Implant/Surgical Procedures

[epcathNP]

Hi,

I am a newly minted AGACNP with many years experience scrubbing and circulating in radiology and cardiac surgical/procedural areas. Currently I work with cardiac electrophysiology, seeing patients in the hospital.

My collaborating physician does many EP/ablation procedures, including implants such as PM, ICD, and loop recorders. Lately, he has broached the subject of whether an NP could do those on the simpler end of the scale: loop recorder implants. These are done in an outpatient setting with no anesthesia other than local.

I realize that all states have differing scopes of practice, and I practice in TN and KY. I find nothing to prohibit this in the states' guidelines. Am I missing something?

Thanks to all...

[traumaRUs, MSN, APRN]

You would want to find out if the hospital would agree to this. Then, usually the hospital wants a checklist to include didactic training, supervision of X-amt of procedures, etc.. They would want to know your back-up plan in case something goes wrong, etc.

For me, I know each hospital system is different.

[epcathNP]

Hi trauma,

Thanks for the reply. I realize that there will be a process for privileging for these procedures. It may even be that I do them in our office. I am particularly interested in the scope of practice aspect.

[Corey Narry, MSN, RN, NP]

You would do the same as what TraumaRUS stated minus the part where you seek approval from the Medical Staff Board since you will be performing these in the out-patient setting under your collaborating physician's approval. Most states don't delve into details about NP's performing procedures. That does not necessarily mean that you can't do them. In these situations, you want to follow what the standard is in your community and even nationally. Are there other NP's with similar roles doing similar things?

Also, you could incorporate details about these procedures in your collaborative agreement with clear protocols for how much supervision you will receive initially as well as when and how you will be deemed capable of doing these independently. Again, there should be a back up plan. What if you couldn't do the procedure (i.e., technical difficulty)? If you are trained to to do the procedure you should be able to deal with the complications or have a back up person who could. A lot of these is really just laying out the process in writing so that you are protected from liability.

[automotiveRN67]

It's just a loop recorder. Not exactly a challenge.

There is nothing in the NP scope of practice that permits or forbids this. You just have to make sure you are

1) trained correctly

2) notify your insurance provider for coverage

3) bill correctly so you can get paid

[leslie.knope]

fascinating post, thank you!

[epcathNP]

Thanks to all who replied and for the thoughtful advice.

TraumaRUS, Juan, and automotiveRN67: During my clinical rotations, my preceptors were performing invasive procedures like inserting central lines and chest tubes. However, this was at another hospital in our city. Interestingly, there are no NPs on any service in our hospital who do any type of procedure.

I'm concerned that it will be an uphill (impossible?) battle to get our request approved by our Medical Staff...but, it doesn't mean that we aren't going to try.