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Featured Practice Question
I work as a nurse practitioner in a county-operated primary/ambulatory care setting. The physicians who work for our organization in ambulatory medicine have notified the Board of Supervisors with their intent to strike. This means that all of our supervising physicians will be out on strike for an unknown period of time. The medical staff office has said that in the event of a strike a physician will be available for "nurse practitioners.”
My concern is that the physician available (1) will not be at all familiar with primary/ambulatory care and (2) has not been assigned as my supervising physician. Can I have clarification on if my supervising physician can change during a strike and if this is acceptable?
There is no statutory limitation on supervision; however, it must be stipulated in your standardized procedure. Section 1474 (b)(7)(8) and (9) require you to (7) Specify the scope of supervision required for performance of standardized procedure functions, for example, immediate supervision by a physician, (8) Set forth any specialized circumstances under which the registered nurse is to immediately communicate with a patient's physician concerning the patient's condition, and (9) State the limitations on settings, if any, in which standardized procedure functions may be performed. None of these regulations require a physician to be physically present when you are seeing patients. The supervision role can be delegated from one physician to another. In the case of a strike you should work with your leadership to identify who this will be.
Regarding your questions specifically:
- Your supervising physician must be actively licensed to practice in California and should be in the same specialty – for example, a cardiologist should not supervise a pediatric NP.
- In this case, you could indicate that your supervising physician or designee would function as your supervising physician.
This is a link to a BRN FAQ and the code about supervision: Business and Professions Code §2836.1 (e). Here is another document from the BRN that may be helpful.
Featured Legal Question
I am working for a doctor who stated to me via text at the beginning of the month that I was going to be an hourly employee. Over the last two weeks I have worked 99 hours, and now she is placing me back on salary since she feels I am stealing time from her. I have a contract with her, but have never signed it. Is there an implied contract in place? The original unsigned contract states I have to give a 90-day notice. Do I have to abide by this unsigned contract? She has consistently changed my duties and has never placed them in writing.
If you never signed a contract then you do not have to abide by one, but do need to be aware of patient abandonment issues. So, you do need to give a 30-day notice. Did she sign the SPs? If not, you are practicing illegally and could lose your license. In that case, you could give her immediate notice.
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