Policy Center One-Pager

Trumping Professional Roles: Collaboration of Nurse Practitioners and Physicians for a Better U.S. Health Care System



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Am Fam Physician. 2001 Oct 15;64(8):1325.

Professional turf battles have yielded variations in the scope of practice for nurse practitioners (NPs) that obstruct collaboration with physicians that would enhance patient care. Patients would be better served if NPs and physicians worked together to develop better combined models of education and service that take advantage of the benefits of both professions' contributions to care.

The legal status and regulation of NPs varies significantly from state to state. Twelve states and the District of Columbia allow independent NP prescribing, while the rest require physician collaboration with other limitations (Table 1). Currently, 21 states and the District of Columbia allow some degree of independent practice for NPs, and the rest require collaboration or supervision by a physician (Table 2). Even licensing authority and classification varies by state.

These variations exemplify and exacerbate a growing professional schism. Although many NPs and physicians enjoy successful collaborations, regulatory variations and the professional turf battles that cause this gap threaten to make such collaboration more difficult.

TABLE 1

Nurse Practitioner Prescribing Status by State in 2000

Status State

Prescribe independently, including controlled substances

Alaska, Ariz., D.C., Iowa, Me., Mont., N.H., N.M., Ore., Vt., Wash., Wis., Wy.

Prescribe with physician collaboration, including controlled substances

Ark., Calif., Colo., Conn., Del., Fla., Ga., Hawaii, Idaho, Ill., Ind., Kan., Mass., Md., Mich., Minn., N.C., N.D., Neb., N.J., N.Y., Okla., Pa., R.I., S.C., S.D., Tenn., Utah, W. Va.

Prescribe with physician collaboration, excluding controlled substances and/or with schedule limits

Ala., Ky., La., Mo., Miss., Nev., Ohio, Tex., Va.

TABLE 1   Nurse Practitioner Prescribing Status by State in 2000

View Table

TABLE 1

Nurse Practitioner Prescribing Status by State in 2000

Status State

Prescribe independently, including controlled substances

Alaska, Ariz., D.C., Iowa, Me., Mont., N.H., N.M., Ore., Vt., Wash., Wis., Wy.

Prescribe with physician collaboration, including controlled substances

Ark., Calif., Colo., Conn., Del., Fla., Ga., Hawaii, Idaho, Ill., Ind., Kan., Mass., Md., Mich., Minn., N.C., N.D., Neb., N.J., N.Y., Okla., Pa., R.I., S.C., S.D., Tenn., Utah, W. Va.

Prescribe with physician collaboration, excluding controlled substances and/or with schedule limits

Ala., Ky., La., Mo., Miss., Nev., Ohio, Tex., Va.

The credible evidence showing that collaboration improves health outcomes for patients entreats the two professions to put cooperation before professional roles. NPs and physicians should work together to create new models of integrated education and collaborative care with patients as the focus. A combined, sustained effort is urgently needed to permit new policies for redesigning and improving the U.S. health care system.

TABLE 2

Legal Status of Nurse Practitioners by State in 2000

Scope of NP Practice NP practice authorized through State Board of Nursing NP practice authorized by Boards of Nursing and Medicine/Others

Without physician supervision or collaboration

Alaska, Ariz., Ark., Colo., D.C., Hawaii, Iowa, Me., Mich., Mont., N.D., N.H., N.J., N.M., Okla., Ore., R.I., Tex., Utah, Wash., W. Va., Wyo.

NA

With physician supervision

Calif., Fla., Ga., Ida., La., Mass., S.C., Wis.

Ala., Miss., N.C., Pa., S.D., Va.

With physician collaboration

Conn., Del., Ill., Ind., Kan., Ky., Ohio, Md., Minn., Mo., Neb., Nev., N.Y., Vt.

Tenn.


NP = nurse practitioner; NA = not applicable.

TABLE 2   Legal Status of Nurse Practitioners by State in 2000

View Table

TABLE 2

Legal Status of Nurse Practitioners by State in 2000

Scope of NP Practice NP practice authorized through State Board of Nursing NP practice authorized by Boards of Nursing and Medicine/Others

Without physician supervision or collaboration

Alaska, Ariz., Ark., Colo., D.C., Hawaii, Iowa, Me., Mich., Mont., N.D., N.H., N.J., N.M., Okla., Ore., R.I., Tex., Utah, Wash., W. Va., Wyo.

NA

With physician supervision

Calif., Fla., Ga., Ida., La., Mass., S.C., Wis.

Ala., Miss., N.C., Pa., S.D., Va.

With physician collaboration

Conn., Del., Ill., Ind., Kan., Ky., Ohio, Md., Minn., Mo., Neb., Nev., N.Y., Vt.

Tenn.


NP = nurse practitioner; NA = not applicable.

Adapted from Policy Center One-Pager #9. Phillips RL, Green LA, Fryer GE, Dovey SM. Trumping professional roles: collaboration of nurse practitioners and physicians for a better U.S. health care system. February 2001. Available at: http://www.aafppolicy.org/onepagers/20010227b.html. From the Robert Graham Center: Policy Studies in Family Practice and Primary Care, 2023 Massachusetts Ave., NW, Washington, DC 20036 (telephone: 202-986-5708; fax: 202-986-7034; e-mail: policy@aafp.org).

 


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