Policy Center One-Pager

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

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.

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.

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.

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.

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, D.C. 20036 (phone: 202-986-5708; fax: 202-986-7034; e-mail: policy@aafp.org).

---

Copyright © 2001 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

---

October 15, 2001 Contents | AFP Home Page | AAFP Home | Search

---