| (1) |
Nurse Practitioners. Nurse practitioners provide basic preventive health care to patients, and increasingly serve as primary and
specialty care providers in mainly medically under-served areas. The most common areas of specialty for nurse practitioners are family practice, adult practice, women's health, pediatrics, acute care, and gerontology; however, there are many other specialties.
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| (2) |
Certified Nurse Midwives. Certified nurse midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care.
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| (3) |
Certified Registered Nurse Anesthetists. Certified registered nurse anesthetists (CRNA) administer
anesthesia, monitor patient's vital signs during surgery, and provide post-anesthesia care. A CRNA administers anesthesia and anesthesia-related care in four general categories:
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| a. |
Works as a licensed, independent practitioner.
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| b. |
Examines patients and establishes medical diagnoses by client history, physical examination, and other criteria.
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| c. |
Orders, conducts, and interprets screening studies, tests, and diagnostic procedures to assess and diagnose problems and establish management/treatment
plans.
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| d. |
Initiates consultation, collaboration, and referral requests to specialists and other health professionals.
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| e. |
Teaches, counsels, and advises patients, families, and communities about current health status and illnesses, and provides health promotion and
disease prevention services, taking into account age, developmental status, disability, culture, ethnicity, sexual orientation, spiritual/religious
affiliation, and lifestyle issues.
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| f. |
Provides appropriate periodic mental health assessments and screening, and counseling for mental illness, family violence, and diseases of addiction.
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| g. |
Prescribes and dispenses medications and durable medical devices and supplies.
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| h. |
Prescribes and dispenses controlled substances within an individual’s Advanced Practice Nurse State license.
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| i. |
Admits, cares for, and discharges
patients, when privileged to do so by the employing facility.
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| j. |
Provides culturally competent care with respect to cultural, Tribal, and spiritual beliefs and incorporates ceremonies and practices of the patient belief system into the plan of care.
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| k. |
Practices within specialty area of training and certification only.
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| l. |
Incorporates new procedures and treatment protocols into practice after appropriate training, evaluation of competence, identification of consultation and referral system related to the new procedure, and periodic outcome and competency review.
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| m. |
Practices in accordance with the standards of practice as defined by the American Academy of Nurse Practitioners and/or as outlined by an American professional organization for a specific specialty such as pediatrics, geriatrics, emergency care, etc.
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| a. |
Works as a licensed independent practitioner.
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| b. |
Provides health care of women focused primarily on, but not limited to, reproductive health.
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| c. |
Admits and discharges women to health care facilities when privileged to do so by the employing facility.
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| d. |
Orders diagnostic exams, laboratory tests, x-rays, and sonograms.
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| e. |
Analyzes and interprets data, formulates diagnoses, and establishes management/treatment plans.
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| f. |
Provides prenatal,
intrapartum, and postpartum care of the low and designated at-risk
obstetrical patient.
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| g. |
Manages complicated pregnancies by consultation or collaboration with a physician. A physician is not always present in rural areas and patient conditions are sometimes managed via phone “consultation.”
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| h. |
Utilizes written practice guidelines that describe the parameters of service for independent and collaborative midwifery management and transfer of care when needed.
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| i. |
Evaluates fetal well-being in labor.
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| j. |
Evaluates and cares for the newborn, including airway management, resuscitation, and initial examination and well-baby care.
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| k. |
Manages acute, episodic, and chronic conditions occurring in women, referring patients when disease process exceeds provider education, training, and experience.
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| l. |
Prescribes and dispenses medications and durable medical devices and supplies.
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| m. |
Prescribes and dispenses controlled substances within an individual’s certified nurse-midwife State licensure.
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| n. |
Develops health promotion and maintenance plans, including disease prevention and health education counseling.
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| o. |
Provides age-appropriate, periodic physical health screening.
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| p. |
Screens, assesses, treats, and provides health education to patients with gynecological conditions and treats sexually transmitted diseases in women and their contacts.
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| q. |
Provides initial infertility evaluation and referral as appropriate.
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| r. |
Screens and treats for behavioral health problems, including addiction, domestic violence, and depression.
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| s. |
Incorporates new procedures and treatment protocols into practice after appropriate training, evaluation of competence, identification of consultation and referral system related to the new procedure, and periodic outcome and competency review.
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| t. |
Practices in accordance with the standards for the practice of nurse-midwifery, as defined by the American College of Nurse-Midwives.
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| a. |
Works as a licensed independent practitioner.
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| b. |
Performs and documents pre-anesthetic assessment and evaluation of the patient, including requesting consultations and diagnostic studies; selects, obtains, orders, and/or administers pre-anesthetic medications and fluids; and obtains informed consent for anesthesia.
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| c. |
Develops and implements an anesthetic plan.
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| d. |
Selects and initiates the planned anesthetic technique, which may include general, regional, and local anesthesia and intravenous sedation.
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| e. |
Selects, obtains, and administers the anesthetics, adjuvant drugs, accessory drugs, and fluids necessary to manage the anesthetic, to maintain the patient's physiologic homeostasis, and to correct abnormal responses to the anesthesia or surgery.
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| f. |
Selects, applies, and inserts appropriate non-invasive and invasive monitoring modalities for collecting and interpreting patient physiological data.
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| g. |
Manages a patient's airway and pulmonary status using endotracheal intubation, airway adjuncts, mechanical ventilation, pharmacological support, respiratory therapy, or extubation.
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| h. |
Manages emergence and recovery from anesthesia by selecting, obtaining, ordering, and/or administering medications, fluids, or ventilatory support in order to maintain homeostasis, to provide relief from pain and anesthesia side effects, or to prevent or manage complications.
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| i. |
Releases or discharges patients from a post-anesthesia care area and provides post-anesthesia follow-up evaluation and care related to anesthesia side effects or complications.
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| j. |
Orders, initiates and modifies pain relief therapy, through the utilization of drugs, regional anesthetic techniques, or other accepted pain relief modalities, including labor epidural analgesia.
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| k. |
Prescribes and dispenses controlled substances as authorized by an individual's Certified Registered Nurse Anesthetists State licensure.
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| l. |
Responds to emergency situations by providing airway management, administering of emergency fluids or drugs, and using basic or advanced cardiac life support techniques.
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| m. |
Initiates consultation, collaboration, and referral requests to specialists and other health professional when disease process exceeds provider education, training, and experience.
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| n. |
Performs additional nurse anesthesia responsibilities, which are within the education, training, and expertise of the individual Certified Registered Nurse Anesthetists.
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| o. |
Practices in accordance with the American Association of Nurse Anesthetists Scope and Standards for Nurse Anesthesia Practice.
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