ST. JOHN S HOSPITAL-ALLIED HEALTH PROFESSIONALS ADVANCED PRACTICE NURSE IN THE EMERGENCY DEPARTMENT

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1 ST. JOHN S HOSPITAL-ALLIED HEALTH PROFESSIONALS ADVANCED PRACTICE NURSE IN THE EMERGENCY DEPARTMENT (APN) In accordance with the Nursing and Advanced Practice Nursing Act (225 ILCS 65) (the Act ), the collaborating physician(s) of an advanced practice nurse shall maintain the final responsibility for the care of the patient and for the performance of the advanced practice nurse. The collaborating physician shall have full authority and responsibility to direct, supervise and limit the role of the advanced practice nurse. At any time the collaborating physician is unable to provide the appropriate collaboration to the advanced practice nurse, he/she shall designate an alternate collaborating physician to provide such supervision. Collaborating physician(s) are directly responsible to the medical staff and hospital for quality of care provided, as well as the conduct, liability and competence of their advanced practice nurse. The Emergency Department collaborating physician(s) will identify the responsibilities of the advanced practice nurse working in the Emergency Department at St. John s Hospital. Delegated duties and responsibilities are consistent with the collaborating physician s and advanced practice nurse s skill, training, education and competence, and are within the scope of practice of both the collaborating physician and advanced practice nurse in Emergency Medicine. The physician(s) may delegate the authority to diagnose, perform a medical screening examination, to deliver health care services and treatments and to administer, dispense and prescribe drugs (as allowed by Act) pursuant to hospital and department policies and guidelines regarding care of patients by an advanced practice nurse in the Emergency Department. The advanced practice nurse shall immediately notify a collaborating physician of any serious or significant changes to a patient. The collaborating physicians practices are located at the Emergency Department of St. John s Hospital, Springfield, Illinois and the advanced practice nurse will practice at this same location. A collaborating physician shall be continuously present in the Emergency Department. A. General Qualifications 1. The advanced practice nurse must be currently licensed as a registered nurse in Illinois, have attended a post-basic program in an advanced practice nurse area, and possess current national certification. 2. While providing patient services, the practice of the advanced practice nurse shall only be under the supervision of a licensed physician. 3. Additional certification in PALS and ACLS must be obtained within 3 months of receiving privileges and must be continuously maintained. 4. Satisfactory documentation of continuing medical education activities (50 CME or current licensure requirements) over every 2 years; 16 hours to be related to pediatric emergency medicine topics.

2 Page 2 of 5 B. Requirements 1. Submit a completed allied health professional (AHP) application which will include at least two adequate references and signature(s) of sponsoring medical staff member(s). Application will be accompanied by a copy of the duties/responsibilities established by the collaborating physician which are specific to the physician s and advanced practice nurse s setting. 2. Currently have and will maintain professional lability insurance from a recognized carrier, in good standing, and in the amount of the medical staff/board approved minimum for the specialty of the collaborating physician, and agree to provide documentation of such coverage and agree to notify the hospital within 30 days of any intent to cancel said coverage, and further agree to purchase a reporting endorsement or other prior acts coverage in the amount of any original claims made insurance should the policy be canceled or terminated. 3. Complete orientation interviews with the following persons: a) Hospital Medical Director b) Hospital designee(s) c) Chairman, appropriate department 4. Must agree to provisional appointment for a six month period with review and evaluation at that time to determine eligibility for a permanent appointment with subsequent periodic consideration for reappointment. 5. Must acknowledge Medical Staff Bylaws provide for up to 90 days after receiving completed application for review prior to submission to Board; who will consider application at next meeting. 6. Abide by the principles described in these guidelines, the Medical Staff Bylaws and Rules and Regulations, the Ethical and Religious Directives for Catholic Health Care Services, any pertinent rules, regulations and statutes of the State of Illinois and comply with all applicable hospital policies and procedures pertinent to this position. 7. Comply with all ethical relationships as set forth by the appropriate professional society. 8. Agree to abide within the limits of the general duties/responsibilities, and the current version of the general Triage guidelines, realizing that any deviations without prior medical staff approval will result in Credentials Committee review and possible suspension and/or withdrawal of all privileges. 9. Must be professionally attired and wear personal identification (name tag) stating, name and position while visiting patients in the hospital. 10. Must maintain close liaison with hospital employed personnel so that instances of misunderstandings in patient care may be avoided.

3 Page 3 of Must establish effective rapport and cooperative spirit with the related hospital personnel. Failure to establish this cooperative situation and/or repetitious contention and altercation may be sufficient reason for terminating privileges. 12 May initiate or change orders at the request of the collaborating physician. 13. Agree to notify the Medical Staff Office immediately, as applicable, of any change in employment; change in information provided in the application or reapplication process; and, change in the physician/advanced nurse practitioner s collaborative agreement. C. Duties And Responsibilities Of Advanced Practice Nurse Working in the Emergency Department The scope of practice of an advanced practice nurse shall include, but is not limited to, the following services and procedures: 1. Taking patient histories and performing physical examinations of a patient. 2. Performing diagnostic and therapeutic studies. 3. Ordering and interpreting tests and diagnostic laboratory and radiological services, ordering of therapies, and using procedures approved by a collaborating physician. 4. Establishing and recording diagnostic impressions, evaluation situations and instituting treatment procedures. 5. Instructing and counseling patients regarding mental and physical health using procedures reviewed and approved by the collaborating physician. 6. Emergency evaluation and treatment of patients in crisis situations with immediate reporting to a collaborating physician. 7. Referring to appropriate community health facilities, agencies and resources. 8. Dictating discharge summaries and other records as instructed by a collaborating physician. 9. Performing such other tasks, not prohibited by law, with the collaboration of a licensed physician, in which the advanced practice nurse has been trained and is proficient to perform. Physicians delegate the authority to perform a medical screening examination, to deliver health care services and treatments and to administer, dispense and prescribe drugs (as allowed by the Act in the scope of practice of emergency medicine).

4 Page 4 of 5 An Advanced Practice Nurse applicant may be awarded specific privileges based on their individual training, documented experience, and documented clinical competence. Please indicate additional clinical privileges, which may apply. Privilege (Check those requested) Prescriptive authority of legend drugs and legend controlled substances categorized as Schedule III, IV, or V (Copy of license must be provided.) Assist in reduction of PIP and shoulder dislocation Arthrocentesis of knee Fracture care for clavicles and metacarpals Endotracheal intubation Lumbar puncture Specify: Awarded Applicant: I attest that I meet requirements for training, experience and demonstrated competence in the field of Advance Practice Nurse. I agree to produce documentation to substantiate these requirements if requested, and to comply with hospital guidelines for advanced practice nurse. I have reviewed and agree to abide by the policies and guidelines of this position. Signature of Advanced Practice Nurse Applicant Collaborating Physician(s): This is to verify as sponsor and/or employer (circle as applicable) of,, an Advanced Practice Nurse, I (we) have reviewed and agree to abide by these guidelines for this position and further assume ultimate responsibility for all acts of the Advanced Practice Nurse unless otherwise designated and explained below: Comments: Signature of Medical Staff Sponsor/Collaborating Physician Signature of Medical Staff Sponsor/Collaborating Physician

5 Page 5 of 5 Department Chairperson: I have reviewed the application and privilege request for this applicant. The privilege request(s) appears appropriate Yes No. (If no, indicate reasons.) DATE Signature/Approval of Department Chairperson Approved by Department of Emergency Medicine - 10/01, 11/02, 5/06 Approved by Credentials Committee - 11/01, 11/02, 6/06 Approved by Medical Staff Executive Committee 12/01, 12/02, 7/06 Approved by Board of Directors 1/02, 1/03, 8/06

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