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Mon Dec 17 14:24:34 GMT 2007

I have to concur with Lorick.  There are many acute care NPs whose job
description explicitly includes management of critically ill patients.

I believe the ACS requires that a surgeon be the *initial* evaluator of
all trauma patients, and that they be *in charge* of the patient's care,
but that doesn't mean that many aspects of that care cannot be delegated
to others capable of making those kinds of decisions.  Especially in
places like mine, where there are no residents.

One of the big differences between NPs and PAs are that NPs do not
routinely get an education in surgical practice beyond minor office
procedures.  I had to take a special course in intraoperative procedures
and surgical assisting.  There are fewer of us who enjoy the OR, because
as staff RNs most of us came from the ICU.  But in all three states
where I hold licenses, it is legal for an NP to first assist in the OR
and manage patients perioperatively, in ICU and in PACU where hospital
policy allows.  My experience is that hospital policies are much more
restrictive than state law.

Jane

----------------------
Jane Harper, PhD(c), RN, ACNP, CCNS, CNRN, CCRN
Rockford, IL
m.jane.harper at osfhealthcare.org

  _____  

From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Lorick Fox, PA-C
Sent: Monday, December 17, 2007 8:18 AM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Physician Extenders (was RE: trauma-list Digest, Vol 54,
Issue 16)

I understand what Pret means, but for clarity:

Always have to have the surgeon in place for trauma admissions. 
However, I can assure you that many PA's manage SICU, MICU, CCU patients
routinely, with the physician in the OR, at home or otherwise occupied. 
They don't provide SOLE management, but they provide initial/primary
management, with the MD fine tuning (or making the "no good answer"
decisions), either in person or via phone. 
St, Joseph's wasn't a trauma center (that was next door) but we had at
least 30 ICU beds that I was the primary call person for between 2000
and 0800 for the year and half I survived that.  The post CABG patients
were primarily managed by the surgeon from home, but he would ask us to
see them if there was question or they needed cardioversion/new
line/airway management/etc.  If there was a surgical decision to be
made, however, either the cardiac surgery PA or the surgeon would come
in (often without my involvement at all - they could open chests, I
couldn't).  "Manage ICU patients" was certainly in my state approved job
description in both Georgia and Virginia.

Lorick

At 03:54 PM 12/17/2007, you wrote:

Our general/trauma extenders assist in the OR, round with the attendings
on all inpatients (inc ICU), do a variety of procedures (chiefly wound
care, tubes, and lines), and handle much of the day to day
documentation.  Our trauma surgeons also staff a busy general surgery
practice, so there's a wide variety of work to be done.

The PA's (there are no NP's in trauma at the moment, but our recruitment
is non-discriminatory on that account) do not take call, and are not
assigned to the trauma response team as such; however, when they're on
site (weekdays mostly), at least one of them is usually accompanying the
trauma attending, and thus tags along and acts as an extra set of hands,
further freeing the surgeon to direct the resuscitation.

I don't think you'll find a Level I or II center which lists "management
of ICU patients" in the PA/NP job description.  Functional realities
notwithstanding, you've got to have a doctor (almost certainly a
surgeon, and further, a boarded intensivist) directly responsible for
ICU care.  It's part of the verification requirement.

In my observation, our PA's get more OR and procedure time than most.
I'm aware of plenty of practices wherein the extenders are used for
clinical and clerical infrastructure (i.e., scut work).  But then, ours
were selected in large part for their surgical experience, and have
enormous operative credibility.  We've been immensely fortunate in our
hiring, and have a team of surgeons that admires and supports the unique
surgical capacities of its assistants.  

All of which is to say that in a great many programs, and for any number
of PA's and NP's, one person's scut work is another's indispensable role
in a comprehensive system of patient care.  I have no doubt that the use
of extenders in trauma centers will continue and increase; but I can't
see there ever being a standardized job description across the
profession.

Pret Bjorn, RN
EMMC Trauma Program (ACS Level II)
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[ mailto:trauma-list-bounces at trauma.org
<mailto:trauma-list-bounces at trauma.org> ] On Behalf Of
czuehlke at frontiernet.net
Sent: Friday, December 14, 2007 5:50 PM
To: trauma-list at trauma.org; trauma-list-request at trauma.org
Subject: Re: trauma-list Digest, Vol 54, Issue 16

Greetings list members,

This is directed toward those that are in Level I and II centers (or
other
high volume centers).

How many of you use physician assistants on your service?

For those that have residents and fellows, what is the role of the PA
during
pt care? Does the PA take call? Do the PAs manage patients in the SICU?

Do you see a change in demand for PAs in trauma care?

Hi,
In the one trauma centers I work in the PA sees just the mildly ill  
patients and places sutures and or staples in patients. The PA is  
never seen in the trauma rooms nor is he/she in a place where there  
are serious medical conditions. NP's are treated exactly the same way.
At the other hospital newly named trauma center level II for 2010. It  
does not use NP's or PA's at all.
Carol Eisenbrandt

Quoting trauma-list-request at trauma.org:

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> Today's Topics:
>
>    1. Nearly Famous! (tuganddawn at talktalk.net)
>    2. Physician Assistants in Trauma (Michael Krowka)
>    3. Re: Physician Assistants in Trauma (Ronald Gross)
>    4. RE: Physician Assistants in Trauma (Brian E. Fletcher)
>    5. Re: Nearly Famous! (Krin135 at aol.com)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Thu, 13 Dec 2007 20:56:15 -0000
> From: <tuganddawn at talktalk.net>
> Subject: Nearly Famous!
> To: <trauma-list at trauma.org>
> Message-ID: <000a01c83dca$9b0826f0$4752f259 at 049682920380>
> Content-Type: text/plain;      charset="iso-8859-1"
>
> Hello to everyone.
>
>   Before I begin may I wish all of you wherever you are and whatever  
>  your beliefs a very Merry Christmas and a pleasant and event free   
> New Year.
>      I am a Paramedic/Firefighter working in the UK and have   
> recently been asked to consider appearing in a  documentary series   
> about the ambulance service speciffically dealing with concerns   
> about the increase in calls, abuse of the service and out of hours   
> GP service effects.
>     A few months ago I would have been completely against this idea   
> but recent reforms, behaviour of management and treatment by other   
> health care professionals has made me consider the potential   
> benefits of exposing certain ignored aspects of my service   
> (including the appalling lack of professionalism, training and   
> negligence by many Paramedics).
>   I wonder if the list might offer any insights they have about the   
> ethics and problems faced with this sort of media exposure   
> especially when one considers the uncontrolable environment we work   
> in. I would also appreciate any advice about how to deal with these   
> "cutthroat" sensationalist media types!
>    In any event, thanks for your time and trouble and I hope to hear  
>  your responses.
>
>   Yours with kindest regards
>
>   Tug Crumpton
>
> ------------------------------
>
> Message: 2
> Date: Thu, 13 Dec 2007 16:00:59 -0700
> From: Michael Krowka <mkrowka at gmail.com>
> Subject: Physician Assistants in Trauma
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <C38707BB.3C00%mkrowka at gmail.com>
> Content-Type: text/plain;      charset="US-ASCII"
>
> Greetings list members,
>
> This is directed toward those that are in Level I and II centers (or
other
> high volume centers).
>
> How many of you use physician assistants on your service?
>
> For those that have residents and fellows, what is the role of the PA
during
> pt care? Does the PA take call? Do the PAs manage patients in the
SICU?
>
> Do you see a change in demand for PAs in trauma care?
>
>
>
> Michael D. Krowka
> EMT-P
>
>
>
>
> ------------------------------
>
> Message: 3
> Date: Thu, 13 Dec 2007 19:17:30 -0500
> From: "Ronald Gross" <Rgross at harthosp.org>
> Subject: Re: Physician Assistants in Trauma
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <47618535.7FF1.00B9.0 at harthosp.org>
> Content-Type: text/plain; charset=US-ASCII
>
> Michael,
>
> We have 4 PAs and one APRN on service.  Contact me off-line and I   
> would be happy to discuss.......
>
> Ron
>
>>>> Michael Krowka <mkrowka at gmail.com> 12/13/2007 6:00 PM >>>
> Greetings list members,
>
> This is directed toward those that are in Level I and II centers (or
other
> high volume centers).
>
> How many of you use physician assistants on your service?
>
> For those that have residents and fellows, what is the role of the PA
during
> pt care? Does the PA take call? Do the PAs manage patients in the
SICU?
>
> Do you see a change in demand for PAs in trauma care?
>
>
>
> Michael D. Krowka
> EMT-P
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
> ------------------------------
>
> Message: 4
> Date: Thu, 13 Dec 2007 19:44:10 -0500
> From: "Brian E. Fletcher" <bfletcher at columbus.rr.com>
> Subject: RE: Physician Assistants in Trauma
> To: "'Trauma &amp; Critical Care mailing list'"
>        <trauma-list at trauma.org>
> Message-ID: <20071214004410.BJDP22267.hrndva-omta06.mail.rr.com at BRIAN>
> Content-Type: text/plain;      charset="us-ascii"
>
> We have 10 Nurse practitioners.  We manage the step down ICU, floor
> patients, and respond to traumas.  We essentially function like a
resident,
> performing primary/secondary assessment, FAST, central lines, Chest
tubes, A
> lines, suturing etc.  We also have an NP clinic and an attending
clinic. The
> NP clinic sees lower acuity patients and we also assist in the
attending
> clinic.  Hope this helps.
>
> Brian
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
[ mailto:trauma-list-bounces at trauma.org
<mailto:trauma-list-bounces at trauma.org> ]
> On Behalf Of Michael Krowka
> Sent: Thursday, December 13, 2007 6:01 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: Physician Assistants in Trauma
>
> Greetings list members,
>
> This is directed toward those that are in Level I and II centers (or
other
> high volume centers).
>
> How many of you use physician assistants on your service?
>
> For those that have residents and fellows, what is the role of the PA
during
> pt care? Does the PA take call? Do the PAs manage patients in the
SICU?
>
> Do you see a change in demand for PAs in trauma care?
>
>
>
> Michael D. Krowka
> EMT-P
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
> ------------------------------
>
> Message: 5
> Date: Thu, 13 Dec 2007 20:39:34 EST
> From: Krin135 at aol.com
> Subject: Re: Nearly Famous!
> To: trauma-list at trauma.org
> Message-ID: <c73.2076a517.349338d6 at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
>
>
> In a message dated 13-Dec-07 14:57:36 Central Standard Time,
> tuganddawn at talktalk.net writes:
>
> I  wonder if the list might offer any insights they have about the
ethics and
>  problems faced with this sort of media exposure especially when one
> considers  the uncontrolable environment we work in. I would also   
> appreciate any
> advice  about how to deal with these "cutthroat" sensationalist media
types!
> In any event, thanks for your time and trouble and I hope to  hear
your
> responses.
>
>
>
> Tug:
>
> good luck with your project.
>
> You might have better luck posting to the EMS-L using instructions
found  at:
>
> List FAQ:      http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2007-December/_HTTP://EMS-L.ORG <http://ems-l.org/> _
(http://EMS-L.ORG <http://ems-l.org/> )
> Unsubscribe:   _EMS-L-UNSUBSCRIBE at EMS-L.ORG_
> ( mailto:EMS-L-UNSUBSCRIBE at EMS-L.ORG
<mailto:EMS-L-UNSUBSCRIBE at EMS-L.ORG> )
> (subscribe should be _EMS-L-SUBSCRIBE at EMS-L.ORG_
> ( mailto:EMS-L-SUBSCRIBE at EMS-L.ORG <mailto:EMS-L-SUBSCRIBE at EMS-L.ORG>
) )
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<http://ems-l.org/MAN-EMS-L.HTM> _
( http://EMS-L.ORG/MAN-EMS-L.HTM <http://ems-l.org/MAN-EMS-L.HTM> )
> Post to list:  _EMS-L at EMS-L.ORG_ ( mailto:EMS-L at EMS-L.ORG
<mailto:EMS-L at EMS-L.ORG> )
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> Moderator:   _MODERATOR at EMS-L.ORG_ ( mailto:MODERATOR at EMS-L.ORG
<mailto:MODERATOR at EMS-L.ORG> )
>
> Or one of the various Yahoo Paramedic groups...
>
> ck
> Charles S. Krin, DO FAAFP
>
>
>
> **************************************See AOL's top rated recipes
> ( http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004
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>
>
> ------------------------------
>
> --
> trauma-list : TRAUMA.ORG
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>
> End of trauma-list Digest, Vol 54, Issue 16
> *******************************************
>

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LFFox, MPAS, PA-C
Distinguished Fellow, AAPA
CCA, American College of Cardiology
Associate, Society for Critical Care Medicine
Associate, Underwater and Hyperbaric Medical Society 

Lorick Fox, MPAS, PA-C
SEAVIN/Peace Vector IV
Unit 64903, Box 1201
APO, AE 09868-4903
(cell) +20-18-230-4448
(landline) +20-45-240-9450
www.lorick.org
<http://www.lorick.org/> 

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Physician Extenders (was RE: trauma-list Digest, Vol 54, Issue 16)