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State Practice Agreements

State Practice Agreements

State Practice Agreements
State Practice Agreements Essay Paper
State Practice Agreements Essay Paper

State Practice Agreements

The practice agreements for PMHNPs in Indiana State

Psychiatric Mental Health Nurse Practitioners (PMHNPs) practicing in Indiana is mandated to carry out nursing tasks under the collaboration with a licensed physician. The PMHNPs may diagnose and treat patients under the supervision of a physician and in accordance with a collaborative agreement. According to Buppert (2017), a collaborative practice agreement sets forth the way in which the supervising physician and the nurse practitioner will consult, coordinate or cooperate with one another in providing health care to patients. the collaborative agreement outline the way the physician and PMHNP will work in cooperation, share practice tasks and the way coverage will be offered when the collaborating physician is not present. PMHNPs may prescribe legend drugs, including schedule two to schedule five controlled drugs as outlined in the collaborative agreement with the supervising physician. In addition, nurse practitioners must submit an application to the Indian state board of nursing to prescribe controlled drugs.State Practice Agreements Essay Paper

Physician collaboration issues

The physician collaboration issue I identified is that the requirement for the PMHNPs to practice and prescribe medications under a physician negatively affects the availability of PMHNPs to provide care, particularly in rural areas. Barnes et al (2017) assert that requiring nurse practitioners to have collaborative agreements restricts the ability of the nurse practitioner to provide any form of service without the collaborative agreement. Additionally, if the collaborating physician decides to relocate or terminate the agreement, a nurse practitioner is not able to render services. Since most physicians are clustered in urban areas, PMHNPs practicing in rural regions find it difficult to find a collaborating physician


Collaboration also makes PMHNPs incur huge operation costs since they are required to pay collaboration fees. Although PMHNPs in Indian are authorized to open and run their own clinics and provide diagnosis and treatment services to patients, the collaborative agreements usually require that the supervising physician review five percent of prescription charts weekly, in which the nurse practitioners are required to pay a fee to the collaborating physician. As indicated by Martin and Alexander (2019), nurse practitioners working in private clinical and rural regions are often to pay collaborative practice agreement fees, of not less to six thousand dollars to fifty thousand dollars yearly. State Practice Agreements Essay Paper

Barriers to PMHNPs practicing independently in Indiana

Several barriers hinder the capability of PMHNPs in Indiana to practice independently. Restrictive legislation and federal barriers are the most outstanding barriers halting PMHNPs to practice independently to the full level of their educational preparation. Indiana state scope of practice law mandate nurse practitioners to have a collaborative agreement with a physician for them to practice. As Bosse et al (2017) indicate, state supervision mandates lessens the ability of the nurse practitioner to provide care that is less costly and of superior quality. Nurse practitioners are adequately knowledgeable, educated, skilled and experienced to offer comprehensive and basic primary care services but state regulations continue hindering them from practicing autonomously.

Deferral barriers to PMHNP independent practice in Indiana relate to the reimbursement offered Medicare. Medicare reimburses nurse practitioners at a reduced rate for the same services provided compared to physicians. For a nurse practitioner practicing independently, Medicare reimburses eighty-five percent for services provided by the nurse practitioner. Reduced reimbursement significantly affects the ability of nurse practitioners to practice autonomously and fully utilize their training, education, and licensure (Barnes et al, 2017). Additionally, health insurance plans are discrete in establishing the types of services they cover as well as the providers they acknowledge. Some plans fail to cover services provided by PMHNPs, while numerous managed care plans failing to acknowledge PMHNPs as designated primary care providers.State Practice Agreements Essay Paper

Apart from state and federal barriers, Lack of recognition for physicians, physician professional organizations and the public is another barrier to the independent practice of PMHNPs in Indiana. Physicians, as well as physician associations, are key opponents to nurse practitioners’ full practice authority. They are adamant that nurse practitioners do not have the intensive training to make complex medical decisions and thus cannot provide safe patient care without the proficiency of a supervising physician (Dillon & Gary, 2017).State Practice Agreements Essay Paper

A plan of how I might address POMHNP practice issues in Indiana

I might address PMHNP practice issues in Indian by advocating for the relaxation of the scope of practice laws that mandates PMHNPs to practice in collaboration with physicians in order to enable them to practice independently. I would also advocate for w equal reimbursement for physicians and nurse practitioners when they deliver the same service. To ensure equal reimbursement, I would advocate for the development of partnerships amid state insurance commissioners and nurse practitioners to support increased reimbursement of nurse practitioners and acknowledgment as credentialed providers. Concerning interprofessional barriers, I would encourage physicians to view PMHNPs as part of the bigger health care time and work jointly on the mutual goal of providing quality care and improving patient outcomes.State Practice Agreements Essay Paper

Lack of awareness among state and local government and the general public concerning the capabilities and medical qualifications of PMHNPs is a significant barrier that prevents PMHNPs from being granted full practice authority. I might address this issue by educating and informing legislators as well as the general public about the skills and competencies that PMHNPs have to enable them to provide cost-effective, safe and high-quality care. I would also encourage practicing PMHNPs and psychiatric mental health nursing students to participate in policies at the state level and to educate lawmakers who might lack the understanding of the positive effect that granting nurse practitioners full practice authority can have on populations’ health outcomes. State Practice Agreements Essay Paper


Barnes, H., Maier, C., & Sarik, D et al. (2017). Effects of regulation and Payment Policies on Nurse Practitioner’s Clinical Practices. Medical Care Research and Review, 74(4), 431-451.

Bosse, J., Simmonds, K., & Hanson, C et al. (2017). Position statement: Full Practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761-765.

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

Dillon, D., & Gary, F. (2017). Full Practice Authority for Nurse Practitioners. Nursing Administration Quarterly, 41(1), 86-93.

Martin, B., & Alexander, M. (2019). The Economic Burden and Practice Restrictions Associated with Collaborative Practice Agreements: A National Survey of Advanced Practice Registered Nurses. Journal of Nursing Regulation, 9(4), 22-30. State Practice Agreements Essay Paper

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