Physician assistants

PAs are a new category of health-care provider being introduced in Alberta through an Alberta Health Services (AHS) demonstration project. They are unregulated workers who work under the supervision of physicians and provide direct patient care.

The supervising physician is responsible for the supervision and oversight of the PA. As supported by our Practice Standards for Regulated Members, CARNA members should question policies and procedures inconsistent with therapeutic client outcomes, best practice and safety standards and discuss these with your manager or supervisor.

Any treatment or medication order from a PA must be signed by the supervising physician before it is carried out. It is the responsibility of the PA to ensure that the order is co-signed by the supervising physician in a timely manner.

Registered nurses who are working with PAs should have full access to information on:

• the competencies of the individual PA they will be working with
• the role and responsibilities of the PA including what they can and cannot do, and
• contact information for the supervising physician.

Each PA and their supervising physician have a practice agreement. It is important that you have information on the provisions in the practice agreement and updates as the practice agreement changes. It is our understanding that the practice agreement may change over time so your unit needs to develop a process for communication of those updates and changes to the practice agreement.

It is the patient's right to be informed and make decisions about who will care for them. According to the College of Physicians and Surgeons of Alberta standards of practice, there must be client consent if the physician supervises an unregulated care provider in the provision of care. The supervising physician and the PA are responsible for getting consent from the patient/client and it needs to be documented so that you know which patient/clients have provided their consent to having care provided by the PA.

We have suggested to Albert Health Services that there be an ongoing process for management, staff, the PA, the supervising physician and those responsible for the initiation of this project to address and work thorough issues related to the implementation of this project. Research has shown that most errors and miscommunications occur at patient care transition points. It will be important for staff to understand the day-to-day responsibilities of the PA when on the unit; when they should refer to the PA and when to the supervising physician; and what the responsibility of the PA will be for follow up when they leave the unit. We believe there needs to be robust discussion of these issues to ensure continuity of care and patient safety.

If you have any questions please do not hesitate to contact one of our policy and practice consultants here at CARNA by calling 1.800.252.9392 or emailing practice@nurses.ab.ca.