Emergency NP scope, clarification needed

[BruceWilly]

Apparently at some universities, NP's teach other NP's how to work in emergency departments. I think they're calling it a residency.

Does this mean NP's that undergo this training can work independently in ED's, or does this mean NP's are just undergoing extra training to help them get jobs in a fast track attached to an ED?

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[fahimaz7]

They can already practice without supervision in many states...

 

[link2swim06]

Apparently at some universities, NP's teach other NP's how to work in emergency departments. I think they're calling it a residency.

Does this mean NP's that undergo this training can work independently in ED's, or does this mean NP's are just undergoing extra training to help them get jobs in a fast track attached to an ED?

Both fast tracks and EDs with too low of volume to justify hiring a doc.

Listen to EM RAP from this month...University Mississippi explains how they have put NPs in the rural areas and their scope.

 

[Arcan57]

Apparently at some universities, NP's teach other NP's how to work in emergency departments. I think they're calling it a residency.

Does this mean NP's that undergo this training can work independently in ED's, or does this mean NP's are just undergoing extra training to help them get jobs in a fast track attached to an ED?

The NPs I know that are doing that type of program are doing so to become competent to function in an emergency department. With more of what we consider "fast-track" being siphoned off by urgent cares and free-standings, the number of EDs that can maintain an area that doesn't require at least moderate medical decision making is shrinking. In addition, needed monkey skills do not appear to be universally acquired in NP programs and an NP that can't suture, remove FBs, or perform simple reductions is an NP that's not going survive in the ED. So at least for now it seems like they're modeling it after PA residencies. They call it a residency for political reasons since theoretically a DNP that completes a "residency" could claim to be a residency trained Emergency Doctor.

 

[BruceWilly]

Rookie question here. Assume NP's initially staff rural ED's but then increase their training and eventually staff ED's in larger cities (entirely independent, no physician). Would hospitals be:

A) Excited about potentially staffing ED's with NP's because they are cheaper than EP's.

B) Terrified about potentially staffing ED's with NP's because they are more likely to get sued than EP's.

C) None of the above

 

[EMIM2011]

A, A, and A

 

[Birdstrike]

A

 

[Arcan57]

Way too cynical guys, it's much more nuanced than that.

Hospital administrators would be fine with animatronic rabbits staffing the ED if they provided reasonable d-to-d times and didn't cause core measure fallouts. But most hospitals are guided by an uneasy truce between what admin wants and what the high-volume proceduralists (surgery, interventional cards, etc) want. And if there's one thing high-volume proceduralists can't stand, it's slow turn-around times on their rooms. If there's two things they can't stand, it's the room thing and having to talk to midlevels calling from the ED. So I think that they'd be fine with midlevels from a monetary standpoint (especially if the APCs were hospital employees so they could directly pocket the savings), but I think they'd break out in a cold sweat thinking about their phone blowing up at 2am on a Saturday because Dr. Bypass got woken up by a midlevel.

Also, I'm not sure that there's any data that independent NPs get sued any more than MDs doing the same type of work. Part of that is going to be that their aren't many fields where case mixes are identical, part of that is going to be that being sued has only a tenuous relation to quality of care. I think there are EDs where staffing with a midlevel probably makes sense. I just got a flyer in the mail about EmCare trying to staff a low volume outpatient surgical hospital's ED offering 12-72h shifts. It's ridiculous to employee a BCEM to see 1-2 patients per day, but I could see it being a good fit for a CRNA since you're essentially looking for airway management and the ability to call the surgeon quickly.

 

[Boatswain2PA]

....I think there are EDs where staffing with a midlevel probably makes sense. I just got a flyer in the mail about EmCare trying to staff a low volume outpatient surgical hospital's ED offering 12-72h shifts. It's ridiculous to employee a BCEM to see 1-2 patients per day, but I could see it being a good fit for a CRNA since you're essentially looking for airway management and the ability to call the surgeon quickly.

Agree with everything you said....except for that last part. We do a little bit more than that at rural hospitals that only see 10-30 patients a day.

 

[deleted6669]

Agree with everything you said....except for that last part. We do a little bit more than that at rural hospitals that only see 10-30 patients a day.

YUP, agree. I work a few rural per diem jobs, one of them solo coverage doing 24 hr shifts seeing 12-14 pts per shift, most fairly old and sick. I direct ems, do all the procedures, and either d/c, transfer(mostly stemis, cvas, and trauma) or admit to an on call FP hospitalist who manages routine floor care. codes on the floor at night are mine. 6 inpatient beds(usually 2-3 full at any given time) and 3 medium acuity ICU beds(usually 1-2 full at any given time). ICU pts are generally not intubated as we don't have 24/7 in house RT coverage(they and a crna are on call at night), but may be on antiarrhythmic drips or multiple abx, bipap, etc . we staff either a pa or an fp doc 24/7. we have one boarded em doc who is the medical director. great job. hope to be full time there in a few years. that would be 8 24 hr shifts/mo.