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Featured Practice Question

I am an Acute Care Nurse Practitioner that will be working in a community hospital ICU. I will be trained to independently do common ICU procedures such as central line placement, thoracentesis, paracentesis, and lumbar puncture.

The hospital will not allow the NP who is trained to do these procedures give informed consent for those same procedures. They require a physician to give informed consent for the procedure the NP will perform. Is there anything in California law that prevents an NP from obtaining informed consent for a procedure they have been trained and privileged to perform?

There is not a statute that exists pointing to who can obtain consent outside of a few individual procedures (blood products, sterilization, etc.). CANP sponsored a bill to codify the right of an NP to obtain consent for blood transfusion several years ago because a certain large hospital system in California was restricting NPs from obtaining informed consents for infants in their NICU.

Here is the information about that language from the BRN:

Can nurse practitioners obtain consent for blood transfusions? Yes, nurse practitioners are clearly authorized to obtain consent for autologous blood and direct/non-direct homologous blood transfusions. (HSC §1645)

Given the lack of statute, health care systems typically have a policy regarding consent for treatment. Here is what Stanford and the UC systems use:

“The attending physician who orders, performs, or oversees the procedure or treatment or other health care provider who is credentialed to perform the procedure or treatment is responsible for obtaining informed consent from the patient or legal designated representative.”

Title 22 does not specifically state one way or the other, but the practice of obtaining informed consent has always been considered the practice of medicine, so this would need to be spelled out in a standardized procedure. Hospital policy should dictate who can perform informed consent, and you should work with your collaborating physician to get this into hospital policy and supported by the Med Executive Committee.

CMS does not specify any other licensed entities that may be performing procedures or administering medications that would require informed consent, but simply states that it needs to be the licensed practitioner performing the procedure. It is reasonable that if the practitioner is ordering and performing the procedure and they are operating under appropriate Standardized Procedures (SPs), they could obtain informed consent from the patient.

Featured Legal Question

My wife and I are both FNPs in California and are inquiring to start a "nursing" S corporation with my CPA. I have contacted the BRN and was referred to CANP. I have also contacted NPBO, which is a private membership for advance clinicians, and was informed that, unless it’s a "medical" corporation, no additional paperwork needs to be submitted other than my CPA legal documents and compliance with California "nursing" naming standards. Please advise if any other requirements are needed prior to establishing a "nursing" S corporation.

First of all, starting a nursing corporation is more than filing the paperwork. That is all your accountant can do. The only additional paperwork that needs to be filed is that you will have to get a business license wherever your business is located. Nursing corporations for NPs are not really independent in that there has to be a collaborating physician. The physician needs to be incorporated, as the contracts need to be corporation to corporation. If you plan to work with insurance companies, they will usually not bill nursing corporations. You would then need a medical corporation.

If you are billing straight fee for service, there should not be a problem. You will also need your Standardized Procedures (SPs) in order and signed by the physician. An S corporation is just an IRS filing. You want to establish a professional nursing corporation, which must have the word “nursing” in it, and then file it on Form 2553 as an S corporation. This is basic information and you need an attorney who works with NPs to advise you specifically on what you plan to do with your corporation.

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