I . NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS SUMMARY AND OVERVIEW

This Organization Statement describes the concept and functioning of NP's and PA's within an organization or health system. This section is also designed as an educational tool for those not familiar with NP/PA functioning. This document does not replace a traditional job description without a second section of procedure guidelines, which describes and delineate the scope of practice, prescribing medications, laboratory and diagnostic procedures and supervision for each individual NP/PA.

NPs and PAs are educated to implement and perform many health and medical functions traditionally carried out by physicians. Furthermore, the NPs and PAs possess extensive knowledge in relation to health maintenance and illness prevention concepts, illness adaptation and psycho-social influences that affect health behaviors.

The medical activities and functions authorized for each individual NP/PA are developed in collaboration with their supervising physician and are based on the appropriate education, training and competence of each individual provider.

Specific Responsibilities of NP and PAs

A. Gathers and evaluates health histories and records, complete or episodic

B. Performs and records complete physical examinations or examinations required to evaluate a specific health problem.

C. Analyzes and interprets data, formulates problem lists, and establishes plans for resolution of clinical problems (Refer to Scope of Practice).

D. Within limits of statute, manages acute and chronic illness independently (according to the procedure guidelines and protocols) and in consultation with other members of health care team (Refer to Scope of Practice).

E. Orders and interprets appropriate laboratory studies, x-rays,, electrocardiograms and other special examinations (Refer to Laboratory and Diagnostic Procedures).

F. Collects specimens for pathologic examinations such as pap smears, biopsies, etc. (Refer to Laboratory and Diagnostic Procedures).

G. Prescribes medications in accordance with established guidelines (Refer to Prescribing Medications).

H. Identifies need, then initiates and coordinates referrals for specialty consultations. These consultations may include in-house referrals or referrals to outside specialists or agencies (Refer to Referring Procedures).

I. Institutes and completes measures to promote or maintain health, such as well child visits, prenatal visits, yearly gynecological and pap exams, breast exams, immunization scheduling, routine examination scheduling, cancer detection, hypertensive and diabetic screening, etc.

J. Counsels and advises patients and families about physical, developmental, and psychosocial aspects of health through individual and group contacts to promote optimal health.

L. Counsels and provides anticipatory guidance to patients and families in such areas as pregnancy and childbirth, infant care, parenting, family planning, family dynamics, smoking, personal hygiene, PMS, exercise and activities, nutrition and diet, accident prevention, substance abuse, communication, stress management, use of community resources, and general health practices, etc.

M. Contributes to the health education of individuals groups and applies methods designed to increase person's motivation to assume responsibility for own health care.

N. Provides exchange of information and serves as consultant to other members of the health care team.

O. Participates in development and functioning of organization's Quality Assurance and Utilization Review Programs, when appropriate.

P. Develops and utilizes standards of care against which to appraise the quality of professional performance of self and others.

Q. Seeks opportunities and accepts responsibility for self growth and development through review of literature, workshops and continuing education.

R. Educates consumers, community agencies, students, local physicians and nurses about the role of respective professions (NP or PA). Assumes responsibility for the direction and growth of ones' profession by active participation in related professional organizations.

III. Supervision

Immediate supervision by the responsible physician for medical activities. The supervision should include:

A. Availability of onsite consultation/supervision by physician, and/or telephone consultation.

B. Periodic review of medical records to include:

      I . Legibility
      2 . SOAP Format
      3 . Appropriateness

C. Evaluation as is routine and customary within this organization.

Detailed Procedure Guidelines for scope of practice, prescribing medications, laboratory and diagnostic procedures, and supervision within the organization's different practices, supervisors, and PA/NPs should be provided as part of this document.

Note: This document is provided for information purposes only. Permission is given to physician assistants to copy. All other uses require the permission of the Paladin Group.