Hiring a Nurse Practitioner Enhances Practice When Done Carefully

Q. I am considering a contract arrangement with a nurse practitioner. The nurse practitioner would come to my office two days a week to assess patients and handle routine medication refills. The individual would be an independent contractor, and I would function as his or her supervisor. I am a participant in the APA-endorsed Psychiatrists' Professional Liability Insurance Program. Is there coverage under my policy for this arrangement? Will my professional liability risk increase?

A. Utilization of allied health care professionals can be an effective solution to the problem of limited psychiatric resources. As such, more and more psychiatrists are incorporating nurse practitioners in their practices. As with all practice arrangements, you are wise to take steps against potential professional malpractice exposure.

First, entering into a practice agreement with a nurse practitioner constitutes an important change in your practice. Therefore, you should notify your professional liability insurance carrier of the change and discuss coverage issues with your underwriter.

Second, there are some steps you can take to minimize professional malpractice risks. The scope of a nurse practitioner's practice, including prescribing authority, is defined by each state. You should have a clear understanding of what is required by the state's nursing board. You should also verify the nurse practitioner's education, training, licensing, and credentialing, as well as inquire about any administrative complaints or lawsuits that may have been filed against the individual. Contact your state Board of Medicine and review the practice of medicine statutes and any regulations regarding the relationship between physicians and nurse practitioners.

You and the nurse practitioner should have a clear agreement and understanding, preferably in writing, about some specific aspects of the practice relationship including (1) the frequency and type of supervision and record review, (2) notification by the nurse practitioner of any changes in his or her professional status, and (3) information to be given to patients about the respective roles of yourself, the nurse practitioner, and the patient. Other elements may be indicated by the statutes and rules of your state or jurisdiction. In addition, various third-party payers and facilities where you practice may have their own rules about practice relationships with nurse practitioners.

Adequate supervision and involvement in the new treatment delivery arrangement are necessary to maintain high-quality patient care. You should tailor your level of involvement to the nurse practitioner's education, training, and skills, as well as to the clinical needs of patients. Do not make assumptions about the nurse practitioner's knowledge; assess the person's skills carefully. You want to ensure good, ongoing communication between yourself, the nurse practitioner, and patients, especially with regard to the appropriate threshold for notification of material changes in the status of patients—for example, emergencies, crises, and medication side effects. If the nurse practitioner will be prescribing on his or her own, be sure the individual has complied with regulatory requirements and has obtained a DEA number and prescription pads.

Program participants may contact the Risk Management Consultation Service help line for additional guidance on reducing and managing risk in this area.

This column is provided by PRMS, manager of the Psychiatrists' Program, for the benefit of members. More information about the Program is available by visiting its Web site at www.psychprogram.com>; calling (800) 245-3333, ext. 389; or sending an e-mail to [email protected].▪