Since NPs and PAs are licensed differently, there are different supervision requirements for both. NPs practice under standardized procedures with protocols; PAs can practice with one of two mechanisms for supervision: the MD countersigns the chart notes (or some percentage thereof) or the standardized procedures/protocols required of NPs. Both professionals can practice with remote supervision by telephone, but of course, that will depend on the experience of the PA or NP. Many sites use the same method of supervision for both NPs and PAs who practice there. You may wish to reference certain texts as the basis for your clinical protocols. Two examples include:
1. Nurse Practitioner/Physician Collaborative Practice: Clinical Guidelines for Ambulatory Care,
UCSF Nursing Press, GM Collins-McBride and JM Saxe, Editors, ISBN 0943671161.
2. The Roles of Physician Assistants and Nurse Practitioners in Primary Care
by Kay Clawson, ISBN 1-879694-07-7.
Your malpractice carrier might also be able to suggest sources of sample protocols.
It is essential that the supervising physician be comfortable with the amount of oversight he or she has with midlevel providers, as the physician employee typically covers the midlevel under his or her malpractice policy. (Occasionally, midlevel providers have their own malpractice insurance.) For more information about NP scope of practice laws, visit The California Board of Registered Nursing
; for more information about PA scope of practice laws, visit California Department of Consumer Affairs, Physician Assistant Board
. Be sure to contact your malpractice carrier before adding a midlevel to your practice.