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Np Collaborative Agreement by State

NP Collaborative Agreement by State: What You Need to Know

In recent years, the role of nurse practitioners (NPs) has become increasingly important in the healthcare system. As a result, many states have adopted collaborative practice agreements (CPAs) to regulate the relationship between NPs and physicians. In this article, we will focus on NP collaborative agreement by state and what you need to know about these agreements.

What is an NP Collaborative Agreement?

An NP collaborative agreement is an agreement between an NP and a physician that outlines the scope of practice and responsibilities of each party. These agreements are required in many states for NPs to practice independently.

The purpose of these agreements is to ensure the quality of care provided by NPs. By establishing a collaborative relationship with a physician, the NP can seek guidance and resources when needed. This collaboration also helps to ensure that patients receive coordinated and comprehensive care.

Which States Require NP Collaborative Agreements?

The requirements for NP collaborative agreements vary by state. Currently, 25 states require NPs to have a CPA with a collaborating physician. These states include Alabama, Arkansas, Florida, Georgia, Indiana, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

In some states, such as Kentucky and South Carolina, the NP must have a CPA with a physician in the same practice or clinic. In other states, like Ohio and Wisconsin, the collaborating physician may be located off-site and may collaborate with multiple NPs.

What are the Requirements for an NP Collaborative Agreement?

The requirements for NP collaborative agreements also vary by state. In general, the agreement must outline the scope of practice for the NP, including the types of services that the NP can provide and the procedures that the NP can perform.

The agreement must also specify the conditions under which the NP can prescribe medications. Depending on the state, the agreement may require the physician to review and co-sign the NP`s prescriptions.

The agreement may also address the process for referrals to specialists or other healthcare providers. In some states, the agreement may require the physician to be available for consultation or to review a certain percentage of the NP`s charts.

Why are NP Collaborative Agreements Controversial?

NP collaborative agreements are controversial because some argue that they limit the ability of NPs to practice independently and provide access to care, particularly in rural areas or underserved populations. Supporters of NP collaborative agreements argue that they help to ensure the quality of care provided by NPs and protect patient safety.

Many states have recognized the need to expand the scope of practice for NPs and have made changes to their laws and regulations. For example, in some states, NPs may practice independently after a certain number of years of experience or after completing additional education and training.


NP collaborative agreements are an important part of the regulatory framework for NPs in many states. This type of agreement helps to ensure the quality of care provided by NPs, but also limits their ability to practice independently. As the healthcare system continues to evolve, it will be important to re-evaluate the role of NPs and the regulations that govern their practice.

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About David Hayden

David Hayden is the creator of The Hospitality Formula Network, a series of websites dedicated to all aspects of the restaurant industry. He is also the author of the book Tips2: Tips For Improving Your Tips and Building Your Brand With Facebook.


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