NeoTrion Posted December 2, 2015 Share Posted December 2, 2015 I was wondering if I could get some opinions from the forum, and maybe some advice. I work with three other PA's at an Amarillo hospital that is requiring physician co-signatures on all of our H&P's and orders including all medication orders, scheduled drugs and dangerous drugs (for those outside of Texas, 'legend' drugs are referred to as 'dangerous' drugs here in the Lone Star State). After doing some investigation the hospital does not require the same for NP's. Orders from NP's do not require a physician co-signature. As PA's we inquired with the medical staff office at our hospital asking for clarity as to why PA's and NP's have different requirements regarding co-signatures. Their responses have all had a central theme: The hospital's medical staff office is convinced that PA's have more restrictions and less privileges when compared to NP's. I work in a group with 3 other P.A.'s and although we are not the first to be employed by our group, we are the first that seem to be seeing these issues come up. We submitted the Texas Medical Boards laws and regulations, but after calling them they do state that every hospital has to interpret the words for themselves. TMB treats NP's and PA's the same. When confronted with this they then claim that the Texas Nursing Board has a rule saying that nurses cannot take orders from PA's. Obviously I found this questionable but did do some digging. All I could find was a "Position Statement" saying the following: I work in a group with 3 other P.A.'s and although we are not the first to be employed by our group, we are the first that seem to be seeing these issues come up. We submitted the Texas Medical Boards laws and regulations, but after calling them they do state that every hospital has to interpret the words for themselves. TMB treats NP's and PA's the same. When confronted with this they then claim that the Texas Nursing Board has a rule saying that nurses cannot take orders from PA's. Obviously I found this questionable but did do some digging. All I could find was a "Position Statement" saying the following: 15.1 Nurses Carrying out Orders from Physician's Assistants The Nursing Practice Act includes the "administration of medications or treatments ordered by a physician, podiatrist or dentist" as part of the practice of nursing. There are no other health care professionals listed. The Board recognizes that in some practice settings nurses work in collegial relationships with physician assistants (PAs) who may relay a physician's order for a client being cared for by a nurse. A nurse may carry out a physician's order for the administration of treatments or medications relayed by a physician assistant (PA) when that order originates with the PA's supervising physician. Supervision must be continuous but does not require the physical presence of a supervising physician at the place where the PA services are performed provided a supervising physician is readily available by telecommunications. The supervising physician should have given notice to the facility that he/she is registered with the Texas Medical Board (TMB) as the supervising physician for the PA and that he/she has authorized the PA to relay orders. The PA must be licensed or registered by the TMB. A list of physician assistants credentialed by the medical staff and policies directing their practice should be available to the nursing staff. The order relayed by the PA may originate from a protocol; if the order originates from a protocol, the PA may select specific tasks or functions required to implement the protocol, provided they are within the scope of the protocol. The protocol must be signed by the supervising physician and should be made available as necessary to verify authority to provide medical aspects of care. If the tasks or functions ordered fall outside the scope of the protocol, the PA must consult with the physician to obtain a verbal order before the nurse may carry out the order. As with any order, the nurse must seek clarification if he/she believes the order or treatment is inaccurate, non-efficacious or contraindicated by consulting with the PA and physician as appropriate. The nurse may request to review the PA’s protocol as one mechanism for clarification of orders and treatments. (Board Action: 01/1994; Revised: 01/2005; 01/2006; 01/2010; 01/2012) (Reviewed: 01/2007; 01/2008; 01/2009; 01/2011; 01/2013; 01/2014; 01/2015 ) I could not find a rule saying this other than this position statement. We have contacted some other colleagues at MD Anderson that were kind enough to send us their hospital guidelines for PA practice. Obviously they have none of the above mentioned restrictions. The colleagues at MD Anderson also put us in touch with the council for TAPA. The main issue now is actually getting the hospital to talk to the council for TAPA and the administration at MD Anderson. We were originally encouraged by medical staffing to reach out to other facilities and get this information for them. Now we are in the position now of convincing administration to even call these people for the information they requested. Does anyone have any further advice on what we can do to get these guys off their can and look at the information? Maybe ask AAPA to write a letter? Link to comment Share on other sites More sharing options...
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