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SCO-010: Scope of Practice for Physician Assistants and Nurse Practitioners

 
Scope of Practice for Physician Assistants and Nurse Practitioners: The report of the American Medical Association (AMA) Board of Trustees on physician assistants and nurse practitioners, as amended and adopted at the 1995 Annual Meeting of the AMA House of Delegates, was accepted as Wisconsin Medical Society policy. The report offered the following guidelines for the roles and responsibilities of physician assistants and nurse practitioners:

Model Guidelines for Physician/Nurse Practitioner Integrated Practice

The physician is responsible for the supervision of nurse practitioners and other advanced practice nurses in all settings. While the Wisconsin nurse practice act and administrative rules provide for “the execution of procedures and techniques in the treatment of the sick under the general or special supervision of a physician” (Wis. Stat. sec. 441.114.), advanced practice nurses and nurse practitioners who have qualified for and received a certificate to prescribe can prescribe on an independent basis. This may affect the physician’s responsibility for the supervision of nurse practitioners in all practice settings.

The physician is responsible for managing the health care of patients in all practice settings.

Independent prescribing authority for advanced practice nurses may affect the physician’s responsibility for managing the health care of patients in all practice settings. Advanced practice nurses, including nurse practitioners, with independent prescribing authority are required to collaborate with at least one physician, but the administrative rules with regard to prescribing loosely define collaboration and the definition does not require physician supervision of the advanced practice nurse with prescribing authority.

Health care services delivered in an integrated practice must be within the scope of each practitioner’s professional license, as defined by state law.

In an integrated practice with a nurse practitioner, the physician is responsible for supervising and coordinating care and, with the appropriate input of the nurse practitioner, ensuring the quality of health care provided to patients.

Independent prescribing authority for advanced practice nurses may affect the physician’s responsibility for supervising and coordinating care. Advanced practice nurses, including nurse practitioners, with independent prescribing authority are required to collaborate with at least one physician, but the administrative rules with regard to prescribing loosely define collaboration and the definition does not require physician supervision of the advanced practice nurse with prescribing authority.

The extent of involvement by the nurse practitioner in initial assessment, and implementation of treatment will depend on the complexity and acuity of the patients’ condition as determined by the supervising/collaborating physician.

The role of the nurse practitioner in the delivery of care in an integrated practice should be defined through mutually agreed upon written practice protocols, job descriptions, and written contracts.

These practice protocols should delineate the appropriate involvement of the two professionals in the care of patients, based on the complexity and acuity of the patients’ condition.

At least one physician in the integrated practice must be immediately available at all times for supervision and consultation when needed by the nurse practitioner.

Patients are to be made clearly aware at all times whether they are being cared for by a physician or a nurse practitioner.

In an integrated practice, there should be a professional and courteous relationship between physician and nurse practitioner, with mutual acknowledgment of, and respect for each other’s contributions to patient care.

Physicians and nurse practitioners should review and document, on a regular basis, the care of all patients with whom the nurse practitioner is involved. Physicians and nurse practitioners must work closely enough together to become fully conversant with each other’s practice patterns.

Suggested Guidelines for Physician/Physician Assistant Practice

The physician is responsible for managing the health care of all patients in all settings.

Health care services delivered by physicians and physician assistants must be within the scope of each practitioner’s authorized practice as defined by state law.

The physician is ultimately responsible for coordinating and managing the care of patients, and with the appropriate input of the physician assistant, ensuring the quality of health care provided to patients.

The physician is responsible for the supervision of the physician assistant in all settings.

The role of the physician assistant in the delivery of care should be defined through mutually agreed upon guidelines that are developed by the physician and the physician assistant and based on the physician’s delegatory style.

The physician must be available for consultation with the physician assistant at all times either in person or through telecommunication systems or other means.

The extent of the involvement by the physician assistant in the assessment and implementation of treatment will depend on the complexity and acuity of the patient’s condition and the training and experience and preparation of the physician assistant, as adjudged by the physician.

Patients should be made clearly aware at all times whether they are being cared for by a physician or a physician assistant.

The physician and physician assistant together should review all delegated patient services on a regular basis, as well as the mutually agreed upon guidelines for practice.

The physician is responsible for clarifying and familiarizing the physician assistant with his/her supervising methods and style of delegating patient care. (HOD, 0411)*

*Currently under five-year policy review.