St Thomas University Collaborative Practice Agreement PMHNP Report

This professional portfolio assignment will prepare the students to market and negotiate for employment as an advanced nurse practitioner.

The portfolio will include the forms below and all the forms are available on Module 7: Lecture Materials & Resources page.

Collaborative Practice Agreement. Choose the NSC attachment, based on the program you are enrolled in, on Module 7: Lecture Materials & Resources page. Fill out your name and all the other information should be filled out fictitiously. Once you have filled out the application, save as a collaborative practice agreement, and upload the file as an attachment.

Professional Liability Insurance: Fill out the Certificate of Liability Insurance (COI). Fill out your name and all the other information should be filled out fictitiously. Once you have filled out the application, save as “certificate of liability (COI) insurance”, and upload the file as an attachment.

NP Secure: Print out the form, fill out the application for malpractice insurance, and upload the document.

AANP or ANCC application. Choose one of the certification applications.  St Thomas University Collaborative Practice Agreement PMHNP Report

Collaborative Practice Agreement PMHNP

This agreement sets forth the terms of the Collaborative Practice Agreement between Type Name, Degree, and Title, Credentials and Credentials at Credentials. This agreement shall take effect as of Click or tap to enter a date..

Credentials meets the qualifications and practice requirements as stated in Section 464.012, F.S., holds a Florida State license and is currently in good standing a certified family psychiatric/mental health nurse practitioner pursuant to Section 464.012 of the Florida Statute and herein meets the requirement of maintaining a collaborative practice agreement with Credentials a duly licensed and currently registered physician in good standing under Chapter 458.313, Florida Statute.

1. Nature of the Practice

This collaborative agreement is to establish and maintain a practice model in which the ARNP will provide health care services under the general supervision of Credentials. This practice shall encompass family psychiatric/mental health practice and shall focus on health screening and supervision, wellness and health education and counseling, and the treatment of common health problems.

1. Conditions for which therapy may be initiated include, but are not limited to:

1. The NP is authorized to provide psychiatric and medical care under this collaborative practice agreement (CPA) in all outpatient office locations of above agency, and to any contracting agencies.
2. An NP, who is board certified as a family psychiatric/mental health nurse practitioner, is licensed to provide psychiatric and limited medical care, as defined by the ANA scope of practice to adult, geriatric and pediatric populations. St Thomas University Collaborative Practice Agreement PMHNP Report
3. The NP is authorized to provide the following medical functions.  (NOTE: This is sample language only to assist the practitioners in discussing and writing the medical functions authorized.  Practicing outside the scope of a CPA is a basis for discipline.  The CPA should provide authorization for the specific medical acts the NP will be performing.)
   1. Provides psychiatric diagnostic evaluations to assess for and determine psychiatric illness.  Diagnoses that can be made include but are not limited to mood and anxiety disorders, psychotic disorders, disruptive behavior, developmental disorders, eating disorders, delirium and dementia, substance use disorders and personality disorders.
   2. Request and interpret lab and other diagnostic procedures, such as EKGs, to rule out medical etiology for psychiatric illness or other medical conditions; and to assist in diagnosis, and monitoring for adverse effects from medications.
   3. Request assessments/evaluations, as needed, to confirm or support diagnoses, or guide treatment, including but not limited to psychological and educational testing; speech/language, vision, and hearing assessment; neurological evaluation; or referral to their primary care physician.
   4. Prescriptive Authority.

ORDER  A PLAGIARISM FREE PAPER  NOW

1. Drug categories that may and may not be prescribed by the NP (including controlled (II-V), legend, and over the counter drugs) are listed in Attachment A.
2. May prescribe drugs commonly used in psychiatry following accepted standards of practice as recommended by either the American Psychiatric Association or the American Association of Child and Adolescent Psychiatry. These drugs may be prescribed “off label” (without FDA approval) if it is an accepted standard of practice.

• May only prescribe drugs for consumers being served above agency or any contracting agencies

1. May provide pharmaceutical samples to consumers.

1. 1. Provide on call coverage when scheduled.
   2. Provide education to the consumer as indicated about psychiatric illness and, medication (including adverse effects).
   3. Obtain consultation from the collaborating psychiatrist for complicated illnesses perceived by the NP to be beyond one’s knowledge and skills. St Thomas University Collaborative Practice Agreement PMHNP Report
   4. Provide follow up services to consumers after surgical implantation of a vagal nerve stimulator, including computerized adjustment of device, to provide optimal response.
   5. The NP may refer a consumer’s care to the psychiatrist if the NP feels the case exceeds the NP’s scope of practice which was part of their graduate curriculum.
2. The NP does not have the legal authority to involuntarily commit a person to inpatient psychiatric treatment.
3.  Plan for Emergency Services

1. In the event of a life-threatening medical or psychiatric emergency, the consumer is informed to call 911 or to present to the local hospital emergency room. For an urgent need, a provider is available on call 24 hours, seven days per week through the agency emergency phone line.
2. The practice of a registered professional nurse as a nurse practitioner may include the diagnosis of illness and physical conditions and the performance of therapeutic and corrective measures including prescribing medications for patients whose conditions fall within the authorized scope of the practice as identified on the college certificate. This privilege includes the prescribing of all controlled substances under a DEA number. The nurse practitioner, as a registered nurse, may also diagnose and treat human responses to actual or potential health problems through such services as case finding, health counseling, health teaching, and provision of care supportive to or restorative of life and well-being. This practice will take place at Credentials or in such other facility or location as designated by Credentials or by the parties of this contract.
3. Physician Consultation

The physician shall provide general supervision for routine health care and management of common health problems, and provide consultation and/or accept referrals for complex health problems. The physician shall be available by telephone or by other communication device when not physically available on the premises. If the physician is not available, his associate, Credentials, title, Florida license number/DEA #999999), will serve as backup for consultation, collaboration and/or referral purposes.

III. Record Review

A representative sample of patient records shall be reviewed by the collaborating physician every three months to evaluate that Credentials, NP’s practice is congruent with the above identified practice protocol documents and texts. Summarized results of this review will be signed by both parties and shall be maintained in the nurse practitioner’s practice site for possible regulatory agency review. Consent forms for such review will be obtained from any patient whose primary physician is other than Credentials. St Thomas University Collaborative Practice Agreement PMHNP Report

1. Education and Certification Requirements for Registration as a Nurse Practitioner

 

The following items will be maintained and available on site for the Nurse Practitioner:

1. Proof of RN licensure (current RN licensure status may be verified at FBON).
2. Proof of current registration.
3. Proof of current approval to practice.
4. Proof of current national certification.
5. Proof of a current DEA number.
6. A copy of the collaborative practice agreement.
7. The nurse practitioner will maintain documentation of completing 50 contact hours each year of AMA or ANCC approved continuing education courses.

 

1. Resolution of Disagreements

Disagreement between Credentials, and Credentials regarding a patient’s health management that falls within the scope of practice of both parties will be resolved by a consensus agreement in accordance with current medical and nursing peer literature consultation. In case of disagreements that cannot be resolved in this manner, Credentials opinion will prevail. In disagreements between the nurse practitioner and non-collaborating physicians, the collaborating physician’s opinion will prevail.

1. Alteration of Agreement

The collaborative practice agreement shall be reviewed at least annually and may be amended in writing in a document signed by both parties and attached to the collaborative practice agreement. St Thomas University Collaborative Practice Agreement PMHNP Report

VII. Agreement

Having read and understood the full contents of this document, the parties hereto agree to be bound by its terms.

 

Student’s information: Signature: ______________________ Printed Name: License # Date:

Physician’s information Signature: ______________________ Printed Name: License # Date: