Published Jun 29, 2009
Are there any NPs floating around here who do median nerve blocks? I have been talking to a local chiropractor about a position, but I am just not entirely sure about the legality and other issues. I would have a collaborating physician, but he/she would not be on-site. The collaborating doc is going to be hired by the chiropractor to be the official "chart signer" and not much more than that. I know there are NPs working in pain management who do median nerve blocks, but I wondered about being the only person in the office able to do them, with no on-site backup.
The chiropractor is doing a one million dollar office add-on, with three OR rooms and fluoroscopy, and I think the potential is there for a really cool job, if it were all legit.
If it is a skill you are competent to preform I would not worry about being the only one in the office who can do the procedure. I have many days that I am the only one in an office that can do specific procedures. Are you competent to preform the procedure and handle complications if so I would not be concerned. Just make sure you are acting within your state requirements.
Out of curiosity, what is the chiropractor doing that he needs an OR room or for that matter a median nerve block? Can Chiropractors do surgery?
I'm kind of with wowza here when asking why on earth would a chiropractor be doing nerve blocks? As far as I know, that's not even within a chiropractor's scope of practice-- I thought that was something mostly pain docs and anesthesiologists did. And if something goes wrong, who is going to help you?
The other thing to consider is this considered in the scope of the CRNA in your state. Or do you live in one of the few states where pain medicine is the practice of medicine and outside the scope of practice for NPs. Both would influence the legality. Your state BON might be able to give you some guidance.
This chiropractor sounds fishy to me. They are not even allowed to give an injection or break the skin in any way, or prescribe. So what is with the OR's and all this stuff that is obviously out of the chiro's scope of practice? Are there going to be MD/DO's involved in this? It's also fishy when someone says the doc is just going to be the "chart signer" and not involved on a level well enough to reduce any liability or be there for consults, etc.
I think the chiropractor is actually good in buisness. Anyone can own an ambulatory surgery center, then once it is accredited pain injections are often reinbursed at a greater level if done at an ASC rather than office setting. The DC will just own the building, and collect facility fees for procedures done there bu MDs, NPs or PAs.
For NPs and PAs in independant practice paying a consulting physician to sign charts and review cases is common to meet state law requirements. Hopefully the physician will understand pain management procedures and serve as a resource for the NP with meetings for discussions and phone contact. If a provider is good at a technical procedure it is still worth having someone to talk to about other options. At my facility we do a lot of blocks (I do not preform them as a NP) for patients that they work they are great but be prepared to have significant interaction with patients who don't respond (I do get this job as the NP).
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