Week 9 Practicum Journal: State Practice Agreements.

Posted: January 15th, 2023

Week 9 Practicum Journal: State Practice Agreements.

Assignment 2:
Week 9 Practicum Journal: State Practice Agreements
In many states, nurse practitioners are completely autonomous professionals. In other states, however, NPs have a wide range of “restrictive” practice ranging from requirements for a “supervising” physician to requirements for a “collaborative” agreement with a physician. Week 9 Practicum Journal: State Practice Agreements.


In this Practicum Journal Assignment, you will examine the requirements of your own state in order to prepare yourself for the realities of practice upon graduation.

Learning Objectives

Students will:

Analyze state PMHNP practice agreements
Analyze physician collaboration issues
Analyze barriers to PMHNP independent practice
Create plans for addressing state PMHNP practice issues

To Prepare for this Practicum Journal:

Review practice agreements in your state.
Identify at least two physician collaboration issues in your state.
For this Practicum Journal:

Briefly describe the practice agreements for PMHNPs in your state.
Explain the two physician collaboration issues that you identified.
Explain what you think are the barriers to PMHNPs practicing independently in your state. Week 9 Practicum Journal: State Practice Agreements.
Outline a plan for how you might address PMHNP practice issues in your state.

Note: Please make sure you include an introduction with a purpose statement and a conclusion paragraph. References should not be more than 5 years old. Thanks

State Practice Agreements
PMHPs play a crucial role in providing primary care and reducing the shortage of providers the United States have experienced for decades. However, the scope of practice regulations and laws differ from one state to another. While some states allow nurse practitioners to practice independently, others mandate collaborative agreement and supervision of a physician. The paper addresses practice agreements for PMHNPs in Maryland state, physician collaboration issues, barriers to PMHNPs practicing independently in Maryland and a plan of how I might address PMHNP practice issues in Maryland. Week 9 Practicum Journal: State Practice Agreements.
Practice agreements for PMHNPs in Maryland
PMHNPs in Maryland are allowed to practice autonomously without the requirement to enter into a collaborative agreement with the physician. PMHNPs may practice independent physician to assess, diagnose and order tests. Maryland PMHNPs are allowed to prescribe controlled substances but they must first enter into a collaborative agreement with PMHNPs who is fully authorized to practice fully or a physician for eighteen months, after which they can practice independently. As Buppert (2017) asserts, nurse practitioners who are certified as advanced from the Maryland board of nursing have the authority to prescribe non-controlled substances, but they are also allowed to apply for authorization to prescribe Schedule II to V controlled substances. PMHPs are acknowledged as primary care providers.
Physician collaboration issues
Physician collaboration prevents PMHNPs from practicing to the full level of their education, training, licensure, and certification. Bosse et al (2017) assert that mandatory collaborative practice agreements along with physician supervision results in gaps in care, increase healthcare costs and also deter PMHNPs from working independently. In addition, the requirement for a nurse practitioner to have a physician listed on his or her collaborative agreement is challenging for PMHNPs, particularly those working in regions that are experiencing a shortage of physicians. This directive is a barrier to access to health care and a cause of loss of sole health care providers in several regions. As Cabbabe (2016) alleges , nurse practitioners could be the solution to the increasing shortage of primary care compared to physicians, since Nurse practitioners take six years on average to complete their training and education, entailing graduate and undergraduate degrees, compared to eleven to twelve years on average taken by physicians, entailing residency training and schooling. Week 9 Practicum Journal: State Practice Agreements.
Barriers to PMHNPs practicing independently in Maryland
Reimbursement policies are a key barrier to PMHNPs practicing independently in Maryland. According to Kaplan (2015), managed care organizations and insurance companies necessitate that for a PMHNP to get reimbursement, the insurance firm should credential the physician listed on the collaboration agreement. Numerous nurse practitioners providing care to Medicaid managed care organizations patients can’t be get credentialing under the present rules. Interprofessional wrangles are another barrier to the independent practice of PMHNPs in Maryland. According to Kraus and DuBois (2017), physicians and numerous national medical organizations view PMHNPS are disqualified to work independently and provide safe and quality care. They argue that nurse practitioners have a lesser number of years of training and education in comparison with physicians, and thus they might expose patients to risks and generate a medical care system that is two-tiered. Week 9 Practicum Journal: State Practice Agreements.
Addressing PMHNP practice issues in Maryland
I might address barriers to PMHNPs practice issues in Maryland by advocating for the loosening of state scope of practice regulations to give PMHNPs fully practice authority. I might also actively lobby for reforms in public and private insurance payers to reimburse PMHNPs independently without the requirement for credentialing from a physician. I might also advocate for the removal of barriers that do not acknowledge PMHNPs’ clinical preparation and advanced education to deliver the variety of services as provided for by their licensure. I would encourage physicians and medical organizations to recognize PMHNPs are qualified professionals, with the capability to deliver safe, cost-effective and quality care and who can make great contributions to healthcare teams.
It is crucial that PMHNPs clearly understand the way their state regulations and laws influence their practice. Maryland state laws allow PMHN Ps to practice independently without a physician’s supervision. To prescribe controlled substances, PMHNPs are required to have a collaborative agreement with a physician or PMHNP who has authority to practice autonomously. Although PMHNPs in Maryland have the authority to practice without physician oversight, reimbursement policies and interprofessional squabbles prevent them from practicing independently. Week 9 Practicum Journal: State Practice Agreements.


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