Before nurse practitioners begin working with a supervising physician, they must enter into a collaborative practice agreement. The collaborative practice agreement (CPA) will stipulate as to what medical acts a nurse practitioner will perform. CPAs need to be specific as to what clinical problems the nurse practitioner may frequently encounter and what treatment the nurse practitioner is to give the patient. So, if a CPA has proper quality assurance standards and outlines the treatment for frequent clinical problems, then when does a nurse practitioner need to confer or consult with their supervising physician?
First off, a collaborative practice agreement must meet certain quality assurance standards under 21 NCAC 32M .0110. The quality assurance standards regarding reporting and communicating with a primary supervising physician include, but are not limited to, the following:
- Continuous availability of the primary or secondary supervising physician(s) and the nurse practitioner (NP) to each other for consultation by direct communication or telecommunication.
- Process developed and implemented between physician(s) and NP for the ongoing review of care. This includes each practice site. The process must be written and include one or more frequently encountered clinical problems.
- NPs and the supervising physician are required to meet at least every six months to identify clinical problems and implement changes in treatment plans, if needed. The meeting must be documented, and the document must be signed and dated by those who attended. The meeting documents must be available for review by members or agents of both Boards for five years and retained by both the NP and the supervising physician.
- If a collaborative practice agreement is new, then the NP and supervising physician must meet at least once a month for the first six months from the implementation of the CPA. The duo will document the meetings and identify clinical problems and implement changes in treatment plans, if needed. Just like the meeting held every six months, these meetings will be documented with the document signed and dated by everyone that attends the meeting. Again, the meeting documents must be available for review by members or agents of both Boards for five years and retained by both the NP and the supervising physician.
Now, what a nurse practitioner does is going to be in the collaborative practice agreement. If a NP is seeing a patient and it becomes apparent that she/he either cannot provide proper treatment or the treatment is out of scope of the CPA medical acts, then he/she should contact the supervising physician immediately. Once that it is done, it should be documented in writing. Once the supervising physician has treated the patient, the nurse practitioner and supervising physician should discuss what the proper treatment of that patient was and potentially add it to the CPA medical acts that the NP can perform at the next quality improvement meeting between the two medical providers (with approval of the NC Board of Medicine and NC Board of Nursing, of course). Remember, communication, specifically in writing, is the key to any good working relationship. If you have doubts about treatment or diagnosis of a patient do not hesitate to consult with the supervising physician to ensure proper treatment and/or diagnosis of a patient.
This information is not intended to be legal advice and does not establish the attorney-client relationship. As always, please do not hesitate to contact us at 919-521-8810 to set up a consultation. Learn more about our firm by clicking here.