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Featured Practice Question

My employer (a hospital) does not have Standardized Procedures for me as an NP, but instead utilizes Privileges. I'm told by the Director of Medical Staffing that this essentially trumps Standardized Procedures. To my knowledge, no NP at this facility (including clinics) works off Standardized Procedures, but instead have been granted privileges based on their competencies and what is needed in their setting. Am I at risk if something happens, given I do not have a set of Standardized Procedures?

Privileging and credentialing are not the same as Standardized Procedures (SP), and, yes, you are at risk without SPs. It would be considered practicing medicine without a license if you are functioning without SPs because this is a requirement of NP practice in California. You must create one that is specific for your department and organization.

The organization’s Interdisciplinary Committee or Credentialing Committee is the appropriate body to approve your SP. If they are not familiar with SPs, it is important you develop your own and then be present to walk through the 11 required elements with them.

You could contact other NPs in your area (through your local CANP chapter) and ask for their support in developing SPs. You should also use the BRN guidelines to ensure you include the required 11 elements. You could also reach out to other NPs in your organization or in your local CANP chapter for guidance.

There is not one specific template for SPs. You can review the document example on the BRN website. You can also look at the Rebecca Zettler example.

Also, it is critical to understand that your employer will have insurance that covers their practice and it names you as a covered contractor. This insurance will not protect YOU from litigation and/or license threat – it protects the practice. CANP strongly suggests you carry your own insurance to protect you and your license from potential litigation. NSO has a very comprehensive insurance program for NPs and we recommend them. Insurance costs can be expensive but they are much less expensive than attorney fees.

Featured Legal Question

What do I do if there is suspicion that my patient may be abusing his controlled medications: zolpidem, lorazepam, hydrocodone? The patient has a history of not following up with the recommended treatments, and often asking for medications earlier. The patient does follow up in office when the refill depends on them coming in to be seen.

You discharge the patient. This is a non-compliant (adherent new terminology) patient who will only get you into trouble. If the patient will not come in for refills, you give the patient enough for a month and tell her/him that s/he needs to seek another provider who may meet the patient’s needs better. Otherwise, you are the one who will get in trouble, not the patient.

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