SCOPE OF PRACTICE
( continued from page 7 )
regulatory agencies to expand their scope of practice , gradually gaining independent status for many activities previously reserved for physicians . Many health employers could not / would not hire more expensive physicians , so they built up their workforce with APPs and APRNs . Improved access , efficiency and cost were the rationale for diversifying their workforce , both in the hospitals and in ambulatory care . Yet , the physician ’ s responsibilities and liabilities risks did not go away . Even though physicians were now employed , the need for the official role of “ physician collaborator ” was even greater , and the connection became contractually formalized . Today , it is rare not to be expected to enter in to a “ collaborator ” role as part of your job and clinical responsibilities .
Some confuse the roles of collaborator with medical director . During the days of private practice , medical directors were at times ceremonial posts to give independent physicians an administrative voice regarding hospital coverage or system politics . Medical directors today have expanded duties overseeing quality of care , managing staff , coordinating policies and collaborating with other leaders . The key differences with collaborators are the scope of responsibilities and level of involvement . Collaborators work with specific APPs where medical directors are over physicians and APPs – usually in specific services lines . Herein lies one of the biggest challenges for these roles , a clear understanding of focus on direct patient care and the scope and ultimately liability for another ’ s actions or omissions .
State and federal licensing bodies – including Kentucky and Indiana – have similar requirements for Collaborative Agreements , which are formal , in writing and filed with the Kentucky Board of Nursing and / or the Indiana Professional Licensing Agency ( IPLA ). These agreements are required for the APPs ’ independent practices and prescriptive authority and must be signed by both providers . It must set forth the specific manner of collaboration , describe any limitations placed by the MD on each APRN ’ s prescriptive authority and detail the manner of review of prescriptive practices . 1 Each hospital system also has its own policy on supervisory responsibilities and agreements . Most have other restrictions and regulations , including that APPs may not independently admit or discharge hospital patients , must submit to regular chart reviews , adhere to continuing education requirements ( CEUs ) and bill at approximately 85 % of the physician rate for the same service . 1
Robust collaboration leads to better care quality , including patient safety outcomes , patient satisfaction , cost savings and reduced physician and nurse burnout . According to The Joint Commission , communication failure is one of the most common root causes for sentinel events ( an adverse event causing serious harm or death ). 2 Other obstacles to collaboration include limited knowledge of the other ’ s role , hierarchy , differing goals and incivility .
Why are there so many barriers to good collaboration ? Much of that falls on us as individual professionals . Many of us lack the motivation to take on these responsibilities , especially the liability . There is insufficient time in a workday for communication , much less collaboration . Though we accept that there are not enough doctors to do the work , both sides harbor negative stereotypes that sour honest interactions . It is good to speak of mutual respect , but quite another to practice civility daily .
In summary , being collegial and a good mentor may be skills you develop naturally with experience and time , but today ’ s “ contractual collaborator ” is held to a higher standard and legal agreement . We must work to understand our roles and responsibility to the patients and the system . Remember , you are expected to address complex cases , solve clinical dilemmas and resolve team conflicts all the while never seeing the patient , nor having first hand exposure to the situation . You must trust your nurse collaborator to honestly relay important information , accept feedback , deliver state of the art care , get regular sign off of medication orders , while always staying within the APRN scope of practice and duties . How many of us regularly monitor these agreements that we have signed ? It is time to take this expanding responsibility seriously . Annual review with annual renewal signed by both parties would be a good start . And systems should designate a clinician leader to monitor and drive compliance with collaborative arrangements throughout the system to ensure the patients are getting the best care possible . We can ’ t go back to the old model , so let ’ s work together to understand and effectively communicate as collegial team members to achieve optimal outcomes for the patients we serve .
References :
1 https :// kbn . ky . gov / Licensure
2 https :// www . jointcommission . org /
Dr . Wernert is the Executive Medical Director of Norton Medical Group and practices with Norton Behavioral Medicine . He also served as Secretary of the Indiana Family and Social Services Administration ( FSSA ) during the Pence Administration 2014-2017 .
8 LOUISVILLE MEDICINE