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Am Fam Physician. 2001;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.

Prescribe independently, including controlled substancesAlaska, Ariz., D.C., Iowa, Me., Mont., N.H., N.M., Ore., Vt., Wash., Wis., Wy.
Prescribe with physician collaboration, including controlled substancesArk., 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 limitsAla., 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.

Scope of NP PracticeNP practice authorized through State Board of NursingNP practice authorized by Boards of Nursing and Medicine/Others
Without physician supervision or collaborationAlaska, 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 supervisionCalif., Fla., Ga., Ida., La., Mass., S.C., Wis.Ala., Miss., N.C., Pa., S.D., Va.
With physician collaborationConn., Del., Ill., Ind., Kan., Ky., Ohio, Md., Minn., Mo., Neb., Nev., N.Y., Vt.Tenn.

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