SEPTEMBER 2024

Independent Practice for Nurse Practitioners

Are you an emergency physician who has been approached by a nurse practitioner to sign off on autonomous practice? Or are you an NP in an ED seeking independent practice? Ensure these competencies are met first.

A message from VACEP Leadership to Virginia Emergency Physicians:

The leadership at VACEP has long advocated to ensure physician-led teams of Emergency Physicians are the “gold standard” and the core of Emergency Medicine practice in Virginia and across the country. That is why we successfully introduced and passed legislation to ensure that a physician is always physically present and primarily responsible for every Virginia ED, a law that will go into effect in July 2025. We firmly believe the training and skills gained during an Emergency Medicine residency are essential to providing the best care to our patients and communities.

We were greatly disappointed to see the requirement for independent nurse practitioner practice in Virginia recently reduced from five years to three. We fear independent practice by NPs without sufficient training runs the risk of endangering our patients and also putting these same practitioners in situations where they are not able to adequately manage a patient’s care.

In particular, the Emergency Department serves as a location where patients turn after they have exhausted other options, and their case is too complicated for primary or urgent care. In these critical situations, we believe it is imperative that they see a physician with the skills and knowledge necessary to develop a plan for their care, both during their ED encounter and beyond. Any other providers in the ED must also have the highest level of education and training in acute and emergency care, especially if they are seeking a license to practice independently.

We urge you to thoroughly evaluate any NP who comes forward asking you to sign paperwork to allow them to practice independently. Virginia law requires them to collaborate with a physician in the specialty in which they seek to practice independently for three years. It is best practice for any NP seeking independent practice to notify their collaborating physician of this intent prior to entering a collaborative practice agreement.

We strongly believe that any NP seeking a signature for independent practice in Emergency Medicine should satisfy the six core competencies required of emergency medicine residents: patient care, medical knowledge, professionalism, system-based practice, practice-based learning and improvement, and interpersonal and communications skills. The requirements listed in sections A-D (included here) are based on these core competencies, and any provider seeking independent practice in emergency medicine should provide proof of these requirements.

We believe this is the best way to ensure excellent care for those we serve. Thank you for your consideration.

EMERGENCY DEPARTMENT INDEPENDENT PRACTICE CORE COMPETENCIES

Section A: Clinical Competency Attestations

Modeled after emergency medicine resident requirements from the American Board of Emergency Medicine (ABEM) and the Accreditation Council for Graduate Medical Education (ACGME)

___ I attest that this provider can competently and reliably provide an airway in a critically ill or injured patient regardless of patient age.

___ I attest that this provider can competently and reliably provide vascular access (including central venous access) in a critically ill or injured patient regardless of patient age.

___ I attest that this provider can provide high-quality care leading a trauma resuscitation in infants, children, and adults.

___ I attest that this provider can provide high-quality care leading an adult medical resuscitation.

___ I attest that this provider can provide high-quality care leading a pediatric resuscitation.

___ I attest that this provider can provide high-quality care leading a resuscitation of the newly born.

___ I attest that this provider effectively listens to patients and families.

___ I attest that this provider effectively communicates challenging information with patients and families.

___ I attest that this provider has had no disciplinary actions and that if there were disciplinary actions, they were completely remediated.

___ I attest that this provider actively participated in quality improvement activities

___ I attest that this provider has demonstrated the ability to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve patient care.

Section B: Pass an In-Person Exam in Emergency Medicine

To obtain board certification in emergency medicine, physician candidates must pass a written qualifying exam. Similarly, a non-physician pursuing independent practice must pass a nationally recognized examination that explicitly tests readiness for the practice of emergency medicine. The Emergency Nurse Practitioner Specialty Examination administered by the American Academy of Nurse Practitioners Certification Board (AANPCB) is one such exam that may satisfy the requirements of this section. An online-only examination cannot fulfill this requirement.

___ I attest that this applicant has passed an examination in emergency medicine as described in this section.

Section C: Certification from a Nationally Recognized and Accredited Body to Practice in the Emergency Department

The AANPCB offers specialty certification to recognize eligible Family Nurse Practitioner’s expertise in emergency care. The Emergency Nurse Practitioner certification program was designed to align with the Advanced Practice Registered Nurse Consensus Model for specialty nursing practice and meet national standards for nursing and healthcare certification program accreditation.

___ I attest that this applicant is certified to provide emergency care by the AANPCB or another nationally recognized certifying body with similar standards and requirements.

Section D: Procedure Requirements for Emergency Medicine

Adapted from the ACGME key index procedures requirements. Providers seeking independent practice should have the following minimum number of logs for each procedure. No more than 30 percent of the required logged procedures performed in simulated settings can count toward the required minimum, with the exception of rare procedures, namely pericardiocentesis, cardiac pacing, and cricothyrotomy. One hundred percent of these rare procedures may be performed in the lab. Vaginal delivery and intubations are not considered rare procedures. Of note, each of these procedures are also listed on the AANPCB Procedural Skills list for Emergency Medicine.

Procedure & Minimum Logs

  • Adult Medical Resuscitation: 45

  • Adult Trauma Resuscitation” 35

  • Cardiac Pacing:

  • Central Venous Access: 20

  • Chest Tubes: 10

  • Cricothyrotomy: 3

  • Dislocation Reduction: 10

  • ED Bedside Ultrasound: 150

  • Intubations: 35

  • Lumbar Puncture: 15

  • Pediatric Medical Resuscitation: 15

  • Pediatric Trauma Resuscitation: 10

  • Pericardiocentesis: 3

  • Procedural Sedation: 15

  • Vaginal Delivery: 10  

___ I attest that the provider seeking independent practice in emergency medicine has completed the procedure requirements in accordance with these guidelines

Questions or Concerns? Email us and a member of the VACEP leadership team will contact you.