Medical Staff Classifications, Education, and Licensure Guide

Classification and Definitions of Medical Staff

• Clinical Personnel: Refers to any medical staff members who provide direct, hands-on care to patients.
• Nonclinical Personnel: Refers to medical staff members who do not provide direct care to patients.
• Access to Records: The level of access to patient medical records vary significantly between clinical and nonclinical staff members.
• General Requirements for Licensed Providers:     * Must be licensed physicians or providers permitted by law and granted clinical privileges.     * Education must come from an accredited program.     * Must pass a licensure examination to practice.     * Maintenance of licensure often requires the completion of continuing education, specifically Continuing Education Units (CEUs).     * Licensure renewal typically occurs on a set timeframe, commonly every $2$ years for doctors, nurses, and physical therapists, depending on state regulations.

Physician Classifications

• Doctor of Osteopathy (DO): Physicians who focus on a holistic treatment approach.
• Doctor of Podiatry Medicine (DPM): Specialized providers focusing on podiatric health.
• Medical Doctor (MD): The most commonly recognized providers, often serving as general practitioners.
• Doctor of Dental Surgery (DDS): Specialized providers who perform dental surgeries, detailed tooth extractions, teeth realignment, and root canals.

Educational and Licensure Path for Medical Doctors (MD)

• Undergraduate Education:     * Must complete a bachelor's degree from an accredited college.     * While no specific major is required, medical schools prefer backgrounds in premedicine, biology, chemistry, or exercise science.
• Admissions Testing: Completion and passing of the Medical College Admissions Test (MCAT).
• Application Process: Students use the American Medical College Application Services (AMCAS). This system allows a student to submit a single application that is distributed to all targeted medical schools of their choice (primary, secondary, etc.).
• Medical School: Requires approximately $4$ years of full-time study beyond the undergraduate level.
• The United States Medical Licensing Examination (USMLE): A three-part examination taken during and after medical school:     * Part 1: Taken during the third year of medical school study.     * Part 2: Taken during the fourth year of medical school study.     * Part 3: Taken after the completion of medical school and residency.
• Residency: Training at a teaching college or hospital where the graduate practices under the direction of a senior physician.
• Final Certification: Upon completion of medical school, residency, and all parts of the USMLE, the physician earns board certifications and a state license.
• Professional Practice: Licensed physicians can either obtain credentials and clinical privileges for hospital settings or open a private practice.\n

Educational and Licensure Path for Specialized Physicians

• Doctor of Osteopathy (DO):     * Requires a bachelor's degree (preferred sciences include biology, physics, chemistry, and English).     * Requires a $4$-year Osteopathic Medical Program.     * Licensure Exam: The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA).     * Must complete an internship and a residency.
• Doctor of Podiatry Medicine (DPM):     * Requires a bachelor's degree (recommended background includes chemistry, physics, and biology).     * Requires a $4$-year program specifically for podiatry medicine.     * Requires a residency typically performed at a hospital or medical clinic.
• Doctor of Dental Surgery (DDS/DMD):     * Requires a bachelor's degree (recommended concentration in biology or pre-dentistry, with courses in chemistry).     * Must pass the Dental Admission Test (DAT).     * Completion of a $4$-year dentistry degree program resulting in either a DDS (Doctor of Dental Surgery) or DMD (Doctor of Medicine in Dentistry).

Nurse Practitioner (ARNP) Education and Scope

• Overview: The Advanced Registered Nurse Practitioner (ARNP) is one of the highest levels of nursing. They must hold at least a master's degree, though some hold a doctorate in nursing.
• Process:     * Step 1: Obtain a Registered Nurse (RN) license.     * Step 2: Complete a Bachelor of Science in Nursing (BSN).     * Step 3: Gain real-world patient care experience, including active involvement in diagnosing and recognizing signs and symptoms of illnesses.     * Step 4: Complete a master's degree program (typically $2$ years).     * Step 5: Pass a specific certification exam for nurse practitioners in addition to holding an RN license.

Registered Nurses (RN)

• Educational Options:     * Associate Degree: A $2$-year program, sometimes referred to as a "diploma nurse."     * Bachelor Degree (BSN): A $4$-year degree for those without a background, or a $2$-year transition for those already holding an associate degree.
• Licensure: Must graduate from an accredited program and pass the NCLEX-RN examination.
• Renewal and Ethics:     * License renewal occurs every $2$ years in states like Colorado and Florida.     * Compliance with HIPAA (Health Insurance Portability and Accountability Act) regarding strict patient confidentiality is mandatory.
• Clinical Responsibilities:     * Medication administration.     * Performance of treatments.     * Clinical documentation.     * IV pushes, IV medication administration, and blood administration.     * Authority to delegate certain responsibilities to subordinate staff.

Licensed Practical Nurse (LPN) and Licensed Vocational Nurse (LVN)

• Naming Convention: The title depends on the state; some use LPN (Licensed Practical Nurse) and others use LVN (Licensed Vocational Nurse).
• Education: Requires a diploma or certificate from an approved educational program lasting $1$ to $2$ years at a junior college, community college, or technical school.
• Licensure: Must pass the NCLEX-PN examination.
• Compact State License: Some states recognize a "compact state license" which allows an LPN/LVN to practice in multiple states under a single license.
• Renewal: Requires CEUs and renewal every $1$ to $2$ years.
• Clinical Responsibilities and Restrictions:     * Passing medications, wound treatment, and documentation.     * IV medication administration is allowed only after completing an IV certified course.     * Can access (but not insert) central lines if they have the specific certification.     * Can start peripheral IV lines and administer meds via these lines.     * PROHIBITED: LPNs and LVNs are not allowed to hang blood products.     * Assessment Distinction: RNs perform patient assessments, whereas LPNs and LVNs perform patient evaluations.

Certified Nurses Assistants (CNA)

• Education: Completion of a state-approved program lasting between $4$ and $16$ weeks, followed by a state-specific certification exam.
• Professional Designation: Dr. Hartniss describes nurses as the "hands and heart" of the medical field, while CNAs are considered the "backbone."
• Responsibilities:     * Daily living assistance: toileting, feeding, and peri care.     * Mobility: Transferring patients between beds and wheelchairs.     * Observation and Reporting: Documenting patient appetite and daily intake.     * The depth of CNA documentation provides critical insights for the nurse regarding what the patient is able to achieve and how they are functioning physically and emotionally.