Scope of Practice for ER PA

[Derbingle]

I would lik to know from you folks What things are we doing as ER PAs across the country? Im asking because im slowly progressing into caring for more complicated pts and a couple of times didnt seize the chance to intubate or chest tube when was briefly put on my plate. Ive done aterial lines and intubated newborns in the past but feels so long ago. last night figuring out appropriate bicarb dripp for renal patient in rhabdo and wondering "why isnt phamacy figuring tis out". I should like this right?

 

Are there many PAa placing central lines in ER pts? Doing entire codes without docs availabl? Im in a place where if you can start an EJ line, no one will stop you. But you have to get it right. Id like to know the areas of ER which are mid level heavy if there is such a thing. Fast track, can be varying and trciky, medicine side have sick patients, chest pain side and have resp failure, stemi and codes. Are all the PAsNPs doing most of the procedures and orders or splitting the pts with the docs?

 

So tell me my fellow PAs....what experiences are you all having with regard to intervetion type medicie ? Would love to hear if its as diverse as our field itself or there is a common base!

[True Anomaly]

I feel I have a pretty good scope of practice- better than some, not as good as others.  We've got folks here like EMED and kargiver who are staffing solo rural ER's on their own.  Because I work in the city, I don't do that, but I'm still able to do things like central lines and LP's and intubations.  I don't run codes on my own, haven't done a chest tube or arterial line since residency and have never come close to cracking a chest or floating a pacemaker.  Nonetheless, I see patients side-by-side with the doc, and since I still work in the same system as I did my residency, the docs trust me since they trained me.

[EMEDPA]

really depends where you work. on the west coast a good scope of practice generally means working at community hospitals or rural facilities. the larger medical centers have lots of docs/residents/specialty teams who see most of the sick folks.

 I have 3 jobs:

job #1(full time job) inner city trauma ctr: PAs work fast track, obs unit, and an intermediate care unit. docs only in main but PAs are anticipated to work in main by next year. we also staff a satelite facility 24/7 which sees around 30k pts/yr with docs there day shift only( I work nights...:) )

job #2 1 weekend/mo at rural critical access hospital working double coverage with a doc alternating charts regardless of acuity. on occasion I will be intubating while the doc is seeing a kid with a cold. I direct medics here.

job#3 per diem 24-60 hrs/mo rural/critical access hospital. solo coverage. see all pts and do all procedures.direct medics in the field.  respond to the floor and icu for pt issues. can admit pts to myself for obs for up to 24 hrs(shifts are 12 or 24 hrs).

 

job #2 will likely become my full time job in a few years when my kids go off to college.

[Derbingle]

That helps give me some reference. Thank you. Im in a large city (15 hospitals) and I go to 4 of their EDs as were contracted. we are expected to run fast track, (which are appys, preg vag bleeds, asthma, cp, stones, dka, etc,) separate wait room (over flow) for bones throats and teeth (30 beds) and if doc needs help in the main ED (35 beds) we move to the front and fast track waits, a little. We do our own admissions and consult residents and specialties for said pts. Im 11 months into it so I have alittle time i guess to muster guts...or more guts to jump in.

 

The administrative stuff (insurance, pages, whose covering what groups) drives me crazy but I really like doing procedures. I know i have to get on board with the procedure requests when asked or theyll stop asking. The resident are so busy, not really interested in stealing procedures.

 

After reading the above posts, I think im in the middle of our scope right now, with room to grow. its difficult to tell where I am bc the PAs/NPs are so busy, we dont really cross paths or know what each other is doing. Reading the forum and what you guys are doing is very helpful as far as understanding what direction I (any of us) can go. Thanks to all of you for updating.

[EMEDPA]

it sounds like your fast track sees stuff we see in our intermediate area. lots of pelvic and abd pain in folks under 65. not a bad first job. in our system most folks with any real complaint over 65 go to the main dept. We see those at our satelite facility but not at the main hospital.

our fast track is really super minor stuff unless one of the traige nurses messes up(see the thread here on fast track disasters called "it's probably nothing"-fast track disasters). try and get some lps and central lines. paracentesis is fun and easy to do. IOs are always fun. try to be involved in codes and trauma. sounds like you are on the right path. good luck.

[PA-Larb]

I work in a rural ED in Arkansas. Myself and fellow PAs are given opportunity to run codes, intubate, conscious sedation procedures, art lines, LPs. I haven't had the opportunity to do chest tube, however we have trauma surgeons at all times. If we ask, then 99% of the time we are free to do whatever. Of course, our docs have supervised us initially with each procedure. They are also always available if needed.