GENERAL DESCRIPTION OF ASSIGNED DUTIES A NP is a credentialed health care professional who provides patient centered medical care to assigned patients as a member of a health care team. NPs practice with clinical oversight, consultation, and input by a designated collaborating physician. Although NPs are not Licensed Independent Practitioners, they are authorized to practice with defined levels of autonomy and exercise independent medical decision making within their scope of practice. Scope of practice: The APN in all areas of clinical practice is defined in the nine (9) dimensions outlined in the Nurse Qualification Standards, dated March 17, 2009, and is specific to the Grade and Level: Nurse I, II, or III: Executes position responsibilities that demonstrate leadership, experience, and creative approaches in the management of complex patient care. FUNCTIONS OR SCOPE OF ASSIGNED DUTIES The core elements for a NP Scope of Practice may include, but are not limited to: (1) Obtaining medical histories and performing physical examinations. (2) Providing and coordinating medical care for assigned patients in any care setting, including establishing diagnoses, formulating and implementing care plans, and providing follow-up care. (3) Evaluating outpatients to determine the need for further health care. (4) Ordering diagnostic studies and other special tests, such as Magnetic Resonance Imaging (MRI), Computerized Tomography (CT) scans, etc. (5) Carrying out health promotion, disease prevention, and patient education activities. (6) Ordering or obtaining laboratory specimens. (7) Ordering ancillary services, such as, pharmacy, social services, physical medicine and rehabilitation therapies, prosthetic services, etc. (8) Ordering VA specialty service consults and initiating requests for non-VA medical care and consults in accordance with VHA and local facility policy and procedures. (9) Ordering patient care supplies. (10) Writing orders for or prescribing medications (see paragraph c. of this App (11) Admitting and discharging patients in consultation with, and on behalf of, the collaborating physician, obtaining admission history and performing physical examinations, conducting patient rounds, documenting progress notes and summaries in the patient record, and writing patient orders on assigned patients. NPs may be delegated the responsibility of documenting operative notes if the NP was present for the procedure, but the operative surgeon must review and co-sign the note. The NP may also be delegated the task of documenting the discharge summary, but the collaborating physician must write a discharge note, or co-sign the discharge summary written by the NP in accordance with The Joint Commission standards that are applicable. (12) Other patient record entries by NPs, including medical histories, physical examinations, progress notes, service consults, Compensation and Pension evaluations, and patient orders do not require physician co-signature unless specifically required by Federal law, VA policy, or the standards of applicable external accrediting bodies. (13) Obtaining and documenting informed consent for treatments and procedures for which the NP is responsible. The NP's Scope of Practice must authorize obtaining informed consent for the treatment or procedure being performed. In addition, the Scope of Practice must authorize the NP to perform the procedure or provide the treatment for which the consent is being obtained or to actively participate as an integral member of the treatment team performing the procedure such as assisting the primary surgeon. NOTE: The NP need not participate in the particular procedure the patient is scheduled to undergo but the NP must be authorized to perform or participate in the procedure by their Scope of Practice and must have sufficient knowledge and training in the treatment or procedure, its indications, risk and benefits, complications, and alternative treatments, to effectively counsel the patient. (14) Providing education and counseling of patients and families in preventive care, medical conditions, and the use of prescribed treatments and drugs. (15) NPs may prescribe or order all medications listed in the VA National Formulary consistent with the NP's level of prescribing authority and practice setting. Exceptions include medications restricted to specific clinical services outside of the NP's practice setting and those specifically restricted by VHA or local VA medical facility policy. An individual medication formulary included in the Scope of Practice is not required. (16) Controlled Substances. Authorization for medication prescribing or inpatient ordering of controlled substances can only be granted in accordance with the Federal Controlled Substances Act and applicable regulations contained in Title 21 of the Code of Federal Regulations (CFR) Chapter II, Part 1306. NPs may be authorized to prescribe or order controlled substances utilizing the PA's individual Drug Enforcement Administration (DEA) registration when: (a) The schedules of drugs the NP is authorized to prescribe by their Scope of Practice is consistent with the schedules established by the NP's State licensure or those included on the NP's individual DEA registration certificate, whichever is more restrictive. Work Schedule: 8:00AM - 4:30PM - Monday - Friday Financial Disclosure Report: Not required
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.