• Lack of Benefits
• Biased Termination Provisions (With or Without Cause)
• Small Production Bonuses (RVU and gross income)
Additionally, common terms that need to be examined include:
• Arbitration
• Call Schedule
• Continuing Medical Education (CME)
• Dues and Fees
• Holiday Pay
• Hours
• Insurance
• Moving Expenses
• Repayment Obligations
• Salary
• Signing Bonus
• Suspension provisions
• Tail Insurance
• Termination
Coming into a new organization with a favorable contract can put the Nurse Practitioner in a positive financial situation for years to come. Before you sign the most important contract of your life, turn to Lawyer for assistance. Employment relationships often begin with an Offer Letter which outlines certain terms of employment. However, an Employment Agreement is a more detailed document as it allows parties to provide very detailed information. It creates no doubt or questions about what is expected of both parties as it defines all the responsibilities and sets out all the terms and conditions as agreed by both parties.
When a Nurse Practitioner is hired, the terms of the relationship should be clearly defined in an agreement and should not be based merely on a handshake. Memorializing the terms of the agreement legally protects both the medical practice and the Nurse Practitioner if a dispute arises.
In general, with an employer-employee relationship, the employer has more control over the employee’s duties. However, as an independent contractor, the nurse practitioner has greater control in performing the expected duties. Sometimes a physician wishes to hire the nurse practitioner as an independent contractor because that means the practice would not have to pay any share of payroll taxes or benefits or pay for liability insurance. But the Internal Revenue Service in some cases has ruled that an independent contractor is really an employee because of the way the employment relationship is set up.

So if the nurse practitioner is hired as an independent contractor, it is advisable to include a provision similar to the following to clarify that the Nurse Practitioner is retained as an independent contractor and not as an employee. The Agreement will contain information such as the names of the parties to the Agreement, the nature of employment, role and responsibilities of the employee, compensation, conditions for termination of the employment and all other conditions as may be agreed by both parties. Once parties have signed the contract, it becomes a binding contract. That is, a breach in any clause in the contract entitles the other to a remedy in law.
Financial compensation is one of the most negotiated terms of an employment agreement and will undoubtedly be an area of great discussion between the parties.
Before the practice hires the Nurse Practitioner, the practice should calculate the estimated amount of income the Nurse Practitioner is expected to bring to the practice and the associated cost of employment. When determining the Nurse Practitioner’s compensation, it is important to focus on three main elements: cost (the nurse practitioner’s compensation), the practice’s overhead attributable to the nurse practitioner (rent, utilities, payment to support staff, supplies, etc.), and liability insurance.
In addition, it is advantageous to outline when the nurse practitioner’s evaluation will be conducted and who will contribute to the evaluation process. When a Nurse Practitioner leaves your medical practice, there is a risk that some of your patients will follow him or her to the next place of employment. However, this risk can be minimized by including a restrictive covenant in the nurse practitioner’s agreement.
This clause prohibits a nurse practitioner from practicing within a specified geographic area for a stated period of time. Restrictive covenants are legally enforceable as long as they are reasonable in time and geographic scope. The restrictive covenant also includes language that would prevent an existing Nurse Practitioner from trying to induce, entice or solicit patients to follow to the new practice, or otherwise interfere with the business of the former practice.
Although the termination clause is frequently addressed toward the end of the contract, it is one of the most important aspects of the employment agreement for both parties. Generally, this clause contains a provision addressing termination without cause and a separate provision with a list of conditions that are bases for termination with clause. Without clause generally requires some sort of warning. With clause must be spelled out in the contract, because it can allow immediate termination for certain acts, such as any criminal or fraudulent act toward the practice, or a felony plea or conviction for specific crimes, failure to stay licensed or certified, or other major event. Firing for mere poor performance would be allowed, but it still is advisable to give some sort of written warning.
How to use this document
This document can be used by an employer who has decided to retain the services of another person or an employee after deciding to accept an employment.
In this document, both parties can set out terms and conditions which will protect them from any dispute that may arise in future. It can also be used to provide a suitable dispute resolution method in case any dispute arises.
The employee can also use this document to set out terms like compensation, bonus and other benefits like health insurance, pension, etc. for the services rendered. Also, with this document, the employee is fully aware of his/her roles and duties.
When filling the form, the form filler will define the important components of the agreement by choosing clauses the filler desires to have in the agreement. With this document, the filler can have a simple agreement with just the basic terms or an agreement incorporating specific terms.
After filling the form, it should be printed. The Parties must sign the document and the document must be witnessed by two persons. The two witnesses are required to hand fill their names, addresses, occupation and also sign this document.

Once parties have signed this document, it means that the parties have agreed to all the terms and conditions of the agreement and this creates a binding contract between them. It is ideal that each party keeps one original copy of this document for record purposes.
When you are negotiating almost any contract, it’s vital that you prepare yourself in the same manner as you would any time you are negotiating. You’ll have to be clear on what you are negotiating since employment contracts are the most common contracts clinicians will see. These are a few items you’ll want to see addressed and written into the contract:
• Start and end dates of the contract. What are the terms for renegotiation, notices etc
• Who is the contract between?
• Responsibilities of each party including patient care and call
• Tools and resources available to allow you to do your job
• Support services: Clinical assistance, equipment, collaboration, records, etc.
• Salary and benefits: What remuneration you can expect, if there is a productivity formula, you’ll need to know how is it calculated, any consequences for not reaching performance goals, salary reviews and increases, insurances, vacation/paid-time-off, etc.
• Billing Issues: Who is doing the coding and billing, how can your review charges or codes being billed, is incident to utilized in this practicing setting. Non-compete Clause are basically restrictions on your practice. They will say that you may not practice in a certain geographic location for a certain length of time after you leave someone’s employ.
The importance of an employment contract review
• An employment contract sets out the terms by which you are employed and will include things like your hours of work, pay rate and termination provisions. Signing your employment contract means that you are agreeing to adhere to the terms that it sets out. You may not realize the implications of the terms of your contract until well after you signed it. A lot of the time, people don’t pay much attention to their employment contract until an issue arises with their employer. If there ever is such an issue, the terms of your contract are going to be extremely important.
• Enlisting the professional services of a competent lawyer to review your employment contract is a valuable way to ensure that you understand what your rights are, what your employer’s rights are, and whether there are any clauses that might one day take you by surprise.
• To ensure that the drafting of your contract complies with legislative requirements including the Fair Work Act and the National Employment Standards. For example, these standards relate to maximum weekly hours, parental leave, and notice of termination and the provision of a Fair Work Information Statement.
• To ensure that all critical clauses have been included in the contract.
• To ensure that the terms of the contract are clear and free of ambiguity. This is important to ensuring that both you and employer’s understanding of the terms are the same.
• To ensure that you as the employee are fully aware of your responsibilities.
• To ensure that the contract accurately reflects your understanding of any verbal agreements that has been made by you and your prospective employer, to you prior to signing the contract.
• To ensure that any conditions relevant to your individual circumstances are appropriately set out by the terms of the contract.

Employment Contract Terms
A contract of employment is an agreement between the employer and employee and will contain some terms such as:
Statutory terms: are imposed, varied or regulated by law such as the minimum statutory notice period.
Express terms: these are terms that have been specifically mentioned, either in writing or orally, and have been agreed by both employer and employee.
Implied terms: these are terms that are not set out in writing or agreed orally, but may be too obvious to need to be recorded. An example of this may be that the employee will not steal from the employer.
Incorporated terms: are things that have been put into contracts from work rules or collective agreements.
When you need legal help with a nurse practitioner contract, make sure you understand the terms of the relationship and the corresponding agreement prior to signing.