Truly Independent NP's/APRN's

  1. Lots of change going on here in Connecticut. APRN's are lobbying for NO MD collaboration. Currently you must have a collaborative relationship with an MD to practice here. Frankly, for me it means grab him when I need him and have lunch with him monthly for clinical supervision with 2 other APRN's. I have mixed feelings about the proposed changes. What do people here think?
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  2. 11 Comments

  3. by   akoster
    I live in Arizona and do not have to have any supervision. I consult and have a very good relationship with all the providers in town. I don't think that not having someone review charts or whatever is required of you is going to change how much you talk with other providers. I live in a small rural town and call any of them if I have clinical situation that I need help with and want to run it by a internist or pediatrician for guidance. We are also on the medical staff together at the hospital and still collaborate even though it isn't the formal kind.
  4. by   Psychaprn
    Thanks for your reply, akoster. It sounds great. I guess you don't worry about liability, making mistakes etc. How long have you been an NP? I've been one for 7 years. I'll bet the MD's are glad not to have liabilty for you too.
  5. by   caldje
    Quote from Psychaprn
    Thanks for your reply, akoster. It sounds great. I guess you don't worry about liability, making mistakes etc. How long have you been an NP? I've been one for 7 years. I'll bet the MD's are glad not to have liabilty for you too.
    once someone is "consulted" on a case they do have liability for the patient. I guess you could just not document it, but that would also be illegal. If you write, "called dr. so and so and he recommended/concured with this treatment plan" in the chart.. that doc can and likely will be named in any lawsuit. Ive been slowly looking up cases and trying to learn about this. I am admitedly still not all that knowledgable on the subject, but I do know that many of the cases with midlevels and physicians named were in this sort of set up.
  6. by   core0
    Quote from caldje
    once someone is "consulted" on a case they do have liability for the patient. I guess you could just not document it, but that would also be illegal. If you write, "called dr. so and so and he recommended/concured with this treatment plan" in the chart.. that doc can and likely will be named in any lawsuit. Ive been slowly looking up cases and trying to learn about this. I am admitedly still not all that knowledgable on the subject, but I do know that many of the cases with midlevels and physicians named were in this sort of set up.
    Having done some expert witness work (and I'm sure Siri can chime in) even having a collaboration agreement will be enough to get a physician on a lawsuit. With the cap on pain and suffering there is an incentive to getting as many different people as possible on the suit (especially if they are in different practices). Now that is a long way from winning a suit or even being kept on the suit after discovery. In Colorado physicians that have collaboration agreements pay about 10% more in malpractice than those that don't (Physicians with PA or NP employees pay about 12% more).

    David Carpenter, PA-C
  7. by   akoster
    Why so hostile? And why would you think that I wouldn't worry about mistakes? Just answering your questions.
  8. by   Psychaprn
    Akoster-I'm sorry-what did I say that you thought was hostile? I was serious-I would worry about making mistakes if I was out on my own solely and having total liability if I had no collaborative relationship with an MD-that doesn't effect how I talk to other profesionals-it just gives another set of checks and balances when deciding upon a course of care.

    I have a collaborative relationship with an MD and 2 other APRN's to learn and grow and beceause it's required by law-we even have a written contract. I don't have a collaborative relationship with him to ensure I'll talk to him or vice-versa.

    I was sincerely interested in hearing in hearting more about you asnd your practice as the laws are different in Ct. Sorry If you felt offended

    Dave-Thanks for your input. I hope to hear from Siri also.
  9. by   sirI
    Hello, Psychaprn,

    I have a collaborative agreement as well. Essentially, I have almost total autonomy, but I refer to/consult with my in-house physicians frequently.

    For any APN to think that a practice without a collaborative agreement means to be totally "on your own" is inaccurate. No healthcare provider practices totally "on your own". It takes a close working relationship with the providers in all areas of medicine.

    As for liability, yes, when you have a collaborative agreement with a physician, he/she will be liable for anything the APN does. That is true for any provider that takes on the responsibility of a patient either by consult or assignment acceptance.

    I fear the push for no collaboration might offer the false sense of security that many APNs will "think" they are solo and therefore, no need for any input from physicians/other APNs. Unfortunately, there are those out there that resent the "stigma" collaboration carries.

    I have zero issues with it. I'm not a physician nor do I hold myself out as one. But, I do, after many years experience, practice with almost complete autonomy.

    And, a collaborative agreement does not reduce mistakes either.
    Last edit by sirI on Mar 1, '07
  10. by   Psychaprn
    Thanks Siri! I agree a collaborative agreement won't decrease mistakes but I guess I think if I seek consultation with my MD-especially around an off-label med or something I've little experience with-that I'm less likely to make a mistake following his advice-He's had much more experience in the field than I have-I hope that doesn't make me sound like I lack self-cofidence but I do respect those who are more experienmced and educated than I am. Plus I'd feel guilty if I made a mistake because I didn't talk to him and he got dragged into a lawsuit too. I don't really feel my education prepared me to be a solo practitioner. Maybe I'll feel different in the future.
  11. by   sirI
    Quote from Psychaprn
    Thanks Siri! I agree a collaborative agreement won't decrease mistakes but I guess I think if I seek consultation with my MD-especially around an off-label med or something I've little experience with-that I'm less likely to make a mistake following his advice-He's had much more experience in the field than I have-I hope that doesn't make me sound like I lack self-cofidence but I do respect those who are more experienmced and educated than I am. Plus I'd feel guilty if I made a mistake because I didn't talk to him and he got dragged into a lawsuit too. I don't really feel my education prepared me to be a solo practitioner. Maybe I'll feel different in the future.
    I understand what you mean. You will get more comfortable as you go along. And, no, it does not sound like you lack confidence. You are trying to prevent/meet head on, any potential future problems. Smart, IMHO.:wink2:
  12. by   joyrochelle
    HI everyone-- i searched for collaborative agreement and came upon this discussion-- i dont want to hijack the thread so to speak, but if anyone here wouldnt mind giving me some advice about developing a collaborative agreement. that would be fantastic!

    I am a new grad in a private practice and apparently this practice isnt normally used to creating agreements with their aprn's; the two that they had for almost 15 yrs were hired on before it was really required I suppose. I do not want to let it to go nor do I want to be naive and get screwed! Can anyone direct me to a template or any advice on how to construct one? Is this something I need to go to an attorney to draw up? I am also in CT.

    Many many MANY thanks-- Joy
    :bowingpur
  13. by   mom and nurse
    I know in some states they have the collaborative agreement that needs to be filled out online at the board of nursing website. Perhaps check the website of your BON...

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