I. POLICY Program Inclusion Criteria The Interim Nurse Practitioner (NP) program is available to Nurse Practitioners without inpatient training. The program consists of a six (6) month preceptorship for: New NP graduates without inpatient training NPs who have only outpatient experience, but request inpatient privileges; NPs whose inpatient experience differs from their requested privileges; NPs who have not worked in an inpatient setting for more than two years (lack of current clinical competence as define by the CSMC Medical Staff). The Interim NP program is individualized based on the NP s experience and on the privileges requested. II. PURPOSE To establish the Interim Nurse Practitioner role and scope of practice. III. DEFINITION: Immediate supervision: means that the supervisor shall be physically present while a task is being performed. Authority cited: Section 208 (a), Health and Safety Code. Reference: Section 1276, Health and Safety Code. Supervising Physician: Physician member of the Medical Staff in good standing, practicing in the same specialty that the Interim Nurse Practitioner is planning to exercise inpatient privileges and who is assigned to oversee, delegate to and immediately supervise the care management provided during a preceptor period for the purposes of assisting the Interim Nurse Practitioner in preparing for the exercise of inpatient privileges. Supervising Inpatient Nurse Practitioner: Nurse Practitioner member of the Allied Health Professional Staff with at least three (3) years of clinical practice experience, in good standing who has been granted privileges in the same specialty that the Interim Nurse Practitioner is planning to exercise inpatient privileges and who is assigned to immediately supervise the care management provided during a preceptor period. Page 1 of 5
IV. GENERAL DEPARTMENT POLICIES OF CLINICAL ACTIVITIES PERFORMED AND SETTING: The Interim NP may assist in medical and surgical management of patients in both the inpatient and outpatient setting and will participate in aspects of patient care as indicated. The incumbent will also have direct reporting responsibility to the Supervising Physician. The Interim NP is responsible and accountable for the application of the nursing process, supervision of clinical practice, education, leadership and patient care management across the health care continuum from preventative and acute care through discharge in addition to outpatient management. The Interim NP provides assistance to the health care team in maintaining optimum quality of nursing care of assigned patients, regardless of geographic location. The Interim NP may provide only those medical services within the Registered Nurse Scope of Practice or performed under immediate supervision by a Supervising Physician who is responsible for the patients care rendered by the Interim NP. The Interim NP shall consult with a physician regarding changes in patient condition, procedure or diagnostic problem. V. SCOPE OF PRACTICE, ROLE AND SETTING (INCLUDING STANDARDIZED PROCEDURES): The Interim NP may: 1. Facilitate the movement of inpatients through the levels of care, keep the patients and family abreast of patient condition and conduct patient education. 2. Complete forms and charts pertinent to the patient's medical record within the Registered Nurse Scope of Practice unless immediately supervised by the Supervising Physician and Supervising Nurse Practitioner. 3. Under immediate supervision of the Supervising Physician and Supervising Nurse Practitioner and the interdisciplinary team perform: History and Physical exam Make an assessment and diagnosis based upon the examination. Initiate, review and revise treatment and therapy plans Review the patient and the workup prior to a medical admission. Contribute to the formulation of patient management plans 4. Communicate to and guide the interdisciplinary team in structuring and relaying information regarding patient diagnosis, management plan and progress to the patient/client/family. Page 2 of 5
5. Actively participate in the management of inpatients, under the immediate supervision of the Supervising physician and Supervising Nurse Practitioner: Take and document a verbal or telephone order within the Registered Nurse Scope of Practice with the Supervising Physician s name and I.D. number for orders as needed for patient care. The Interim NP may, administer medication to a patient as ordered by the Supervising Physician within the Registered Nurse Scope of Practice. The Interim NP may not administer controlled substances in Schedules II through V inclusive without a verbal, telephone or written order by the Supervising Physician. Follow through and ensure that pre and post operative orders are implemented. Provide pre and post procedure/operative education to patients and their families regarding the procedure(s) performed and provide services to patients requiring continuing care. Instruct and counsel patients regarding their physical and mental health; Counsel patients on medications, diets, social habits and understanding of long-term management of their diseases. Initiate and facilitate the referral of patients to the appropriate health facilities, agencies, and community resources. 6. Participate on departmental or interdisciplinary committees as requested. 7. Participate in activities that enhance professional development such as reading professional journals and texts to maintain currency on the latest clinical and professional information, attending continuing education programs, attending education programs relevant to the Interim NP area of practice and participating in professional organizations. 8. May be trained to perform selective medical services, which augment his/her current areas of competency under the immediate supervision of the approved Supervising Physician and Supervising Nurse Practitioner who is directly in attendance and assisting the Interim NP in the procedure and as approved by the relevant Department Performance Improvement Committee, Joint Practice Committee and Medical Executive Committee.. 9. Document procedures and patient responses in the patient record. 10. Attend Advance Practice Nursing Council monthly meetings. 11. Perform other duties as determined collaboratively by the Supervising Physician and Supervising Nurse Practitioner that are within the scope of practice of the Interim NP and approved AHP credentialing either under Immediate supervision of the Supervising Physician and Supervision Nurse Practitioner or are within the Registered Nurse Scope of Practice. Page 3 of 5
12. Field phone calls from patients regarding current problems and illnesses, and problem-solve appropriate evaluation and intervention for those problems with the Supervising physician or Supervising Nurse Practitioner. VI. SUPERVISING PHYSICIAN AND SUPERVISING NURSE PRACTITIONER PROCESS: The Supervising Physician and Supervising Nurse Practitioner will provide immediate supervision of the Interim NP when performing NP functions outside the scope of practice of the Registered Nurse. The Supervising Physician and Supervising Nurse Practitioner shall delegate to the Interim NP only those tasks and procedures consistent with the scope of practice of a Registered Nurse. The Supervising Physician and Supervising Nurse Practitioner shall observe or review evidence of the Interim NP performance of all tasks and procedures to be delegated to the Interim NP until competency is assessed. The Supervising Physician and Supervising Nurse Practitioner shall participate in the evaluation and recommendation process of the Interim NP upon application for inpatient privileges at CSMC and will subsequently support the Interim NP s need for completion of FPPE and peer review as per hospital policy. VII. QUALITY INDICATORS AND THE QUALITY MONITORING PROCESS: The Interim NP will actively participate in the Medical Center's Performance Improvement Program which may include the periodic assessment of the quality of patient care delivery to identify opportunities for changes in practice, rooted in evidence-based standards of care/protocols, to promote positive patient outcomes. VIII. HEALTH CARE MANAGEMENT PROTOCOLS, CONSULTATION AND CLINICAL CARE: The Interim NP shall not function autonomously. The Supervising Physicians shall be responsible for all medical services provided by the Interim NP under his/her supervision. The Interim NP and his/her Supervising Physician and Supervising Nurse Practitioner shall establish, in writing, guidelines for the adequate supervision that shall include one or more of the following mechanisms: Examination of the patient by the Supervising Physicians at the same time care is given by the Interim NP. Countersignature and dating of all medical records entries immediately after being documented by the Interim NP. Page 4 of 5
IX. ORDERING OF LAB, DIAGNOSTIC STUDIES AND MEDICATIONS: The Interim NP may only take and implement verbal, telephone or written orders for labs, diagnostic studies and medications, procedures within the Registered Nurse Scope of Practice. X. COMPLETION OF INTERIM NP PROGRAM INPATIENT PRIVILEGING/FPPE: Upon successful completion of the Interim NP program the NP may apply for inpatient NP privileges and if granted will be subject to required FPPE pursuant to AHP Rules and Regulations, Article VI, Section 6.2.2. ORIGINATORS AND APPROVALS A. ORIGINATOR(S) Honore Kotler, RN, NP Leslie Sampson, MSN, RN Sherry Mehler Joyelle Sudbury Lauren Polak, Esq. B. APPROVALS: Linda Burnes Bolton, Dr.P.H., RN, FAAN Vice President, Nursing and Chief Nursing Officer Co-Chairperson, Joint Practice Committee David Ramin, MD Co-Chairperson, Joint Practice Committee Original Effective Date: April 2011 Page 5 of 5