Currently, 19 states require PNs to have a collaborative agreement for the entire career, and another 12 require supervision or team management with a physician, with nurses prescribing by physicians, according to the American Association of Nurse Practitioners (AANP). Cooperation agreements, which are made official by forms signed by the PNP and the doctor, can be very different. Kentucky, for example, has never asked doctors to check or meet with NPNs on prescription regimes, but some states do. Collaborative documentation materials are available on the Board of Directors` website (kbn.ky.gov/aprnlicenseinfo/Pages/default.aspx). The Board of Directors will request notification of the Cooperation Agreement (kbn.ky.gov/practice/Pages/aprn_practice.aspx). “The concern is that you don`t know what you don`t know,” said Robert McLean, an internist in New Haven, Conn., where a 2014 law requires nurse practitioners to spend 2,000 hours in a collaboration agreement with a doctor before practicing independently. “There are a lot of nurses who provide good services, but if you make a law that allows them to be independent, even if they are not experienced, how many patients are less than ideally cared for?” For nearly two decades, nurses in the state have only been able to prescribe drugs such as antibiotics and antihypertensive drugs if they have entered into a cooperation agreement with a doctor who can charge a fee. But if the doctor broke the agreement, the nurses were forced to find other doctors or limit their practices by not prescribing. According to Beth Partin, vice president of the Kentucky Coalition of Nurse Practitioners – Nurse Midwives, most firms cannot survive diagnostic and physics tests.
Sheila Schuster, a lobbyist for the Coalition of Nurses and Midwives, said replacing the career requirement with the four-year cooperation agreement was “a big step forward in reaffirming independent practice.” The NP is required to have a cooperation agreement with a supervisory physician for the prescribing of drugs. After four years of practice under the cooperation agreement, an NP can prescribe drugs independently. Ky. Rev. Stat. 314.042 At the national level, however, stakeholders doubt that this approach is truly an innovative compromise. “If it becomes easier for someone to meet an unnecessary burden to meet the requirements, the fact that it is a burden will not be reversed,” said Tay Kopanos, AANP`s vice president for government affairs. She said the cooperative agreement on controlled drugs, which the government considers dangerous and addictive, is a major obstacle. An NP may prescribe legendary drugs as part of a cooperation agreement with a doctor. If an NP has met certain requirements after four years, the NP may prescribe drugs independently. If the NP wants to impose schedule II-V controlled substances, the cooperation agreement must be maintained.
Ky. Rev. Stat. 314.042 Having this scaffolding on site would make a big difference to Brenda Pittman, a nurse practitioner at Mt. Sterling, Ky. One doctor withdrew from an agreement with her in June 2013, another last March.