How APRNs complement a PEM training program

Advanced Practice Registered Nurses (APRNs) can and should do more than churn through patients. At Cincinnati Children’s, they also play a role in our educational mission. In a previous post, we outlined how APRNs function in a pediatric emergency department. This time, Julie Miller–a nurse practitioner and APRN educational consultant in our ED–and I answer frequently asked questions about the role of APRNs in education and training.

Do physicians precept APRNs?

In regards to APRN education and training, a preceptor is  an experienced APRN or physician who serves as a role model and clinical expert and provides oversight in the clinical practicum experience. Physicians frequently precept nurse practitioner students and this is allowable. The term may also be used when a nurse practitioner collaborates with a physician in managing a patient with an illness outside of the NPs scope of practice.

What is a split visit?

In institutions that allow nurse practitioners to see patients independently and bill for their services, split visits are Evaluation and Management (E/M) visits that are split between a NP and a physician. Per CMS reimbursement, nurse practitioners are reimbursed at 85% of the physician schedule amount. By documenting a split visit, the reimbursement increases to 100%.

Requirements for a split visit are that the visit is medically necessary (outside the scope of the NP practice such as fever with neutropenia- a patient with simple AOM seen by the MD to generate more RVUs would not qualify) and the physician and the NP must perform and document the face-to-face encounter. The physician documentation must include key elements of the history and physical.

What can Pediatric Emergency Medicine fellows learn from experienced APRNs?

geralt / Pixabay

Experienced APRNs can be an invaluable source of knowledge to pediatric emergency medicine fellows. As registered nurses and advanced practice nurses, the nurse practitioner has experience at both the bedside and as a practitioner in providing care to patients. This experience is beneficial in case management and care coordination, particularly with patients with chronic and complex medical needs. From a practice perspective, many NPs have specific areas of expertise and interest, such as suturing and immunizations. NPs with experience in research and quality improvement can assist fellows in conducting projects. Most importantly, the experienced NP can serve as a role model for NPs practicing in the pediatric emergency department and work together with fellows in providing quality, evidenced-based, and efficient care.

What do fellows have to teach APRNs?

For the nurse practitioner practicing in a pediatric emergency department, the opportunity to work alongside and learn from PEM fellows is unparalleled. By working with fellows, the NP is educated on the most up-to-date and evidence-based clinical practice guidelines. In addition, fellows’ lectures provide integral continuing education opportunities.

How should a fellow approach a family who has a problem with being seen by a nurse even though the APRN providing care is experienced and competent?

Many families are now familiar with the role of the APRN in the pediatric emergency department and are satisfied with the care APRNs provide. On occasion, a family member may request their child be seen by a physician instead of a nurse practitioner. This is most commonly expressed at the start of the visit when the NP introduces him/herself to the family. Most NPs will try and get a sense of why the family does not want to be seen by a NP and provide education on the role if warranted. If this does not appease the family, the NP will discuss the situation with the fellow and ask them to either assume total care of the patient or to work with them in caring for the patient. Once the fellow introduces him/herself, a statement regarding the role of the nurse practitioner as a competent member of the emergency medicine team may help to further educate the family.

Where can I learn more about the role of APRNs in the Pediatric Emergency Department?

American College of Emergency Physicians (2012). Physician Assistants and Nurse Practitioners in Emergency Medicine

Emergency Nurses Association. (2008). Competencies for Nurse Practitioners in Emergency Care.

Emergency Nurses Association. (2012). Advanced Practice Nurses in Emergency Care.


 

unnamedJulie Miller, PhD, APRN, PPCNP-BC, CPNP-AC, FNP-C is a nurse practitioner in the Division of Emergency Medicine at Cincinnati Children’s Hospital and also serves as the divisions APRN education consultant. Her research interests include nurse practitioner education and childhood vaccinations. She can be contacted at Julie.Miller1@cchmc.org.


 

Brad Sobolewski MD MEd

Brad Sobolewski MD MEd

Assistant Professor of Clinical Pediatrics, Division of Emergency Medicine at Cincinnati Children’s Hospital Medical Center
Dr. Sobolewski also serves as the rotation director for the pediatric residents on the Emergency Department rotation. His interests are in medical education and technology, and he is the author of PEMBlog, a Pediatric Emergency Medicine educational website and is an active participant in the #FOAMed movement on Twitter @PEMTweets. You can learn more about Brad at his educator portfolio: http://www.bradsobolewski.com
Brad Sobolewski MD MEd
Brad Sobolewski MD MEd

Brad Sobolewski MD MEd

Dr. Sobolewski also serves as the rotation director for the pediatric residents on the Emergency Department rotation. His interests are in medical education and technology, and he is the author of PEMBlog, a Pediatric Emergency Medicine educational website and is an active participant in the #FOAMed movement on Twitter @PEMTweets. You can learn more about Brad at his educator portfolio: http://www.bradsobolewski.com