Collaboration and Supervision in Advanced Practice Nursing: An Exploration of Current Policy,Steps to Enact Policy Change and Educate Nurses to Become Advocates for Change

Mandated collaborative agreements are a restriction to practice for nurse practitioners in the United States. According to the Pearson Report 2010, eleven states and the District of Columbia allow nurse practitioners to practice without mandated agreements. Progress is being made in states such as Colorado where nurse practitioners achieved a victory in removing collaborative agreements and are now only required to have a onetime physician’s signature on articulated plan. The Institute of Medicine (IOM) issued a report on October 5, 2010 calling for removal of barriers to allow advanced practice nurses (APNs) to practice to their potential in a time when primary care providers are a great need. These victories are significant but many APNs continue to work in oppressive environments. Stiff opposition from the American Medical Association (AMA) and state medical associations is one obstacle to removing these restrictions. Opponents to the removal of mandated supervisory/collaborative agreements cite a concern for patient safety. A comparison to the number of malpractice cases in states without mandated physician involvement such as Alaska where the ratio of National Practitioner Data Bank (NPDB) malpractice cases to the number of nurse practitioners in 1:93 and 1:4 for both MD’s and DO’s proves this concern unwarranted. The goal of this presentation is to offer advanced practice nurses with guidelines and tools for impacting legislation. Guidelines and tools for nurse practitioner faculty will be offered to educate future APNs in effective methods to impact policy and legislation.