Vanderbilt University Medical Center Advanced Practice Orientation Part I Confidential – do not distribute
Agenda • Advanced Practice at Vanderbilt – Overview • Shared Governance, Professionalism and Collaboration • Credentialing and Privileging • Tennessee Guidelines for Practice • Prescribing in Tennessee • Vanderbilt University Medical Center Guidelines for Advanced Practice (Bylaws, policies, eStar) National Guidelines for Advanced Practice • • VUMC Advanced Practice – Professional Practice Evaluation • Disclosure Training • Risk Management Training • Orientation Packet and Checklist • Office of Advanced Practice Virtual Tour
Advanced Practice Overview Welcome to VUMC Advanced Practice – Your Journey Begins Here!
History Image goes here In the 1960s – the first NP, CNM, CRNA and PA programs were launched. In 2004, VUMC had 100 APRNs and PAs. Today, the U.S. has over 300,000 APRNs and 100,000 PAs. And VUMC has grown to over 1000! • Nurse Practitioners >750 • Certified Registered Nurse Anesthetists >155 • Certified Nurse Midwives >50 • Clinical Nurse Specialists >20 • Physician Assistants >65
Magnet Designation Image goes here • “ . . person, place, object, or situation that exerts attraction” • Commitment, Quality, & Excellence In Nursing • Awarded by American Nurses Credentialing Center (ANCC) • 9% of US hospitals designated In 2017, VUMC received its 3 rd Magnet • Designation!
Magnet Professional Practice Model Image goes here • Evidence based practice • Quality, safety, service • Professionalism and Leadership • Integrated Technology Essential Components of the Magnet Model • Transformational Leadership • Structural Empowerment • Exemplary Professional Practice • New Knowledge, Innovations & Improvements • Outcomes
Shared Governance “A commitment to others to have an Image goes here active voice and participation in improving practice in collaboration leaders.” Shared Governance supports: • Decentralized decision making • Shared accountability • Partnerships to deliver VUMC Advanced Practice Committees: • Advanced Practice Standards Advanced Practice Professional Development • • Advanced Practice Council • Advanced Practice Leadership Board
Professionalism, Collaboration and Teamwork It’s the Vanderbilt Team that Makes all the Difference!
Building Relationships Image goes here Nursing • CREDO Behaviors • Service is the HIGHEST priority • Communicate effectively • Professional self ‐ conduct • Committed to my colleagues • Maintain self ‐ awareness Physicians • Promote trust & credibility • Integrated into care • Continuous presence • Increase knowledge & expertise
Collaboration Image goes here “. . joint & cooperative, integrates individual perspectives & expertise of team members” (Resnick & Bonner, 2003, p. 344) Collaboration… • Enhances empowerment • Increases job effectiveness and satisfaction • Associated with improvements in patient outcomes, healthcare costs and decision ‐ making.
APRN/PA Patient Care Center Name Title (PCC), Hospital or Area CRNA/VPEC Brent Dunworth Director/Chief CRNA MEDICINE Jane Case Director NEUROSCIENCES Briana Witherspoon Director OBGYN ‐ DEPT Angela Wilson ‐ Liverman Division Director SURGERY (and Position open Director TRAUMA/OrthoTrauma/Pain) TRANSPLANT Deonna Moore Director VCH Acute and Critical Care Michelle Terrell Director VCH Acute and Outpatient Care Jill Kinch Director VHVI Tiffany Street Director VICC Position open Director OBGYN ‐ SON MIDWIFERY & SON Pam Jones Sr. Associate Dean Community CLINICS Partnerships PSYCHIATRY Molly Butler Team Lead OCCUPATIONAL HEALTH Clinical Manager Catherine Qian ORTHOPAEDICS Mary Duvanich/Jonathan Riggs Administrative Director/Team Lead
Which does NOT describe a Magnet designated facility? A. Committed to quality and excellence in nursing B. Awarded by Centers for Medicare/Medicaid (CMS) C. Only 9% of US hospitals have designation D. Awarded by American Nurses Credentialing Center (ANCC)
Which describes the culture of shared governance? A. Advocacy of active voice B. Commitment to active participation C. Improving practice through collaboration D. All of the above
Which is not true about collaboration? A. Includes perspectives & expertise of team members B. Enhances empowerment C. Decreases job satisfaction D. Is associated with improved patient outcomes
Credentialing and Privileging “It is truly a privilege to care for patients within Vanderbilt Medical Center”
Core Privileges
Core Privileges • Basic delineation of privileges to practice as an advanced practitioner • These are essential to the role, the main responsibilities for practice • DOP available for NP, CNS, PA, CNM, CRNA • All practitioners must apply for and be approved for core privileges Process for approval • Complete one packet (every single document!) 90 ‐ 120 days for verification and review • • File goes to Joint Practice for recommendation • File goes to VUMC Credentials Committee for recommendation • File goes to Medical Center Medical Board for recommendation • File goes to Board of Directors for final approval
Credentialing and Privileging Tips • Fill out the entire application, “One Packet”, and keep copies of everything. This packet can be processed in 60 to 90 days from receipt of application by Vanderbilt Provider Support Services. • Use references who have current knowledge of your training/competency within the last 2 years (i.e. supervising physician, APN leader, preceptor, faculty instructor) • Provide complete information regarding all prior malpractice coverage. A certificate of insurance or face sheet from the carrier is preferred. • Read and answer all disclosure questions carefully prior to signing. • For gaps in employment >30 days, please provide a brief written explanation. The Notice & Formulary is now termed “Collaborative Request”. Please submit the original to the • State BON, keep a hard copy for your records and submit a copy with your one packet. • You will receive a payor enrollment packet soon after you submit your One Packet. This packet will look a lot like the One Packet but it is indeed different. This packet contains documents to sign up with each payor. One of the documents will require a notary. We have a notary right here in OAP for you, so please drop by anytime to sign these documents and notarize as applicable. • After credentialing is completed, you will receive a VHAN Application. VHAN is our extended health affiliate network. The application will be mostly complete and all you will need to do is sign.
Additional Privileges
Additional (non ‐ core) Privileges • Non ‐ core, usually procedural • Granted only after procedural competency demonstrated and application submitted • Must be medical necessary and supported by volume • Application required to request additional privileges • Can only be requested with initial privileges and in January, July and October • Advanced practice leader must request the application for you • Application completed by practitioner, AP leader and supervising physician Must submit procedural log with application (MR#, date, procedure, supervisor) • • Each procedure requires initial number of supervising procedures and number of procedures to maintain privileges every two years • High risk procedures require separate application: colposcopy, moderate sedation, circumcision, acupuncture, nitrous oxide administration
Credentialing and Privileging • Process flow for credentialing and privileging Image goes here in orientation packet • APRNs and PAs are termed “Professional Staff with Privileges” in the Medical Staff Bylaws and are credentialed under the process defined in the Medical Staff Bylaws • May apply as a billing or non billing provider Billing requires additional membership with • Vanderbilt Medical Group and is subject to VMG Bylaws • Billing providers may or may require a faculty appointment • Billing providers are credentialed with all VUMC insurances, or payers
Provisional Status While waiting for credentialing and privileging Image goes here approval must remain in “provisional status”. Provisional status providers are required to have: • Completed educational requirements for role • Obtained a board certification • Applied for state licensure • Applied for DEA/NPI • Applied for credentialing and privileging Provisional status providers must: • Not represent as NP, CNM, CRNA, PA • Work under direct supervision • Not submit orders under own name • Not write notes intended for billing • Follow ANA, state, specialty organization and practice specific guidelines • Access/enter eStar/epic as a “non ‐ credentialed provider”
Professional Liability Coverage • Coverage through Vanderbilt Self ‐ Insured Image goes here Trust • 5.5 million • PSS reviews malpractice history • Evidence of previous coverage • Collaborative practice critical • Claims such as failure to diagnose or failure to consult/refer
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