Associate Provider Careers
Associate providers have been part of the professional staff at Dartmouth-Hitchcock Medical Center (DHMC) since the 1970s. Approximately 145 associate providers administer expert clinical care in more than 25 sections and divisions at DHMC. Associate providers hold a faculty appointment at the level of Instructor through The Geisel School of Medicine at Dartmouth.
While the legal title for advanced practice nurses in New Hampshire is APRN, they are also categorized as CRNAs (Certified Registered Nurse Anesthetists), CNMs (Certified Nurse Midwives), and NPs (Nurse Practitioners).
APRNs are licensed by the New Hampshire Board of Nursing and must have passed a national certifying exam in their specialty area before applying for licensure. In addition, all new APRNs must have a master's degree. The majority of advanced practice nurses at DHMC are master's prepared.
Physician assistants must be registered by the state Board of Medicine to practice in New Hampshire. Academic preparation at the Master's level is now the standard. All PAs must have successfully passed the National Commission for Certification of PAs Examination initially and every six years thereafter, as well as logging 100 hrs of Continuing Medical Education every two years to maintain their state license.
Before you start work at Dartmouth-Hitchcock, the Medical Staff Office will complete the credentialing and privileging process. Credentialing is the process of obtaining, verifying and assessing the qualifications of a licensed health care practitioner, as required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA). Privileging is the authorization that our Boards of Trustees grant a practitioner to provide specific services based on factors such as license, training, experience, etc.
Advanced practice nurses provide primary care for patients within their licensed scope of practice. "The role of the APRN generally encompasses five aspects: clinical practice, education, consultation, research and quality improvement, and professional practice," says Dorothy Mullaney, APRN, who directs neonatal nurse practitioners in DHMC's Intensive Care Nursery (ICN). "While the majority of what we do is clinical practice, the other aspects of our role are highly valued, both individually and by the organization."
PAs at DHMC work in both medical and surgical specialties settings as part of the physician-PA team. In New Hampshire, as in all the 50 states, PAs have prescription privileges. In this institution, PAs are valued team members and clinicians, recognized by both the physicians we work with and by Dartmouth-Hitchcock.
Most associate providers at DHMC are very involved in education. They participate in preceptoring and mentoring nurse practitioner and physician assistant students, and orienting new staff. They provide formal and informal education through nursing grand rounds; writing manuscripts for professional journals; and speaking at local, regional, and national conferences. Some are on the faculty of local schools.
Associate providers also share their expertise by consulting at DHMC and through regional programs. These consultations are both clinical and educational in nature. "In the ICN, we provide a lot of support to new nurses through informal teaching," explains Mullaney. "We help increase their basic knowledge and understanding of disease processes, and how to apply that to a specific patient's diagnosis. We also help them to develop critical thinking skills, and encourage them to really be part of the team that is planning the care of the patient."
Research and quality improvement are high priorities for associate providers at DHMC. Many are involved in ongoing projects in their sections. Nurse practitioners have participated in the Clinical Evaluative Science program at Dartmouth College and have also applied for and received quality improvement grants from the Hitchcock Foundation.
PAs have been extensively involved in both mentoring and teaching both PA and NP students, as well as participating in the "On Doctoring" program for first and second year medical students, and in resident teaching as well.