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Post RN consults
Author: Mulvey1
Date: Jun 10, 2011 12:15 pm
Our palliative care has 1 full time NP and we just recently hired a RN 0.5FTE. We are not currently billing and administration did not agree to hiring another NP right now. The purpose of hiring the RN was to help me since is has been very busy and to cover when I am off. I know that a RN cannot do consults, but can they have a meeting for e.g. goals of care and then document it as a meeting having discussed the outcome with the Primary MD?
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Re:RN consults (by sjcrump on 06/10/2011)
Thank you for your question. An RN cannot bill for a meeting even if discussed with an MD. However, I don't think that is the question. This is really a scope of practice question. An RN can follow physician orders and can educate on the treatment plan and educate on specific diseases and options. An RN cannot give medical advice -- suggest starting, stopping, modifying specific medical interventions. This often is a fuzzy line. For instance, it seems reasonable that an RN could educate on advance directives but this could be viewed as educating on general interventions and not ordering or suggesting specific medical interventions. Best practices: An RN should only educate and help implement the care plans. A MD or mid-level provider should be involved with changes in treatment plans and for all medical orders and medical advice. RNs, mid-levels, and MDs should only do the above to such extent that they are trained. This in general covers scope of practice.

posted per Sandra Joyce Crump RN, BSN, MBA
Palliative Care Leadership CentersTM
University of Alabama at Birmingham
on behalf of:
Ryan R. Nash, MD, MA
Assistant Professor
UAB Center for Palliative and Supportive Care
Birmingham, AL
+ Re:RN consults (by maryg on 09/09/2011)
This has been a key subject for our practice of late. We are a small enough Hospital that we are not able to keep a physician busy full time and I am a RN not a APN can you all give me more information about why a RN can not do the consults and tell me where I might find more information to support this or not support this.

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