ACEP Guidelines for NPs and PAs
ACEP Guidelines for NPs and PAs
The American College of Emergency Physicians in Dallas has established guidelines on the roles of physician assistants and nurse practitioners in emergency departments. The highlights of their definitions and guidelines are as follows:
1. Role of physician assistants.
They provide services in emergency departments that are staffed 24 hours a day by emergency physicians. Or they could provide services to hospitals in rural areas where off-site physician supervision is allowed by state law.
• PAs should be placed in clinical and administrative situations where they will supplement but not replace the medical expertise and patient care provided by emergency physicians.
• They will work clinically with the supervision of an emergency physician who is present in the ED or available for consultation.
• The PAs’ scope of practice should be clearly delineated, and it should include:
a description of their role in the ED;
a list of conditions they are credentialed to treat;
a list of conditions they may not treat;
a list of conditions that require immediate consultation with the supervising emergency physician;
a list of procedures the PAs may perform before or after consultation and those they may perform only under the direct supervision of the emergency physician.
• All emergency PAs should be nationally certified or meet state and federal requirements.
• The ED medical director or another designee has the responsibility of providing the overall direction of activities of the PA in the ED.
• PAs working in EDs should have or should acquire specific experience or specialty training in emergency medicine, including a supervised orientation program and training and continuing education in emergency medicine.
2. Role of nurse practitioners.
They provide services in a variety of positions in ambulatory care settings, including providing services in emergency departments that are open 24 hours a day and staffed with full-time emergency physicians to those in rural areas with minimal or no emergency physician coverage.
• Nurse practitioners’ specific responsibilities should be clearly defined with written protocols for medical decision-making.
• The NP’s scope of practice should be clearly delineated and consistent with state nursing regulations, including the following:
a description of the NP’s role and responsibilities in the ED;
a list of types of patients and conditions the NP is credentialed to treat, those the nurse practitioner is not credentialed to treat, and those that require immediate consultation with the emergency physician or medical director;
• Credentialing procedures should be specifically stated and should be consistent with those required of other nurse practitioners in that institution. Documentation of training and experience is necessary, and all NPs must meet state or federal licensing requirements.
• NPs working in EDs should possess specific experience or specialty training in emergency care and should participate in supervised orientation programs and continuing education in emergency care. NPs should know the policies and procedures specific to the ED, and they should be aware of and participate in the quality-management activities of the ED.
[Editor’s note: For more information about the American College of Emergency Physicians’ guidelines, contact: ACEP at (202) 728-0610, Ext. 3006, or the Web site at www.acep.org.]
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