NP's in the ED

erjulie · Jan 10, 2006

I'm not an NP, wish i were, actually..

Our ER started using PA's about 5 years ago. Many ER RNs were insulted by this. The Medical Staff decided they would rather go with PAs. The ER docs weren't actually consulted, but I think they had input. The ER docs contract is held by the hospital (i.e. Medical staff). I'm an OLD feminist, but it seems to me to honor the employees who make up probably 75% of your professional staff, and do probably 98% of the actual work, you'd hire from that same profession, i.e. Nurse Practitioners. I like our PAs, but some have the attitude thing going...and you know, their education is way different from ours, and one admitted to me that it was sorely lacking. And he went to a great school! I would welcome NPs into the ER, but don't have that opportunity. To top it off, the PAs can't even do what they're educationally prepared for, so they merely add another level of care (or layer to get through) in the ER. Some insurances won't reimburse for them, so that the patient eats that bill. Doesn't make sense to me...

ED RN 911 · Jan 10, 2006

As I have stated before, our ER rely alot on Paramedics, and they actual have two different classifications for them. They have about the same ratio of nurses to medics, and they operate off of the same job discription as the nurse, so basiclly they are the same as nurses, you would never tell the difference for a nurse or a medic taking care of your loved one.

We used to have a NP and a PA and about a year ago they phased them both out and the Doctor group that staffs our ER elected to bring on Physician-Extender Paramedics. They operate under the MD licenses and can essenitally do what ever the MD lays out to be in their scope of practice. They do see Patients on their own, orders labs, Rad. and Meds, and consults with the MD when needed. They can do every prodecure the MD does and they even make out Rx's to be co-signed (mostly with a rubber stamp) by the MD.

We did go around and around with the hospital at first, but it was proven to staff that they were a extender of the MD. They have actually been working out fine, and to my knowledge, insurance has never turned a bill down for payment.

Trauma Columnist · Jan 10, 2006

I am finishing a CNS in May and would like to work in the ER where I now work. Unsure how that will fit with the teaching hospital issue, so will have to see.

soliant12 · Jan 10, 2006

I'm suspicious of this post. This same info was posted a couple of months ago and the poster was banned. I see you just joined this month just a coincidence or is the banned poster utilizing a new account?

As I have stated before, our ER rely alot on Paramedics, and they actual have two different classifications for them. They have about the same ratio of nurses to medics, and they operate off of the same job discription as the nurse, so basiclly they are the same as nurses, you would never tell the difference for a nurse or a medic taking care of your loved one.
We used to have a NP and a PA and about a year ago they phased them both out and the Doctor group that staffs our ER elected to bring on Physician-Extender Paramedics. They operate under the MD licenses and can essenitally do what ever the MD lays out to be in their scope of practice. They do see Patients on their own, orders labs, Rad. and Meds, and consults with the MD when needed. They can do every prodecure the MD does and they even make out Rx's to be co-signed (mostly with a rubber stamp) by the MD.
We did go around and around with the hospital at first, but it was proven to staff that they were a extender of the MD. They have actually been working out fine, and to my knowledge, insurance has never turned a bill down for payment.

sailornurse · Jan 10, 2006

[elected to bring on Physician-Extender Paramedics. They operate under the MD licenses and can essenitally do what ever the MD lays out to be in their scope of practice. They do see Patients on their own, orders labs, Rad. and Meds, and consults with the MD when needed. They can do every prodecure the MD does and they even make out Rx's to be co-signed (mostly with a rubber stamp) by the MD.

I too am suspicious of this post. What state are you in? The scope of practice you have described is practicing medicine which Paramedics are not trained to do. They are trained as first responders, not primary care or urgent care providers which is where the Physician Assistant & NP's are trained. Our local Er's used FNP's ( only FNP's not Adult or Pediatric NP's) to do Fast track, but in this state, New Mexico, (we) NP's have full independent practice with full prescriptive priviledges.

LeahJet, ASN, RN · Jan 10, 2006

you would never tell the difference for a nurse or a medic taking care of your loved one.

I hate to be contrary but am somewhat suspicious of this poster also.

"RN" is in the nickname but this person is highly pro-medic in previous posts and has even made the above claim in another thread. Which, by the way, I find hard to believe....the fact that medics are assigned exactly in the same capacity as RN's.

But to answer the OP's question.... yes, we have a NP working in the Fast track of our ER. It really works out beautifully most of the time. She/He works under the MD that is working in the Main ED and the MD is always there for teh NP to consult if needed.

tiredfeetED · Jan 11, 2006

Our ED uses both NPs/PAs. They work in the main ED and fast track. They see everything and do a great job. Our PAs are sharp, perform almost every procedure are MDs do and truly listen to the RNs. I know in our area NPs are sought after so go for it!

WhitDogg19 · Jan 14, 2006

"I'm suspicious of this post. This same info was posted a couple of months ago and the poster was banned. I see you just joined this month just a coincidence or is the banned poster utilizing a new account?"

I'm sorry - I tried to find some information on the topic before, but I hadn't been able to find it. I have been a member for longer than a month, I have never been banned, and I am not someone using a new screen name. Frankly, that was a little rude. Anyway, the information that was quoted by soliant12 was not even really relevant. I was asking about NP's, not paramedics, and thank you, I understand the difference and the scope of practice.

For those that were a bit more supportive, thank you very much for the information! I am thrilled that NP's are being utilized in hospital ED's! I wasn't sure if they were, which is why I asked. They always say that there isn't a dumb question.

Keep up the good work everyone!

WhitDogg19 · Jan 14, 2006

By the way, someone asked where I will be practicing - I live in Massachusetts.

veegeern, BSN, RN · Jan 14, 2006

I don't work in the ED, but I have been pulled there. We have 3 rooms set up like a physician's office - Fast Trak. The patients that sent here by triage see the NP. All others are seen by the MD.