Open Forum

Hello, looking for input regarding RN's performing initial Neurosurgery Post-Op visits instead of the APP or Provider. We are in PA and it is hard to decipher our Scope of Practice when trying to investigate if this is something our RNs can do (it was easily determined that this is out of scope for MA's and LPN's).  During the post-op visit patients are assessed on how well they are recovering, suture/staples are removed, and any restrictions are documented per an Epic SmartPhrase developed by the APP and shared with clinical staff (MAs, LPNs, RNs). 

We are trying to ensure all of our staff are working to the top of their licensure. Right now this is the only provider who practices this way in our health system. The practice of clinical staff performing the initial post-op visits has stopped until I can get a concrete answer. I have reached out to our Risk Management, Clinical Quality, and Accreditation and Licensure without a definitive answer as of yet. 

Wondering what other health systems do for the initial post-op visit? Any thoughts on the RN seeing these patients?

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Tina Malec MSN RN-BC, NEA-BC, CPHIMS
York PA

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Hi Tina, I am a Registered Nurse in a neurosurgery clinic. Myself having extensive wound care and previous critical care and home health experience would definitely feel comfortable and would definitely be well within the Registered Nurses scope of practice, however the other clinic RNs I honestly don't think have the best patient assessment skills to monitor such acutely critical patients. I had to run over to one that was telling a patient just out of brain surgery that a moderate amount of clear drainage enough to soak the pillow case was totally normal and of no concern. I begged to differ called the patient back immediately and told them to go to the ER where they were admitted for an additional week for a csf leak. One I would think an extensive training and "check off" system would definitely be prudent but the main reason why it never took off was because Registered Nurses notes are not submittable to Insurance my argument was they are in their global usually so we aren't getting paid anyway but they disputed that and said some charges still are billable and the "cons" outweigh the "pros" so that's what it came down to being able to capture and bill for any patient visits.  All of our 10-14 day post ops are done by the NP or PA and the 6 week follow up is done by the surgeon.

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Megan Jackson BSN RN
Clinical Research Nurse Senior
UT Health Science Center Neurosurgery
San Antonio Texas
210-450-9836
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Original Message:
Sent: 06-14-2022 10:50
From: Tina Malec
Subject: Initial Neurosurgery Post-Op Visit completed by RN

Hello, looking for input regarding RN's performing initial Neurosurgery Post-Op visits instead of the APP or Provider. We are in PA and it is hard to decipher our Scope of Practice when trying to investigate if this is something our RNs can do (it was easily determined that this is out of scope for MA's and LPN's).  During the post-op visit patients are assessed on how well they are recovering, suture/staples are removed, and any restrictions are documented per an Epic SmartPhrase developed by the APP and shared with clinical staff (MAs, LPNs, RNs). 

We are trying to ensure all of our staff are working to the top of their licensure. Right now this is the only provider who practices this way in our health system. The practice of clinical staff performing the initial post-op visits has stopped until I can get a concrete answer. I have reached out to our Risk Management, Clinical Quality, and Accreditation and Licensure without a definitive answer as of yet. 

Wondering what other health systems do for the initial post-op visit? Any thoughts on the RN seeing these patients?

------------------------------
Tina Malec MSN RN-BC, NEA-BC, CPHIMS
York PA

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Original Message:
Sent: 6/14/2022 10:50:00 AM
From: Tina Malec
Subject: Initial Neurosurgery Post-Op Visit completed by RN

Hello, looking for input regarding RN's performing initial Neurosurgery Post-Op visits instead of the APP or Provider. We are in PA and it is hard to decipher our Scope of Practice when trying to investigate if this is something our RNs can do (it was easily determined that this is out of scope for MA's and LPN's).  During the post-op visit patients are assessed on how well they are recovering, suture/staples are removed, and any restrictions are documented per an Epic SmartPhrase developed by the APP and shared with clinical staff (MAs, LPNs, RNs). 

We are trying to ensure all of our staff are working to the top of their licensure. Right now this is the only provider who practices this way in our health system. The practice of clinical staff performing the initial post-op visits has stopped until I can get a concrete answer. I have reached out to our Risk Management, Clinical Quality, and Accreditation and Licensure without a definitive answer as of yet. 

Wondering what other health systems do for the initial post-op visit? Any thoughts on the RN seeing these patients?

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Tina Malec MSN RN-BC, NEA-BC, CPHIMS
York PA

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Hi Tina. I would second checking this out from the billing perspective.  I think there is something called a "Global OR Fee". I'm not sure if neurosurgery falls into this, but if so, it essentially bundles the post-op visit into the cost of surgery.  If that is the case, you may run into trouble if nurses are completing visits that are already billed as a provider visit.

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Keira Washlack
Nursing Professional Development Generalist
Allegheny Health Network
Washington PA
724-470-8026
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Original Message:
Sent: 06-14-2022 10:50
From: Tina Malec
Subject: Initial Neurosurgery Post-Op Visit completed by RN

Hello, looking for input regarding RN's performing initial Neurosurgery Post-Op visits instead of the APP or Provider. We are in PA and it is hard to decipher our Scope of Practice when trying to investigate if this is something our RNs can do (it was easily determined that this is out of scope for MA's and LPN's).  During the post-op visit patients are assessed on how well they are recovering, suture/staples are removed, and any restrictions are documented per an Epic SmartPhrase developed by the APP and shared with clinical staff (MAs, LPNs, RNs). 

We are trying to ensure all of our staff are working to the top of their licensure. Right now this is the only provider who practices this way in our health system. The practice of clinical staff performing the initial post-op visits has stopped until I can get a concrete answer. I have reached out to our Risk Management, Clinical Quality, and Accreditation and Licensure without a definitive answer as of yet. 

Wondering what other health systems do for the initial post-op visit? Any thoughts on the RN seeing these patients?

------------------------------
Tina Malec MSN RN-BC, NEA-BC, CPHIMS
York PA

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