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HL20: Robert D. Donaldson, NPC—The Nurse Practitioner-Run ED

Joe Cantlupe, for HealthLeaders Media, December 13, 2011

The 68-year-old Donaldson, who had a long background in emergency nursing, came to Ellenville in 2004 at a time the hospital was ailing financially. In 2009, the hospital was having trouble filling the medical staff president position. Donaldson kept getting notices about the vacancy, and just threw them out. After he received a third notice, he asked if he could run. But first he asked top leadership if they were okay with a nurse practitioner running. "I'm not going to offend the CEO," he says. Eventually, Donaldson won a runoff against two physicians, and garnered 70% of the vote on the final ballot. Donaldson could not even vote for himself; only physicians could vote.

Donaldson believes he was becoming popular with the physicians because he did "the entire workup for them, and essentially managed their patients prior to admission. It goes a long way and makes their job really easy."

After he was named to head the ED, he reshuffled staff, weeding out some providers who weren't meeting hospital standards, and replaced them with nurse practitioners or physician assistants. In the meantime, the patient load within the ED increased from 8,000 patients a year to about 13,000, he says.

Donaldson acknowledges that the nonphysician provider arrangement is unusual, but says that in New York and some other states "nurse practitioners are basically equal to doctors, they can admit patients, manage patients, and discharge patients." New York is currently a collaborative-practice state, which does not require direct physician supervision.

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