QUESTION:         The law in our state was recently changed and advance practice registered nurses (APRNs) are now allowed to practice independently. How should we handle this change in the law at our hospital? Can we continue to require collaboration agreements? Or should we eliminate that requirement and allow the APRNs to practice on their own?

ANSWER:        There is not a “right” answer to the question about how APRNs should practice in any hospital. There is a trend in licensing statutes around the country to allow APRNs to practice independently. An independent practice for APRNs makes a great deal of sense on an outpatient basis and may work in a hospital setting if you are in a rural setting where the option to have a collaborative relationship with a physician is limited.

However, even with a change in the law, your hospital is not required to allow APRNs to practice independently in your facility. Your hospital may want to put together a task force to consider whether there should be a change in practice for APRNs. In addition to other medical staff and hospital leaders, the task force could include APRNs and physicians who have a history of collaborating with them. Be careful not to load the task force with physicians who have an economic reason to limit the practice of APRNs.

The task force could gather information and then consider whether to recommend that APRNs continue to practice in a collaborative arrangement, whether all APRNs are permitted to practice independently or whether to recommend that the ability of APRNs to practice independently is made by practice specialty (e.g, nurse midwives, CRNAs, APRNs in the NICU).

The task force could also consider whether to recommend requirements for backup and coverage, especially for situations when a patient has a complication that requires expertise outside the scope of practice of the APRN. The task force might also be charged with reviewing how the care provided by APRNs will be evaluated through the peer review process.

It makes sense to continue to evaluate how care is provided to patients in your hospital and to look for ways to improve that care, including the way care is delivered. APRNs and Physician Assistants play a vital role in the delivery of care to patients in most hospitals. You should continue to look for ways to integrate these practitioners into your health care teams in a way that is safe and productive.