PA roles in inpatient setting

[JBH11]

Hi All,

 

I'm working as a nurse aide in a hospital and considering PA school. I have shadowed a couple of PA's but am left with a couple questions regarding their roles that I was hoping I could get some help with.

 

1. On my daily patient list, I see the different types of diagnoses (admitting/working/primary/discharge), my question is do PA's make updates to those diagnoses independent of the attending physician assigned to those patients? For example let's say a patient is admitted from the ED with an admitting diagnosis of X, once on their assigned floor, a PA orders test A and determines another likely diagnosis, will the PA update the status of that patient with what he believes to be the new diagnosis without discussing it with the attending?

 

2. This may be a dumb questions, but do PA's admit patients from the ED? Is it a state by state issue?

 

3. I know there are state laws in place for PA scope of practice, but are there any national laws in place as well? 

 

I apologize if these have already been answered on this forum but I haven't been able to find them.

[wesr_gordon]

I currently scribe for a hospitalist group doing internal medicine.

 

The PA's in the group are primarily responsible for admitting patients from the ER where they do determine diagnoses and order tests, etc. From what I've seen the attending later adds or takes away from these after they sign the chart but the PA has autonomy until then.

 

If they aren't admitting they do help the physicians round and similarly will alter the course of treatment later signed by the attending.

 

So in the end the attending signs off and either agrees or alters the treatment plan. The physicians discharge, so the final diagnoses are made by the attending.

 

This is how it works with my physician group in Denver but it may be different elsewhere - hope it helps.

[andersenpa]

Hi All,

 

I'm working as a nurse aide in a hospital and considering PA school. I have shadowed a couple of PA's but am left with a couple questions regarding their roles that I was hoping I could get some help with.

 

1. On my daily patient list, I see the different types of diagnoses (admitting/working/primary/discharge), my question is do PA's make updates to those diagnoses independent of the attending physician assigned to those patients? For example let's say a patient is admitted from the ED with an admitting diagnosis of X, once on their assigned floor, a PA orders test A and determines another likely diagnosis, will the PA update the status of that patient with what he believes to be the new diagnosis without discussing it with the attending?

 

2. This may be a dumb questions, but do PA's admit patients from the ED? Is it a state by state issue?

 

3. I know there are state laws in place for PA scope of practice, but are there any national laws in place as well? 

 

I apologize if these have already been answered on this forum but I haven't been able to find them.

 

Some of my answers regard practice in WA state

PAs can enter and modify the inpatient diagnosis list. This is a dynamic list and the autonomy to do this will sometimes be prescribed by the relationship between the PA and SP. Establishing a dx list is a fundamental part of the PA's practice of medicine, and I would hesitate to work with a doc who restricted a PA form doing this (unless it was a new grad situation).

PAs can admit as delegated authority. I have not seen PAs admitting under their own name for a formal 24hr+ inpatient admission, but they can certainly admit to the attending, write orders, initiate workup etc

The national laws are the CMS restrictions. Homecare prescribing is the hot button issue example of this. For the msot part though the federal restrictions are limited and the bulk of what drives PA scope is at the state and institutional/practice level.

 

Matt

[hereandnowiamu]

As previously noted, the role of the PA is dependent upon the group and state of practice.  In Illinois I was an inpatient scribe for a hospitalist group and the PA's acted just as an attending and did not require an attending to sign the note.  They rounded on their own and had their own patients.  Newer NP's or PA's had the attending see patients afterwards and sign their note or change the treatment and sign the note.