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Nursing State Practice Agreements

Nursing State Practice Agreements

Nursing State Practice Agreements
Nursing State Practice Agreements Essay
Nursing State Practice Agreements Essay

Assignment 2: Week 9 Practicum Journal: State Practice Agreements

In many states, nurse practitioners are completely autonomous professionals. In other states, however, NPs have a wide range of “restrictive” practice ranging from requirements for a “supervising” physician to requirements for a “collaborative” agreement with a physician.

In this Practicum Journal Assignment, you will examine the requirements in the states of Maryland in order to prepare yourself for the realities of practice upon graduation. Nursing State Practice Agreements Essay

You will:

Analyze state PMHNP practice agreements
Analyze physician collaboration issues
Analyze barriers to PMHNP independent practice
Create plans for addressing state PMHNP practice issues

To Prepare for this Practicum Journal:

Review practice agreements in the states of Maryland.
Identify at least two physician collaboration issues in the states of Maryland.
For this Practicum Journal:

Briefly describe the practice agreements for PMHNPs in the state of Maryland.
Explain the two physician collaboration issues that you identified.
Explain what you think are the barriers to PMHNPs practicing independently in the state of Maryland.
Outline a plan for how you might address PMHNP practice issues in the state of Maryland.




American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

State Practice Agreements

The practice agreements for PMHNPs in the state of Maryland

PMHNPs in Maryland are not mandated to have collaborative agreements with physicians for them to practice. A collaborative practice agreement is a written contract amid the APRN and a physician, outlining the practice privileges given to the nurse practitioner, how regularly the collaborating or supervising physician should review patient records, the extent to which the physician supervises the daily work of the nurse practitioner with patients and the way both the nurse practitioner and the physician should interrelate with patients in instances when either the nurse practitioner or physician is absent (Buppert, 2017). Nursing State Practice Agreements Essay


Collaborative practice agreements between the collaborating APRN and the collaborating physician should be dated and signed by both the physician and APRN prior to its implementation, indicating that both understand its content and are in agreement to adhere to the terms of the collaborative agreement (Buppert, 2017). Maryland PMHNPs can autonomously, without a collaborative practice agreement and physician involvement perform patient assessments, diagnose patients and prescribe some medications, without being required to have an attestation agreement with a physician. In addition, nurse practitioners in Maryland are acknowledged as primary care providers.

Two physician collaboration issues that I identified

The first physician collaboration issue that I identified is that the collaborative practice agreement limits the ability of a PMHNP to deliver care within his or her scope of practice, education, training, competency, and experience. The collaborative practice agreements outline the restrictions that govern the practice of nurse practitioners as well as the terms under which the physician will interrelate with the nurse practitioner (Blair & Jansen, 2015). Mandated collaborative practice agreements and physician supervision augment the cost that PMHNPs incur in providing care since physicians usually charge PMHNPs for collaborative services. The amount that physicians should charge is not regulated by the state and can be heavy, amounting to thousands of dollars yearly. To enable PMHNPs to practice to the full extent of their competence and education, the collaborative practice agreement should not mandate a level of physician supervision that restricts effective reimbursement or clinical practice. Nursing State Practice Agreements Essay

The second issue is that several physicians are hesitant to have collaborated agreements with nurse practitioners because they are afraid of incurring extra liability. Blair and Jansen (2015) claim that a lot of specificity within the agreement limits the ability of APRNs to individualize care and also exposes both the APRN and the physician to legal claims if they fail to adhere to the specifities precisely. Laws on collaboration that puts a limitation on the distance between the PMHNP and the collaborating physician, for instance, laws requiring the supervising physician to be fifty miles or less from where the PMHNP is practicing discourage nurse practitioners from setting up practices in rural regions where they are mostly required. This is so because the majority of physicians are concentrated in urban regions. Nursing State Practice Agreements Essay

Barriers to PMHNPs practicing independently in the state of Maryland

Insurance payer regulations are the key barriers that limit the ability of PMHNPs to practice independently in the state of Maryland. Unequal rates of reimbursement for nurse practitioners and physicians prevent PMHNPs from practicing autonomously of setting up their own clinics. According to Cabbabe(2016), Medicare reimburses nurse practitioners 85% of the physician rate for similar services which Medicaid for free service pay nurse practitioners a reduced rate.

Apart from regulations from the Medicare and Medicaid, private health insurance plans are discrete in determining the form of services they cover along with the providers they acknowledge. Cabbabe (2016) asserts that numerous plans do not cover the services provided by nurse practitioners. Additionally, several managed care plans necessitate their enrollees to appoint a primary care provider but in many instances, they do not acknowledge nurse practitioners as primary care providers.

Organizational barriers also prevent PHMNPs from practicing independently. Organizations that employ nurse practitioners create barriers that prevent the independent practice of PMHNPs Poghosyan (2018) asserts that medical assistants provide support to physicians in their primary care practices while nurse practitioners do not have such support in their primary care practices. Lack of support makes nurse practitioners take on duties that are usually assigned to medical assistants, a phenomenon that makes them unable to fully utilize their competencies and advanced skills. Nursing State Practice Agreements Essay

A plan of how I might address practice issues in the state of Maryland

I might address practice issues in the state of Maryland by recommending Congress to reform public as well as private payment systems to permit independent and equitable reimbursement for PMHNPs delivering primary care in every setting. Eliminating reimbursement barriers will enable PMHNPs to practice independently and deliver care that is less costly, safe and of high quality. I may also recommend organizations that employ PMHNPs to provide PMHNPs with needed staff to enable PMHNPs to offer high-quality and efficient care and also patient care that is more cost-effective. Another strategy would be to undertake media campaigns to emphasize the important role of PMHNPs in improving the accessibility, safety and quality of patient care and highlight and demonstrate the impact of PMHNPs care can help in the promotion of psychiatric nursing care that is in line with the scope of practice, training and education. Nursing State Practice Agreements Essay


Cabbabe, S. (2016). Should Nurse Practitioners Be Allowed to Practice Independently? Missouri Medicine, 113(6), 436-437).

Blair, K., & Jansen, M. (2015). Advanced Practice Nursing, Fifth Edition: Core Concepts for Professional Role Development. New York: Springer Publishing Company.

Buppert, C. (2017). Nurse Practitioner’s Business Practice and Legal Guide. Burlington, MA: Jones & Bartlett Publishers.

Poghosyan, L. (2018). Federal, State, and Organizational Barriers Affecting Nurse Practitioners Workforce and Practice. Nursing Economics, 36(1), 43-45.Nursing State Practice Agreements Essay

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