Help regarding regulated collaborative agreement

[APei]

Hi all,

I was looking at the AANP's "State Practice by Type" webpage and my state (Maryland) is listed as "State practice and licensure law reduces the ability of nurse practitioners to engage in at least one element of NP practice. State requires a regulated collaborative agreement with an outside health discipline in order for the NP to provide patient care. " I went on the Maryland board of nursing's webpage but couldn't find any information regarding this - it just says that I do in fact need a written attestation form/agreement with a physician. My question is this: What does the written attestation agreement mean later? I don't think it means I have to practice under the direct supervision of a MD. If I don't need the direct supervision of a MD, what does the attestation agreement have to do with anything? Thanks!

P.S. Long story short, I am researching the level of autonomy for nurse practitioners in Maryland.

[Corey Narry, MSN, RN, NP]

These are all semantics states use to keep NP's "dependent" on physicians to practice. It comes in many forms as you go from state to state with the exception of independent practice states. Maryland is actually quite simple in that all you need to do as an NP is to submit the "attestation form" which basically identifies the name and license number of the physician designee who will serve as your collaborator of record.

The form nor the state regulation do not stipulate the frequency of collaboration nor the degree of collaboration required. This is implied as an agreement based "on good faith" that both parties will use better judgement as situations arise. That said, Maryland does say that NP's are independent in terms of the general scope of NP roles which are enumerated here: http://www.dsd.state.md.us/comar/getfile.aspx?file=10.27.07.02.htm.

That list is a pretty extensive scope if you ask me. One last thing, Maryland also require NP's to submit an addendum to the attestation form that includes procedures that they will be performing (i.e., invasive procedures, casting and splinting, etc.).

[APei]

Hi Juan,

Thanks a lot for your answer! You are always very helpful on the message boards. I came to the same conclusion but ultimately thought I was reading something wrong. It's good to know that you re-affirmed my suspicions. I was mainly confused because on one website, I read that Maryland is independent in terms of the general NP roles however the AANP site and Maryland Board of Nursing stated that I need that attestation. I plan to become a surgical NP and obtain my RNFA certification after completing school. Thanks again! :)

[Corey Narry, MSN, RN, NP]

You're welcome. I always look at this issue on a case to case basis as an individual provider. I applaud AANP as they forge ahead with pushing for legislation across the US that would make NP's independent of physician involvement. I also applaud their efforts in guiding the public about how state legislation affect NP practice by assigning scores and ratings on practice climates for NP's in specific states. However, I personally believe these as just guides. Individual "happiness" in our respective roles is not just dictated by being independent as a provider.

I have been an Acute Care NP for years and never felt stifled by the fact that I've only worked in states where physician collaboration is required. By now, I could admit a run of the mill ICU patient, know what to do to get them to the point of being ready to be transferred out of the ICU on my own. However, I still feel that having that team approach to care with physicians would be the ideal model even if I have to accept that the team leader would have to be the physician. It is the only way to provide safe care in a setting where patients have complicated clinical pictures.

The way I see it, I would rather state that I've hated working in places where the spirit of collaboration between physician and NP is not as upheld in its true sense and have enjoyed working in places where the two-way respect between physicians and NP's in working towards a common goal of patient care is a well orchestrated art. Both places required collaboration in paper but it doesn't take a genius to figure out where NP satisfaction in their roles is better in those two situations.

[APei]

Such a great informative post. I agree on everything that you've said. Interpersonal collaboration (especially between physicians and NPs) does lead to improved patient outcomes. I am working on my nurse practitioner degree and I feel that I would actually prefer a physician to collaborate with (especially starting out as a new grad)! I could go on and on about the benefits versus having no team collaboration at all however I would just be reiterating everything you've just said in a nice long post. Always great to hear from you. Thanks again!

[mgrenwic]

I have nothing of value to add to your thread - I just found your Hannibal Lector avatar to be a hilarious choice!

"Hello Clarice"