What Needs to go in a Nurse Practitioner Termination Letter? | Nurse Practitioner Resignation Letter When It’s Time to Leave

Termination Letter

What needs to be in a termination letter for a nurse practitioner? First, you always want to go to your NP employment contract and look underneath your termination clauses. It honestly depends on why you are terminating your employment. If you are terminating it just because you feel like it’s not a good fit, you don’t like the leadership, you hate the area or something like that, you’d want to look for the without-cause termination. In there, you’ll find how many days prior notice you need to give upon your termination. It’s normally anywhere between 60 to 90 days. In that case, if you’re terminating your agreement for a without cause or no cause reason, you would just simply write in your termination letter that you are terminating your employment.

What Should a Practitioner Put in Termination Letters?

You are giving your notice starting on this day and then, per our agreement, my last day will be, and then insert whatever your last date will be. You also want to be careful about how you deliver your termination letter. Again, that’s outlined in your employment contract, you’re going to look under the provision that says “notices”. Sometimes you’re able to hand-deliver your termination, other times it must be emailed or certified mail to a certain address or multiple addresses. You want to be very careful and make sure that you give proper notice. So, you turn that termination letter in properly because the clock doesn’t start until you give proper notice. If you have a 90-day notice period, and you haven’t given proper notice and you think you’re on day 30, but they never received your termination letter, that’s difficult. The 90 days or 60 days or anywhere in there does not start until you give proper notice.

So, make sure you read your employment agreement. If it’s a without-cause termination and you have that clause in your contract, your termination letter can be very simple. You can thank them for the opportunity and let them know that you’re happy to help with the transition, but this is not required by your employment contract. You could just simply state, this is my notice, this is the day that I’m giving my notice, this is my last day. That’s really all you have to have. You don’t have to give a reason if it’s a without cause termination. Now, let’s talk about if you are in an instance where there’s no without cause termination. So then, it gets a little bit difficult.

If you want to terminate your agreement, there are a couple of different ways you can do it. First, you have to know if they have breached the agreement. That could let you out if they’ve breached. But you need to give them notice of the breach and what the breach is. What the breach typically looks like is that they’re not paying you. That would probably be the biggest material breach that you could hold them accountable for and therefore terminate your agreement. Most of the time though, you have to give them notice that they are in breach of the contract and give them the amount of time to cure their breach. If they don’t, then you can terminate the agreement. And then the last way, if they have not breached the agreement, you just went out, but you don’t have a without cause termination, this is a difficult position to be in.

Nurse Practitioner Notice Letter

Then you’re kind of at their mercy. In your termination letter, if you do not have a without cause termination, just saying that one more time, you must ask to be let out of your agreement. So, this time I would put in language asking to be released from your agreement. You can state the reason if you think that it would help your case. It kind of just depends on the situation. Also, I feel like if you need to be let out of your agreement, it might be helpful if you’re going to be moving out of the area. So, you’re letting them know that you’re not wanting to compete with them. You just have to move back maybe for family reasons or personal reasons, and you don’t have to get into those. You can just say, for family reasons, I’m moving out of the area, and I need to be released from my employment contract. An NP also must consider the ramifications of their compensation if they leave.

But you are kind of at their mercy, so the tone of that termination letter, you want to ask and be gracious and let them know that you’re willing to work with them to make the transition as easy as possible. This is kind of a difficult situation. So, I do recommend if your contract does not have a without cause provision, sometimes it is better to consult with an attorney to kind of discuss the repercussions because sometimes in employment agreements, there are clauses that are called liquidated damages, which just mean that if you don’t give proper notice or you terminate the agreement for any reason, without their approval within this specific period or the term of the agreement, they can ask for money from you. And that can be tens of thousands of dollars. So, this is a serious thing that you want to take very seriously. Read your contract first, look for that without cause termination. If you have that clause, you’re good to go. Just give your notice and let them know you’re giving your notice on this day, you’re leaving on that day.

If there’s no without cause termination, you want to check and see, are they in breach? If they are, give them notice. You may need to give them time to cure this and if they don’t, then you can terminate the agreement. And if they’re not in breach of the contract, then you’re kind of at their mercy, you have to be asked to be released. And you want to do this very carefully. And if you’re in this situation, I always recommend consulting with an attorney who is familiar with contract employment contract issues specifically for nurse practitioners within healthcare.

Do Nurse Practitioners Repay Bonuses after Submitting a Resignation Letter?

Does a nurse practitioner have to pay back their bonuses if they terminate their contract early? The answer to this is normally 99% of the time, yes, you will have to pay back either a portion or all of your bonuses. Let’s first talk about what kind of bonuses there are. Typically, there is some type of sign-on bonus. It can be called a signing bonus, or a sign-on bonus. Sometimes it’s relocation expenses, but it’s given to you a lump sum at the time that you either sign your employment agreement or at the time that you commence, which means start your employment, so like your first day. Those are the bonuses that are offered to you. Now, the reason why you get these bonuses is to attract you to become employed with the employer and provide your services.

So, it’s great. It’s exciting. And normally, there are significant amounts of money anywhere from 10,000 and up, but the thing you need to know, and you need to read very carefully, there is always some type of strings attached to this sign-on bonus because it also helps your employer retain you to keep you there. There’s normally some type of payback provision, and it normally states anywhere between one to three years, you must have continuous employment with the facility. Otherwise, you have to pay back either the entire bonus or the bonus at a prorated amount. So, for however many months you’ve been employed, that portion will be forgiven off that bonus. Some things you want to really consider before you sign your employment contract are if you receive this money at the beginning of your employment as a bonus, it is considered income and therefore it’s taxed as income.

Do You Need to Leave After the Initial Term?

Let’s just say, they’re offering you a $10,000 signing bonus, you sign, you receive the money. You won’t receive the full 10,000 because taxes will be taken off the top as they do normally with income. However, let’s say you want to leave within a year and your contract agreement states that you must pay back your entire signing bonus. They mean the full 10,000. They don’t mean the amount minus any taxes that you’ve paid. So, this is something that you really want to consider. I always recommend either limiting the amount of time like down to a year before the amount is forgiven or asking it to be prorated as I talked about before that every month a portion of the bonus is forgiven. Sometimes you have to sign something called a promissory note. It’s almost structured like a loan. They’re going to loan you this amount of money.

And if you leave before and you have signed that promissory note, they can come after you for that money. And normally, on the promissory notes, there’s some type of interest. So, if you don’t pay back within 30 days of your termination, they can tack on anywhere from 12 to 15%. Again, these sign-on bonuses are attractive, but you want to make sure that you read your employment agreement very carefully to know how long you have to be employed with the practice before this amount is forgiven.

Tail Insurance

What is tail insurance for a nurse practitioner? Anytime a nurse practitioner is employed, they need to have professional liability insurance, also known as malpractice insurance, and depending upon what type of policy it is, they may need a tail insurance. Let’s first break down the different types of policies for a practitioner. Normally, there are two types of main policies. One is called occurrence-based then the other is called claims-made. In an occurrence-based policy, a policy must be in effect when the malpractice occurs. This means tail insurance is unnecessary for occurrence-based insurance. Now, why would someone go with occurrence over claims made? Well, it’s kind of a math equation, but occurrence coverage generally costs about a third more than claims-made coverage.

And I find most employers, maybe some smaller owned physician practices, depending upon what state you are, maybe smaller nurse practitioner owned practice, if it’s an employer, normally they’ll have a claims-made policy and then they’ll pay for the underlying premium, so how much they pay to insure the nurse practitioner per year, but they may put the cost of the tail insurance upon the nurse practitioner when the contract terminates. Going back to occurrence-based insurance. You do not need tail insurance for that. So, when you do need tail insurance is if there’s a claims-made policy, and that means a policy must be in effect when the claim is actually made. Think of the scenario where an NP leaves an employer. Well, there’s going to be a window from the last patient they see for that employer until the last day that patient can sue the practitioner.

Considerations to Make About Your Nurse Practitioner Employment Contracts

Newly minted nurses who have completed their education and received their certification to practice nursing are justifiably excited about the opportunity to finally work in the career field that they have been training for their entire life. When they receive their first job offer, they are over the moon. Caution is advised in these moments though. The contracts that nurses receive to begin work at a specific facility are very detailed, and it is smart to keep a level head about things in order to put yourself in the best possible position as far as contract negotiations are concerned. 

There are several factors that every nurse should look over when they are handed their contract and asked to sign. They may even consider hiring a nurse practitioner contract attorney to review their paperwork with them to ensure that everything seems correct. 

Salary

Everyone goes to work to earn money, it is as plain and simple as that. Yes, nurses also often find great satisfaction in the work that they do, but they will still tell you that they wouldn’t do this work if there were no money involved. No one can blame a nurse for wanting to make a living for themselves. 

Nurse.org gives the statistics about what a nurse may expect to make: 

In addition to being professionally and emotionally gratifying, becoming a nurse practitioner provides the security of knowing you’ve chosen a career that has tremendous job security and is also financially rewarding. The average nurse practitioner’s salary is $111,680 according to the U.S. Bureau of Labor Statistics as of May 2020.

Not every nurse makes that much annually. That figure is an average, and that average includes nurses with many decades of experience. It also includes nurses who work in many different states with the various salary expectations that come in those states. Clearly, there will always be some variation from state to state and even based on the experience level of the nurse. However, this gives you some idea about how much a given nurse can demand as her salary. 

Continuing Education Allowance

Nurses do not stop learning the minute that they leave whichever nursing school they attended. Those schools give them all of the basic skills that they need to become a nurse, but they also need some continuing education in order to keep up to date on the latest in the healthcare sphere and make sure they don’t miss out on any new information or procedures that they need to be aware of. Given all of this, it is often the case that employers are expected to pay for the continuing education costs of their nurses. 

Continuing education may include: 

• Renewing licenses
• Certification
• Special training classes
• Online learning materials

Anything that can help a nurse continue to develop skills and stay informed may all fall under the umbrella category of continuing education. These are exactly the types of things that nurses should demand during the employment negotiation process. After all, why should they pay the thousands of dollars per year that this training can cost? 

Health Insurance

Many hospitals and other healthcare facilities are able to insure their employees for far less than the average employer. This is due in part to the fact that they can offer some services in-house in a way that other facilities simply cannot. Thus, low or no-cost health insurance should be part of the package for hiring a new nurse. There is a give-and-take on this particular benefit. Some nurses are willing to overlook the lack of health insurance benefits if they can receive higher than normal pay. It all depends on how the math works out. If the extra pay is more valuable than the health insurance premiums, then some may decide to pay for their own insurance out of pocket using the extra money that they make at their job. Much of the decision on this one can come down to what the dollars and cents add up to.

Work-Life Balance/Scheduling

A typical work schedule for a nurse may involve working three days with 12-hour shifts followed by four days off one week, and then four days of 12-hour shifts with three days off the next. Some nurses say that this works brilliantly for them and that they are thrilled to have the extra days off. Some use those extra days off to pick up another job, a hobby, or simply to relax and recoup from the long work week that they just endured. However, not everyone is as into this idea. 

The stress and mental fatigue of working a 12-hour shift are hard to overstate. This is a job in which the individual is standing virtually the whole time. They are not permitted to leave their workstations, and their meal breaks are short if they exist at all! Thus, it is incredibly important for any nurse who is about to enter the field to think carefully about the kind of schedule they would like to have and if they can find an employer who can work with them to create the most ideal schedule possible to balance out their work and life needs. 

Nurse Practitioner Benefits Package

What should be included benefit-wise in an offer letter for a nurse practitioner? An offer letter is normally step one of your employment with your prospective future employer. In the offer letter, it’s normally going to outline a couple of things. One is going to explain what your position is. If you’re specialized, what kind of services are you going to be providing, and what location and what setting, is it a hospital, clinic, or hybrid? Kind of just depends on your specialty. Normally, there will also be something in there roughly about your schedule. Sometimes it will just say 40 hours, or it may break it up if you’re helping in the OR, or a hospital setting will say 70% this, 30% in the clinic.

And it may discuss if you have any call duties, so like nights or weekends, that’s typically included in an offer letter as well. Now, let’s talk about the benefits. What benefits are going to be included in that offer letter? Let’s start with some of your health benefits. Normally, you don’t get a detailed outline or even a benefits package at this level when you’re just first receiving your offer letter. Once you receive the offer letter, it will normally just state that you will get some sort of health insurance, vision, dental, life insurance disability, maybe long-term, short-term, and then some type of retirement. And it’s not going to say a detailed explanation of how much each policy is going to pay out, like all that stuff. That’s going to be in a benefits summary or a benefits package. Sometimes that’s included later in your employment agreement, but when we’re just at the level of your offer letter, it just states this is what they provide.

So, that’s going to be the number one, probably it’s just going to outline them briefly, just say the name of what it is. Then the next set of benefits you’re sort of like your ancillary benefits. Those are normally included also in your offer letter. That’s going to include any type of continuing education allowance, licensing, fees, dues, especially a DEA license right now. Those are normally always included in there. If you have any type of board expenses that they’re going to be paying for, that also would be in there, and then also for sure, it will be your compensation. Probably the number one thing you want to look at is what is your compensation and how is it calculated? And then PTO time will also be in there as well.

Days of Vacation and Paid Time Off

How much you’re offered if you have any additional PTO days for continuing education, that’s something you always want to look out for as well. And then any type of signing bonus or relocation bonus, all of those will be in the offer letter. The purpose of the offer letter is to start the process of negotiating and to start the process of you becoming an employee. Now, if you sign an offer letter, you’re not agreeing to become employed by the practice. You’re agreeing to enter into negotiations for your employment. And normally, offer letters are pretty good, too. They’re going to be forthcoming with your benefits because they want to entice you to become an employee. So, they’re going to show you all the good stuff right up front.

Your benefits should always be included. You’re going to look for all those health benefits like we just talked about retirement but go further and look and make sure there’s continuing education, there’s reimbursement for those expenses like dues, licensing fees, DEA license, any type of boards that you may be taking, all that kind of stuff you’ll want to look for as well. And then lastly, always look for PTO, how much you’re getting, and look, are you able to calculate it? Sometimes it gets a little confusing. I know it’s popular right now to do a four-day workweek, but when your PTO time is calculated in hours, sometimes that can get a little confusing. So, you may want to reach out and ask them to clarify what that is, and how many weeks is that with your four-day work week if that makes sense.

Nurse Practitioners Practice Agreement Checklist

Every nurse practitioner’s employment contract is unique.  However, nearly every practitioner contract for health care professionals should contain several essential terms.  If these essential terms are not spelled out in the employment contract, disputes can arise when there is a disagreement between the employer and employee as to the details of the specific term.  For instance, if the NP is expecting to work at the practice Monday through Thursday and the employer is expecting the provider to work Monday through Friday, but the specific workdays are absent from the contract; who prevails?  Spelling out the details of your job is crucial to avoid conflicts during the term of your employment.  Below is a checklist of essential terms that employment contracts should contain (and a brief explanation of each term):

1. Services Offered: What are your patient care duties? Are providers given time for administrative or planning tasks?
2. Patient Care Schedule: What days and hours per week are providers expected to provide care?
3. Locations: Which facilities will you be scheduled to provide care at (outpatient clinic, surgical sites, in-patient services, etc.)?
4. Outside Activities: Are you permitted to pursue moonlighting or locum tenens opportunities? Do you need permission from the employer before you accept those positions?
5. Nurse Practitioner Oversight: If nurse practitioner oversight is needed due to state law; who will be the supervising nurse practitioner?
6. Call Schedule: How often are you on call (after hours office call, hospital call (if applicable)?
7. Electronic Medical Records (EMR): What EMR system is used? Will providers receive training prior to providing care?
8. Base Compensation: What is the annual base salary? What is the pay period frequency?  Does the base compensation increase over the term of the Agreement?
9. Productivity Compensation: If there is productivity compensation; how is it calculated (wRVU, net collections, encounters, etc.)?
10. Benefits Summary: Are standard benefits offered: healthcare, vision, dental, life, disability, retirement, etc.?
11. Paid Time Off: How much time off is offered? What is the split between vacation, sick days, CME attendance, and holidays?
12. Continuing Medical Education (CME): What is the annual allowance for CME expenses and how much time off is offered?
13. Dues and Fees: Which business expenses are covered in the contract (licensing, DEA registration, privileging)?
14. Relocation Assistance: Is relocation assistance offered? What are the repayment obligations if the Agreement is terminated prior to the expiration of the initial term?
15. Signing Bonus: Is a signing bonus offered? When is it paid?
16. Professional Liability Insurance: What type of professional liability insurance is offered: claims made, occurrence, self-insurance?
17. Tail Insurance: If tail insurance is necessary, who is responsible to pay for it when the Agreement is terminated?
18. Term: What is the length of the initial term? Does the Agreement automatically renew after the initial term?
19. For Cause Termination: What are the grounds for immediate termination for cause in the Agreement for providers?
20. Without Cause Termination: How much notice is required for either party to terminate the Agreement without cause?
21. Post-Termination Payment Obligations: Will you receive production bonuses after the Agreement is terminated?
22. Non-Compete: How long does the non-compete last and what is the prohibited geographic scope?
23. Non-Solicitation: How long does it last and does it cover employees, patients, and business associates?
24. Notice: How is notice given in the contract? Contact via email, US mail, etc.? Do the practice and their lawyer have to be notified?
25. Assignment: Can the Agreement be assigned by the employer?

Alternative Dispute Resolution: If there is a conflict, will mediation or arbitration process be utilized? Who decides what attorney oversees the process? What litigation is allowed? Who is responsible for attorney’s fees?

A Lawyer Will be Happy to Help with your NP Contract

We have plenty of experienced lawyers who will be happy to help you through the entire contract process that you are working through at this time. They specialize in these types of contracts (and independent contractor agreements), and they will make sure of the following: 

• Your contract is written in a way that abides by all local, state, and federal laws
• You have the benefits that you desire from your contract
• There are no hidden clauses or stipulations that you need to be aware of 
• Your malpractice insurance and tail costs are taken care of

Essentially, our lawyers will stand by you and be your biggest advocate in this whole process. We only need to be compensated for the time that it takes to read and go over your contract. If you will contact us today, we can start to look over the critical elements that make up your contract for you. We know that you want to get started on your new job as soon as possible, and we want that for you as well. Just give us the chance to make sure everything is tied up nicely for you before you do so.