State Practice Agreements

State Practice Agreements

In 2010, the state of Maryland adopted a new statute that eliminatedthe need for collaboration agreements between nurses and physicians.The law required that NPs should have an ‘Attestation’ documentonly (Buppert, 2014). Five years later, in 2015, the state passed the“Nurse Practitioner Full Practice Authority Act”. According tothe current legislation, NPs can provide medical services withintheir training scope without the need for attestation orcollaborative agreements from a registered physician. Consequently,they have authority to diagnose and prescribe drugs. They can alsooperate private clinics without the supervision of a doctor. The newstatute is aimed at improving the accessibility of health careservices in the state and deal with the staffing challenges. However,this does not apply to all nurses (Kaplan, 2015).

The legislation has eliminated legal barriers that prevented NPs fromoperating as independent health care providers. Several issues areassociated with these collaborations. The primary concern has beenthe high physician oversight fees related to the agreements. Theyvary from one contract to another. Additionally, the NP pays for thesignature rather that real collaboration (Buonato, 2014). Anothercritical issue has been the quality of health services provided byNPs. Some people have argued they may not be adequately trained todeliver the required quality of care without the supervision of adoctor (Schadewaldt et al., 2013).

In my view, abolishing collaboration agreement will have positiveimpacts on the health care system. It will increase the scope ofnursing practice by eliminating unnecessary collaboration fees.Nonetheless, the NPs should provide services depending on theirtraining. Additionally, relooking at the training programs to enhancetheir skills may be necessary.


Buppert, C. (2014). Nurse Practitioner`s Business Practice andLegal Guide. Burlington, MA: Jones &amp Bartlett Publishers.

Buonato, M. (2014). Are Physicians Affecting Your Attestation?

Kaplan L. (2015). Maryland`s nurse practitioner full practiceauthority act of 2015. Nurse Pract. 15 40(5):8. doi:10.1097/01.NPR.0000461956.53786.5b.

Schadewaldt, V. et al (2013). Views and experiences of nursepractitioners and medical practitioners with collaborative practicein primary health care – an integrative review, BMC FamilyPractce, 14:132 DOI: 10.1186/1471-2296-14-132