IN A VARIETY OF SETTINGS
advanceD practice registereD nurseS
CRNAs work in supervision with physicians, dentists, and podiatrists. Supervision means that the CRNA is under the direction of a physician, dentist, or podiatrist when providing direct patient care. When administering anesthesia, the CRNA must be in the immediate presence of the physician, dentist, or podiatrist, according to section 4723.01(M) of the Ohio Revised Code.
The supervising physician, dentist, or podiatrist must be actively engaged in direct clinical practice in Ohio and practicing in a specialty that is the same as, or similar to, the CRNA's nursing specialty, according to section 4723.43(B) of the Ohio Revised Code.
All CNPs, CNMs, and CNSs in Ohio who provide direct patient care are required to work in collaboration with one or more physicians or podiatrists. Collaboration means that a physician or podiatrist has entered into a Standard Care Arrangement with the CNP, CNM, or CNS and is continuously available to communicate with the CNP, CNM, or CNS either in person or by electronic communication in accordance with section 4723.01(L) of the Ohio Revised Code.
The collaborating physician or podiatrist must be actively engaged in direct clinical practice in Ohio and practicing in a specialty that is the same as, or similar to, the APRN's nursing specialty in accordance with section 4723.431(A) of the Ohio Revised Code.
The collaborating physician is not required to be on site where the CNP, CNM, or CNS is practicing. However, a back-up plan is required in case of emergencies or planned absences. If a collaborating physician or podiatrist enters into a Standard Care Arrangement with an APRN who prescribes, the physician or podiatrist shall not collaborate at the same time with more than five nurses (known as the 5:1 ratio) in the prescribing component of their practice, according to section 4723.431(A)(1) of the Ohio Revised Code..
Mandatory collaboration between APRNs and physicians sometimes requires Ohio APRNs, especially those who are self-employed, to contract with physicians or podiatrists for their ongoing consultation services. The price varies, but it is reportedly anywhere from $250 or more per hour and as much as $2,500 per month (Tumolo, 2015).
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