Published Apr 6, 2014
I live in NY so this bill is very interesting to me as I will be starting a PMHNP program this summer. I was reading headlines stating that NP's now have independent practice. I have read through the article and it states that the APRN has to have an agreement even after the 36 months with a physician. What am I missing? How is this independent practice?
"A NURSE PRACTITIONER, CERTIFIED UNDER SECTION SIX THOUSAND NINE
HUNDRED TEN OF THIS ARTICLE AND PRACTICING FOR MORE THAN THIRTY-SIX
MONTHS AND THREE THOUSAND SIX HUNDRED HOURS, SHALL EITHER HAVE A WRITTEN
PRACTICE AGREEMENT AND WRITTEN PRACTICE PROTOCOLS WITH A LICENSED PHYSI-
CIAN IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN PARAGRAPH (A) OF
THIS SUBDIVISION OR SHALL HAVE COLLABORATIVE RELATIONSHIPS WITH ONE OR
MORE LICENSED PHYSICIANS QUALIFIED TO COLLABORATE IN THE SPECIALTY
INVOLVED OR A HOSPITAL, LICENSED UNDER ARTICLE TWENTY-EIGHT OF THE
PUBLIC HEALTH LAW, THAT PROVIDES SERVICES THROUGH LICENSED PHYSICIANS
HAVING PRIVILEGES AT SUCH INSTITUTION AND QUALIFIED TO COLLABORATE IN
THE SPECIALTY INVOLVED. SUCH COLLABORATIVE RELATIONSHIP SHALL INCLUDE
WRITTEN GUIDELINES FOR PRACTICE THAT PROVIDE FOR THE CRITERIA TO BE USED
REGARDING CONSULTATION, INCLUDING METHODS AND FREQUENCY OF HOW CONSULTA-
TION SHALL BE PROVIDED, COLLABORATIVE MANAGEMENT AND REFERRAL, INCLUDING
EMERGENCY REFERRAL PLANS, TO ADDRESS THE HEALTH STATUS AND RISKS OF
juan de la cruz, MSN, RN, NP
This paragraph states that:
An experienced NP (with more than 36 months or 3600 hours of practice) are to either
- have a written practice agreement and written protocols with a physician
- have a collaborative relationship with one or more physicians qualified to collaborate in the specialty involved or a hospital
The law distinguishes between a written practice agreement/protocols "WPA/P" (akin to supervision) vs a collaborative relationship. It excuses experienced NP's from the WPA/P but forces them to collaborate with physicians which NP's do already independent or not.
I agree that the language in this law while allowing independence for NP's is not similar to "independent" language in other states with independent practice.
The NP Association of NY has the interpretative guidelines about this law here.
cayenne06, MSN, CNM
Ugh, I hate language like that in APRN regulations.
Say you are an endocrinologist. Your diabetic patient needs surgery to correct some emergent diabetic-related complication. You refer your patient to the surgeon you usually work with. There is no LAW stating that endocrinologists must have a "collaborative" relationship with a surgeon. You refer your patient when they need a referral. There is no reason APRNs need regulations specifying that they have collaborative relationships with other providers. OF COURSE they collaborate. We ALL collaborate. It's very patronizing.
OK, that's kind of what I got out of it too but I don't quite understand the difference. I am new to many of the details about agreements with physicians, so please feel free to enlighten me. What is a collaborative agreement with a physician entail? I thought it was either they review your records periodically or you were independent. Can you give me an example of how this collaboration would work? I appreciate the answers from both of you, your posts are always very informative to read.
The link to the NP Association of NY has the details.
The current system requires a Written Practice Agreement and Written Practice Protocols with a physician. Examples of these are:
- FNP working with a Family Practice physician writes an agreement that NP will see established patients only. The NP and physician writes in the agreement the office procedures that the NP is allowed to do.
- Family Psych and Mental Health NP working with a Psychiatrist will agree that NP will see patients but will discuss his/her assessment and plan with Psychiatrist prior to proceeding with it.
- this system is highly variable depending on what the written agreement states. It could even be restrictive enough that the NP has a set formulary of medications that can be prescribed.
In a Collaborative Relationship as defined in the new NP Act in NY:
- a NY State Education Dept Attestation Form will be developed prior to 1/1/15 (the day the new law goes in effect)
- the form will state that the NP has established collaborative relationships with one or more physicians (names and signatures are not required).
- the form will state how to resolve cases of dispute between the NP and physicians (it also says that physician prevails but NP has option of seeking another physician's opinion).
- the NP has no restrictions of which patients he/she wants to see and has unlimited privilege to write prescriptions, tests, etc.
- the NP must be able to present the Attestation Form in the event the NYSED asks for it.
It is clearly different than having a WPA/WPP. However, I assume this was a later edit to the originally proposed language of the act to please the physician lobby who likely were scaring the lawmakers that NP's will never consult them. It also protects their turf as the "top of the food chain" in terms of healthcare.
Can anyone give me ideas how to get experience as a FNP,everywhere I apply Iam told that they are looking for someone with experience.How can I get the experience if I cant get hired.
Thanks Juan, That helps clarify it. I will try the to find the correct site again, I looked previously to posting but I must have not been on the right website.
I can't speak to NY, but my health insurance in GA mandates that at least one of my visits during a calendar year be with an MD and not a NP solely. I found this interesting since I have to wait for months to see my primary care MD. That's why I see the NP. So there are others things in play also.
zmansc, ASN, RN
That's interesting, but it is also an issue that each state is addressing. In the forward thinking state of NM (I love saying that, lol) it is against the law for the insurance companies to do that kind of thing. I'm not saying they don't try every now and then, but the law prohibits them from reimbursing one type of provider over another. Yes, it still allows them to pay us less, but it's a start.
I think as we gain autonomous practice in more and more states, we will also be able to push for more protections from this kind of collusion by insurance companies and others in healthcare.
It is really simple. Independent practice means just that, no oversight required, at all. So it is akin to being pregnant, you are or you aren't, no in between.
I can understand not wanting NPs fresh out of school to practice independently. Why does a collaborative relationship have to exist for seasoned NPs though? Why not allow experienced NPs to collaborate/supervise new NPs until they have had X number of practice hours. NPs aren't truly independent until they can practice without being required to collaborate / be supervised by physicians.
I agree with the other guys. Collaborative practice agreements are just silly and offer nothing to NPs or our patients. They offer plenty to the physicians getting paid to do nothing, which is why I'd never agree to it. I collaborate plenty, but I'll be damned if I'm going to pay someone to chat with me at the water cooler.
"Supervision" is outright ridiculous, unnecessary and offensive. NPs in states with restrictive language need to leave those states in droves. Last I knew most of the Western states with independent practice were still desperate for NPs and I get recruiter emails for MT, CO, AZ and NM every week. Leave the ignorant legislatures high and dry with angry constituents because of the lack of access, and they'll learn. As long as you all stay there and put up with it, nothing is going to change. NYs practice act can be improved, and my understanding is that there is favorable sentiment. States like NY, that are listening and beginning to evolve, are worth staying in and fighting for practice rights. But Florida? Mississippi? Georgia? Not worth it. Leave. Let them figure out the hard way that they need you. Unless anyone believes the few FP/IM physicians that there are are going to flock to Biloxi, Ocala or rural Georgia.
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