FORT HAMILTON HOSPITAL DELINEATION OF CLINICAL PRIVILEGES & QUALIFICATIONS ADVANCED PRACTICE NURSE CERTIFIED NURSE PRACTITIONER (CNP) (8/07)

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1 Name FORT HAMILTON HOSPITAL DELINEATION OF CLINICAL PRIVILEGES & QUALIFICATIONS ADVANCED PRACTICE NURSE CERTIFIED NURSE PRACTITIONER (CNP) (8/07) ELIGIBILITY REQUIREMENTS Required Qualifications: Bachelors of Science in Nursing (BSN) unless a new practitioner after the year 2000, in which case, a Masters of Science in Nursing (MSN) is required consistent with area in which CNP will practice. Successful completion of an NLN-accredited nurse practitioner training program. Certification by a national certifying organization recognized by the Ohio Board of Nursing. Current Licensure by the Ohio Board of Nursing as a CNP. Current BCLS certification required; Current ACLS certification required if working in the Emergency Department; ACLS certification preferred when working in all other areas of hospital Current Certificate of Authority by the Ohio Board of Nursing. Current Standard Care Arrangement with (s) or podiatrist(s) whose practice is the same as or similar to the nurse s nursing specialty and who is continuously available to communicate with the CNP. The Standard Care Arrangement must meet the criteria set forth in applicable laws and regulations. Current Ohio Prescriptive Authority License if requesting prescription privileges. DELINEATION OF PRIVILEGES Please place a checkmark before each privilege you are requesting. Some privileges may require documentation of special training or experience before privileges are granted. Rounds with/or for (s). Obtain, dictate, write and sign a relevant History & Physical, according to the standards established by FHH. Obtain, dictate, write and sign a relevant Medical Screening Exam for EMTALA purposes, according to the standards established by FHH. Collaborate with Hospital nursing staff in assessing, planning, implementing and evaluating care for individual patients. Obtain, dictate, and write discharge summaries. Dictate/write and sign progress notes.

2 Delineation of privileges (continued) Page 2 of 6 Initial and periodic age-specific assessment of inpatients and outpatients; physical, medical, and psychosocial status including: Relevant health status and medical history Performing a physical examination Preventative screening procedures based on age and history Identifying medical and health risks and needs of the patient. Identifying and considering the needs of the patient s family and community as they relate to or affect the patient s health and well-being. Formulation of an appropriate differential diagnosis based on the assessments completed, within competency parameters. Establishment of priorities and development and implementation of a mutually-agreeable plan of care to maximize the health potential of the patient, his family, and his community including: Ordering appropriate diagnostic tests within training competency Accurately conducting and interpreting diagnostic tests within training competency Identifying and prescribing non-pharmacologic therapies and interventions within training to competency. Utilization of pharmacologic therapies under the direction of. Developing patient and family education plans Providing patient and family education for discharge planning Seeking and utilizing appropriate health care personnel and resources including communicating with, seeking consultation from and making appropriate referrals to other health professionals and community agencies as needed Procedures: Venipuncture Electrocardiogram (not including interpretation) Care and suturing of minor lacerations. Removal of superficial foreign bodies after consultation with the attending physician and under their direction (excluding the eyes).

3 Delineation of privileges (continued) Page 3 of 6 Application and removal of splints under the direction of attending physician. The attending physician, and any necessary reduction by the attending physician shall make such application only after examination. Application of dressings and bandages. Order and administration of medication and intravenous fluids upon review with the attending physician. Cleansing and debriding wounds. Carry out aseptic and isolation techniques. Catheterization of the urinary bladder. Write orders for medications, treatments, blood products/components per approved OBN Formulary, IV fluids (countersigned by the supervising physician). Write outpatient prescriptions to be reviewed by the supervising physician. Patient education and counseling covering such things as health status, test results, and discharge planning. Cardiopulmonary resuscitation per ACLS/PALS certification Provide advanced life support per ACLS/PALS certification. Endotracheal intubation in accordance with ACLS/PALS certification. Incision and drainage of superficial abscesses or hematomas. Subungual hematoma drainage. Unguectomy and/or partial unguectomy. NG tube insertion and removal CRITICAL CARE/PULMONARY PRIVILEGES Ventilator Management Insertion of Swan Ganz Catheter

4 Delineation of privileges (continued) Page 4 of 6 Paracentesis Insert Arterial Catheters Insert Central Venous Catheters

5 Delineation of privileges (continued) Page 5 of 6 Insert Thoracostomy Tube Thoracentesis NOTES: PRESCRIPTIVE AUHORITY: Non-narcotic medications Additional documentation required: Current Certificate to Prescribe by the Ohio Board of Nursing. Only medications listed in the Standard Care Agreement and the Ohio Committee on Prescriptive Authority Governance (CPG ) formulary may be prescribed. PRESCRIPTIVE AUHORITY: Narcotic medications Additional documentation required: Current Certificate to Prescribe by the Ohio Board of Nursing and Federal DEA license. Only medications listed in the Standard Care Agreement and the Ohio Committee on Prescriptive Authority Governance (CPG) formulary, and within the narcotic classes on the individual s DEA license may be prescribed. 1. All inpatients for whom CNPs holding clinical privileges provide assessment and/or care shall have been admitted to the hospital by a doctor of medicine who is a member of the medical staff, a doctor of osteopathic medicine who is a member of the medical staff or a dentist who is a member of the medical staff per Ohio Revised code (O.R.C.) All such patients shall remain at all times under the supervision of a doctor of medicine or doctor of osteopathic medicine or dentist per O.R.C and O.R.C

6 Delineation of privileges (continued) Page 6 of 6 2. All orders for diagnostic and/or therapeutic intervention for an inpatient written by an appropriately credentialed and privileged CNP shall be counter-signed by the CNP s or podiatrist within the time frames specified by applicable hospital and medical staff by-laws, rules and regulations, and policies, procedures and protocols. 3. CNPs do not have admitting privileges. Printed Name of Applicant Printed Name of Collaborating Physician Signature, Applicant Signature, Collaborating Physician Date Date Approved 9/20/07 Approved 5/20/10 Approved 5/18/11 Fort Hamilton Board of Trustees DEFINITION AND SCOPE OF PRACTICE OF SPECIALIZED NURSING SERVICES means a registered nurse who holds a valid certificate of authority issued that authorizes the practice of nursing as a certified nurse practitioner in accordance with section of the Revised Code and rules adopted by the Board of Nursing. A nurse authorized to practice as a certified nurse practitioner, in collaboration with one of more physicians or podiatrists, may provide preventive and primary care services and evaluate and promote patient wellness within the nurse s nursing specialty, consistent with the nurse s education and certification, and in accordance with rules adopted by the Board. A certified nurse practitioner who holds a certificate to prescribe issued under section of the revised Code may, in collaboration with one or more physicians or podiatrists, prescribe drugs and therapeutic devices in accordance with section of the Revised Code.