QUESTION:        We recently received an application from a nurse practitioner who crossed out the line on our application form asking for the name of the collaborating/supervising physician and wrote that he didn’t have a collaborating physician because our state allows nurse practitioners to practice independently.   Is this true?  Do we have to change our forms and process?

ANSWER:            It depends, but probably not.  A state’s decision (through modification of the professional licensing statutes and regulations) to expand the scope of practice for an advance practice nurse, and to allow such practitioners to practice independently in that state, does not generally supersede the policy decision of a hospital that such practitioners must still work in collaboration with a physician appointed to the medical staff in that hospital setting.  The only exception would be if the changes in the state law were to actually “mandate” that such practitioners be permitted to practice independently — in all clinical settings.  In our experience, with a handful of exceptions, this is not what most states have done, at least not yet.

While it may be a question that the medical staff and board wish to consider further, there is a significant difference between a statute that permits independent practice and one that mandates independent practice.  If the hospital policy continues to require a collaborative relationship, this applicant should be informed that he or she is ineligible to apply unless he or she can supply evidence of a collaboration agreement with a physician.