Advanced Practice Registered Nurses / Physician Assistants
Internal Number: 613576000
GENERAL DESCRIPTION OF ASSIGNED DUTIES A PA is a credentialed health care professional who provides patient centered medical care to assigned patients as a member of a health care team. PAs practice with clinical oversight, consultation, and input by a designated collaborating physician. Although PAs 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 Core Elements. The core PA Scope of Practice elements are based on nationally standardized training by PA training programs accredited by the Accreditation Review Commission on the Education of Physician Assistants (ARC-PA) and the ongoing medical knowledge and clinical skills assessment performed by the National Commission on Certification of Physician Assistants (NCCPA). The core elements for a PA 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. PAs may be delegated the responsibility of documenting operative notes if the PA was present for the procedure, but the operative surgeon must review and co-sign the note. The PA 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 PA in accordance with The Joint Commission standards that are applicable. (12) Other patient record entries by PAs, 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 PA is responsible. The PA'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 PA 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 PA need not participate in the particular procedure the patient is scheduled to undergo but the PA 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) PAs may prescribe or order all medications listed in the VA National Formulary consistent with the PA's level of prescribing authority and practice setting. Exceptions include medications restricted to specific clinical services outside of the PA'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. PAs 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 PA is authorized to prescribe by their Scope of Practice is consistent with the schedules established by the PA's State licensure or those included on the PA's individual DEA registration certificate, whichever is more restrictive. Work Schedule: 8:00AM - 4:30PM - Monday - Friday Financial Discloser 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.