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Best Practices for Hiring and Making Use of Nurse Practitioners, Physician Assistants

The number of nurse practitioners (NPs) in the United States has doubled in the last decade, from 106,000 in 2004 to 205,000 in 2014, according to the American Academy of Nurse Practitioners. Similarly, the number of physician assistants (PAs) grew 219% from 2003 to 2013, according to the National Commission on Certification of Physician Assistants.
Scrupulous hiring and supervision are crucial for reducing compliance risk and maintaining quality patient care. Before hiring an NPP, physicians first must assess whether they have the time and temperament for supervision, because at least initially it will increase the workload. A physician’s lack of accessibility and approachability may lead NPPs to avoid and work around him, possibly acting beyond their scope of practice and increasing liability exposure.

In hiring NPPs:
  • Know  and follow state licensing laws and regulations concerning the use and supervision of NPPs to determine what type (e.g., NP or PA) is needed;
  • Create a job description;
  • Even if not required by law, obtain and tailor a supervisory/collaborative  agreement, delineating duties, practice protocols, authority limits and the supervisor’s role; and 
  • Verify candidates’ credentials, including education, licensing status and board complaints, certification, continuous education (CE) hours, employment and malpractice history, credit and criminal background checks.

To promote a healthy practice:
  • Introduce staff to NPPs and clarify their involvement in patient care;
  • Train front office staff to stipulate patient appointments are with NPPs;
  • Post NPP roles in brochures and websites;
  • Ensure NPPs wear name tags with their credentials;
  • Correct those who refer to NPPs as “doctor”;
  • Review regularly and sign off on, but don’t co-sign, NPP records (“reviewed by” or “under the supervision of”); and
  • Allow patients who insist, to be seen by a physician.

NPPs are not a panacea for solving the physician shortage. If vetted properly at hire and managed effectively, however, NPPs can be valuable assets, helping reduce workload and improving patient satisfaction and outcomes.

Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
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