Scope of Practice

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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?

1 minute ago, CentralNJ said:

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. 

Ah I missed that part. My apologies about that as I presumed you were looking into it versus checking out someone else's credentialing path. Not angry. But annoyed when I hear about FNPs working that far out of their scope. Just like I was annoyed to hear a family medicine doc who does these kind of injections on the side. I worked in pain management and specifically with injections and saw first hand the expertise and knowledge base involved. The thought of anyone trained in primary care doing these types of procedures is concerning at a minimum and IMO borderline malpractice.

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It will not affect me in all probability, but it is still very, very concerning.

Like some of the posts here that say "why can't I do PMHNP school full time while I work full time, and take care of my 2 toddlers?"

One can get these pain management credentials in a weekend course?

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I spoke with the DO and he is definitely family medicine. He checked with the nj board of medical examiners and since he did a few weeks of surgical rotations back in god knows when -that the board said it’s fine. I know most are anesthesia or physiatrist some neuro but like I said I’m not looking to do these at all. I was really just surprised the patients injection was done by the NP and not the MD. I don’t know how they bill or any of that. Just found it odd is all.

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When the NP role first started some 50 years ago, we were limited to a very narrow and strict, simple set of protocols. The supervising physician usually had to be almost in the next room, while we only prescribed antibiotics and birth control pills. Not kidding.

Over the years, it gradually became clear that all the restrictions and strict practice protocols weren't necessary. NP practice expanded.

And we have done quite well as a profession. And now some of the physicians that trained us are complaining. They can't figure it out. We are doing their jobs just as well as they do, sometimes better, with apparently quite a bit less education on paper.

Food for thought.

Just from my experience, I knew quite a number of MDs, who already had completed a psychiatric residency, who then completed a year long forensic fellowship.

But they still could not identify a malingerer if one came up and introduced himself as such. And we had probably 40% malingerers.

Food for thought. Some people get nothing at all out of a fellowship.

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Specializes in Vascular Neurology and Neurocritical Care.

Well I did fellowship for two years in Neurocrit and certainly was trained in invasive procedures, EVDs, bronchoscopy, chest tubes, lumbar drains, etc. I know NPs in New York who are credentialed to perform cardiac caths. They've been formally mentored and supervised doing a great number before being permitted to doing on their own. They're ACNPs, not FNP. I think we should perform procedures that we've been adequately trained to do. Doesn't necessarily have to be in a fellowship as long as we're trained properly. Many surgeons and other docs learn new techniques after fellowship at surgical conferences, workshops, or even having the pioneer of the new technique visit their hospital and mentor on said new technique. I've seen it. See one, do one, teach one. At the end of the day, moderation and understanding limitations (whether educational, knowledge, practical) is key, not hard and fast rules about who can do what.

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Specializes in Vascular Neurology and Neurocritical Care.
On 5/6/2019 at 5:13 PM, djmatte said:

Ah I missed that part. My apologies about that as I presumed you were looking into it versus checking out someone else's credentialing path. Not angry. But annoyed when I hear about FNPs working that far out of their scope. Just like I was annoyed to hear a family medicine doc who does these kind of injections on the side. I worked in pain management and specifically with injections and saw first hand the expertise and knowledge base involved. The thought of anyone trained in primary care doing these types of procedures is concerning at a minimum and IMO borderline malpractice.

I do agree. There was a case about this in New Jersey recently.

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15 hours ago, Neuro Guy NP said:

Well I did fellowship for two years in Neurocrit and certainly was trained in invasive procedures, EVDs, bronchoscopy, chest tubes, lumbar drains, etc. I know NPs in New York who are credentialed to perform cardiac caths. They've been formally mentored and supervised doing a great number before being permitted to doing on their own. They're ACNPs, not FNP. I think we should perform procedures that we've been adequately trained to do. Doesn't necessarily have to be in a fellowship as long as we're trained properly. Many surgeons and other docs learn new techniques after fellowship at surgical conferences, workshops, or even having the pioneer of the new technique visit their hospital and mentor on said new technique. I've seen it. See one, do one, teach one. At the end of the day, moderation and understanding limitations (whether educational, knowledge, practical) is key, not hard and fast rules about who can do what.

Think of surgeons who went from performing choles open, to laparoscopic to using a robot. They went to training courses, performed a certain number supervised, then were signed off. Same for us. I was taught central lines, paras/thoras, LPs, etc in school. But I see no problem if I were to take a job in IR to learn how to do liver biopsies, ESIs/foramenal injections and more. If you are trained and can demonstrate competence, by all means. I'll agree that each NP should be comfortable with the path they have chosen and not expect to work in areas that fall within other NP specialty tracks.

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Specializes in Vascular Neurology and Neurocritical Care.
20 hours ago, Dodongo said:

Think of surgeons who went from performing choles open, to laparoscopic to using a robot. They went to training courses, performed a certain number supervised, then were signed off. Same for us. I was taught central lines, paras/thoras, LPs, etc in school. But I see no problem if I were to take a job in IR to learn how to do liver biopsies, ESIs/foramenal injections and more. If you are trained and can demonstrate competence, by all means. I'll agree that each NP should be comfortable with the path they have chosen and not expect to work in areas that fall within other NP specialty tracks.

This.

And as a foot note, I think this is the spirit of the Consensus Model.

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