At DRH, we are encouraged to ignite our spirit of inquiry. Latonia Davis RN Staff Nurse 4V

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1 Force 9 Autonomy Nurses are permitted and expected to practice autonomously, consistent with professional standards. Independent judgment is expected to be exercised within the context of a multidisciplinary approach to patient care.

2 Magnet Nurses are permitted and expected to practice autonomously, consistent with professional standards. Independent judgment is expected to be exercised within the context of a multidisciplinary approach to patient care. Society grants the professions authority over functions vital to itself and permits them considerable autonomy in the conduct of their affairs. In return, the professions are expected to act responsibly, always mindful of the public trust. Self-regulation to assure quality in performance is at the heart of this relationship. It is the authentic hallmark of a mature profession. Donabedian, The Nursing Audit: Self Regulation in Nursing Practice, Nursing most definitely is an autonomous discipline. We are trained to be independent practitioners to use critical thinking with a high emphasis on competence, as major ingredients for autonomy. Through our professional practice model, accountability and autonomy are closely linked. I am personally committed to an environment that promotes accountability and autonomy because of their relationship to excellence in nursing practice and job satisfaction. My emphasis is on promoting accountability and competence in professional nurses by creating an environment where knowledge and professional development and shared decision-making is valued so that nurse gain the confidence and understanding they need to practice autonomously. These are the hallmarks, the prerequisites for nursing excellence, which blossoms into independent judgment. Tommye Hinton, RN, MSN, CPHQ, NEA-BC CNO At DRH, I am afforded the opportunity of assuming many roles in the delivery of care to my patients. Almeta Jackson, RN Staff Nurse 5N I have the authority to make decisions regarding the care of my patients and the responsibilities to ensure those decisions improve the health outcomes for everyone entrusted in my care. Erin Goyt, RN Staff Nurse 5T My unit-based leadership expects me to practice autonomously and always adhere to the professional standards as I deliver care at the bedside. Melissa McKinney, RN Staff Nurse 4Q At DRH, we are encouraged to ignite our spirit of inquiry. Latonia Davis RN Staff Nurse 4V Page 1

3 Autonomy enables all of us to be critical thinkers, strong and knowledged-based decision-makers within a shared governance environment. Charmaine Bond, RN, BSN Self-sufficient. Self-rule. Independence. Authority. Accountability. That s what autonomous nursing practice means to me. Laura Harmon MSN APN Autonomy is an intrinsic characteristic of professional nursing practice at DRH as nurses claim it as part of the tapestry of practice environment. At DRH, autonomy is regarded not only as an independent behavior, but also as an ethical one because the patient s interest is at the nucleus of the effort. Autonomy is a protected treasure and an expected element of professional expression. The Legacy of Caring at DRH is epitomized by autonomous nursing actions. Many of DRH Nurses say that they would not work in a practice environment that did not value the autonomy of its practitioner. As the DRH nursing team considered evidence of autonomy in the practice environment, it was decided to ground the examination in common terminology through informal discussions and personal experience. Further conversation revealed that autonomy means that the nurse is expected to practice to the fullest extent of the scope delineated in the Nurse Practice Act. In order to fully enact that scope, the nurse must be competent to do so. Skills and capabilities relating to specialty practice, patient population is then developed to further enable autonomous practice. When these elements of autonomy are fully enlivened in the professional environment, the nurse and the organization have confidence that the caregiver is fully prepared and fully supported to engage in the autonomous exercise of the scope of practice. Nurses uphold Kristin Swanson s Caring Principle of Doing For others by: anticipating needs, comforting, performing skillfully and competently, and protecting the one cared for while preserving dignity. Nurses consistently practice fully within their scope, working with others and foreseeing patient needs. Autonomy is exercised through the ability of nurses to determine with the patient what is in their best interest and to negotiate the circumstances to meet those needs in the absence of a specific resource, policy or process. DRH Nurses, with support from others, are the primary patient advocates. Page 2

4 SOE 1: Describe the process by which advanced practice nurses are credentialed, privileged, and evaluated. Because the scope of practice for the APN contains not only independent functions but some delegated functions from the physician scope of practice, the credentialing process for Advanced Practice Nurses (APN), and certified registered Nurse Anesthetists (CRNA) mirrors that of the physicians. Education, training, skills and experience in specialized areas of practice is assessed in the same manner and privileged accordingly. The scope of practice for the APN is outlined with regard to those activities that the APN practices both independently and under the supervision of a physician consultant. Policy 1 MS 007 (Attachment 9.1.a, p. 6) Allied Health Professionals - Credentialing supports the CNO s approval of an APN s privileges at both the site and system level. At DRH, the process for credentialing APNs starts with Ms. Hinton, the CNO, regardless of the practice setting. Because of her accountability for patient care in the entire practice environment, she reviews role expectations with Dr. Meg Campbell, RN, who has delegated authority for the practice of APNs throughout the organization. Once completed, the next review is with the sponsoring physician. The CNO approves the scope of practice and delineation of privileges for each APN. Without her concurrence, the APN cannot practice at DRH. Figure 9.1 illustrates the entire credentialing process, showing also where CNO input enters on various credentialing committees, with final approval being granted by the DMC Joint Conference Committee. Initial Authorization and Prescription Privileging Process Figure 9.1. DRH APN Credentialing Process Flow. Page 3

5 Evaluation Process Detroit Receiving Hospital Though the formal recredentialing process occurs every two years or when the scope of practice or the collaborating physician changes, evaluation of APNs is an ongoing process. Each departmental advisory committee establishes observation criteria for provisional staff members. The purpose of the observation is to evaluate the member's proficiency in the exercise of the clinical privileges initially granted and to determine overall eligibility for continued staff membership. In addition, the observation validates that the nurse continues to function within the approved scope of practice. These criteria may define the frequency and format each department deems appropriate to adequately evaluate the provisional staff member status including, but not limited to, concurrent or retrospective chart review, mandatory consultation and/or direct observation. The results of this observation are communicated to the Credentials Committee at the end of the provisional period. Performance evaluation is an expectation and component of ongoing professional competency. Each APN participates annually with the CNO and designee, Meg Campbell, RN PhD., practice group and physician in an evaluation and discussion about job performance. New goals are set annually and subsequent discussion provides an opportunity to develop practice, as shown in (Attachment 9.1.b, APN goals p. 8). Specific criteria related to the organization strategic plan are used as the basis for determining the employee s work performance level. Included in the assessment are job duty performance, contribution to patient, family and/or customer satisfaction, and work group interaction behaviors. Each APN selects at least five customers or stakeholders who are asked for input. Performance is evaluated on an ongoing basis to assure safe and appropriate patient care services. Currently, DRH APNs report to Margaret Campbell, RN, Ph.D, and then to Ms. Hinton. These leaders validate scope of practice and documented plans of care and the exercise of the role components of the APN as noted in the DMC APN job description. The APNs physiciansponsors also evaluate basic knowledge, professional judgment, clinical competence, skills, quality of medical records and ability to work with others. APNs are concurrently evaluated in these areas by 3 of their peers. In addition to the expanded scope of practice evaluation there is an evaluation of the primary job duties and responsibilities identified in the Nurse Practitioner Job Description (Attachment 9.1.c, p. 9). Dr. Campbell uses an evaluation worksheet named the Page 4

6 Job Performance Expectations to document APN performance. Evaluation of APNs is an ongoing process that is formalized annually. Page 5

7 Allied Health Professionals Credentialing Policy Attachment 9.1a Title: Allied Health Professionals - Credentialing Page 1 of 4 Policy No: 1 MS.007 Effective Date: 03/03/08 OBJECTIVE To define the credentialing process for Allied Health Professionals and specific rules for Allied Health Professionals privileged through the Medical Staff credentialing process. SCOPE DMC Medical Affairs, DMC Medical Staff and Clinical Departments. DEFINITIONS 1. Allied Health Professionals (AHP) include employees of the Detroit Medical Center (DMC) and non-dmc employed practitioners. AHP's are not members of the Medical Staff but may request certain privileges through the Medical Staff structure. Any AHP desiring to provide services to patients who are customarily provided by the Medical Staff must be credentialed through the Medical Staff credentialing process as defined in Section 2. below. 2. Employees of the DMC shall practice under the authority of an approved job description. Qualifications will be verified through the employment process by the Human Resources Department. An employed AHP requesting privileges outside of the approved job description shall do so through the procedures described in Medical Staff Policy, MS-002 Initial Appointment. Such privileges shall be approved by the Credentials Committee, the Medical Executive Committee (MEC) and the Governing Body. The ongoing performance of the employee shall be monitored through the annual performance evaluation process and through the review process described herein. 3. AHP's eligible to apply for privileges through the Medical Staff credentialing process include individuals who hold an advanced license through the state of Michigan. AHP's under this section include: Certified Registered Nurse Anesthetists (CRNA) Certified Nurse Midwives (CNM) Certified Nurse Practitioners Psychologists and Doctoral Scientists Allied Mental Health Professionals Physician Assistants Optometrists Other appropriately trained and licensed AHP s as may be approved by the Governing Body. PROVISIONS 1. Qualifications, Responsibilities and Prerogatives a. As required by their particular discipline, AHP's shall have satisfactorily completed the requirements of a fully-accredited professional program, and shall meet all educational and training requirements specified by the department to which they are applying. b. AHP s shall hold an advanced license or certification required to practice their profession in the State of Michigan as required for their discipline, and shall meet the basic qualifications required by the State Board for that profession. c. AHP's shall meet the responsibilities for continuous licensure and professional liability insurance and all other responsibilities described in the Medical Staff Bylaws, Article III, Section 7. d. AHP's are eligible to serve on Medical Staff, department, service and hospital committees. e. AHP's shall attend meetings of the department and service to which they are assigned, as required. Sponsor: DMC CVO Title: Allied Health Professionals - Credentialing Page 2 of 4 Policy No: 1 MS.007 Effective Date: 03/03/08 2. Sponsoring Practitioner a. The services of an AHP must be engaged by a Member of the Medical Staff either as a DMC-employee, an employee of the practitioner or his medical group. The Medical Staff Member shall be identified as the "Sponsoring Practitioner." Fully licensed Psychologists (Ph.D.) shall not be required to identify a Sponsoring Practitioner. b. Any member of the Active Staff is eligible to sponsor an AHP, and in doing so shall assume total responsibility for the performance of any AHP used by him. An AHP may have more than one Sponsoring Practitioner, and the Sponsoring Practitioner may sponsor more than one AHP, as defined by law. The Sponsoring Practitioner(s) must hold an appointment in the same department/specialty in which the AHP is applying to practice. c. In the case of Advanced Practice Nurses, as part of the privileging process, the Sponsoring Practitioner and the APN shall provide a collaborative agreement which shall describe the medical functions, duties, and responsibilities of the APN. In addition, this plan shall address specific departmental requirements for supervision for both routine and emergent situations. The Sponsoring Practitioner shall provide a list of designated practitioner(s) to supervise the APN in his absence. d. Should the relationship of the AHP and the Sponsoring Practitioner be terminated, it shall be the responsibility of the Sponsoring Practitioner to immediately notify DMC Corporate Medical Affairs of the termination. The privileges of the AHP shall be suspended immediately upon receipt of such notification. e. Should the Membership of the Sponsoring Practitioner be terminated, the privileges of the AHP shall be suspended immediately upon such action. f. In either instance, the AHP shall have thirty (30) days in which to identify an alternative approved Medical Staff Member to assume the responsibilities of Sponsoring Practitioner. If an alternative Sponsoring Practitioner is not identified, the privileges of the AHP shall automatically lapse. 3. Bound by Rules and Regulations and Policies a. Each AHP, in connection with submitting his application, shall verify by written statement that he has read and understands this Policy governing AHP's and agrees to be subject to and abide by such provisions. b. While within the DMC operating units, all AHP's shall be governed by the general policies of the DMC as well as by specific policies relating to delivery of services and conduct of care by AHP's. 4. Procedure for Approval, Renewal and Revocation a. Application forms to be used in applying for privileges or renewal of privileges to act as an AHP shall be developed by DMC Medical Affairs and approved by the Governing Body. DMC Medical Affairs shall be responsible for the distribution and processing of the applications. b. Upon receipt, the application will be examined for completeness, the information contained therein shall be verified and the application, when complete and verified, will be referred to the Allied Health Professional Executive, Department Chief/Specialist-in-Chief or designee, the Credentials Committee, MEC and the Governing Body. All requests for AHP privileges (or Scope of Practice) are subject to biennial review and approval, as appropriate, by AHP Executive or other individuals, the Department Chief/Specialist-in-Chief or designee, and by the Credentials Committee, the MEC, and the Governing Body. Sponsor: DMC CVO Page 6

8 Allied Health Professionals Credentialing Policy Attachment 9.1a Title: Allied Health Professionals - Credentialing Page 3 of 4 Policy No: 1 MS.007 Effective Date: 03/03/08 c. Once a completed application has been received and the information contained therein has been verified according to Medical Staff Policy MS-004 Temporary Privileges AHP's privileges may be granted to fill an important patient care need, pending the MEC and JCC approval, by the following: 1. Nursing manager or other AHP Executive or appropriate manager; and 2. Department Chief or designee; and 3. Chief of Staff or President of the Medical Staff; and 4. Administrative Representative. d. The AHP shall hold only temporary approval until the recommendation has been reviewed and acted upon by the Credentials Committee, the MEC, and the Governing Body. e. The respective department(s) in which the AHP performs privileges shall monitor the performance of the AHP and shall regularly report such monitoring activities to any appropriate clinical improvement committee. f. Each AHP authorized to perform privileges within the DMC shall be subject to probationary periods and reappraisal in the same manner as Medical Staff appointees, as described in Medical Staff Policy. The Sponsoring Practitioner shall participate in the evaluation of the performance of the AHP. Any AHP whose privileges have expired or are not renewed may not provide any services in the DMC. g. The privileges of an AHP may be revoked at any time, after consultation with the Sponsoring Practitioner, by the President of the DMC, the Chief of Staff of a Hospital in which the AHP practices, the Chief of Service, the Chair of the Credentials Committee or the President of the Medical Staff when, in the opinion of such individual, the failure to take action might in any way result in a threat to the safety, health or welfare of any patient or other person or to the orderly administration of the DMC. h. For DMC-employed AHP s, violation of Human Resources Policy, professional practice code and practicing beyond the scope of practice are also reasons for removal of privileges. i. If the Credentials Committee recommends the denial, non-renewal or revocation of the privileges of any AHP, the AHP may request a personal meeting with the Credentials Committee. A written request must be delivered to the Chair of the Credentials Committee in care of DMC Corporate Medical Affairs within ten (10) days after receipt of the notification of the action of which he wishes to complain. The Credentials Committee may, in its sole discretion, meet with the AHP and discuss his situation in person. The AHP shall not be entitled to be accompanied to such meeting by any individual other than his Sponsoring Practitioner. After such meeting the Credentials Committee may maintain, reverse or modify the recommendation, and will forward such recommendation to the MEC. The AHP shall not be entitled to any further hearing or appeal or other proceeding. j. If the AHP's privileges have been terminated, he must wait at least one (1) year before re-requesting privileges. k. Failure of an AHP applicant to submit the required credentialing documentation upon request will have their application considered a voluntary withdrawal. l. Failure of an AHP staff member to submit the required reappointment form and supporting documentation upon request will be considered a voluntary resignation. The AHP s employer or Sponsoring Physician (DMC and non-dmc) will be notified of their non-compliance prior to their voluntary resignation being sent to the Credentials Committee. In the case of DMC employees, DMC Human Resources will also be notified. Sponsor: DMC CVO Title: Allied Health Professionals - Credentialing Page 4 of 4 Policy No: 1 MS.007 Effective Date: 03/03/08 ADMINISTRATIVE RESPONSIBILITY The Executive Vice President, Clinical and Medical Affairs has operational day-to-day responsibility for this policy. APPROVAL SIGNATURE(S) President of the Medical Staff Date Executive V. P. Clinical and Medical Affairs Date REVIEW DATE 03/11 SUPERSEDES 01/02 ; 09/04 Sponsor: DMC CVO Page 7

9 2008 APN Goals Attachment 9.1b 2008 GOALS FOR PATRICIA VERNIER GOAL # GOAL MEASURE STRATEGIC PLAN REFERENCE 1 Help build institution s financial strength 2 Enhance customer service 3 Foster professional development of self and staff nursing Sustain length of stay for Green Surgery division Positive feedback on post discharge phone calls to 50% patients from Green Surgery Division Develop one or more research publications and/or collaborative projects with staff RNs utilizing evidence based practice A.2.2 B.4.2 B.3.2 C.3.2 Page 8

10 Nurse Practitioner Job Description Attachment 9.1c JOB POSTING SUMMARY Title: Nurse Practitioner Page 1 of 6 Job Code: 4NG35 Date: 05/07 Summary Description The Nurse Practitioner (NP) is an advanced practice nurse, who utilizes advanced knowledge and clinical expertise in providing primary and/or specialized health care services to individuals, families, groups and communities across the health-illness continuum. Diagnostic reasoning, advanced therapeutic interventions and education are key elements in the direct provision of care using a collaborative model. The nurse practitioner works as an autonomous practitioner or in collaboration with a physician, and is directly accountable for making clinical judgments using independent and interdependent decision-making skills. The nurse practitioner's primary focus is on the provision of direct and indirect patient care in managing the health care needs of the identified client population(s). The nurse practitioner provides care to a specific patient population using advanced skills in physical exam, diagnosis and treatment. The nurse practitioner writes medical orders (medications, tests and invasive procedures) and may perform invasive procedures, and perform or assist with surgical procedures; subject to internal and external rules and regulations credentialing. The nurse practitioner also functions as a consultant, educator, researcher, resource and role model for patient, families, community, nursing personnel and other health care providers. The nurse practitioner evaluates the quality of care rendered; analyzes and promotes system changes to enhance quality of care and organizational effectiveness/efficiency; conducts/utilizes research to promote health and improve health care delivery. The nurse practitioner assumes responsibility for own professional development. Appropriate privileges are required to prescribe pharmacological and medical interventions. The nurse practitioner obtains privileges to practice within the Detroit Medical Center as an Allied Health Professional through the Detroit Medical Center Medical Staff Organization, according to internal and external rules and regulations. A. PRACTICE *1. Assesses the health status of patients through eliciting comprehensive health histories, performing physical exams and analyzing data to formulate appropriate diagnoses. Develops prioritized, comprehensive problem list and prioritizes/prescribes interventions and diagnostic tests, when appropriate, in collaboration with a physician or according to established standards. Consistently collects patient data, which is prioritized according to the patient's immediate condition or needs. *2. Identifies expected patient outcomes and develops appropriate plan of care to manage patients' health problems, promote health maintenance and prioritizes multiple patient needs. The plan of care is developed in collaboration with the patient, family and other health care professionals. The plan of care is documented and specifies appropriate diagnostic and therapeutic strategies to attain expected outcomes which are individualized, consistent with goals of care, cost-effective, reflective of current scientific knowledge and which anticipate and address the continuing needs of the patient. *3. Prescribes and implements interventions identified in the interdisciplinary plan of care. Interventions may include a variety of therapeutic interventions, including diagnostic tests, pharmacologic and nonpharmacologic interventions, invasive procedures, providing patient/family education and counseling, and initiating health care and community referrals. Nurse Practitioner_4NG35.doc Date Printed: 03/17/20095:54 AM JOB POSTING SUMMARY Title: Nurse Practitioner Page 2 of 6 Job Code: 4NG35 Date: 05/07 *4. Evaluates and documents patient progress toward the attainment of expected outcomes utilizing interdisciplinary collaboration, appropriate quality indicators and multiple sources of data, including the patients' assessment of progress. Coordinates and facilitates continuity of care that crosses institutional and organizational boundaries, as required. *5. Acts as a patient/family advocate to ensure health care services are delivered in an ethical and culturally sensitive manner. B. CONSULTATION *1. Acts as a consultant to patients, families, the community, nursing staff, medical staff and other health care providers by providing clinical expertise. 2. Promotes the integration of a nursing perspective in planning, policy making and problem-solving. *3. Provides consultation to various agencies and groups (i.e., government, planning groups, health institutions, community groups, policy makers, organizational leaders, teaching institutions and other educational groups/agencies). C. EDUCATION 1. Assesses the knowledge, skills and ability of the nursing staff to provide quality patient care. Provides education opportunities to develop and enhance performance, problem-solving and critical thinking skills of nursing staff. 2. Designs, implements, coordinates and evaluates materials and programs for clients, health care professionals and the community, based on identified needs. 3. Educates nursing staff and other health care providers in the development, implementation and evaluation of teaching strategies for patients/families. *4. Instructs patients/families/caregivers about medical condition, management, follow-up care, medications, illness prevention, health promotion, coping strategies. The intent is to increase knowledge and the ability to manage the illness and maximize coping strategies for patients, families/caregivers. 5. Precepts, teaches, coaches and mentors students, nurses and other health care providers. D. RESEARCH 1. Conducts research independently or in collaboration with other nurses and/or other disciplines. *2. Analyzes and disseminates relevant nursing research. Applies research findings in clinical setting to improve practice. E. MANAGEMENT/LEADERSHIP Nurse Practitioner_4NG35.doc Date Printed: 03/17/20095:54 AM Page 9

11 Nurse Practitioner Job Description Attachment 9.1c JOB POSTING SUMMARY Title: Nurse Practitioner Page 3 of 6 Job Code: 4NG35 Date: 05/07 *1. Acts as an independent practitioner. Utilizes independent judgment to effectively recommend changes in clinical practice and/or prescription of nursing interventions in patient care. 2. Utilizes continuous quality improvement to effect system changes. Integrates clinical and management skills with fiscal responsibility. 3. Provides proactive leadership to attain excellence in clinical nursing practice and quality patient care at the departmental, divisional and organizational levels. *4. Supervises clinical practice to ensure effective, efficient quality care delivery. *F. PROFESSIONAL Maintains current knowledge and clinical expertise through ongoing involvement in professional activities. Engages in collaborative appraisal of professional practice. Models professionalism and positive guest relations. Engages in activities that enhance/advance the profession of nursing. Sets professional goals and demonstrates achievements. COMPLIANCE STATEMENT Supports the standards set forth in the DMC Code of Conduct by creating an atmosphere of commitment to legal and ethical standards, and as directed, implementing external and internal audit recommendations. Monitors activities to ensure compliance with applicable laws, regulations JCAHO requirements, and DMC policies and procedures. *The essential functions of this job include but are not limited to those marked with an asterisk. Minimum Qualifications 1. Registered nurse licensure to practice in the state of Michigan. 2. State of Michigan Nurse Specialty Certification as a Nurse Practitioner. 3. Master's degree in nursing from an accredited nurse practitioner training program. 4. Two years clinical experience as a professional nurse. 5. National certification in advanced practice nursing specialty from one of the following certification bodies: American Nurses Credentialing Center (ANCC) National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNPN) National Certification Corporation for the Obstetric & Gynecologic & Neonatal Nursing Specialties (NCCOGNS) American Academy of Nurse Practitioners (AANP) Oncology Nursing Certification Corporation (ONCC) Nurse Practitioner_4NG35.doc Date Printed: 03/17/20095:54 AM JOB POSTING SUMMARY Title: Nurse Practitioner Page 4 of 6 Job Code: 4NG35 Date: 05/07 6. Eligible for approval of privileges to practice within the Detroit Medical Center as an Allied Health Professional through the Detroit Medical Center Medical Staff Organization. Application for Allied Health Professional credentialing must be submitted to the Detroit Medical Center Medical Affairs Office upon hire. 7. Prior to obtaining privileges through the Detroit Medical Center Medical Staff Organization, the nurse practitioner may: a. See patients under the direct supervision of a nurse practitioner, who has obtained privileges through the Detroit Medical Center Medical Staff Organization, or the attending physician. b. Prescribe medications and treatments, and order diagnostic tests as a delegated responsibility from the attending physician. The orders will be written as verbal orders and must be co-signed by the supervising nurse practitioner or attending physician within 24 hours. 8. In accordance with State of Michigan administrative rules R , Only nurses certified in a nursing specialty field may hold themselves out to the public as nurse specialists using the title nurse anesthetist, nurse midwife, or nurse practitioner. Conduct contrary to this rule is deemed a violation of sections 16221(g) of the act. Therefore, prior to obtaining national certification in an advanced practice nursing specialty and State of Michigan Specialty Certification as a Nurse Practitioner, the title nurse practitioner may not be used and newly graduated nurse practitioners will be hired under Graduate Advanced Practice Nurse job description. LEGAL SCOPE OF PRACTICE 1. In the state of Michigan, certified nurse practitioners have the scope of practice of both a Registered Nurse and a Nurse Practitioner. 2. A certified nurse practitioner may prescribe/write medical orders according to collaborative practice agreement with a licensed physician. The physician s name must appear on the prescription along with the NP s name and signature. Example: Sarah Smith CNP/Alex Jones, MD. 3. According to Michigan law, nurse practitioner s have delegated authority to prescribe non-controlled and controlled substances II-V as a defined in Michigan Administrative Code Rules & b. 4. According to Michigan Public Health Code Part 178, Physical Therapy, : Physical therapy may only be provided upon the prescription of a physician, dentist or podiatrist. 5. Nurse practitioners may perform medical procedures as defined in collaborative practice agreement with a licensed physician upon: a. Initial training in performance of specific procedure, which shall include appropriate didactic instruction and demonstration of clinical competence in performing the procedure. b. Documentation of ongoing clinical competence in performance of specific procedure. 6. Nurse practitioners may bill for professional services under physician provider ID number or may bill under own provider ID number, according to requirements of individual insurers. For example, as of Nurse Practitioner_4NG35.doc Date Printed: 03/17/20095:54 AM Page 10

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