I am hoping to get some feed back for this question, especially from New York state based APN's.
What procedures (central lines, a-lines, intubation, moderate sedation, etc) are you able to be credentialed for by your hospital?
I work in a moderate sized community hospital with antiquated medical staff policies. I am hoping to expand my credentials to include the above listed procedures, but must document that other facilities offer their APN's these types of procedures. Additionally, what process did you have to undertake to add any of these to your credential list (test, minimum number of supervised procedures, etc.)
If willing or able could you share any links to policy/ procedure manuals, or be open to a PM discussion.
Jul 8, '10
I am credentialed for all of those and more. I am cleared to place all central lines, a-lines, chest tubes, intubate, use paralytics and moderate sedation, lumbar punctures, pelvic exams, cardioversion, and more. I am sure I'm missing a lot, but its the start of a 12 hour shift. In my interview when the discussion came up as to what I should be credentialed for, they basically asked me what I was comfortable with, to which I said everything except surgery and bronchoscopy, and I think they would have put that word for word if they could!! good luck!!!
Jul 9, '10
Thank you for your quick response. In what state do you work?
I also work Emergency Medicine. I am trying to expand my role in to the ICU and have to present documentation to the Credentials Committee that I am not the only APN in the state (or world) that would be doing invasive procedures.
Jul 10, '10
It's not unusual for ICU NP's to be credentialed to perform invasive procedures. This is part of being an ICU provider. Do a search on PubMed and you'll find that there are various ICU NP roles with various abilities to perform different types of procedures. I practiced in Michigan as a Cardiothoracic ICU NP from 2005-2009. The NP's were credentialed to insert all sorts of central venous catheters (triple lumen, introducer, Swan-Ganz, Qunton), all sites of arterial line placements, chest tube placements, thoracentesis, and bronchoscopies. It wasn't much of a struggle for the NP's to be credentialed in the said procedures because the physician leadership in the department of critical care were the ones who initiated the ICU NP role in the institution. They also made sure that the NP's had adequate training and have been supervised or precepted when performing the procedures for the first time. The first group of NP's hired were sent to a SCCM-sponsored ICU procedures workshop.
I'm now in California since 2009 in the same role as an ICU NP though our priviledges and credentialing in my current role is slightly different than in Michigan because we cover more than just the Cardiothoracic Surgery ICU. Documentation of procedures performed is monitored more closely in my current job and NP's have to meet annual minimums for each procedure for the NP to be considered as proficient. We have our own hospital-sponsored procedure log via the hospital's intranet site and this is reviewed each time our credentialing renewal is up. This is more in-line with JCAHO requirements to make sure that the NP's can show that they are skilled in the procedures they are performing.
As far as you situation, it shouldn't be that hard to prove to your employers that other ICU NP's in other parts of the country perform invasive procedures. In fact, I have ICU NP colleagues in our group here in California who moved here from out of state as well and have worked as ICU NP's in states like Ohio and New York. I think that based on what I got from your post, the harder part is showing how you will be receiving the adequate training and being able to show proficiency afterwards. This is something you'll need to personally work on as far as a game plan for making the transition to doing procedures. Do you already know how to perform the procedures you mentioned and can you show proof of such claim? if not, is there a supervising physician who will take on the responsibility of training you and what is the minimum number of cases you need to perform while supervised in order to be able to do the procedures on your own?
Another thing to consider is that the standard of care for placing central venous catheters at the current time is using ultrasound guidance in finding the target vessel. Does the unit have a portable ultrasound machine for venous access and are the physicians using this technique? if so, are they willing to train you on how to use the device?
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