I work as a utilization review nurse for an insurance underwriting company. My supervisor is not a nurse. Could that be a problem?
Dear Nancy replies:
In a perfect world, your supervisor would be a nurse. In today’s healthcare environment, innovation, change and new organizational structures have resulted in nurses working in various organizations with non-nurses supervising them, such as in your situation. It is hoped you have access to a nurse within this company to whom you could raise questions or issues concerning your decisions as a utilization review nurse.
Whether or not this is the case, it is important for you to remember you are a licensed nurse and must abide by the state nurse practice act and its rules. You are accountable and responsible for your decisions. As a result, no one can “make” you practice outside your scope of practice or dictate what nursing practice is in your state and in general.
It might be helpful to determine if you could identify a nurse lawyer or lawyer in your state whom you could retain as a consultant for issues that might arise, which could raise legal or ethical problems for you if pressured to make decisions contrary to your obligations as a nurse licensee. If there were an issue you needed to question with your supervisor, being armed with sound legal and ethical advice would be essential. It also would help you to know you are not alone in your duty to maintain your practice in accordance with the nurse practice act and the requirements of your profession.
You also might want to become certified in the area of utilization review to further boost your knowledge and expertise in your role within this company. There are numerous certification associations/organizations you can consider, if this option interests you. Added benefits from certification in this area are educational programs, networking and online information that might help you as well. Simply enter the words “utilization review certification” in your search bar to evaluate which might be best for you.