Guidelines Regarding the Role of Physician Assistants and Nurse Practitioners in the Emergency Department

Revised and approved by the ACEP Board of Directors January 2007 by replacing two policy statements,  "Guidelines on the Role of Physician Assistants in Emergency Departments approved February 2002 and "Guidelines on the Role of Nurse Practitioners in the Emergency Department" approved June 2000. 

Physician assistants (PAs) and nurse practitioners (NPs) provide services in various roles in emergency departments (EDs), including out-of-hospital patient care, patient triage, patient care in the ED, and selective administrative functions. The American College of Emergency Physicians (ACEP) endorses the following guidelines for EDs that utilize PAs and NPs.

• Due to variations in state regulations, it is imperative that the emergency physician be aware of the scope of practice for PAs and NPs including physician supervision where applicable.
• PAs and NPs working in EDs should have or acquire specific experience or specialty training in emergency care, should participate in a supervised orientation program, and should receive appropriate training and continuing education in providing emergency care. They should possess knowledge of specific ED policies and procedures. PAs and NPs must be aware of and participate in the performance improvement activities of the ED.
• PAs and NPs may be placed in clinical and administrative situations in which they will supplement and assist emergency physicians. PAs and NPs do not replace the medical expertise and patient care provided by emergency physicians.
• The PA's and NP's scope of practice must be clearly delineated and must be consistent with state regulations. This delineation should include a list of symptom complexes that may initially be evaluated and addressed by the PA or NP. The delineation also should include a list of the medical procedures that PAs or NPs may perform:
  • without consultation with the physician.
  • before consultation with the emergency physician.
  • only after consultation with the supervising emergency physician.
  • only under the direct supervision of an emergency physician.
   
• Although PAs and NPs are sometimes required to work under the supervision of an emergency physician who is present and available for consultation in the ED, independent practice is authorized in some states. Each emergency physician shall determine which PA or NP patient's evaluation and care will be reviewed in greater detail prior to disposition in accordance with the defined PA or NP scope of practice and state law. When such is required, the supervising physician for each PA or NP encounter should be specifically identified. The ED medical director should define the number of PAs and/or NPs whose clinical work can be simultaneously supervised by one emergency physician, guided by ED clinical needs and state laws.
• The medical director of the ED or a designee has the responsibility of providing the overall direction of activities of the PA or NP in the ED.
• Credentialing procedures for PAs and NPs in the ED must be specifically stated and must meet the requirements of the state or federal jurisdiction in which they practice and should be appropriately certified.