Do NP's do independent practice for EM (anywhere in the country)? I did some googling but want a straight answer from some attendings. Mostly I have seen two-tiered systems wherein the EM physician is required to signoff on all NP charts or have the patient transferred to the physician for further workup/tx
Do NP's do independent practice for EM?
- Thread starter GalenAgas
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Not sure if they can practice independently in other spots, but at my part time gig, I work with NPs and we have to write addendums/attestations to their notes.
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We don't have any NPs in the ED in the group I currently work for but I've worked in another group that does and we had to sign off on their documentation the same way we do for PAs.
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In Texas, you have to sign off on 10% of their charts. We have about 3 midlevel shifts at our ED; they come ask us if they have a big issue. They mainly see (ESI) 4s and 5s, occasionally will cherry pick some 3s if the is not enough of the others around.
Most of us have one mid level assigned to us and we sign the 10% of their charts that they send our way. Our charting program allows us to type stuff that DOES NOT become part of the medical record so we can say if we would have done something different, etc. We also get a small monthly stipend for them being under us.
We do not have to see that patient; its more of a 'chart review' that is often done weeks and sometimes months after the fact depending on how well you stay caught up.
Most of us have one mid level assigned to us and we sign the 10% of their charts that they send our way. Our charting program allows us to type stuff that DOES NOT become part of the medical record so we can say if we would have done something different, etc. We also get a small monthly stipend for them being under us.
We do not have to see that patient; its more of a 'chart review' that is often done weeks and sometimes months after the fact depending on how well you stay caught up.
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From an attending point of view, if you do attest to their charts do you also examine the patient? Is it similar to an attending attesting a resident written chart? Do you perform a history and physical in addition to the NP? My worry in all of this is that if a case goes to trial and you've attested to the chart and the NP/PA missed something will you be held liable as the supervising physician?
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Our ED NP's are hospital employees and are not part (financially) of our department (academic). Therefore, we do not make any money off them. They work independently until they have an issue. When they do, they come to us and we do our own separate full note and bill for it. I think this is not the norm. In our system, we're not able to attest to their documentation even though we do attest to resident charting.
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This was and is confusing to me.
There was an NP that I worked with and I wanted more done for the patient and I told him to do it, he did it - but now I'm not sure if I overstepped my bounds. If my attestation does not really mean that I am liable, then I could've just let the NP do their thing.
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So it's not 100% chart review? I remember when I started my ED job in TX I was told 100% chart review due to the complexity of the patients I would be seeing?(Maybe that was an Attending specific thing since he never had a PA prior to me or maybe it's different for rural EM in TX?)
Also I have been away from TX for several years due to medical school so a lot could have changed.
