NP protocols

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    Hi, Everyone.

    I imagine this has been asked before, so I apologize for the redundancy. My question is about protocols for nurse practitioners. Can someone explain what they are/how they work/give an example? I've heard it referred to as "cookbook medicine." Is this an accurate description? Do all NPs follow protocols? Is it true that physician assistants aren't confined by protocols? Is "confined" the right word? (do NPs see protocols as limiting what they are able to do?)

    Thanks!
  2. 4 Comments so far...

  3. 2
    Depends on the state... Some states NPs and PAs have protocols others they don't.

    For example in California a NP does not have a scope of practice, rather all advanced functions are done under standardized procedures. Jump state lines to Arizona and there is no legal requirement for protocols or physician involvement.
    menetopali and ILoveIceCream like this.
  4. 0
    I do not see my protocol as limiting, it is between your supervising MD and you so whatever you are comfortable with can be in the protocol. It also can be changed at any time. I think a sample is available on the AANP site
  5. 1
    Quote from ILoveIceCream
    Hi, Everyone.

    I imagine this has been asked before, so I apologize for the redundancy. My question is about protocols for nurse practitioners. Can someone explain what they are/how they work/give an example? I've heard it referred to as "cookbook medicine." Is this an accurate description? Do all NPs follow protocols? Is it true that physician assistants aren't confined by protocols? Is "confined" the right word? (do NPs see protocols as limiting what they are able to do?)

    Thanks!
    There are a few states that require NP protocols. However, in reality this rule is so broad as to be useless. For example in Georgia NPs with prescriptive authority need a protocol for medications. The board uses the following protocol as an example:
    APRN may refer to and use the following guidelines (in their latest, current edition)
    when treating and managing patients pursuant to this Agreement:
    i. Uphold and Graham, Clinical Guidelines in the Family Practice.
    ii. Sanford, Gilbert and Sandle, Guide to Antimicrobial Therapy.
    iii. Danbro, Williams & Wilkins, Griffith’s 5 Minute Clinical Consult.
    iv. Schwartz, The 5 Minute Pediatric Consult.
    v. Colyar, Ehrardt, Ambulatory Care Procedures.
    vi. Uphold and Graham, Clinical Guidelines in Child Health.
    vii. Physician’s Desk Reference.

    So if its not in one of these references (unlikely) then you couldn't prescribe it. Theoretically you could get in trouble for off label use of a drug but again enforcement is unlikely (and to use it you would simply have to amend the protocol with a paper showing the off label use).

    Other examples of protocols I've seen used are the Washington manual or Harrison's. Again so broad as to be meaningless. There are one or two states where PAs have to use protocols in a similar manner.

    Basically protocols are mostly bureaucratic red tape that no one pays attention to once they are filed.

    David Carpenter, PA-C
    kanzi monkey likes this.
  6. 0
    Quote from core0
    There are a few states that require NP protocols. However, in reality this rule is so broad as to be useless. For example in Georgia NPs with prescriptive authority need a protocol for medications. The board uses the following protocol as an example:
    APRN may refer to and use the following guidelines (in their latest, current edition)
    when treating and managing patients pursuant to this Agreement:
    i. Uphold and Graham, Clinical Guidelines in the Family Practice.
    ii. Sanford, Gilbert and Sandle, Guide to Antimicrobial Therapy.
    iii. Danbro, Williams & Wilkins, Griffith’s 5 Minute Clinical Consult.
    iv. Schwartz, The 5 Minute Pediatric Consult.
    v. Colyar, Ehrardt, Ambulatory Care Procedures.
    vi. Uphold and Graham, Clinical Guidelines in Child Health.
    vii. Physician’s Desk Reference.
    A few of these are in my protocols... They will be checked when one is being audited! If one has it on the list/protocol one better have easy access to it.

    So if its not in one of these references (unlikely) then you couldn't prescribe it. Theoretically you could get in trouble for off label use of a drug but again enforcement is unlikely (and to use it you would simply have to amend the protocol with a paper showing the off label use).

    Other examples of protocols I've seen used are the Washington manual or Harrison's. Again so broad as to be meaningless. There are one or two states where PAs have to use protocols in a similar manner.

    Basically protocols are mostly bureaucratic red tape that no one pays attention to once they are filed.
    Until the crap hits the fan....

    David Carpenter, PA-C
    Overall I would have to agree....

    I have a list of texts, etc.
    I have a lists of doctors..
    I have a lists of limitations... The word limitations may raise up red flags for some but in one instance for me its a God send.

    Three different employers with three different protocols but I made sure each one has the same basic bones.

    Protocols can scare you, they can burden you, they can help you but if in the mind of the user their is doubt and there is no communication with the MD they are useless and may be harmful.


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