FNP Family Nurse Practitioner/ NP Nurse Practitioner

Job Description

Job Description

FNP/ NURSE PRACTITIONER RESPONSIBILITIES AND STANDARDIZED PROCEDURES

This document establishes the legal authority for the Nurse Practitioners at AFC Urgent Care Ladera Ranch, 27522 Antonio Pkwy, ste P3, Ladera ranch, CA 92694, to perform certain functions and procedures that overlap with Physicians.

These standardized procedures are in accordance with the Nurse Practice Act in the California Business and Professions Code, Chapter 6, Section 2725, and the California Administrative Code, Title 16, Article 7, Section 1470-4 and Title 22, Division 3, Section 51240 (Medical). The numbering and lettering below parallel the Title 16 Code guidelines.

Nurse Practitioners and Physicians, who are in collaboration to provide patient care, jointly wrote these standardized procedures. These standardized procedures are signed and dated by those parties who share responsibility for the care of those patients to be cared for by the Nurse Practitioners at this site.

The standardized procedures shall remain at AFC Urgent Care Ladera Ranch, 27522 Antonio Pkwy, ste P3, Ladera ranch, CA 92694, for review by interested parties.

AUTHORIZED PROCEDURES AND DUTIES

The Nurse Practitioner is authorized to do the following patient related activities without the Physicians approval or observation:

Obtain patient medical history and perform physical examinations for presenting problem(s) within the established scope of practice

Laboratory tests: Blood finger sticks, throat swabs, nasal swabs, skin/wound swabs for culture, swabs for STI testing, urine tests, hemoccult test, and serum blood draws. This also includes all Clia-Waived laboratory tests offered as POC testing at AFC Urgent Care Ladera Ranch.

Counsel patients and their families on health promotion, diagnosis, and medical management

Evaluate, diagnose, and treat conditions within the established scope of practice

Maintaining medical records in electronic medical record

EKG

X-Ray

Initial soft read

Spirometry

Audiometry

IV placement

Administration of IV medication

IM injection of medications

Administration of Vaccines

AUTHORIZED DIAGNOSIS AND MANAGEMENT

Nurse Practitioners are authorized to evaluate, diagnose, and treat minor medical injuries and illness for adults and children over the age of two weeks including but not limited to:

Animal Bites (minor)

Ear infections

Otitis Externa

Otitis Media

Eye disorders

Blepharitis

Chalazion

Conjunctivitis

Hordeolum

Headaches (minor)

Sinusitis

Health screening

Blood pressure evaluation/treatment

Diabetes screening/treatment

Pregnancy screening (urine test)

STI screening/treatment

Respiratory disorders

Allergic rhinitis

Covid

Bronchitis

Influenza

Pharyngitis

Pneumonia

Viral URI

RSV

Skin, hair, and soft tissue disorders

Acne

Burns (minor)

Cellulitis

Dermatitis

Herpes Simplex

Impetigo

Insect bites and stings

Pediculosis

Tinea pedis

Tinea corpus

Laceration evaluation and repair

• Simple Interrupted

• Running Stitch

• Corner Stitch

Strains and sprains (minor)

To include all extremities and trunk/back/neck

• Splinting/sling

Urinary tract infection

Male and Female

The Nurse Practitioner is authorized to diagnose and prescribe under the protocols established in this document without the direct (on-site) supervision or approval of the delegating or alternate Physicians.

EMERGENCY CARE

Whenever necessary, the Nurse Practitioner shall attempt to sustain life. This includes, but is not limited to:

Establishing and maintaining airway

Assist breathing

Cardiopulmonary resuscitation

Control of hemorrhage by external pressure

Injection (subcutaneous) of epinephrine for anaphylactic shock

MD must be made aware of all patients requiring ER follow up/care

AUTHORIZATION TO FURNISH DRUGS AND DEVICES

The Nurse Practitioner may order/prescribe drugs and medical devices pursuant to B&P Code Section 2836.1 and must include the following criteria:

Include the furnishers name and furnishing number on the prescription transmittal order form for drugs, devices, or both. Prescription pads and electronic prescription may be used as a transmittal order form as long as they contain the furnishers name and furnishing number. The NPs DEA number is also required on the prescription transmittal form for Schedule II, III, IV, or V controlled substance.

The drugs and devices furnished by Nurse Practitioners are in accordance with the standardized procedures, and established formulary.

California law (Health and Safety Code Section 11165.1) requires all California licensed prescribers authorized to prescribe scheduled drugs to register for access to CURES 2.0 by July 1, 2016 or upon issuance of a Drug Enforcement Administration Controlled Substance Registration Certificate, whichever occurs later.

California Law (Health and Safety Code Section 11165.4) requires all California authorized licensed prescribers of scheduled drugs to consult CURES prior to prescribing, ordering, administering, or furnishing a Schedule IIIV controlled substance:

The first time a patient is prescribed, ordered, administered, or furnished a controlled substance, unless one of the exemptions below apply. For purposes of this paragraph, first time means the initial occurrence in which a health care practitioner, in his or her role as a health care practitioner, intends to prescribe, order, administer, or furnish a Schedule II, Schedule III, or Schedule IV controlled substance to a patient and has not previously prescribed a controlled substance to the patient.

Within the twenty-four hour period, or the previous business day, before prescribing, ordering, administering, or furnishing a controlled substance, unless one of the exemptions below apply.

Before subsequently prescribing a controlled substance, if previously exempt.

At least once every four months if the controlled substance remains a part of the patients treatment plan.

California Law (Health and Safety Code Section 11165.4) states a health care practitioner is exempt from consulting the CURES database before prescribing, ordering, administering, or furnishing a controlled substance in any of the following circumstances related to our practice:

The patient is receiving hospice care

The Nurse Practitioner may accept, sign for and distribute prescription drug samples.

STANDARDS FOR CARE

Standards for adequacy of diagnosis, management, and treatment shall be consistent in accordance with the standardized procedures established at AFC Urgent Care Ladera Ranch, 27522 Antonio Pkwy, ste P3, Ladera ranch, CA 92694.

Protocols for the Management of General Health Status and Wellness exam:

Subjective data

Patient concerns noted

Health and Social History

Established patients

Interval History

New patients

Past health history via interview, previous medical records

Recent interval history

Symptoms relevant to any chronic/acute disease process

Present status of current symptom(s)

Objective data

Physical exam addresses chief complaint

Appropriate lab tests performed

Assessment

Consistent with subjective and objective findings

Assessment of the status of any acute/chronic diagnosis

Treatment

Supportive measures that are appropriate to health maintenance, i.e., immunizations, screening measures, age-related anticipatory guidance, patient education regarding health care

Referral to appropriate specialty

Addressing patient concerns

Guidelines for follow-up

Consultations

Protocol for Management of Common Acute Illness

Subjective data:

Symptoms relevant to the acute illness and organ systems affected. Status of current symptoms, i.e., duration, frequency, and in relation to chronic, underlying health problems

Objective data

Physical exam appropriate to acute illness signs and symptoms

Laboratory testing as appropriate

Assessment

Consistent with subjective and objective findings

Treatment

Supportive measures that are appropriate to the patients illness

Education regarding administering medications if indicated

Guidelines for follow-up

Consultations

Protocol for the Management of Chronic Illness:

Subjective data

Symptoms relevant to the chronic disease process and organ systems affected

Status of current symptom(s), i.e., present stable or absent

Objective data

Physical examination appropriate to the disease process

Laboratory evaluation as appropriate

Assessment

Consistent with subjective and objective findings expected with diagnosis

Status of chronic disease

Treatment

Initiation or manipulation of prescriptive medication

Patient education regarding the administration of prescription medication

Referral for physical, occupational, or psychological therapy if appropriate

Diet and exercise prescription as indicated by the disease process and patient condition

Guidelines for follow-up

Consultations

To perform the roles in these standardized procedures, the Nurse Practitioner must have:

Possession of a valid California license as a Registered Nurse Certification by the state of California, Board of Registered Nursing, as a Nurse Practitioner

Possession of a valid Furnishing Number from the State of California

Possession of valid DEA license

Masters Degree in Nursing

National certification as a Nurse Practitioner within six months of hire

Continuing competence shall be evaluated by regular review of patient care provided by the Nurse Practitioner. The scope of supervision for the performance of the functions named in the procedure shall include:

Regular chart review by collaborating Physicians

CONSULTATION AND REFERRAL

Consulting Supervising Physician should be available to the Nurse Practitioner by direct on-site, phone or via electronic means. Communication with a Physician should be sought for the following situations and others deemed appropriate:

Emergent conditions requiring prompt medical intervention

Emergent conditions requiring referral to the ER for management

Acute decompensation of patient situation or condition

Increase in severity of symptoms after initial treatment

Unexplained historical, physical or laboratory findings

Upon request of patient, Nurse Practitioners, or Physician

Initiation of medication regimes which are currently not defined as standard of care dependent upon diagnosis

Patient contacts and visits not in accordance with standardized practice and/or facility policy

Review of specific management guidelines and complications related to treatment of disease process less familiar to the Nurse Practitioner

When a Physician is consulted, a notation, including the Physicians name, should be noted in the chart.

SITE

The Nurse Practitioners shall perform these functions AFC Urgent Care Ladera Ranch, 27522 Antonio Pkwy, ste P3, Ladera ranch, CA 92694,.

MEDICAL RECORDS

Electronic medical records shall include the chief complaint; history; review of pertinent systems; objective findings; lab results; assessment; differential diagnoses as needed; and management plan. Management may include prescriptions, procedures, patient education, and referrals. Medical records shall be completed within 72 hours of an encounter and remain confidential.