Emergency department triage nurse practitioners (adopted by many hospitals for several reasons).
By ordering labs, xrays at triage for physician assitants and MD's practicing on same patient after the patient is admitted to the main ED (emergency department)-utilizing no other advanced practice skill set- are these nurse practitioners practicing beneath scope of practice expectation for NP's (nurse practitioners)? Orders are co-signed by MD. Sometimes orders are cancelled or cancelled and then re-entered and "added to" by other midlevel or MD.
Safety and reimbursement are partial keys for placing NP at ED triage. If a fast track is not added or other patient services implemented-how can a broader more appropriate scope of practice be created for these advanced practice nurses taking these positions?
Please comment ASAP! Thanks.
Feb 11, '12
In your example, I don't see any "scope of practice concerns" the way the NP is utilized in this ED's triage area. It sounds like they practice pretty much like any other triage RN who is not an APN (i.e., they can order tests but these are later signed by providers once they are assigned to the main ED and a formal Evaluation and Management is done). It even sounds like the NP in this case is underutilized. The main argument for ED's to assign a provider in triage is to improve patient flow from triage to ED and to decrease incidence of patients leaving before being seen (thus, resulting in better revenue capture and better patient satisfaction with the ED experience). It will be beneficial if the triage NP can perform Evaluation and Management right there in triage. This is a better use of the NP's advanced clinical skills. Some patients seen in triage can even be discharged by the NP and not have to go through the main ED.