Compliance Guidelines for NP's Expanded Scope of Service
NURSE PRACTITIONER'S WITH PHYSICIAN COLLABORATION
It’s essential to have documented proof that reflects the collaboration between the physician and the nurse practitioner. This collaboration shouldn’t be limited to verbal confirmation but should be supported by a formal Collaboration Agreement signed by both parties.
In California, a Nurse Practitioner (NP) to physician collaboration agreement, also known as a "standardized procedure" agreement, is a legally binding document that outlines the scope of practice and protocols for patient care that an NP can perform in collaboration with a supervising physician, requiring detailed agreements on specific medical conditions, diagnoses, and treatment plans that the NP can manage within their practice area; this agreement is crucial for NPs to legally practice in the state and is governed by the California Board of Registered Nursing, providing a template for these standardized procedures. - California Business and Professions Code Section 2725(b)(4)
For a home health organization, it can be challenging to consistently verify these collaborations by requesting documentation each time. A more streamlined approach would be for the nurse practitioner to verbally confirm their collaborative relationship with a physician, after which the agency can issue a physician’s order. This order, signed by the collaborating physician or nurse practitioner, would confirm their partnership. This process helps to ensure compliance while minimizing administrative delays and maintaining professional integrity.
SUGGESTED ORDER VERBIAGE For Physician This is to confirm that [Nurse Practitioner’s Full Name], and I have a current standardized procedure agreement authorizing the nurse practitioner to manage specified patient care tasks in collaboration with me. For Nurse Practitioner
I attest that I have a current standardized procedure agreement with [Physician’s Full Name] in compliance with the, authorizing me to manage specified patient care tasks in collaboration with the physician.
NURSE PRACTITIONER'S TO PRACTICE INDEPENDENTLY IN CALIFORNIA
What qualifications must a nurse practitioner meet to be eligible for independent practice?
NP passes a national NP board certification examination.
The NP must be properly certified by “a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and those national certifications need to be recognized by the BRN.”
The nurse practitioner must provide documentation to show their training was “consistent with current BRN standards and any applicable regulations as they specifically relate to requirements for clinical practice hours. Online educational programs that do not include mandatory clinical hours shall not meet this requirement in the new law.”
The NP must finish a California transition-to-practice (TTP) requirement of three full-time equivalent years or 4600 hours – according to BRN regulations.
California Regulations:
Assembly Bill 890 (AB 890):
Enacted in 2020, AB 890 introduced pathways for NPs to practice independently, without standardized procedures or physician supervision, under specific conditions. This legislation established two categories of independent practice:
Section 2837.103 NPs (103 NPs): Effective January 1, 2023, NPs meeting certain education and experience requirements can practice independently within defined healthcare settings, such as clinics or group practices. They must have a master's degree in nursing or a related clinical field, hold a valid California registered nurse license, and have completed a transition to practice program.
Section 2837.104 NPs (104 NPs): Beginning January 1, 2024, NPs with additional experience can practice independently outside the specified settings of Section 2837.103. These NPs must have practiced as a nurse practitioner in good standing for at least three years beyond the transition to practice period. They are required to consult and collaborate with other healthcare providers based on the patient's clinical condition and establish referral plans for complex cases.
In a home health organization, verifying a nurse practitioner’s compliance with the requirements for independent practice can present challenges, given the complexities of ensuring that each practitioner’s qualifications align with regulatory standards. However, as an organization committed to quality care and regulatory compliance, it is essential to confirm that all nurse practitioners practicing independently meet the mandated criteria. To facilitate this, we can adopt a best practice approach by requiring each nurse practitioner to provide an attestation. This attestation serves as a documented affirmation that they meet all qualifications for independent practice
SUGGESTED ORDER VERBIAGE
I attest that I meet all qualifications required for independent practice under California Assembly Bill 890 without standardized procedures or physician supervision.
FAQS
Question: How about Nurse Practitioner's in Nevada?
Answer:
In Nevada, nurse practitioners (NPs) have full practice authority, allowing them to work independently in various healthcare settings, including home health care. This means NPs can evaluate patients, diagnose conditions, interpret diagnostic tests, and initiate and manage treatments without physician supervision.
In the context of home health care, Nevada has adopted provisions that permit advanced practice registered nurses (APRNs), including NPs, to order and sign for home health care services. This change, influenced by the CARES Act, permanently allows NPs to establish and certify a patient's plan of care and sign necessary orders directly, eliminating the previous requirement for physician signatures.
Reference: Nevada Revised Statutes (NRS) §632.237 and Nevada Administrative Code (NAC) §632.259 and §632.2595 - https://www.leg.state.nv.us/nrs/nrs-632.html
Question: How about Nurse Practitioner's in Oregon?
Answer:
In Oregon, nurse practitioners (NPs) are granted full practice authority, enabling them to operate independently across various healthcare settings, including home health care. This autonomy allows NPs to evaluate patients, diagnose conditions, interpret diagnostic tests, and manage treatments without the need for physician supervision.
Regarding home health services, Oregon law permits NPs to order and oversee these services. Specifically, NPs can conduct face-to-face encounters with patients to assess their need for home health care and are authorized to certify and establish the patient's plan of care. This process ensures that patients receive timely and appropriate home health services under the direct care of an NP.
Therefore, as an NP in Oregon, you have the authority to practice independently in home health care settings, managing patient care and fulfilling all necessary documentation and orders within your professional scope.
Reference: (1) https://oregon.public.law/statutes/ors_678.380 (2) https://www.oregon.gov/osbn/Documents/FAQ_APRN.pdf
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