Discussion: State Practice Agreements

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Discussion: State Practice Agreements

Discussion: State Practice Agreements

This week you will have an opportunity to evaluate state practice agreements in your state and examine issues related to NP practice.

To prepare:
  • Review practice agreements in your state
  • Identify at least two physician collaboration issues in your state
By Day 3

Post a brief description of the practice agreements for NPs in your state and the two physician collaboration issues that you identified. Explain what you think are the barriers to NPs practicing independently in your state. Finally, outline a plan for how you might address NP practice issues in your state.


  1. Review, as needed, any of the resources linked above.
  2. In a formal paper, follow the rubric found in the resources and pasted below to describe:
    1. your future career role: nurse practitioner, nurse educator, or nurse administrator, and
    2.  without repeating, yet another outbreak from history and how you would foresee functioning if a major outbreak of infectious disease affected your institution or community, including working with the media and public,
    3. apply the 10-steps of outbreak investigation, and
    4. one way in which this training in avoiding epidemiologic traps might come in handy in helping manage the outbreak.
    5. Mention at least one specific epidemiologic trap.

As with most healthcare professions, working as a nurse practitioner entails a significant amount of paperwork. To practice, NPs must have both a national certification and a state license. Nurse practitioners must also have an NPI number and credentialing documents in order to charge insurance companies. State scope of practice rules in some areas need additional documents to meet practice standards, therefore NPs in those areas have even more to organize. A joint practice agreement is one such document.

Nurse practitioners are regulated in one of three ways by scope of practice statutes enacted by state legislatures:

Nurse practitioners’ prescribing practices should be regulated.
Nurse practitioners’ practice should be regulated.
Nurse practitioners’ practice and prescriptions should be regulated.
For example, scope of practice laws may prevent NPs from prescribing prohibited medications. Alternatively, these regulations may stipulate that in order to practice, nurse practitioners must complete a certain number of hours of continuing medical education. The most typical requirement in state scope of practice statutes is that NPs cooperate with physicians or practice under their supervision. The specifics of these statutes differ from one state to the next.

Currently, roughly 21 states allow nurse practitioners to practice and prescribe without the involvement of a physician. A collaborative practice agreement is necessary in states where physician oversight is required for practice, prescribing, or both. A collaborative practice agreement is a document that outlines the nurse practitioner and physician’s combined practice relationship. In general, the paper defines each party’s rights and responsibilities, formally establishing the relationship.

The following information is often included in a collaborative practice agreement:

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Name of each party, location(s) of practice, and effective date
The nurse practitioner’s scope of practice as it relates to patient diagnosis and treatment
The scope of a nurse practitioner’s practice as it relates to prescribing authority
Practice protocols are mentioned.
Requirement that the physician review and cosign the documentation
Minimum supervisory criteria as well as the availability of the supervising physician
On their websites, many state boards of nursing provide sample collaboration agreements for usage. Sample collaborative practice agreements for nurse practitioners may be found at the following websites:

Sample No. 1 Sample No. 2 Sample No. 3
Nurse practitioners should keep in mind that if their practice location, employment, or collaborating physician changes, they will need to update their practice agreement and file a new one to the state board of nursing. In some states, the collaborative practice agreement must also be placed in a conspicuous location in the office space for patients to see. Overall, both NPs and MDs should familiarize themselves with scope of practice rules to ensure that they practice in accordance with state law both individually and as a team.

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