Legal Implications of Not filling a Benzo as cross covering doctor:

[finalpsychyear]

Scenario is an NP has been prescribing benzos to those on multiple controlled substances at high doses. Np current is out till end of year so clinic is distributing his patients to other NPs.

If the collaborator of this NP and the other covering NPs refuse to fill the benzos of this patient and there is some medial complication ex: seizures etc are they directly liable as the last person to touch the patient in a cross covering capacity since they refused to prescribe?

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[calvnandhobbs68]

Yes if you saw the patient you're responsible for what happens past that encounter. So don't go stopping high dose benzos cold turkey.

Just document everything. Your conversations with the patient that this is not an appropriate med regimen for them. Conversation that they probably need to wean down and likely completely off this medication. Emphasize risks of high dose benzos.

If it's only until the end of the year, I'd just tough it out till then. Also document if the patient refuses to wean down that since you're covering for this other provider and they likely will return to this provider at the end of the year, so by the time you do any meaningful weaning, they'll probably end up back with this other person (who might just reverse what you did). Give your reasoning for everything and you'll be covered.

 

[birchswing]

So a month and a half? I can't imagine you would have a good working relationship with the NP if all of her patients are suddenly going to the ER for abrupt cessation.

I'm not a doctor or lawyer, but of course they're liable as the treating provider. Whether they're held accountable is another issue, as the patient would probably muddle by in the ER and be referred to another outpatient provider—causing more ill will with the NP. I don't see how it could possibly help a patient to get "tough love" for a month and a half and then back to the other provider. It's like a reversal of patients pitting providers against each other. This seems like using the patients as pawns against the NP.

 

[whopper]

If this NP is part of your organization and the organization allows for cross coverage, yes do what was recommended above but discuss with the organization.

You work with this schmuck and this shmuck put you and other practitioners into a position where you didn't feel comfortable continuing their prescription regimen.


When working with others in a practice things like the above need to be done. If a practitioner is acting in an inappropriate manner the organization has some responsibility to confront that provider, and this will not be the last time this happens unless that provider changes his ways.

You or at least your organization will have some liability if you simply just stop his treatments, especially so if he told his patients others in the organization would take over his care while he was gone.

Whenever I had my patient on a seemingly odd regimen (e.g. 3 antipsychotics) I always wrote an explanation as if another provider could carry it on without puzzlement. (e.g. was already tried on 8 other meds and this was the only regimen that worked, his EKG was normal on these 3 antipsychotics, and I've encouraged him to try to wean off of one of them but each time he got significantly worse).

That's the entire purpose of keeping the notes. It's so others can take over. If this NP didn't write his notes justifying his prescribing of benzos then he's not fulfilling his requirements are a clinical practitioner.

 

[keifernny2]

I've run into cross-coverage situations where , if I'm not initially comfortable, I will bring the patient in for a drug screen, see them once, and continue current meds for 1 month. If their provider doesn't come back (which happens more often than you think), then we start to taper.

 

[Jules A]

Also document if the patient refuses to wean down that since you're covering for this other provider and they likely will return to this provider at the end of the year, so by the time you do any meaningful weaning, they'll probably end up back with this other person (who might just reverse what you did). Give your reasoning for everything and you'll be covered.

While I don't think it is necessary to make major changes to someone else's patient if the covering physician feels the medications are unsafe or grossly inappropriate documenting the patient refused to taper is not really going to cut it should a sentinel event happen. Even if only short term my understanding is once you touch it, you own it. I do not continue inappropriate regimens without at least a very small reduction in the offending agent and documenting this was discussed with the patient. Also if there is concern this NPs prescribing style is unsafe consider contacting the board of nursing.

 

[Mass Effect]

Scenario is an NP has been prescribing benzos to those on multiple controlled substances at high doses. Np current is out till end of year so clinic is distributing his patients to other NPs.

If the collaborator of this NP and the other covering NPs refuse to fill the benzos of this patient and there is some medial complication ex: seizures etc are they directly liable as the last person to touch the patient in a cross covering capacity since they refused to prescribe?

Yes, you are definitely liable if something happens because you didn't continue the benzos. I think it would be dangerous to not continue them if someone is out on leave and also, it's not good patient care and undermines the NPs care. What you can do is talk to the NP when he/she returns about the care he/she is providing and bring it to the attention of your superiors/whoever is supposed to be supervising the NP. If the NP is out on extended leave and you are now inheriting these patients, then it's your call, but even if you don't think benzos are appropriate, you can't just cut them off. You need to do a taper and most tapers, if done right, are going to take several months/years to be effective (which is why you don't do it when the NP is on leave for a month).

Document in your notes why you're continuing the benzos.

 

[Armadillos]

Scenario is an NP has been prescribing benzos to those on multiple controlled substances at high doses. Np current is out till end of year so clinic is distributing his patients to other NPs.

If the collaborator of this NP and the other covering NPs refuse to fill the benzos of this patient and there is some medial complication ex: seizures etc are they directly liable as the last person to touch the patient in a cross covering capacity since they refused to prescribe?

Is this a joke? Of course it’s a provider’s fault if they cause complications by abruptly interrupting a stabilized patients med regimen. Honestly, I don’t understand how this is even a conceivable question a doctor would need to ask.

 

[Doctorows]

I'm curious, what if the patient suffers an adverse event related to being on an inappropriately high regimen of controlled substances during the month that the NP is out and his/her meds are continued? Would the cross-covering physician be held liable? How do you balance the two risk spectrums?

 

[Armadillos]

I'm curious, what if the patient suffers an adverse event related to being on an inappropriately high regimen of controlled substances during the month that the NP is out and his/her meds are continued? Would the cross-covering physician be held liable? How do you balance the two risk spectrums?

Is a nuclear reactor more likely more likely to melt down when being turned on/off or during a randomly selected month of routine operations after running smoothly for years?

It always seems strange that benzos lead to such bizarrely extreme decision making on both extremes from psychiatrists.

 

[Doctorows]

Is a nuclear reactor more likely more likely to melt down when being turned on/off or during a randomly selected month of routine operations after running smoothly for years?

It always seems strange that benzos lead to such bizarrely extreme decision making on both extremes from psychiatrists.

I'm not arguing one way or the other. Just asking a genuine question.

 

[clausewitz2]

Is a nuclear reactor more likely more likely to melt down when being turned on/off or during a randomly selected month of routine operations after running smoothly for years?

It always seems strange that benzos lead to such bizarrely extreme decision making on both extremes from psychiatrists.

I have done a nonconsensual benzo taper once, with a middle-aged person with OSA who walked with a cane and had two falls requiring hospitalization in the past three months, was on four other sedating medications I did not have any control over, was mildly delirious at interview, and scored 20/30 on a MOCA. This was for anxiety that still kept them more or less housebound so obviously not working very well.

That is the sort of extreme situation that warrants an inflexible attitude, I reckon. I will wheedle and suggest and MI other folks about how maybe Valium isn't the greatest idea but sending someone into unnecessary withdrawal during a covering situation seems like a last resort, not a first.

 

[Stagg737]

While I don't think it is necessary to make major changes to someone else's patient if the covering physician feels the medications are unsafe or grossly inappropriate documenting the patient refused to taper is not really going to cut it should a sentinel event happen. Even if only short term my understanding is once you touch it, you own it. I do not continue inappropriate regimens without at least a very small reduction in the offending agent and documenting this was discussed with the patient. Also if there is concern this NPs prescribing style is unsafe consider contacting the board of nursing.

Unfortunately the BON in many states are either a joke or as incompetent as the NPs prescribing inappropriately. I've heard more than a few accounts of NPs prescribing wildly inappropriate regimens who didn't even get a slap on the wrist. I'd still report, I just wouldn't hold my breath that anything would come out of it.

 

[VA Hopeful Dr]

I have done a nonconsensual benzo taper once, with a middle-aged person with OSA who walked with a cane and had two falls requiring hospitalization in the past three months, was on four other sedating medications I did not have any control over, was mildly delirious at interview, and scored 20/30 on a MOCA. This was for anxiety that still kept them more or less housebound so obviously not working very well.

That is the sort of extreme situation that warrants an inflexible attitude, I reckon. I will wheedle and suggest and MI other folks about how maybe Valium isn't the greatest idea but sending someone into unnecessary withdrawal during a covering situation seems like a last resort, not a first.

Yep.

Back in the spring I did a lot of cross cover for another FP when she was out every other week doing chemotherapy. At the time our NPs couldn't do schedule 2 so all of her norco/xanax patients came to me for refills. Assuming they weren't borderline comatose when they saw me I'd refill for a month.

 

[Mass Effect]

I'm curious, what if the patient suffers an adverse event related to being on an inappropriately high regimen of controlled substances during the month that the NP is out and his/her meds are continued? Would the cross-covering physician be held liable? How do you balance the two risk spectrums?

The same way you do any risk/benefit analysis. You document appropriately that you've reviewed the medical record, examined the patient, had a frank discussion with the patient about the risks and benefits of long-term benzo use, and in the interest of not destabilizing the patient when their primary provider is on leave, you've decided to continue current regimen after reviewing the risks with the patient. You note that the patient is comfortable with this plan.

Is a nuclear reactor more likely more likely to melt down when being turned on/off or during a randomly selected month of routine operations after running smoothly for years?

It always seems strange that benzos lead to such bizarrely extreme decision making on both extremes from psychiatrists.

This. So much this. I never understand the affect surrounding benzo use. I mean, I've seen some pretty lousy regimens (Xanax qid in a 70 yo female for instance), but on both ends of the spectrum, people go to extremes (no benzos for anyone ever was a clinic policy at a psych clinic in town where I was in med school) when it comes to benzos. Honestly, I'm more concerned about the providers prescribing antipsychotics nightly for sleep than I am about the ones giving someone Klonopin when they're flying.

 

[SourceOfDenial]

I expect that in the next few years we will see a similar trend to what we are seeing with opioids—pts committing suicide when a force taper is initiated. At least with opioids I can taper and transition someone to a partial agonist, restabilize and then taper that if the pt chooses.

I’m general psychiatrists taper bzds way too quick. High maintenance doses that have been continued for years? I’m expecting at least 12-18 mo to get off. And this is for the folks who already want to be off.

 

[downwithDTB]

I expect that in the next few years we will see a similar trend to what we are seeing with opioids—pts committing suicide when a force taper is initiated.

The above is already happening.

That said, I personally have no interest in allowing terrible medicine to continue unchecked. The alternative answer here is to simply refuse to cover someone who, when they give you sign out or discuss their caseload, is practicing bad medicine. Don't ever let the libabilty touch you. It's the provider or maybe their employer's job to find coverage, not yours to provide it. Any employer who says that you have to practice bad medicine to be employed by them is not an employer worth having.

 

[SourceOfDenial]

The above is already happening.

That said, I personally have no interest in allowing terrible medicine to continue unchecked. The alternative answer here is to simply refuse to cover someone who, when they give you sign out or discuss their caseload, is practicing bad medicine. Don't ever let the libabilty touch you. It's the provider or maybe their employer's job to find coverage, not yours to provide it. Any employer who says that you have to practice bad medicine to be employed by them is not an employer worth having.

I agree with not wanting to continue bad medicine continue unchecked—but also making changes that lead to a patient killing themselves strikes me as bad medicine.

There are legacy opioid patients and there will be legacy bzd patients. I think the belief that we can gets everyone off these without harm is misguided. That doesn’t mean we shouldn’t be regularly assessing harm, but there is absolutely a subsection of folks who simply do terribly once the meds are reduced.

We as physicians to some degree created both of these messes. We won’t be able to deprescribe our way out. We can certainly be MUCH more judicious about who gets these medications to start.

 

[Sushirolls]

The above is already happening.

That said, I personally have no interest in allowing terrible medicine to continue unchecked. The alternative answer here is to simply refuse to cover someone who, when they give you sign out or discuss their caseload, is practicing bad medicine. Don't ever let the libabilty touch you. It's the provider or maybe their employer's job to find coverage, not yours to provide it. Any employer who says that you have to practice bad medicine to be employed by them is not an employer worth having.

These days most jobs will simply say, "Ok, there is the door, we'll hire the subservient ARNP fresh from online school to replace you."

Be prepared to walk. If you aren't prepared to walk, the job owns you.

 

[Sushirolls]

I agree with not wanting to continue bad medicine continue unchecked—but also making changes that lead to a patient killing themselves strikes me as bad medicine.

There are legacy opioid patients and there will be legacy bzd patients. I think the belief that we can gets everyone off these without harm is misguided. That doesn’t mean we shouldn’t be regularly assessing harm, but there is absolutely a subsection of folks who simply do terribly once the meds are reduced.

We as physicians Providers, or LIPs (Licensed Independent Practitioners) to some degree created both of these messes. We won’t be able to deprescribe our way out. We can certainly be MUCH more judicious about who gets these medications to start.

Fixed your post for you.

 

[SourceOfDenial]

Fixed your post for you.

Come on. At best other prescribers picked up our bad practices. I have yet to see a non MD pharma speaker. Use of maintenance bzds has been around long before there were folks holding licenses besides physicians.

Did NPs exist/rx controlled substances in the mid 00s?

‘Blame NPs’ seems to be the ‘thanks Obama’ of the online psychiatry world. Anything else you want to pin on other prescribers?

 

[downwithDTB]

I agree with not wanting to continue bad medicine continue unchecked—but also making changes that lead to a patient killing themselves strikes me as bad medicine.

There are legacy opioid patients and there will be legacy bzd patients. I think the belief that we can gets everyone off these without harm is misguided. That doesn’t mean we shouldn’t be regularly assessing harm, but there is absolutely a subsection of folks who simply do terribly once the meds are reduced.

We as physicians to some degree created both of these messes. We won’t be able to deprescribe our way out. We can certainly be MUCH more judicious about who gets these medications to start.

Everyone has to have their line in the sand. Maybe you have pitty on the np whose caring for loads of people on benzos for 20 years that they didn't start and can't stop. Fine. There is not enough evidence to know whether the harm of stopping is greater than the harm of keeping, acknowledging that they are both potentially harmful. That may be entirely different than covering a doc who is actively putting people on chronic benzos and not getting them off, which is more the situation that I'm referring to where I would be a hard line definite no.

Also, I'd walk to ED gigs while opening a PP any day of the week over being someone's benzo refill jockey. Let them hire an NP to replace me who loves to Rx benzos... I'll laugh all the way to the bank when capitation based payments come along and the practice is saddled with aging benzo dependant patients. I'd find another profession if I had to. I've yet to find a shred of evidence that anything more than a rare PRN actually helps anyone.

Finally, do you guys really expect that a practice in need of coverage for an NP is going to be able to absorb the hit of dumping a doctor at the same time? That costs a lot of money.

 

[Sushirolls]

Come on. At best other prescribers picked up our bad practices. I have yet to see a non MD pharma speaker. Use of maintenance bzds has been around long before there were folks holding licenses besides physicians.

Did NPs exist/rx controlled substances in the mid 00s?

‘Blame NPs’ seems to be the ‘thanks Obama’ of the online psychiatry world. Anything else you want to pin on other prescribers?

Picked up existing, or created new bad practices. Agreed.
I have seen ARNP pharma speakers. I get the fliers dropped off in my office.
You are correct, certain prescribing practices have been in force before ARNP surge.

My point was that things are getting worse, and its not just physicians who need to be labeled in 'bad practices' or 'doctors.' Appropriately labeling is necessary for if the days of congressional reckoning (if, whenever) happening, we don't get swept down river because of the simplicity in labeling has historically labeled only us because of a simplistic oversight.

For instance, I'm all for the push for some states and Big Box shops to have improved badge labeling and identification of whose who. The better this labeling of MD, DO, ARNP, PA-C is, the better things will be if/when there is public push back against midlevel care.

 

[Sushirolls]

...
Finally, do you guys really expect that a practice in need of coverage for an NP is going to be able to absorb the hit of dumping a doctor at the same time? That costs a lot of money.

Big Box shops don't care. The suits are running the ship - not clinical minded people who understand this big picture. To the suits we are cogs, parts to be replaced and it takes as long as it takes. PCPs grumbling about psych access? Don't care. Completely different priorities. I've witnessed a psych specific company and typical Big Box shop health system make poor staffing decisions, repeatedly, one right after another. It is mind boggling.

I've recently even heard from a good friend where they are attempting to require a change from 30 minute follow ups to 20 minute follow ups. Big Box shops don't care.

I've recently learned about one Big Box shop picking up a community mental health type role which was in discussion for more then a year ... and they've not changed a single staffing level, if anything their clinical and support staff volume has decreased, and they are on the cusp of this massive influx of patients very soon. ... Big Box shops don't care.

 

[Jules A]

Unfortunately the BON in many states are either a joke or as incompetent as the NPs prescribing inappropriately. I've heard more than a few accounts of NPs prescribing wildly inappropriate regimens who didn't even get a slap on the wrist. I'd still report, I just wouldn't hold my breath that anything would come out of it.

I hear ya but complaining without taking the time to fill out the form and report it isn't helpful and takes me back to the thread on Physicians selling the farm to midlevels and now lamenting what they allowed to happen. In my anecdotal experience the BON can more harsh than the Board of Physicians when it comes to sanctions.

 

[clausewitz2]

I hear ya but complaining without taking the time to fill out the form and report it isn't helpful and takes me back to the thread on Physicians selling the farm to midlevels and now lamenting what they allowed to happen. In my anecdotal experience the BON can more harsh than the Board of Physicians when it comes to sanctions.

Yeah at least in my state a lot of nurses are perpetually terrified that they are going to get their licenses pulled for fairly minor oversights; sometimes this is the reason for those snotty "MD aware" notes we all just adored in training. The fear is that if something goes wrong if they don't make it really explicit it wasn't their judgement call they're done.

Meanwhile we have Christopher Duntsch.

 

[SourceOfDenial]

Picked up existing, or created new bad practices. Agreed.
I have seen ARNP pharma speakers. I get the fliers dropped off in my office.
You are correct, certain prescribing practices have been in force before ARNP surge.

My point was that things are getting worse, and its not just physicians who need to be labeled in 'bad practices' or 'doctors.' Appropriately labeling is necessary for if the days of congressional reckoning (if, whenever) happening, we don't get swept down river because of the simplicity in labeling has historically labeled only us because of a simplistic oversight.

The view from my high horse is that if psychiatrists want to stay pertinent and valued, they should act like it and lead. Instead, the focus on pitting one profession against another instead of looking for ways to uptrain other providers or find better models of delivering psychiatric care has hurt psychiatry. Same goes for the constant complaining and looking down on other clinician types. That seems like a distraction from the problems facing patients and our field.

 

[Mass Effect]

These days most jobs will simply say, "Ok, there is the door, we'll hire the subservient ARNP fresh from online school to replace you."

Be prepared to walk. If you aren't prepared to walk, the job owns you.

I don't believe most jobs will show you the door, not with the psych need out there and the lack of mental health providers, no matter the degree. A practice full of NPs cannot absorb an MD's patient load without difficulty and one with an NP already on leave? Yeah, I don't think it'll be that cut and dry. That said, there is no shortage of jobs in every single community in America, so while the above may keep someone from speaking up in another profession, in psychiatry, you can find another job.

 

[birchswing]

I have noticed two parallel trends on this forum:

1) Mentioning that psychiatrists are in a good position to pick their patients and avoid situations they don't want to be in.

2) A hesitation about nurse practitioners providing psychiatric care.

I can say I am aware of psychiatrists referring patients who have more complex cases to nurse practitioners, even interestingly in one case I know of an NP that the referring psychiatrist supervises. I'm not entirely sure of what benefit that last scenario presents.

 

[SourceOfDenial]

I have noticed two parallel trends on this forum:

1) Mentioning that psychiatrists are in a good position to pick their patients and avoid situations they don't want to be in.

2) A hesitation about nurse practitioners providing psychiatric care.

Spot on observation. Also seems like the people who say 1 believe 2, and can’t.stand.it.

 

[Sushirolls]

The view from my high horse is that if psychiatrists want to stay pertinent and valued, they should act like it and lead. Instead, the focus on pitting one profession against another instead of looking for ways to uptrain other providers or find better models of delivering psychiatric care has hurt psychiatry. Same goes for the constant complaining and looking down on other clinician types. That seems like a distraction from the problems facing patients and our field.

Psychiatrists have been leading. They led us into the current mess. APA is frequently parroting access, mid level expansion, mid level training, and integrated care models.

 

[Mass Effect]

I can say I am aware of psychiatrists referring patients who have more complex cases to nurse practitioners, even interestingly in one case I know of an NP that the referring psychiatrist supervises. I'm not entirely sure of what benefit that last scenario presents.

I guarantee you it isn't because the referring psychiatrist didn't understand the case.

 

[Mass Effect]

Psychiatrists have been leading. They led us into the current mess. APA is frequently parroting access, mid level expansion, mid level training, and integrated care models.

What's the problem with integrated care?

 

[Sushirolls]

Spot on observation. Also seems like the people who say 1 believe 2, and can’t.stand.it.

N of 1 counterpoint to this is my story. Spent years striving to practice to the height of my training. Starting and expanding in opioid clinic in the heart of the epidemic in state XYZ as employee to Big Box shop. Obamacare authorized the suboxone cap to 275 for those with addiction board certification. I pleaded with every local hospital admin and manager I could, including hospital trustees to give me the bare minimum to do this. Fell on deaf ears. They loved the media attention form the state and national level politicians who would come on by for photo ops. I personally reached out to the OB department streamline their pregnant opioid referrals and tried nudge along some improved management of NAS. Built an ECT service and when waiting lists were emerging presented options to fix that to accommodate the volume - Big Box shop didn't care. Offered to PCP department head to be available for challenging Benzo/opioid/controlled substance polypharmacy patients to either do the tapers or provide consult notes to PCP to follow - nope, Big Box shop didn't care. Discussed setting up a miniature nicotine / tobacco cessation clinic even with hypnosis (cash service) line for the Big Box shop, nope they still didn't care. Also had meetings with local jail to try to streamline a referral/release process to consults to reduce relapse/recidivism, nope, Big Box shop didn't care.

Personally, I've put forth my pound of flesh for the bureaucratic meat grinder to make things better. I'm scaling back to focus on a smaller pond, but criticisms of mid-levels and their impact on health care still isn't any less unjustified.

 

[Sushirolls]

What's the problem with integrated care?

That's a long loaded discussion meant for another thread another day. In summary, good idea stone tossed into the pond, but vicious ripples that will rise to tsunami waves.

 

[birchswing]

I guarantee you it isn't because the referring psychiatrist didn't understand the case.

I can't be too specific. But I think it's that they didn't want the case. I was using the word complex to be vague—not to suggest it was above the psychiatrist's ability. The part I didn't understand was not wanting it but letting the NP they supervise handle it. I suppose it would be kosher for me to come out and say that in this particular case the psychiatrist in question did not prescribe a particular type of medication but the NP took the patients that needed that type of medication prescribed. But since the psychiatrist was ultimately responsible, I did not understand it. It seemed like he wanted to keeps his hands clean so to speak. To be clear, I am not seeing either of the two people I mentioned. It was a prospective conversation that led to this knowledge; nothing came of it.

 

[clausewitz2]

I can't be too specific. But I think it's that they didn't want the case. I was using the word complex to be vague—not to suggest it was above the psychiatrist's ability. The part I didn't understand was not wanting it but letting the NP they supervise handle it. I suppose it would be kosher for me to come out and say that in this particular case the psychiatrist in question did not prescribe a particular type of medication but the NP took the patients that needed that type of medication prescribed. But since the psychiatrist was ultimately responsible, I did not understand it. It seemed like he wanted to keeps his hands clean so to speak. To be clear, I am not seeing either of the two people I mentioned. It was a prospective conversation that led to this knowledge; nothing came of it.

Oh, I get it! It's like a Shabbos goy, only for Klonopin.

 

[deleted480308]

Scenario is an NP has been prescribing benzos to those on multiple controlled substances at high doses. Np current is out till end of year so clinic is distributing his patients to other NPs.

If the collaborator of this NP and the other covering NPs refuse to fill the benzos of this patient and there is some medial complication ex: seizures etc are they directly liable as the last person to touch the patient in a cross covering capacity since they refused to prescribe?

it's not collaborating, it's supervising

And you don't need to talk to the board of nursing, the docs in the group need to talk to that NPs supervising doc to get them in line for the long term. If they won't get in line, the supervising doc needs to drop them

For the short term, everyone on inappropriate doses gets a small taper if they ask you to refill. If they don't like that, they can schedule with someone else. But you need to know that's a high risk of burning bridges and you may be going home instead of the nurse when all the dust settles.

 

[clausewitz2]

it's not collaborating, it's supervising

And you don't need to talk to the board of nursing, the docs in the group need to talk to that NPs supervising doc to get them in line for the long term. If they won't get in line, the supervising doc needs to drop them

For the short term, everyone on inappropriate doses gets a small taper if they ask you to refill. If they don't like that, they can schedule with someone else. But you need to know that's a high risk of burning bridges and you may be going home instead of the nurse when all the dust settles.

In my state unfortunately the legal framework and terminology is "collaboration", not "supervision". It does seem to reduce liability a bit in that there is no expectation of NP charts being signed off on by an MD on a regular basis.

 

[deleted480308]

In my state unfortunately the legal framework and terminology is "collaboration", not "supervision". It does seem to reduce liability a bit in that there is no expectation of NP charts being signed off on by an MD on a regular basis.

I don't care what they call it, if the NP needs a document with your name on it keep working... it's supervision

 

[clausewitz2]

I don't care what they call it, if the NP needs a document with your name on it keep working... it's supervision

My point was that here they don't and that may be the case for OP, although only they can tell us that.

 

[deleted480308]

My point was that here they don't and that may be the case for OP, although only they can tell us that.

NPs are fully independent in your state and don’t need a doctor for any reason?

 

[WisNeuro]

They have full practice authority in my state.

 

[samac]

They have full practice authority in my state.

Family NPs have full practice autonomy in my state, but interestingly psych ones don't. And a significant number of psych NPs can't find a psychiatrist to oversee them. One thing is an NP I knew was basically running a psychiatric NP practice in his family clinic (just doing genetic testing on every patient) but once he got that certification he had to stop. He works for a drug company now. Shilling Trintellix? I think. States have super weird requirements for NPs.

 

[WisNeuro]

I'm fairly certain that the psych NPs here also have full autonomy. I think the state I used to live in had some weird mix of independence/supervision, though.

 

[psychapp121]

How can any NP have full practice authority? Does that mean there are actually no difference in practice between an MD? Why would anyone go to medical school then???

 

[birchswing]

How can any NP have full practice authority? Does that mean there are actually no difference in practice between an MD? Why would anyone go to medical school then???

Maybe to be a thought leader?


(Runs away and hides.)

 

[Jules A]

"In Full Practice Authority (FPA) states, NP licensure is not contingent on unnecessary contracts or relationships with a physician or oversight by the state medical board." "To date, nearly half of states and U.S. territories have adopted FPA licensure laws for NPs.
These include: Alaska, Arizona, Colorado, Connecticut, District of Columbia, Guam, Hawaii, Idaho, Iowa, Maine, Minnesota, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Northern Mariana Islands, Oregon, Rhode Island, South Dakota, Vermont, Washington and Wyoming."

Issues at a Glance: Full Practice Authority

Full Practice Authority (FPA) is the authorization of nurse practitioners (NPs) to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments — including prescribing medications — under the exclusive licensure authority of the state board of nursing.…

www.aanp.org

Interestingly enough this list doesn't include states that require some supervision initially but where NPs can later practice independently. In states like Maryland and Virginia they have full practice authority for NPs after they meet certain supervision requirements. I would imagine there are others also.

 

[Mass Effect]

"In Full Practice Authority (FPA) states, NP licensure is not contingent on unnecessary contracts or relationships with a physician or oversight by the state medical board." "To date, nearly half of states and U.S. territories have adopted FPA licensure laws for NPs.
These include: Alaska, Arizona, Colorado, Connecticut, District of Columbia, Guam, Hawaii, Idaho, Iowa, Maine, Minnesota, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Northern Mariana Islands, Oregon, Rhode Island, South Dakota, Vermont, Washington and Wyoming."

Issues at a Glance: Full Practice Authority

Full Practice Authority (FPA) is the authorization of nurse practitioners (NPs) to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments — including prescribing medications — under the exclusive licensure authority of the state board of nursing.…

www.aanp.org

Interestingly enough this list doesn't include states that require some supervision initially but where NPs can later practice independently. In states like Maryland and Virginia they have full practice authority for NPs after they meet certain supervision requirements. I would imagine there are others also.

If the AMA would grow a spine, maybe when the **** hits the fan with regard to the benzo epidemic, they'll find a way to blame NPs for practicing bad medicine.

 

[psychapp121]

"In Full Practice Authority (FPA) states, NP licensure is not contingent on unnecessary contracts or relationships with a physician or oversight by the state medical board." "To date, nearly half of states and U.S. territories have adopted FPA licensure laws for NPs.
These include: Alaska, Arizona, Colorado, Connecticut, District of Columbia, Guam, Hawaii, Idaho, Iowa, Maine, Minnesota, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Northern Mariana Islands, Oregon, Rhode Island, South Dakota, Vermont, Washington and Wyoming."

Issues at a Glance: Full Practice Authority

Full Practice Authority (FPA) is the authorization of nurse practitioners (NPs) to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments — including prescribing medications — under the exclusive licensure authority of the state board of nursing.…

www.aanp.org

Interestingly enough this list doesn't include states that require some supervision initially but where NPs can later practice independently. In states like Maryland and Virginia they have full practice authority for NPs after they meet certain supervision requirements. I would imagine there are others also.

I’m not trying to be political or controversial, I just legitimately don’t understand how that’s legal or makes any sense. I mean I’m just thinking about going to an NP as my PCP..that’s just nuts or 50x worse my specialist..how in the world..I thought they were always supervised kind of like residents..