Professional Role of Nurse Practitioners: Key Concepts

The Green Light to Practice

• License:
  • Your ticket to practice as an NP.
  • Issued by the state, and each state has its own rules.
  • No current compact license for NPs (unlike RNs).
  • Requires a separate license for each state where you want to work.
• State Nurse Practice Act:
  • Defines the scope of practice for NPs in that state.
• State Board of Nursing:
  • Enforces the nurse practice act, ensuring NPs stick to the rules.
• Certification Exam (ANCC or AANP):
  • Proves you're a safe and competent NP.
  • Almost always needed to obtain your license.
• Credentialing:
  • A detailed verification process that allows you to bill insurance companies.
  • Includes a thorough review of your qualifications and background.
  • Can take several weeks to months before you can start working as an MP.

Collaborative Agreements

• Formal agreements required by some states between NPs and a supervising physician (or even a dentist).
• Chiropractors cannot legally enter a collaborative agreement with an NP in most states.
• These agreements detail:
  • The NP's role.
  • How the NP will work with the supervising physician.
  • Supervision requirements.
  • How the NP will work within their scope of practice.
• Not all states require these; in some, NPs can practice independently.
• Understanding your state's requirements is crucial for practice setup and compliance.

E-Prescriptions

• Must include:
  • Patient's full name
  • Medication name
  • Dosage
  • Frequency
  • Quantity
  • Your name, credentials, and contact information
• For controlled substances:
  • Must be typed and signed on the day issued.
  • System must allow secure digital signing on the same day.

Liability Insurance

• Two main types:
  • Claims-based
  • Occurrence-based
• Claims-Based Insurance:
  • Covers you only while employed.
  • Coverage stops the moment you leave the job.
  • If a claim is made after you leave, you won't be covered unless you have tail coverage.
  • Tail coverage: an insurance "safety net" you need to purchase if you switch jobs.
• Occurrence-Based Insurance:
  • Covers any incident that occurred while the policy was active, regardless of when the claim is filed.
  • If the incident happened while you were insured, you're covered, even if the claim is filed after you changed jobs or retired.
• Scenario: Subpoenaed for a patient visit that happened six months ago, but you've since switched jobs. Occurrence-based insurance has your back.

Patient Confidentiality

• HIPAA protects patient privacy and sets strict rules on when patient information can be shared.
• When you can share information without patient consent:
  • Insurance companies need patient details to process claims.
  • Legal situations: If patient information is subpoenaed.
• Things you should NOT do:
  • Leave a patient's electronic health record open when stepping out.
  • Leave patient results on voicemail, even to say everything's normal.
• Ombudsman:
  • Acts as a mediator and advocate to ensure patient rights are respected.
  • Helps navigate complex health care scenarios.

Advanced Directives

• Crucial tools to ensure a patient's wishes are respected, even when they can't voice them.
• Living Will:
  • Outlines a patient's wishes regarding medical treatment if they become terminally ill or unable to communicate.
  • Covers choices about artificial nutrition, hydration, pain management, life support, and DNR (Do Not Resuscitate) orders.
• Power of Attorney vs. Health Care Power of Attorney:
  • General Power of Attorney: empowers someone to make a range of decisions on the patient's behalf (financial, personal, and medical).
  • Health Care Power of Attorney: specific for making medical decisions.
• Guardian ad Litem:
  • Appointed by a court to advocate for those unable to protect their own interests (minors or incapacitated adults).
  • Ensures that the patient's best interests are represented in court proceedings and medical decisions.

Informed Consent

• A patient's knowledgeable approval of a medical procedure or treatment after fully understanding the risks, benefits, and alternatives.
• Who can legally give consent: Mentally competent adults >= 18 years old.
• Assent:
  • A person < 18 who isn't legally able to give full consent but shows understanding and willingness to participate in research or treatment.
  • Respecting young individuals' capacity to be involved in decisions about their own health.
• Emancipated Minors:
  • Individuals < 18 who can give informed consent just like adults.
  • How a minor becomes emancipated:
    • Getting married
    • Joining the military
    • Living independently and managing their own finances
    • Having a child

Ending the Clinician-Patient Relationship

• Sometimes necessary due to persistent noncompliance or ongoing conflict.
• Termination should never be based on discrimination (age, race, sex, health condition, or any other protected status).
• Prioritize the patient's welfare:
  • Provide adequate notice.
  • Written explanations.
  • Referrals to other clinicians or resources.
• Adhere to state-specific regulations for terminating these relationships.

Social Media

• Navigating social media as a health care professional can be tricky.
• Confidentiality, professionalism, and boundaries are key.
• A seemingly innocent post risks violating HIPAA, potentially resulting in fines or even legal issues.
• Viral posts come with risks.
• Even general comments can harm your reputation and professional image.
• If a patient sends a friend request:
  • It might seem harmless to accept, but it blurs professional boundaries and can lead to potential ethical conflicts.
  • Best to keep professional and personal lives separate, avoiding any overlap on social media platforms.

Healthy Work Environment

• Not just about the physical space being welcoming but about the foundations that make our day-to-day experiences positive and productive.
• Built through:
  • Open communication: everyone feels comfortable sharing ideas and concerns.
  • Feeling safe: not just physically but also safe to speak up if something is off.
  • Work-life balance: respecting boundaries.
  • Professional development: growing in your role is good for you and the whole team.
  • Recognition: feeling seen and appreciated.
• Why is it important? Happier staff means lower turnover and, ultimately, better care for our patients.