Page 23 - Part 2 Collaborating with Advanced Practice Providers - An Overview of State Rules

SVMIC Collaborating with Advanced Practice Providers

find a supervising physician vicariously liable for the negligence of a

physician assistant.

The Cooke case also is significant as the Supreme Court held that the

standard of care applicable to physician assistants is distinct from that
applicable to physicians. However, because the supervision regulations

for physician assistants and nurse practitioners in Tennessee are so

similar, the reasoning in Cooke would likely equally apply to the

supervision of nurse practitioners. Thus, this discussion and

recommended precautions should also be considered by physicians
collaborating with nurse practitioners.

Services and Procedures APPs May Perform

What services and procedures may APPs perform? Generally, nurse

practitioners and physician assistants may provide medical and/or

surgical services as outlined in a written protocol that are within their

education, training and skill level (scope of practice). When evaluating
scope of practice and procedures delegated to the APP, the goal is to

allow the provision of services at his or her maximum level of training

and competency. The APP may perform procedures as outlined in the

protocol once all of the following have been met and documented:

 Appropriate training and direct supervision (if required)

 Certification or credentialing if required

 Demonstrated competency

The training and certification may be obtained during the APP’s

advanced specialty accredited education for licensure (scope of

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