Nurse Practitioner
Orientation
Guidelines
Table of Contents
Purpose 3
Operations 3
Elements of NP Orientation 3
Site/Setting Operational Logistics 4
Finance 4
Professional Practice and Integration (PPI) 5
FHA Nurse Practitioner Encounter Reporting 6
Completing Daily Encounter Records 6
Diagnostic Services 7
Excelleris Launchpad 8
Appendix 1 NP New Hire List 9
Appendix 2 Nurse Practitioner Learning Plan 10
Appendix 3 Example of Prescription Information 15
Appendix 4 NP Office and Exam Room Equipment and Supplies 16
Appendix 5a Fraser Health Nurse Practitioner Manual Encounter Report Summary 21
Appendix 5b Fraser Health Nurse Practitioner Electronic Encounter Report Summary 22
Purpose
The purpose of this document is to guide orientation for Nurse Practitioners (NPs) in Fraser Health Authority (FHA). It is intended to be used by NPs and hiring Directors or Managers to ensure that a suitable orientation is provided for each NP new to FHA. NP orientation is managed by the hiring Director, Manager, or designate.
Operations
Prior to hiring an NP, please review all of the following documents in the NP Resource Centre located on the FH website under Professional Practice and Integration. These documents include:
1. NP Role Implementation Planning Tool
2. NP Job Description
3. Hiring Guidelines
4. NP New Hire Checklist
Elements of NP Orientation
1. New employee orientation:
FHA is committed to ensuring all new employees are supported through an orientation as they integrate into the organization. The Online New Employee Orientation covers FHA’s vision, purpose and values, emergency codes, quality and patient safety issues, infection prevention and control issues, plus an overview of the roles of the departments a typical employee would be likely to come in contact with during the first few weeks of work.
New Employee Orientation – CCRS Online Learning Course
2. NPs are Excluded Staff. It is the responsibility of each new NP to be familiar with the Terms and conditions of Excluded Staff.
Terms of Conditions and Employment – Excluded Staff
3. Orientation to work setting and location.
4. NP clinical role – this section focuses on unique aspects of NP practice such as encounter reporting.
5. NP self-assessment of learning needs in NP role; for completion by NP then discussed with Manager/Director and possibly the collaborating physician. NP self-assessment is based on the CRNBC NP standards and is incorporated as part of the NP’s performance plan in Performance Link. For an example of a learning plan, see Appendix 2
Site/Setting Operational Logistics
Your operational Director or Manager designate coordinates the following items per their cost centres and/or in partnership with the Divisions of Family Practice, as applicable to your position:
1. Tour of work area
2. Keys or access cards
3. Office space and supplies
4. Computer
· PC/laptop and printer
· Profile and log in – New User Access must be fully completed and requires a ten day processing period
· VPN Access
· Meditech Access and Training as mentioned in the hiring guidelines.
5. Parking
6. Communications
· Team/staff communication
o Communication book/board
o Staff meetings
o Patient/resident/client conferences (rounds)
· Telephone
o Telephone numbers, locals
o Voice Mail
o Phone List
o On-line Directory
o Internal
o Outlook Web Access - OWA
· Blackberry
· Photo Identification
· Prescription Pads (see example in Appendix 3)
· Business Cards
· Order stamp with NP name, title, MSP number and prescribing number
· Notification of privileges: lab, pharmacy, diagnostics as appropriate per setting
Finance
1. Payroll
· Timekeeper
· Pay cheque
2. Expense reimbursement
· Review policy regarding allowable expenses
· Expense submission – Employee Expense Report
3. Education Funds
· Your Operations Director manages the funds designated for NP professional development and related forms.
4. Examination room space and equipment (see Appendix 4)
Professional Practice and Integration (PPI)
In collaboration and partnership with internal and external stakeholders, PPI advances scope optimization, best practice, clinical education and quality practice environment as per FHA initiatives. PPI services include supporting organizational initiatives, the Clinical Programs, profession-specific and interprofessional collaboration, optimization of role/scope/functions, clinical education, and quality practice environments through practice consultations, the Practice Start Transition program, Clinical Policy Office and On-Line Learning. For more information, see the PPI website.
As an NP within FHA, you have a professional reporting matrix to the Chief Nursing Officer (CNO). PPI will also assist and support you with professional issues such as:
· Legislation/regulation/policy interpretation and development
· Liaison with Ministries, regulatory bodies
· Liaison with FHA services such as Clinical Programs, HR
· Practice consultations
Community of Practice
All NPs in FHA have a collective Community of Practice (CoP) which includes a business meeting every second month. Meeting space is booked for the alternate months to support Shared Work and Project Teams working on various initiatives, and to provide designated time for professional development activities.
The purpose of the CoP is to create a forum that allows NPs to regularly connect in person or via teleconference to promote best practice and build capacity in FHA.
2013 NP CoP Schedule
NP CoP Terms of Reference
FHA Nurse Practitioner Encounter Reporting
All new NPs are required to have their MSP number prior to the offer of employment.
Introduction
NPs cannot bill the Medical Services Plan (MSP) for the services they provide to B.C. residents.
To monitor services provided, the Ministry of Health (MoH) requires NPs to submit encounter records to MSP for every interaction. The Encounter Record is considered the same as a medical claim submitted by other health care providers.
For more information regarding MSP, go to the Medical Services Plan of B.C. website.
Encounter record Submission Authorization
Once the NP has received their practitioner number, they must complete and sign the HIBC “Encounter Record Submission Authorization” form HLTH2871. Often the form will be included with your MSP number letter. Forward the completed form to Ian Perry (), Finance Department, 5th floor, Sherbrooke Centre, RCH.
Completing Daily Encounter Records
Paper Record
There are three records.
1. Day Sheet
If you receive a computer listing of your clients on a daily basis, it can be modified and used as your encounter record. The following information should be included: PHN number, last name and first initial. You need to add two columns to the sheet, one for the Encounter Code and one for ICD9 codes.
2. Nurse Practitioner Encounter Form (see Appendix 5a)
You need to hand-write in all the information. The following information is required for an encounter code to be processed by MSP:
· Practitioner Number (MSP number)
· Payee number
· Last name, first initial and Personal Health Number (PHN) of the patient
· Number of services
· Date of service
· Location code
· Diagnostic code
3. FHA Nurse Practitioner Record Summary (see Appendix 5b)
This sheet is useful if you have client’s labels that you can attach to the sheet. The sheet can be modified to include your site’s particular information, e.g. payee number, location code and Practitioner MSP number.
Electronic Recording
If your office has an electronic billing system in place, the Medical Office Assistant (MOA) should be able to send your billing information to the MoH. It is the same system used to bill for the physician services. You can record each patient’s encounter codes and ICD 9 codes on the day sheet.
For a guideline on encounter codes, ICD 9 codes and how to submit check the MSP website.
Send your encounter codes to:
Omega
c/o Burnaby Hospital Medical Administration
3935 Kincaid Street
Burnaby, B.C. V5G 2X6
Diagnostic Services
The Laboratory Services Guidelines are divided into two sections:
1. Laboratories
2. Reporting results and follow up system
Nurse Practitioner clients may access laboratory services either on site (if available) or at a nearby community lab. Any service provided on site must meet the standards for processing specimens, transportation and have a reporting system in place.
1. Laboratories
The following section will look at the provincial laboratories the NP will be accessing. Contact client services at each of the above agencies to register as a provider and to enable you to receive test results. Client services will need your provider information including your name, MSP provider number, and clinic and contact information.
The following laboratories will be included:
· Provincial Health Services Authority Laboratories
o B.C. Centre for Disease Control
o B.C. Cancer Agency
o Children’s and Women’s Health Centre of B.C.
· Fraser Health Authority
· B.C. Biomedical Services
· Life Labs of B.C.
Provincial Health Services Authority Laboratories
For healthcare provider contact information, services and supplies, please see this Agencies and Services website.
· B.C. Centre for Disease Control
· B.C. Cancer Agency
· Cervical Screening Program
· Children’s and Women’s Health Centre of B.C.
All maternal screening is done at Children’s and Women’s Health Centre of B.C. Testing includes:
· Quad marker screen
· Serum Integrated Prenatal Screen (Parts 1 and 2)
· Maternal Serum AFP
Excelleris Launchpad
The Excelleris Launchpad program will deliver lab results from Life Labs of B.C. (formerly MDS), B.C. Biomedical Services, Vancouver Coastal Health Authority (VCH), FHA, Valley Medical Labs and a few additional hospital labs, to your computer. It will speed up your access to lab results, allow you to search a lab history on any of your patients and give you the ability to run a cumulative chart on any tests you choose.
There is no cost to NPs for access to Launchpad, and currently there are almost 4,500 physicians and NPs across the province using the program to access their results.
To get the program running at your locations, Excelleris must install a digital certificate on your computer and create a connection to their site which will allow any users with an active User ID and Password access to an Inbox with all of your current lab results. From that point, you can view results on screen, print out selected results, search lab history on any patients and chart any tests using the cumulative function.
Launchpad also offers a PharmaNet link which, at this point, only allows physicians to pull up a drug history and drug interaction profile on any of their patients. If your office is looking at going to an EMR, currently Excelleris is able to import into all of the major EMRs operating in the province.
To set up access to Excelleris Launchpad, you will need to contact Excelleris at 1-866-728-4777 and provide your contact information and MSP billing number. They will contact you for a set up date, the program takes five to ten minutes to set up and training takes about twenty minutes.
You can access more information on the program through Excelleris.
Appendix 1
NP New Hire Checklist
Operations Responsibilities
□ Immediately arrange email – internal (need employee number, contact Service Desk)
· OWA
□ VPN Access
□ Order business cards (confirm name and initials to be used)
□ Order blackberry
□ Order laptop
□ Photo ID
□ Multi-site parking if appropriate to setting (Director to sign and employee to complete and submit)
□ Arrange time with appropriate person to: review timesheets, payroll submission, expenses (including
mileage, parking), vacation requests, sick calls (EARL)
Employee Responsibilities
□ On line New Employee Regional Orientation (refer to employment letter for link)
□ NP Encounter Authorization
□ Photo ID (complete remainder of form and arrange for photo)
□ Multi-site parking pass (complete remainder of form and submit)
□ Completion: “Addition to Provider Dictionary”. See Guidelines in the NP Resource Centre
□ Meditech Access and training
□ Performance Planning In-Service (refer to employment letter – already booked in, please inform
MOA so that she may note this in your clinic schedule
Clinic MOA
□ Order self-inking stamp with name, title, MSP number and prescribing number. Confirm with NP
what title to use.
Name (first, last), MN NP (F)
Nurse Practitioner Prescribing number
MSP number
Clinical Orientation
□ Contact ______to arrange
□ See attached schedule – Clinical Contact ______
Appendix 2
Nurse Practitioner Learning Plan
CATEGORY 1: ASSESSMENT & DIAGNOSIS OF CLIENT HEALTH/ILLNESS STATUS1.1 Performs an advanced, comprehensive & holistic health assessment.
health history & complete physical examination.
considers the psychosocial, emotional, ethnic, cultural & spiritual dimensions of health
involves understanding with clients the meaning of their health/illness experiences & how their daily living is affected
1.2 Synthesizes health assessment information & uses critical thinking & clinical reasoning skills to
identify health concerns & risks
identify normal & abnormal states of health
make differential diagnoses.
1.3 In the process of making a diagnosis, combines client assessment findings with the application of scientific & experiential knowledge, considering such things as:
developmental stages;
behavioural sciences;
lived human experiences & personhood;
pathophysiology & psychopathology;
epidemiology & infectious diseases;
multiple etiologies; &
clinical manifestations of acute illnesses/injuries, chronic diseases, emergency health needs & normal health events.
1.4 Orders appropriate screening & diagnostic investigations. Interprets reports of these investigations based on sound clinical reasoning, scientific evidence & critical thinking. Examples include laboratory tests, x-rays, & ultrasound.
1.5 Diagnoses diseases, disorders & conditions while attending to clients’ responses to the illness experience.
1.6 Communicates with clients about health findings &/or diagnoses. Discusses health outcomes & prognosis. Collaborates with clients to identify & choose treatment or care options.
1.7 Supports & counsels clients with their personal responses to diseases, disorders or conditions while creating an environment in which effective learning can take place.