NP's working at teaching hospitals

Home Health Columnist / Guide · Jul 6, 2011

thomas jefferson university hospital and hospital university of pennsylvania has both medical and nursing college. crnps work in all areas and specialties including cardiology, medical oncology, internal medicine, neurosurgery, otolaryngology, orthopedics and surgical specialties.

thomas+jefferson+university+hospital nurse practitioner profiles

thomas jefferson university : department of emergency medicine

hup:

clinical care nurse practitioners

trauma nurse practitioners

oncology np brochure: nurse practitioners

transplant surgery: nancy p. blumenthal - profile

urology co-director, penn center for continence and pelvic health: diane k. newman, msn, crnp

many np's used in academic university hospitals in my area serving in key roles. several were pioneers in establishing this role.

mammac5 · Jul 6, 2011

Vanderbilt University Medical Center has a LARGE NP practice network. Many of the inpatient NPs teach the residents in their individual fields of specialty.

TicAL · Jul 7, 2011

Vanderbilt University Medical Center has a LARGE NP practice network. Many of the inpatient NPs teach the residents in their individual fields of specialty.

Unless you are referring to unofficial teaching (the same way that RNs can show residents how to put in IVs, etc), NPs can't teach the residents (for legal and other reasons). Not even attendings from other specialties are allowed to oversee residents (unless the resident is rotating through their service). From what I've seen, the midlevels function similarly to 1st and 2nd year residents by taking care of floor work, writing orders, answering pages, etc.

core0 · Jul 7, 2011

Unless you are referring to unofficial teaching (the same way that RNs can show residents how to put in IVs, etc), NPs can't teach the residents (for legal and other reasons). Not even attendings from other specialties are allowed to oversee residents (unless the resident is rotating through their service). From what I've seen, the midlevels function similarly to 1st and 2nd year residents by taking care of floor work, writing orders, answering pages, etc.

Thats incorrect. An NP (or PA) cannot bill for the work that a resident does (while a physician can) but there is nothing that prevents them from precepting a resident in a procedure. What is prohibited is having the NP oversea the resident in the care of the patient.

To answer the OPs question, NPs and PAs in an academic setting will have a wide variety of duties and responsibilities. Some will serve in a manner similar to interns or residents doing floor work. In other cases the NP or PA will serve in a manner similar to the fellows.

For example here on hematology we have two teams. One team is staffed by the attending and the fellow. The other team is staffed by a PA and the attending. They take consults equally and the PA essentially does the work of the fellow. We have two other PAs that do post op cardiology clearances patients. In our ICU we have an PA/NP team and a resident team. What this allows in both cases is for the fellow to have less patient load so teaching can occur and to service the same number of patients without increasing the resident load.

In the ICU the attending rounds with the residents and then rounds separately with the PA or NP. We are expected to do our job autonomously with help from the fellow or attending just like the residents. We are essentially viewed as two sides of the same coin. The PAs and NPs have the advantage of knowing the policies and personalities of the unit. The residents have the advantage of deeper medical knowledge and medical training in their specialty. Evenings and nights the patients are comanaged by PAs and NPs.

Bottom line if you are looking to run your own service in an academic hospital its not going to happen. On the other hand you can achieve considerable autonomy if you have the right situation. The decrease in resident work hours means there are less residents to do the work that was previously done. At the same time the sicker population means there is more work. This is why there has been a huge increase in PAs and NPs working in the inpatient setting.

Advanced Practice Columnist / Guide · Jul 7, 2011

How is the role of an NP at teaching hospitals? I currently work at a teaching hospital as an RN and I do not see many NP's hired due to the abundance of interns and residents. If they were hired I am guessing they would get little respect and get the brunt work.
So, my question is, do any of you have experience with this? Do you know of any NP's, or are one, in a large teaching hospital??

As an ACNP, I've only worked in academic medical centers (Detroit and San Francisco). When I say academic medical centers, these hospitals are attached to a medical school and have a wide array of GME programs and fellowships. There is a demand for NP's (and PA's) in these places. For one, continuous resident hours within the hospital (intern, house officers) is being limited by ACGME. More and more coverage of patients are being changed to 12 hour shifts rather than the typical 24 hour calls residents used to do. NP's (and PA's) have filled in the gaps for the holes the new residency hours have created because the residency slots have not increased. We as providers also offer consistency in the medical (or surgical) services we work in and are a valuable resource for residents who are usually just passing through their rotations. When you say teaching hospitals, are you referring to large academic centers or community hospitals with a few residency programs but are really run by private practice physicians?

shannons1 · Jul 9, 2011

Excellent response Juan. Midlevel providers are in increased demand in the academic medical centers of northeast Ohio due to the changes to resident/intern hours. It is a great opportunity all around in my opinion!

Trauma Columnist · Jul 9, 2011

In my area they have expanded the residency programs too.

Advanced Practice Columnist / Guide · Jul 10, 2011

Well, the new duty hours per ACGME was further restricted by the new rules which took effect July 1, 2011. Regardless of whether the program is brand new or previously existing, all residency programs that are ACGME accredited has to comply. I understand there are other facilities where the residency program is not registered with ACGME (such as osteopathic facilities and programs). It probably will depend on the particular programs, hospitals, and specific services. I know of some surgical services where I work that is definitely struggling with the new rules because these services were dependent on intern coverage and the new rules say that interns can no longer work more than 16 hours (which means no 24 hour call anymore). And this is in a major academic medical center on the top of the list in most research funding rankings. Furthermore, resident supervision by attendings is getting scrutinized more leaving other responsibilities left without adequate coverage. More and more departments are looking into hiring additional personnel and non-physician providers are definitely being considered.

SkiBumNP · Jul 10, 2011

I hear allot of responses about working on the unit, or in special services, I would love to hear about NPs working at Teaching hospitals (Students and Residence) in the ED. One of the things I love about my group is that the NPs/PAs are not relegated to the fast track portion of the ED. I can take any patient i want and feel comfortable taking. Do those of you who work in the ED find that the increased numbers of providers at a teaching hospital dictates the acuity of the patients you see?

sandnnw, BSN, MSN, EMT-B, APRN · Jul 12, 2011

ED NP here. Like you, I can "take" who or whatever I want as well. The reality is, I was hired to move the lower acuity patients and that is my primary goal. Before I was hired, our waiting times in the ED was an average of nearly 6 hours. That has been cut in half over the past year.

Most of the time, I do not get to chose who I see. I have three clinic rooms off the Main ED and usually 2-3 times a week, I move a patient or two onward to a monitored bed in the ED, keeping them myself and mostly admitting them. Out of courtesy, I inform the ED attending of my plan for admission and perform all the tasks myself. I see no real difference between how many providers are in the ED. BTW, I also have a dedicated ED RN helping me.

dissent · Jul 12, 2011

As an ACNP, I've only worked in academic medical centers (Detroit and San Francisco). When I say academic medical centers, these hospitals are attached to a medical school and have a wide array of GME programs and fellowships. There is a demand for NP's (and PA's) in these places. For one, continuous resident hours within the hospital (intern, house officers) is being limited by ACGME. More and more coverage of patients are being changed to 12 hour shifts rather than the typical 24 hour calls residents used to do. NP's (and PA's) have filled in the gaps for the holes the new residency hours have created because the residency slots have not increased. We as providers also offer consistency in the medical (or surgical) services we work in and are a valuable resource for residents who are usually just passing through their rotations. When you say teaching hospitals, are you referring to large academic centers or community hospitals with a few residency programs but are really run by private practice physicians?

Sorry to be technical but they are 16 hours (and were 30 hours). These hours are currently only for interns. Residents still do 28 hour shifts.

I agree though, with the new hours, my hospital has gone to more NP/PA help with the work. Since the workload hasn't decreased and the hours interns can work have decreased, the extra work has to be filled in by someone. In some circumstances this falls on the residents or fellows. In others, to midlevel providers.