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Hospital Bylaws that Favor NP Over PA


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I've been discussing a new critical care position with a CMG that is taking over for a private group at a mid-sized hospital in my area. They posted the job as NP or PA and I had a great phone interview with the regional medical director and have been keeping in touch with the recruiter over the past few weeks as they schedule interviews for the site director prior to conducting APP interviews.

I received an email yesterday that the hospital bylaws "make it nearly impossible" for PAs to practice in the ICU, as in they would need orders cosigned before they would be active, would not be able to do invasive procedures, and that these restrictions somehow don't apply to NPs. I know there are PAs working in the hospital, specifically in ortho and cardiac surgery, but it is a nurse and NP heavy institution.

I've reached out to my state organization to see if they have any guidance on this, but in the meantime, no interviews with PAs are being scheduled. I'm not sure there's any other recourse for me, but I wanted to throw it out to the group and see if others have had similar experiences.

I've heard of hospitals being regressive on both NPs and PAs but I've never encountered an institution that specifically favored one over the other in terms of autonomy and credentialing. 

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Yeah where in the world is this hospital? I haven't heard of such a regressive place in a long long time.

I seriously doubt that all orders would need to be co-signed. Wonder where this information came from? I live in the PNW, my wife was speaking with a recruiter for a large hospital system who said they wouldn't hire a PA because the nurse manager told them a physician had to be on site at all tkmes.

Sometimes the messenger is an idiot. I'd delve deeper.

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On 5/23/2019 at 11:00 PM, bike mike said:

Horrible place to work for a PA. Believe me....I know. 

That's really sad, considering that the NP/PA students do the vast majority of their classes together at that institution? I would think it would a great place for PAs. That's a shame.

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There are some PAs inpatient, mostly in ortho and CT surgery. This is in Virginia, where NPs do now have autonomy starting next year if they have 5 years experience and some other criteria, but I think this is unique to this hospital system's bylaws, and I'm not sure the problem yet, except that perhaps the leadership team is looking out for their own. More to follow.

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9 hours ago, narcan said:

There are some PAs inpatient, mostly in ortho and CT surgery. This is in Virginia, where NPs do now have autonomy starting next year if they have 5 years experience and some other criteria, but I think this is unique to this hospital system's bylaws, and I'm not sure the problem yet, except that perhaps the leadership team is looking out for their own. More to follow.

Why did the VAPA oppose, or impose more limits on OTP last year at the AAPA meeting, given what you said above about NP’s? OTP is still not same as autonomy and  didn’t they want it more restrictive. Who are your Virginia PA leaders looking out for? Certainly doesn’t appear to be PA’s. Just sickening! 

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We had the same problem at a hospital here in Texas.  We had to get our state chapter involved and claim the restriction of trade.  They were making this decision based on a nursing position statement that the Board of Nursing posted on the website.  The admin, that was made up of all nurses with the exception of the legal counsel and the CMO, stated: "we have to protect our nurses."  Our state chapter reached out to the medical board and basically pointed out that the nurses are deciding who can practice medicine in our state.  That caused a meeting between the medical board and the nursing board, and hence that position statement was heavily edited.  The nursing board now recognizes PAs.  

We then went back to the hospital admin that then tried to blame it on corporate.  When the state chapter lawyers contacted corporate they had no idea what that hospital was talking about.  Eventually, we were given parity with the NPs at that hospital.  The nursing admin was not happy about that, and neither was the head of the medical privilege office which was run by an RN.  The key was the help we got from our state chapter.  I will say this little hospital in Texas was educated and credentialing from Baylor and MD Anderson considering PAs and NPs was shown to them on paper.  I had the CMO and CNO say "that is them and this is our hospital."  They did make it sound like their hospital was better than either Baylor or MD Anderson.  Basically, they did not want to be educated  The only thing they responded to was a legal counsel to legal counsel discussion.  It is the main reason why I choose to get involved in the state chapter.  The difference was that I was already on medical staff there and not trying to get a job.  This may be worth going to your state chapter or asking why you need a co-signer.  In our state, we have no OTP but NPs are not independent.    Neither requires a co-signature unless admitting or discharging.

I should add that the NPs in the hospital were not opposed to us and even the RNs were happy to take orders from us.  The RNs in our department also signed a petition.  Our obstacle was the RNs in administration.

Edited by NeoTrion
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yes when this happened it was to restrict NPs from giving verbal orders to MAs...a clear act of protectionism for LVNs. It was absurd. The CNO of this giant corporation actually wrote in an email "most states consider PAs and NPs to be the same thing so this rule should apply to PAs as well."

My head almost exploded. After 3 months of trying to correct this error I too had to draw the lawyer/restriction of trade card. The problem was solved in a couple of weeks.

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I did speak to my state chapter the other day and was basically told, "well it's a private organization, so we can't do anything". What they did offer to do was generate language to take to administration to ease their burden in changing the bylaws. I'm still waiting to get a copy of the actual bylaws, so I can see for myself what's fact and what's not and go from there.

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There was a telemedicine job I saw posted the other day that specifically said "Doctors and independent NP's" only.  "No Physician Assistants".  It went on to explain that they do not hire PA's because they require supervision and a co-signature.....

 

I've never really seen it so "spelled out" before on a job ad.  Sigh...

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9 hours ago, Cideous said:

There was a telemedicine job I saw posted the other day that specifically said "Doctors and independent NP's" only.  "No Physician Assistants".  It went on to explain that they do not hire PA's because they require supervision and a co-signature.....

 

I've never really seen it so "spelled out" before on a job ad.  Sigh...

Absolute  sigh!!!!!!  Yet there are PA’s who speak against OTP and autonomy similar to NP, or want to pussy foot to not upset others. It is not the Nursing groups killing the PA future, can’t blame them, why shouldn’t they set back and enjoy the suicide PA’s have committed from within.

if you look at job postings across the US you will see this more than likely expected. Or if not blatant on posting, try applying to jobs in some states with NP FPA, likely to be shut down on many other than specialties that by nature need oversight. For those that say fine, that’s all PA’s should do, I hope you are kicked out of a specialty job in your prime because your supervisor or hospital can find some young PA for half the price, likely we’ll accept well below the current average to pay off enormous debt. They have incurred. 

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