Physicians who employ NPPs should be very careful in their supervision. Because the physician is liable for negligent medical care rendered by NPPs, a physician should never accept responsibility for an NPP without having the authority to supervise or decline to practice with the person. The physician is also liable for nonmedical actions by the NPP, such as sexual assault, if the physician is negligent in screening or supervising the NPP.

The first step in selecting or accepting supervision of an NPP is to check the person’s credentials personally and carefully. The NPP’s license status must be checked in every state where the NPP has held a license, not just the state where he or she will work. The physician should find out the specifics of the NPP’s training and previous experience to gauge skill levels. Finally, the physician should talk to other physicians who have worked with the NPP, asking specifically about his or her willingness to accept physician authority, clinical skills, and readiness to ask for consultation from the physician. An NPP who worked well with a physician who checks every patient and chart entry may not be compatible with a physician who prefers to delegate by written protocols.

The physician should observe a newly hired NPP in providing patient care and by repeating the physical assessment. It is not possible to know if the NPP recognizes a bulging eardrum until the physician has reevaluated both negative and positive findings by the NPP. This also gives the NPP the opportunity to learn the physician’s preferences and practice habits, making both more comfortable with the arrangement. Many conflicts over supervision arise because the physician never clearly communicates his or her expectations to the NPP.