What is a collaborative practice?
"A nationwide shortage of primary care physicians has combined with recent changes in health economics and politics to give nurse practitioners (NPs) the opportunity to establish a significant and separate role in health care delivery,” according to Physicians and Nurse Practitioners in Collaborative Practice, published by the Harvard Risk Management Foundation. Massachusetts defines a collaborative practice as one in which the nurse functions in an expanded role alongside physicians and other medical professionals to deliver health care in accordance with state law.
Over the last decade, Massachusetts has been expanding its nurse practitioner programs to make up for the shortfall in primary care physicians. Collaborative practices have been expanding as a result of the NP programs.
The evolution of collaborative practice
Initially, the state expects to see more malpractice claims in regard to collaborative practices. Ultimately, however, it will level out. The state attributes this to the fact that NPs focus on education, prevention, communication and many other functions that primary care physicians relegate to the bottom of the patient care list. Ultimately, the article said, this “may help minimize their claim experience.”
A collaborative practice should have a written set of standards and practices so that each party understands his or her job functions and limitations. If an NP will write prescriptions, that should be addressed in writing, for example. Anything that can be done to minimize problems along the way should be done at the beginning of the effort.
In 1993, the Missouri legislature and the governor gave the statutory right for advanced practice registered nurses and physicians to enter into a collaborative practice agreement. Much like the rest of the country, Missouri faced declining numbers of primary care physicians, so it sought some sort of legal remedy to allow nurses to play a larger role within a health care practice.
On its website, the Missouri Division of Professional Registration speaks to the idea of a collaborative practice and nursing requirements to be part of a collaborative practice. To become part of a collaborative practice, the nurse must gain advanced practice registered nurse recognition. When doctor and nurse write up a collaborative agreement, the nurse must have a Document of Recognition in hand in the State of Missouri (check your individual state nursing board for laws specific to your state).
Collaborative practice guidelines
Some of the recommendations for a proficient collaborative practice include:
- Strict, written procedures involving who does what within the practice. For example, if the NP can write prescriptions, that should be written down, including any limitations or situations in which the NP should consult with the physician before writing a prescription.
- A knowledge of state law so that any written agreements made in the collaborative practice agreement adhere to the laws that govern your state.
- Guidelines that cover various scenarios and how to respond to those scenarios, such as suspected child or elder abuse.
- A policy that a physician must be available at all times, either by telephone or in person. Some states do not require the collaboration of a physician in patient care, but in an emerging field, it helps to have the physician available in case unusual cases or problems surface.
- An understanding of federal regulations. While state law might allow nurses to perform certain tasks, the federal government’s Medicare system might require that a task be performed by a physician.
- A commitment to meet regularly to discuss problems that arise within the collaboration. The meetings can be informal or formal and scheduled, but they should be regular to ensure the system works for all parties concerned.
If set up correctly, a collaborative practice yields benefits to physicians and nurses. More than that, it creates a better health care environment for the patient. “Collaborative practice agreements with advanced practice nurses are an effective way of improving access to medical care,” according to the Medical and Public Health Law website of the LSU Law Center.
