VACEP Resource Center
Independent practice attestations for nurse practitioners and physician assistants
Emergency physicians may be asked to attest to the readiness of nurse practitioners and physician assistants seeking independent practice in Virginia. These decisions deserve careful consideration.
A statement from VACEP President Joran Sequeira, MD, FACEP
Virginia’s emergency departments work best when care is delivered by physician-led teams. Virginia law now allows NPs and PAs to practice independently under certain conditions and after three years of training. NPs and PAs are valued members of emergency care teams, but independent practice in emergency medicine requires more than time spent in a clinical setting.
Emergency physicians should only sign attestations when they are confident the applicant has demonstrated the knowledge, procedural skills and clinical judgment necessary to care for patients safely and independently in the emergency department.
VACEP encourages physicians to evaluate these requests carefully and rely on objective measures of competency grounded in nationally recognized emergency medicine training standards.
The emergency department is a unique environment where patients present with undifferentiated, high-acuity and time-sensitive conditions. VACEP believes patients deserve care delivered by physician-led teams and that any practitioner seeking independent practice in emergency medicine should demonstrate competency consistent with nationally recognized emergency medicine standards.
Modeled after ABEM and ACGME standards
The attestations below are adapted from VACEP guidance and modeled after the six core competencies and procedural expectations required of emergency medicine residents by the American Board of Emergency Medicine (ABEM) and the Accreditation Council for Graduate Medical Education (ACGME).
These standards reflect the educational foundation of emergency medicine training in the United States and include:
- Patient care
- Medical knowledge
- Professionalism
- Systems-based practice
- Practice-based learning and improvement
- Interpersonal and communication skills
VACEP recommendation: Physicians should not sign an attestation based solely on employment history, years of practice or generalized clinical experience. Independent practice in emergency medicine should require documented evidence of specialty-specific competency. Finally, supervising physicians should be made aware of the APP's goal of independent practice prior to training so that the provider gains dedicated, focused attention and achieves these requirements during the three years of training.
Section A: Clinical competency attestations
- I attest that this provider can competently and reliably provide an airway in a critically ill or injured patient regardless of patient age.
- I attest that this provider can competently and reliably provide vascular access, including central venous access, in a critically ill or injured patient regardless of patient age.
- I attest that this provider can provide high-quality care leading a trauma resuscitation in infants, children and adults.
- I attest that this provider can provide high-quality care leading an adult medical resuscitation.
- I attest that this provider can provide high-quality care leading a pediatric resuscitation.
- I attest that this provider can provide high-quality care leading a resuscitation of the newly born.
- I attest that this provider effectively listens to patients and families.
- I attest that this provider effectively communicates challenging information with patients and families.
- I attest that this provider has had no disciplinary actions or that any prior disciplinary actions have been fully remediated.
- I attest that this provider actively participated in quality improvement activities.
- I attest that this provider has demonstrated the ability to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve patient care.
Section B: Emergency medicine examination
To obtain board certification in emergency medicine, physician candidates must pass a written qualifying examination. Similarly, providers seeking independent practice should pass a nationally recognized examination that explicitly tests readiness for emergency medicine practice.
- I attest that this applicant has passed an examination in emergency medicine as described in this section.
Section C: Emergency medicine certification
Applicants should hold certification to provide emergency care from a nationally recognized and accredited body appropriate to their profession and specialty.
- I attest that this applicant is certified to provide emergency care by a nationally recognized certifying body with standards and requirements appropriate to emergency medicine.
Section D: Procedure requirements for emergency medicine
Procedure requirements should align with ACGME key index procedure expectations for emergency medicine residents. Providers seeking independent practice should maintain logs demonstrating sufficient experience with emergency medicine procedures and resuscitations.
No more than 30 percent of required procedures should be completed in simulation settings, with the exception of rare procedures such as pericardiocentesis, cardiac pacing and cricothyrotomy.
- I attest that this provider has completed procedure requirements in accordance with these guidelines.
Questions about an attestation request? Contact VACEP before signing.