Transcript The Role of the Nurse Practitioner in an Ambulatory

The Role of the Nurse
Practitioner in an
Ambulatory Oncology
Setting
Pamela Hallquist Viale, RN, MS, CS, ANP, AOCNP
Oncology Nurse Practitioner
Camino Medical Group
Assistant Clinical Faculty, UCSF
Dept of Physiological Nursing
Specialty Nurse
Practitioners
• An idea that is starting to change practice
• NP’s firmly established in primary care and
women’s health; specialty NP’s have grown in
numbers over the last ten years
• Many NPs are adult or family NPs; once trained
they get additional training in specialty areas
• There are 23 specialty NP educational programs
presently in the US
Young, T (2005). Utilizing oncology nurse practitioners: a model strategy. Community Oncology, 2, 218-224.
Differences Between NP and
Physician’s Assistant
• NP must be a nurse
• Nursing model used as primary
training; medical classes serve
as adjunct
• NPs are trained as specialists
(adult, pediatrics, ect)
• Nursing Board oversees NPs
• NPs need to have a
collaborating physician, but
may practice independently
• All NPs are at the Master’s
level; as of 2015 this may
change to doctorate level only
• PA can come from many
backgrounds
• Medical model is used in PA
training; trained in general
medicine
• State Board of Medical
Licensure oversees PAs
• All PAs must have an MD in a
supervisory role
• PA students have more hours of
supervised clinical practice in
training
• PA can be at bachelor level; this
will change to MS in 2006
Young, T (2005). Utilizing oncology nurse practitioners: a model strategy. Community Oncology, 2, 218-224.
Prescriptive Authority
• In California, it is called “furnishing”
• NPs are certified by all but six states
to prescribe medications
• In California, NPs now have the
ability to write for Schedule II-V
medications as of 2005
• NPs are also certified by the ANCC
and ONS (AOCNP)
Young, T (2005). Utilizing oncology nurse practitioners: a model strategy. Community Oncology, 2, 218-224.
Schedule II Prescribing
Frequently Asked Questions
Regarding NP Practice
• Do my charts need to be signed by an MD? The nursing
practice act does not require MD countersignature, but
insurances may require it
• How often do I update my standardized procedures?
Frequently enough to ensure that patients are receiving
appropriate care
• Can an NP request and sign for drug samples? Yes
• In my furnishing procedure, do I need to list the drugs and
devices that can be furnished or may I use categories? The
law requires the identification of the drugs and devices in
standardized procedure or protocol. You may not use drug
categories
Frequently Asked Questions Regarding NP practice (Revised 12/2004). Board of Registered Nursing, State of California
Standardized Procedures
• Standardized procedures are the legal mechanism
for registered nurses, nurse practitioners to
perform functions which would otherwise be
considered the practice of medicine
• Provides the system with satisfactory evidence
that the nurse meets the experience, training,
and/or education requirements to perform the
functions
An explanation of standardized procedure requirements for nurse practitioner practice (12/1998).
Board of Registered Nursing
Roles of Oncology Nurse
Practitioners
• Practice Partner: private, academic, inpatient or
outpatient
• Administrative Partner: documentation and coding
• Research Partner: enrolling patients, writing
study protocols
• Liaison: between nurses and physicians and
patients and physicians
• Triage Nurse: taking patient phone calls, seeing all
walk-in patients, performing chair rounds in
infusion room
Young, T (2005). Utilizing oncology nurse practitioners: a model strategy. Community Oncology, 2, 218-224.
Example of NP Role in Oncology
Ambulatory Setting
• See treatment
patients while on
chemotherapy; write
orders for subsequent
chemotherapy
treatments
• See walk-ins or sick
calls
• See stable follow-up
cancer patients
Example of an NP Role in the
Ambulatory Setting
• Does NOT write initial
chemotherapy orders
or change
chemotherapy orders
independently (except
for those established
by protocol: example
AI’s)
• Patients with urgent
problems or who
appear unstable
reported to MD
Common Problems
Encountered in Ambulatory
Practice
•
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•
•
DVT
• With standardized
Herpes Zoster
procedures/protocols,
CAP
NP’s can manage these
Neutropenic Fever
and like problems,
bringing in the MD
HSR
when appropriate
Abscess
Diarrhea/Constipation
Special Skills ONP’s Bring to
Oncology Setting
• Psychosocial Care
• Patient Education
• Performing Procedures
Young, T (2005). Utilizing oncology nurse practitioners: a model strategy. Community Oncology, 2, 218-224.