Collaborative Agreement PA

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Specializes in Community Health.

Hi!

I started my new FNP position today at a rural FQHC. I will be "shadowing" for about 2 weeks. Problem is that none of the MDs want to sign a collaborative agreement!! The Medical Director is at a conference until next week. My question is...Is there any liability for the MD? It was to my understanding that I would be held responsible for any mishaps??? Help???

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Specializes in Community Health.

I must add that they have never had a NP work at this facility.

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Specializes in Psychiatric Nursing.

I am not sure if you can work at all without a collaborative agreement...I just dont know...you are technically acting as an advanced practice nurse even if you are orienting...I would check with your BON

Maybe the agreement could be done by fax with the medical director who is at the conference. Is there an administrator at your facility...

I have had MD's not want to sign collaborative agreements....They are technically not liable, I dont think. Bu i think they think they are liable...

I dont know why the MD lobbies are so against independent APRN prescribing and then do not want to sign collaborative agreements...

It is easier if everyone has their own independent licenses..

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Specializes in Community Health.

I agree. Technically, I am just shadowing. So I am not seeing any patients yet. I think I can work as long as I have a PA NP license (which I do). I'm just not any good to anybody w/o prescriptive authority.

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Specializes in DHSc, PA-C.

Yes, there is liability for the MD. If there wasn't, then you wouldn't need a collaboration agreement in order to work. You should take some time to read over the rules/regulations of your state before beginning any practice. As they say, just because you don't know the rules, doesn't mean you don't have to follow them. From what I'm reading about PA, you can't work at all until you have this agreement. 049 Pa. Code  18.55. Collaborative agreement.

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Specializes in Community Health.

I've read the PA code cover to cover. And it does not say there is any liability for the MD. It does, however, say that I would need a collaborating physician meaning whoever signs the agreement agrees to be available to collaborate with me for questions (either in person or via phone). It also outlines the specific drugs that are within my scope of practice. If the collaborating physician is not available, then there should be a second physician available. I have my own prescribing number, DEA number and therefore I'm responsible for my actions.

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Specializes in DHSc, PA-C.

Basically, you can't work without a collaberating physician. So, if you get sued for something you can bet on your collaberating physician being named in the suite. Especially if you prescribed something incorrectly or out of your scope or if s/he wasn't available when you should have collaberated or if you failed to collaberate as required. PA's and NP's have there own prescribing numbers and DEA number all over the country....that doesn't mean you're independent every where. Unless the state law says you are an independent provider, you're not and your doc will get named along with you. You should ask your nursing board directly.

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Specializes in Psychiatric Nursing.

At one place I worked the doc designated as my collaborating physician had to get extra to supervise an APRN. I don't know how often lawsuits against APRNs also name the collaborating physician.

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Specializes in Community Health.

I think I will ask the nursing board directly. Thanks

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Specializes in Community Health.

I agree that the collaborating MD may or may not get named in a lawsuit. I also believe the RN, MA or anybody else involved with the patient will also get named. I think people mistake "supervise" with "collaborate". There are some states with collaborative agreements that require a litte more physician involvement then other states. So there would be a little more detail in their agreement. PA is not one of those states. I will check on it.

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I am a legal nurse consultant and a Nurse Practitioner. The collaborating MD IS NOT LEGALLY LIABLE for the NP's actions. To prove malpractice a patient must prove the following 4 elements of negligence:

1. DUTY - the patient must prove that the MD had a duty to care for the patient.

2. BREACH of standards of care.

3. INURY to the patient.

4. CAUSAL RELATIONSHIP - the patient must prove that the negligence caused the patient's injury.

If the Standardized Procedures, comprised by the NP & MD, clearly state the MD's role as a consultant only. Therefore, if the MD does not give any orders, does not co-sign any orders or prescriptions, and does not ever personally see the patient, then the MD never establishes "DUTY" to any of the NP's patients and therefore cannot be held liable.

NPs must have collaborating MDs (not supervising or co-signing MDs) in 42 states to clearly recognize that the NP's scope of practice extends in part into medical practice. The Standardized Procedures are to establish that an MD is available as a consultant when the NP is in need of one while practicing medicine within a limited scope of practice.

[in the other 8 states NPs are completely autonomous]

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Specializes in Nursing Education, CVICU, Float Pool.
I am a legal nurse consultant and a Nurse Practitioner. The collaborating MD IS NOT LEGALLY LIABLE for the NP's actions. To prove malpractice a patient must prove the following 4 elements of negligence:

1. DUTY - the patient must prove that the MD had a duty to care for the patient.

2. BREACH of standards of care.

3. INURY to the patient.

4. CAUSAL RELATIONSHIP - the patient must prove that the negligence caused the patient's injury.

If the Standardized Procedures, comprised by the NP & MD, clearly state the MD's role as a consultant only. Therefore, if the MD does not give any orders, does not co-sign any orders or prescriptions, and does not ever personally see the patient, then the MD never establishes "DUTY" to any of the NP's patients and therefore cannot be held liable.

NPs must have collaborating MDs (not supervising or co-signing MDs) in 42 states to clearly recognize that the NP's scope of practice extends in part into medical practice. The Standardized Procedures are to establish that an MD is available as a consultant when the NP is in need of one while practicing medicine within a limited scope of practice.

[in the other 8 states NPs are completely autonomous]

Thanks

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