Collaboration

Our thanks to previous Professional Issues Chair Rosemary Liguori, PhD, CPNP for providing the answer to this question.

Question: I am a PNP working in a family practice. Can a Family Practice MD be my supervising/collaborative physician or does it have to be a pediatrician?

Answer: The answer to this question is not black and white. It is important for you to review your own state's board of nursing rules and regulations. Each state has laws and rules that regulate the practice of nursing and the role of the nurse practitioner. The legal requirement for collaboration between a physician and NP is present in over 40 states. In some states, collaboration is not defined, but implicit to the relationship defined in the practice act, while in other states collaboration is inferred within the development of practice agreements, collaborative agreements, or protocols. Some states equate collaboration to supervision, while others instead define and compel supervised practice arrangements. Some states require proof of a collaborative MD only for prescriptive practice privileges, while other states require proof of a collaborative MD for licensure at all.. Few states specifically define specialty requirements for collaborating physican.

Each state has very different wording regarding the collaboration requirement, thus the need to check your own sates requirements, and clarify directly with the state board of nursing with your specific question. See below for three different states requirements regarding the collaborating physician requirements. You will note the language is different for each state, thus the need for you to check your own state's requirements.

"Collaborative management" is a mutually agreed upon plan between an advanced practice registered nurse and one or more physicians or surgeons licensed under chapter 147 that designates the scope of collaboration necessary to manage the care of patients. The advanced practice registered nurse and the one or more physicians must have experience in providing care to patients with the same or similar medical problems. (Minnesota Nurse Practice Act, 148.171, Subd.6. http://www.revisor.leg.state.mn.us/stats/148/171.html)

All nurses practicing in an expanded role (physician's office, institution or private practice) shall practice in accordance with written guidelines developed in collaboration with and mutually acceptable to the nurse and to: (a) a physician expert by virtue of training or experience in the nurse's area of practice. Supervising physician means a physician holding an unrestricted full license in Massachusetts who:(a) has completed approved Accreditation Council for Graduate Medical Education (ACGME) training in the United States or is Board certified in the nurse's area of specialty, or has hospital admitting privileges in that specialty area; (Massachusetts Nurse Practice Act, http://www.mass.gov/dpl/boards/rn/cmr/24404.htm)

An Advanced Registered Nurse Practitioner shall only perform medical acts of diagnosis, treatment, and operation pursuant to a protocol between the ARNP and a Florida-licensed medical doctor, osteopathic physician, or dentist. The degree and method of supervision, determined by the ARNP and the physician or dentist, shall be specifically identified in the written protocol and shall be appropriate for prudent health care providers under similar circumstances. General supervision by the physician or dentist is required unless these rules set a different level of supervision for a particular act. The number of persons to be supervised shall be limited to insure that an acceptable standard of medical care is rendered in consideration of the following factors: (a) Risk to patient; (b) Educational preparation, specialty, and experience of the parties to the protocol;(c) Complexity and risk of the procedures; (d) Practice setting; and (e) Availability of the physician or dentist (Florida Nurse Practice Act, 64B9-4.010 Standards for Protocols. http://www.doh.state.fl.us/mqa/nursing/info_PracticeAct.pdf)

(Individual states board of nursing can be found at: http://www.ncsbn.org/regulation/boardsofnursing_boards_of_nursing_board.asp).