Scope of Practice

[CentralNJ]

In NJ can FNP perform minimally invasive spine procedures such as facet injections, Transforaminal injections, discogram, RFA and caudal epidurals? If so does anyone know what qualifies as proper training?

[Neuro Guy NP, DNP, PhD, APRN]

NJ is one of the states in which I practice. The state doesn't maintain a list of procedures you can or cannot do. It's all about what you've been adequately trained to do. Laws can't keep up with the changes in many technical professions to try to keep a list of skills in this manner.

[djmatte, ADN, MSN, RN, NP]

8 hours ago, CentralNJ said:

In NJ can FNP perform minimally invasive spine procedures such as facet injections, Transforaminal injections, discogram, RFA and caudal epidurals? If so does anyone know what qualifies as proper training?

These are procedures that are performed by board certified pain medicine doctors. Typically anesthesia trained, pain trained, or both. As an FNP, you are about as far away from this world as you can get. If you can get honest training from those specialties, maybe it's an option, but there is a huge safety and liability concern. But from someone who worked in that world, I highly recommend you move toward a different certification. This is the exact encroachment doctors rail against. Stay in your lane and don't give them additional fodder. Imo you are neither qualified and as an FNP you should never attempt such procedures.

[CentralNJ]

Seems like there is a difference of opinion in the matter. I only recently had patients that received Transforaminal injections by FNP in which the outcomes were excellent. Initially, I thought the MD did the procedure but after talking with the patient and person who actually performed the procedure did I find out he was a FNP.

[Oldmahubbard]

If there were ever a complaint, or a bad outcome, the FNP would be in an awful position if such procedures were not part of their formal training. Which I am sure they are not.

[traumaRUs, MSN, APRN]

In order to do these types of procedures, most facilities required documented training as well as x-amount of supervised procedures prior to approval.

In IL, the facility and/or practice determine the scope for APRNs. Isn't this the same for NJ?

[Neuro Guy NP, DNP, PhD, APRN]

6 hours ago, traumaRUs said:

In order to do these types of procedures, most facilities required documented training as well as x-amount of supervised procedures prior to approval.

In IL, the facility and/or practice determine the scope for APRNs. Isn't this the same for NJ?

Yes, the credentialing committee would require documentation that you're competent in a particular procedure in order to allow it, especially since there's nothing at the state level. Whether that's documentation of performance of xxx amount elsewhere, fellowship program, etc. varies. An APRN could do the procedure with the physician right there guiding him/her along or could simply assist.

[Oldmahubbard]

Performing the procedure with the physician right there, guiding you along, is a completely different animal. The zoo vs the farm.

My question is, what is the point, and even more importantly-

who bills for this?

I can't believe that insurance companies are reimbursing for APRN's to do these types of procedures all on their own.

Not that many years ago, BCBS in NY didn't reimburse any services provided by psych NPs for several months after someone made a large mistake.

At the time, we were all were under collaborative requirements.

Thankfully they changed their mind.

NP's simply don't have the type of extensive supervised fellowships and residencies that are available to physicians.

To compare some doctor showing you how to do something a time or two, informally, with the types of trainings that physicians have, is a ton of bull malarkey.

And some of you work for 100 or 120k? Think about it.

Let me know if you can prove I am wrong. I would like to be wrong.

[djmatte, ADN, MSN, RN, NP]

5 hours ago, Oldmahubbard said:

Performing the procedure with the physician right there, guiding you along, is a completely different animal. The zoo vs the farm.

My question is, what is the point, and even more importantly-

who bills for this?

I can't believe that insurance companies are reimbursing for APRN's to do these types of procedures all on their own.

Not that many years ago, BCBS in NY didn't reimburse any services provided by psych NPs for several months after someone made a large mistake.

At the time, we were all were under collaborative requirements.

Thankfully they changed their mind.

NP's simply don't have the type of extensive supervised fellowships and residencies that are available to physicians.

To compare some doctor showing you how to do something a time or two, informally, with the types of trainings that physicians have, is a ton of bull malarkey.

And some of you work for 100 or 120k? Think about it.

Let me know if you can prove I am wrong. I would like to be wrong.

That's the frightening thing. We have no formal training in a large array of medical procedures. Yet by simple "difference of opinion", some are under the impression in absence of official prohibition, skies the limit on what we do. It's frightening that someone trained in family medicine (note PRIMARY CARE) would even venture to ask the question in the first place. You would never see a family medicine doc just decide to buy a c-arm and start doing these procedures. He knows there are fellowships to pursue this and they have their own levels of board certifications that he will need to keep up with. Yet give someone an fnp and all bets are off and who gives a hoot about safety or liability! The hours and training that preceed these fellowships training alone put what you know and your own training to shame. Focus on what you trained to do in school. FAMILY MEDICINE. Or put in the work to get your MD if seriously invasive and potentially life changing procedures is your bag.

[CentralNJ]

Funny, I have a friend who is board certified family medicine and did just what you said. Does these exact procedures in office and at surgery centers. He’s formal training was a weekend course in Manhattan. Stones and glass houses.

[djmatte, ADN, MSN, RN, NP]

1 minute ago, CentralNJ said:

Funny, I have a friend who is board certified family medicine and did just what you said. Does these exact procedures in office and at surgery centers. He’s formal training was a weekend course in Manhattan. Stones and glass houses.

Sorry but your "friend" is an idiot. Anybody worth their salt doing these procedures would take their time to get pain certified. "Stones and glass houses"?! Do you actually think about these phrases and what they mean before you throw them around? You asked if one can. A slew of us pointed out why you shouldn't. Take that advice and run with it. Or risk your career over doing whatever you feel inclined. But at the end of the day you are a FAMILY nurse practitioner who is trained in primary care. You are no CRNA. You are no pain specialist. And you sure as eff shouldn't be sticking a needle in anyone's spine.

[CentralNJ]

I think your taking this the wrong way. I was surprised that a NP did the procedure and not the MD. I don’t want to do these procedures in the slightest. I was curious as to why a FNP did them . No where did I say I wanted to do these ( check my second post). You seem angry and should relax a bit.