Hospital Bylaws

[quarternote]

I currently practice in South Carolina as a Hospitalist.

 

We are in the process of changing our hospital bylaws to be more progressive interns of midlevels. We have made some good changes but have a ways to go. This not only pertains to hospitalist PA/NP but to other specialities as well.

 

Do any of you who may work in a more progressive for midlevels/NPP's hospital have access to a copy of your hospital bylaws so that we may see some examples as to how other hospitals do this.

Thanks for any help. You can PM me if you would rather and I'll give you my email address.

[andersenpa]

First off don't use the term ""Midlevel" If you describe yourself as being in the "mid" or below anything then that is the way you will be treated.

If you are trying to describe BOTH PAs and NPs then it is tought. You have to avoid terms that refer the practicing medicine since NPs dont do that (by their own description).

 

If you are serious about your direction contact Josanne Pagel at celveland clinic. She created their PA services dept and was (may still be?) the director. She has some good info for organizing the oversight and steering of PA utilization.

[Hemegroup]

First off don't use the term ""Midlevel" If you describe yourself as being in the "mid" or below anything then that is the way you will be treated.

 

If only the DEA didn't designate us as a "MLP".

[quarternote]

I will, Thank You Anderson. I do not normally use the term midlevel but did slip back here. I have taken to using the term Non-Physician Practitioners, NPP's as we have both NP & PA's at our hospital.

Again, Thank-You! I will let you know how this works out for us.

Kim

[jdtpac]

First off don't use the term ""Midlevel" If you describe yourself as being in the "mid" or below anything then that is the way you will be treated.

If you are trying to describe BOTH PAs and NPs then it is tought. You have to avoid terms that refer the practicing medicine since NPs dont do that (by their own description).

 

If you are serious about your direction contact Josanne Pagel at celveland clinic. She created their PA services dept and was (may still be?) the director. She has some good info for organizing the oversight and steering of PA utilization.

 

I would also add AAPA has an online community for PAs in administrative roles in hospitals(Physician Assistant Administrators Managers and Supervisors) and you can contacting Ellen Rathfon at the Academy (ellen@aapa.org)or by sending an e-mail at PAAMS@aapa.org. you can use this group to network and share information.

 

How large a hospital are practicing in? There are several institutions around the country that have integrated both APNs and PAs into the same department, functioning in the same role, receiving the same compensation and they've been functioning quite well.

[quarternote]

It is a 420 bed hospital in South Carolina. We have both PA's and NP's working and we all work well together. Problem is our bylaws were written 30 years ago and we are in the process of rewriting them.

Thank you for the information. This has been very helpful.

[EMPAhopeful]

I will, Thank You Anderson. I do not normally use the term midlevel but did slip back here. I have taken to using the term Non-Physician Practitioners, NPP's as we have both NP & PA's at our hospital.

Again, Thank-You! I will let you know how this works out for us.

Kim

 

Why not "Advanced Practice Clinician/Provider" or something like that, instead of defining yourself by what you're not ("non-physician")? Just a thought.

[Joelseff]

Why not "Advanced Practice Clinician/Provider" or something like that, instead of defining yourself by what you're not ("non-physician")? Just a thought.

 

You down wid APP? LOL. Sorry couldn't resist.

 

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[sbellin]

I’m interested in what you find out. Our hospital also is in the process of re-writing the By-laws. I am pushing for the maximal allowance that State and Federal law allow but this requires research into those laws. Here in Washington State the law only really limits you to not work beyond the scope of the sponsoring doc(s). Being a Critical Access Hospital, CMS places some and removes other restrictions; such as PA’s can be on the Medical Staff but CMS restricts PA’s from holding the Chief of Staff position.

Another avenue to look at is how PA’s are privileged and credentialed since By-laws may refer to scope of practice. I’ve included the rough draft of the proposed privileging for PA’s here. This same format would apply could NP’s but with pertinent changes in the education and certification. The procedures may be limited but we are not a big facility either.

Also, I went to a PA Hospitalist course at Scott&White Hospital in Temple, Texas last month and they seem to have a progressive PA Hospitalist program. Dr. Santosh Reddy spearheaded the PA service there and seemed very open to accept questions on PA utilization from other facilities. You could look him up there and give him a call. Good luck.

 

PHYSICIAN ASSISTANT INITIAL APPPOINTMENT REQUIREMENTS:

Basic Education/Certification: Graduation from a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) and certified by the National Commission on Certification of Physician Assistants (NCCPA).

Required Previous Experience: Provision of inpatient care to a minimum of 60 patients in the past 24 months. Some clinical activity must be documented within each of the 24 months. For individuals that have completed training within 24 months current clinical competency must be verified by the applicant’s program director or if there is no documented previous experience attestation of clinical competency by their supervising physician.

Supervision: Application for privileges must be accompanied by a letter of recommendation from a physician or physicians that will be supervise and be responsible for the physician assistant while performing patient care at Ocean Beach Hospital. Changes in supervising physician(s) will require a resubmission of Core Privileges form and re-approval of the credentialing committee.

REAPPOINTMENT REQUIREMENTS:

Meeting the requirements of documented clinical activity as outlined within the Medical Staff Bylaws and/or Medical Staff Policies and Procedures within the scope of core privileges requested, without significant quality variations identified.

GENERAL INSTRUCTIONS:

Applicants who limit their practice to general internal/family medicine need only complete the privilege request form. Applicants whose practice incorporates the addition of sub-specialties must complete a sub-specialty request form.

A representative but not conclusive list of internal medicine/ family medicine procedures is stated below. It is expected that other procedures and problems of similar complexity will fall within the identified core and special privilege requests and are not within the scope of listing.

Privileges are awarded to the physician assistant in conjunction with Chapter 246-918 of the Washington Administrative Code (WAC) that limits physician assistants to not practice beyond the scope or specialty of their supervising physician(s).

General Physician Assistant Core Privileges:

Core privileges include admission, work-up, consultation, and providing non-surgical treatment for general medical problems. Core privileges also include surgical assisting, management and closure of uncomplicated lacerations, wound and ulcer debridement, management of uncomplicated fractures not requiring major manipulation, reduction of uncomplicated dislocations of upper and lower extremities, excision and biopsy of uncomplicated cutaneous and sub-cutaneous lesions, and providing local and digital nerve blocks.

Core privileges include the following procedures:

Thoracentesis

Lumbar puncture

Arthrocentesis

Paracentesis

Arterial line placement

Central line placement

Electrocardiography

Cardioversion

Holter monitor interpretation

Ventilator management

Peripherally Inserted Central Catheters (PICC)

Incision and drainage of abscesses

Procedures that fall within the scope of Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS).

PLEASE DRAW A LINE THROUGH ANY PRIVILEGES OR PROCEDURES THAT YOU DO NOT WISH TO REQUEST.

Procedure Special Requests:

Procedural sedation

Chest tube placement and management

Exercise stress testing

Submit in a separate letter a request for procedural privilege not listed above.

I certify that I possess the necessary skills and expertise to justify granting a clinical privilege in each of those areas which I have indicated. I understand that in making these requests, I am bound by applicable bylaws, rules, and regulations or policies of the hospital and medical staff. I also certify that I have no mental or physical conditions that would limit my clinical abilities.

Signature ________________________________________________ Date _________________