RN acting as a Mid-Level provider

[xstraz98]

At a hospital here in Michigan there is an associates degree registered nurse who is not a hospital employee. They are employed by a physicians group to act as a mid-level provider in the hospital. How does one work as a mid-level without an advanced practice degree? They write orders and see consults. I cannot find much regarding this type of situation and would appreciate some input from the community.

Chris.

[Otessa, BSN, RN]

Some of you folks are way off base. Here's an example that I can provide of what commonly is the arrangement.

Lots of interventionalists and proceduralists have RN-Physician Extenders. The role of these people are to do pre-procedure teaching, assessment, documentation, writing pre-procedure/post procedure orders at the direction of the interventionalist. These RNs are NOT practicing as APN. While it may appear they are doing this and that...everything must be co-signed by the LIP they are working with. This does NOT alleviate the LIP from rounding on their patients and writing/adding to the notes written by the physician extender. By having the physician extender, it allows the provider to be in the procedural suites which increases their productivity. The physician extenders are constantly on the phone and talking face to face with the providers throughout the day. It's not like the physician extender is at one hospital and the physician is at another hospital 20 minutes away. They are generally there together...two people doing the work of one.

It's no different than a physician's nurse rounding on the patients early in the morning and the physician coming by after office hours, surgery hours, etc. This helps to create an ease in work flow. Electrolytes can be replaced before the afternoon, diagnostics can be reviewed, etc. Work smarter not harder!

And for those that say they wouldn't be comfortable working under protocols and standing orders....don't obtain a position in an ICU.

Worked in an ICU with standing orders/ protocols for many years. "Guessing"(which is what I have seen, at times) what a provider would want in a certain situation is much different and a position I would not feel comfortable being a party to.

otessa

[LuxCalidaNP]

and I will add, I am NO "physician's nurse."

[celclt]

medicare fraud anyone?

BON needs to be notified.