Where/how to get certified to do invasive procedures?

core0 · Jun 26, 2008

Hi all! I've been crazy busy lately completing summer clinicals and haven't been around much.
Still, my mind starts looking to the future. If mid-level providers are capable of starting central lines, intubations, chest tubes, etc... where can you get certified?
According the PAs from the group I'm interested in interviewing with, they have to be observed completing a procedure 10 times before being allowed to be independent in that area (much like we do for new nurses with arterial sticks in the unit). Mind you, not a single one of them is certified in any area which bothers me.
First, off, is this a red flag that the docs may not be willing to give up those responsibilities to the mid-levels?
Next, if I wanted to become certified, where would I go? Are there courses, or do you simply hope the group you end up working with has someone there to teach you?
Thanks all!
Gotta run back to my clinicals!

Why in the world would you want to get certified in procedures. This is a limiting maneuver (in my opinion). There are two types of certification. Professional certification means that the person has demonstrated minimum competence in their profession. An example of this would be ACNP-C or PA-C. Certification in a procedure usually means that you demonstrated attendance in a class such as BLS. As a professional there is no need to be certified in procedures that are part of the profession.

This is one of my pet peeves about nursing. The alphabet soup of "certifications" devalues the profession. It makes nursing into a technical profession instead of a professional one. In my opinion you need to get out of the nurse mode and into the NP mode .

What you are getting from the PAs is simply the way that we are trained. The scope is defined by the physicians and usually the procedures done are also defined by the physician practice and the relationship with the PA. In most groups the teaching is done internally with either the NPP or the physician teaching then observing a number of successful procedures. In this environment certification simply serves as a limitation because it cements a particular way of documentation. Similarly the lack of certification does not mean that physicians are not willing to share procedures. They may or may not be willing to share but certification is not part of it.

The other issue is hospital credentialing. Most hospitals want you to demonstrate a certain level of competence. This is usually done by demonstrating once again that you can do a number of successful observed procedures. You can document this by previous procedures or by observed procedures in the current workplace. This is why its good to keep a procedural logbook and keep it updated. For example in my previous position the practice wanted me to do large volume paracentesis. We looked at the credentialing guidelines and they stated the provider had to demonstrate 5. Now our GI docs could easily demonstrate this. I did 5 observed paracentesis and then applied for privileges. I could then do them without physician presence.

Good luck

David Carpenter, PA-C

Advanced Practice Columnist / Guide · Jun 29, 2008

Hi all! I've been crazy busy lately completing summer clinicals and haven't been around much.
Still, my mind starts looking to the future. If mid-level providers are capable of starting central lines, intubations, chest tubes, etc... where can you get certified?
According the PAs from the group I'm interested in interviewing with, they have to be observed completing a procedure 10 times before being allowed to be independent in that area (much like we do for new nurses with arterial sticks in the unit). Mind you, not a single one of them is certified in any area which bothers me.
First, off, is this a red flag that the docs may not be willing to give up those responsibilities to the mid-levels?
Next, if I wanted to become certified, where would I go? Are there courses, or do you simply hope the group you end up working with has someone there to teach you?
Thanks all!
Gotta run back to my clinicals!

Like David said, there are no formal certifications available for a NP to be able to perform procedures. Much of what a nurse practitioner is allowed to do will depend on the collaborating physician and the credentialing committee in the hospital where the procedures are performed. In our case as ICU-specific NP's, we had a number of supervised (at least 10) performance of invasive procedures before we can do them on our own. Then the procedures are added to the skill set we are credentialed to perform. In addition, we also have the advantage of being allowed to participate in resident training sessions on invasive procedures offered by the hospital. We have specific training sessions in central line placements conducted in our hospital's patient simulation lab and all the NP's in our group participated in that. Our hospital is also big on ultrasound guidance when performing invasive procedures at the bedside. We are now using new GE Bedside Ultrasound units when we do lines, thoracentesis, and chest tube placements. The SICU alone has three portable ultrasound units. Since ultrasound-guidance seems to be the wave of the future, I recommend you look into training programs offered by SCCM (Soc of Crit Care Med) and Carillion Clinic (Virginia) on ultrasound-guided bedside procedures. Your practice may not utilize ultrasound guidance but at least you'll get exposed to the actual steps in performing invasive procedures.

JDCitizen · Jun 29, 2008

Hi all! I've been crazy busy lately completing summer clinicals and haven't been around much.
Still, my mind starts looking to the future. If mid-level providers are capable of starting central lines, intubations, chest tubes, etc... where can you get certified?
According the PAs from the group I'm interested in interviewing with, they have to be observed completing a procedure 10 times before being allowed to be independent in that area (much like we do for new nurses with arterial sticks in the unit). Mind you, not a single one of them is certified in any area which bothers me.
First, off, is this a red flag that the docs may not be willing to give up those responsibilities to the mid-levels?
Next, if I wanted to become certified, where would I go? Are there courses, or do you simply hope the group you end up working with has someone there to teach you?
Thanks all!
Gotta run back to my clinicals!

I concur with what I have read here so far. There is also all the legal stuff that varies from state to state. Basically is usually depends on the MD and the facility where you working on how/if you will be doing procedures and how thats handled.