What is a Collaborative Practice Agreement?

As with most healthcare professions, there is a lot of paperwork that goes along with practicing as a nurse practitioner. NPs must obtain a national certification as well as a state license to practice. In addition, an NPI number, and credentialing paperwork is necessary for nurse practitioners to bill insurers. In some locations, NPs have even more to coordinate as state scope of practice laws require additional documentation to meet practice requirements. One such document is a collaborative practice agreement.

Scope of practice laws are those passed by state governments that regulate nurse practitioners in one of the following three ways:

1. Regulate the way nurse practitioners prescribe
2. Regulate the way nurse practitioners practice
3. Regulate the way nurse practitioners practice and prescribe

Scope of practice laws, for example, may prohibit NPs from prescribing controlled substances. Or, these laws may require that nurse practitioners complete a specified number of hours of continuing medical education in order to practice. The most common requirement within state scope of practice laws is that NPs collaborate with, or practice under the supervision of, a physician. The specifics of such laws vary from state to state.

Currently, there are about 21 states that allow nurse practitioners to both practice and prescribe without physician involvement. In states where physician oversight is mandated for practice, prescribing, or both, a collaborative practice agreement is required. A collaborative practice agreement is a document outlining this joint practice relationship between the nurse practitioner and physician. In general, the document outlines the rights and responsibilities of each party involved, formalizing the relationship.

A collaborative practice agreement typically contains the following information:

• Name of each party, practice site(s), and effective date
• Scope of practice of the nurse practitioner as it relates to diagnosis and treatment of patients
• Scope of practice of nurse practitioner as it relates to prescriptive authority
• A reference to practice protocols
• Requirement for documentation review and cosignature by the physician
• Availability of the overseeing physician as well as minimum oversight requirements

Many state boards of nursing post sample collaborative agreements for use on their websites. The following sites post sample collaborative practice agreements for nurse practitioners:

It is important for nurse practitioners to note that in the event practice location, employment, or collaborating physician changes, the practice agreement will need to be updated, and a new agreement submitted to the state board of nursing. Some states also mandate that the collaborative practice agreement be posted in a location visible to patients in the practice setting. Overall, both NPs and MDs must familiarize themselves with scope of practice guidelines to make sure they practice both individually, and as a team, in compliance with state law.