Can a Nurse Take Orders from a Physician Assistant?
A Physician Assistant (PA) is a highly trained and skilled licensed professional who acts as an extension, or agent, of a physician. A PA can provide evaluation, education, and other health care services based on patient needs. They can assist surgeons in the operating room and can perform minor procedures in all clinical settings, such as ambulatory care and the hospital. According to the American Academy of Physician Assistants, PA's practice in every state and in every clinical setting.
Some of the medical services provided by a PA include, but are not limited, to:
- Taking a health history
- Performing physical examinations
- Ordering lab tests and X-rays
- Establishing a diagnosis
- Creating a treatment plan
- Administering injections or immunizations
- Performing minor surgeries or procedures
- Responding to emergencies
To become a PA, one must attend a specialized school that is associated with a medical school, which includes both classroom and clinical time. Most PA students have an associate's degree or bachelor's degree prior to entering PA training. Some PA schools require prior medical work experience in order to be accepted. Clinical time involves numerous hours of internship in multiple clinical settings such as family practice, pediatrics, surgery, emergency department, internal medicine, orthopaedics, neurosurgery, etc. PA's must complete around 2,000 clinical hours prior to sitting for a licensing exam through the Physician Assistant Board, which is regulated in each state.
The scope of practice for a PA is as broad as the supervising physician who oversees the PA. Each PA must have a written Delegation of Service Agreement signed by each supervising physician the PA works for in the clinical setting. The PA is only allowed to perform care related to the specialty of the supervising physician. For example, a PA who has an internal medicine physician as the supervising physician cannot provide care to pediatric patients. The PA scope of practice is a mirror of the supervising physician, who is responsible for the care provided by the PA.
As the PA is acting as an agent of the physician, the nurse must follow the patient-specific orders written by the PA. All PA orders must be patient-specific; therefore a PA cannot sign standardized procedures for a nurse to follow. Most states require a supervising physician to co-sign a percentage of the charts and orders written by the PA. Other agencies such as Medicare may require all charts and orders to be co-signed by the supervising physician. By co-signing a chart or order, the supervising physician is attesting that they agree with the plan and have oversight for the PA's care of the patient.
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