There’s been a lot of discussion over the past few years about non-physicians providing medical care.
Some states, such as Texas, allow nurse practitioners (NPs) and physician assistants (PAs) to make a medical diagnosis and prescribe medications, as long as their supervised by a physician. What that supervision looks like varies dramatically. In some cases, it’s a team approach. In other cases, there’s virtually no supervision at all.
The New Republic recently published a piece by pediatrician Niran Al-Agba, MD entitled “When Your Doctor Isn’t a Doctor.” She discusses how many urgent care clinics are solely staffed by NPs or PAs, while patients think they’re receiving care from a physician. She advocates for the right of patients to be informed about the education and preparation of the professionals taking care of them, as well as the right of patients to receive care from a physician.
This is a contentious issue in health care, medicine, and law that some have dubbed scope creep. With scope creep, people with less educational preparation and clinical training advocate for the licensure and scope of practice of those with more educational preparation and clinical training.
Much of the focus in this debate has been on NPs and PAs and their organizations that advocate for unrestricted scopes of practice virtually identical to physicians. This includes certified registered nurse anesthetists (CRNAs) who are pushing for the identical practice rights as physician anesthesiologists. In some states, they’ve succeeded.
But scope creep doesn’t stop there, as recent news from the U.S. Attorney for the Southern District of Florida illustrates.
The U.S. Attorney alleges that some nursing schools were in the business of selling fake diplomas to individuals who wanted to become registered nurses (RNs) or licensed vocational nurses (LVNs). The diplomas were bogus because the recipients hadn’t completed the necessary classwork or clinical training.
According to the unsealed indictments charges were filed against four people from the Houston, Harris County, Texas area. They acted as recruiters for a Florida nursing school, and the indictments allege that they created fake transcripts and diplomas reflecting that individuals had completed all course and clinical work necessary to receive diplomas.
Whatever happened to the idea of studying and working hard? Whatever happened to the idea of following the law? Whatever happened to the idea of honesty?
As a former hospital administrator, I think that scope creep and the alleged criminal activity of churning out fake diplomas and credentials makes the credentialing and training activities of hospitals even more important.
For physicians applying to be admitted to a hospital’s medical staff, there is a formal credentialing process that’s privileged under Texas law. At a minimum, this includes checking licensure, verifying education and training, and reviewing the National Practitioner Data Bank.
For individuals applying for nursing positions, the hiring process is not privileged under Texas. For newly licensed nurses, nursing experts have explained that the standard of care mandates that hospitals verify licensure, education, and training, in addition to requiring a preceptorship and testing to demonstrate nursing knowledge and clinical skills.
As a patient, there are a few ways you can improve your patient safety:
• When meeting a new health care professional, you can ask polite questions about educational preparation and training. Here’s an easy one: Are you a physician?
• If you have concerns about a physician, NP, or PA, you can always ask for a second opinion by a physician.
• If you’re concerned about a nurse’s care or conduct, ask to see the charge nurse or nursing supervisor.
• When seeing a new physician, provider, or nurse, be ready to tell your whole story over—don’t presume that any information has been communicated by someone else.
If you’ve been seriously injured because of poor medical, nursing, or hospital care in Texas, then contact a top-rated and experienced Texas medical malpractice attorney for a free consultation about your potential case.
