Discussion about Cardiology NP reading stress tests

allnurses Guide · Dec 22, 2013

What is your question?

automotiveRN67 · Dec 22, 2013

Less of a question and more of a review of current practice. I am looking for other NP's who are doing this, or not doing this, and their experience. Whether their work is cosigned or not, and whether, the readings, when questioned, will stand up. There really isn't any rules for NP's for this. Fellows perform and read roughly 300-350 stress tests while being monitored by attending. I learned in a similar fashion, but I am wondering if I still need reports cosigned, and how to validate my competency.

Advanced Practice Columnist / Guide · Dec 22, 2013

That would be institution dependent. Like you said there are no hard and fast rules when NPs perform any procedure (including stress tests) because we could bill for them. Regulatory entities, however, can come down on an institution that has no explicit policy on NP practice including how they are credentialed for procedures. This includes TJC or the former JCAHO.

What is the typical practice is that if NPs are going to be independently performing procedures, there should be a policy on how many procedures can be done before the institution can determine competency. This should be well documented. There should be annual quotas and minimums. Different types of NPs at our institution perform procedures independently from bone marrow biopsies to lines to conscious sedation.

Such NPS have to log in their procedures for the institution to monitor that 1. They have met the minimum required to be deemed competent and 2. They are continuing to be competent by meeting annual minimums. This sounds like something you can propose.

automotiveRN67 · Dec 22, 2013

Thanks for your information. That's what I am figuring out also. I have my own stress lab now, within our group, so it is strictly outpatient under our rules. I was hoping to run across someone else who has done this. My plan is to continue to have my work cosigned, and show competence by having not only my own cardiologists but a cardiologist who is independent of my practice review my work. We do the same when other cardiologists read stress tests also.

If I am understanding it correctly, I think I need to:

1. Write a specific policy including oversight provisions and third party review requirements

2. Keep reports of how many stress tests I do vs our other cardiologists

3. Have my oversight cardiologist write an attestation of my competence

4. Show education process and continuing education

Is there anything else you can think of?