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NP & PA Student Blog

To Be Or Not To Be... Autonomous

Published August 5, 2014 9:59 AM by Rachel Matson

I'm sitting here at work, trying to figure out what to write about today. As I ruminate, I realize what a great team of people I work with every day and this reminds me of an assignment I recently completed for class. The question proposed for class was, "Do physicians work autonomously?"

As I wrote the assignment it made me think about nurse practitioners and our battle for autonomy in healthcare.

Each state has different laws governing the rights and practices of nurse practitioners. Some states have a collaborative agreement with a physician to practice, but there are states that ARNPs can work independently without physician guidance or supervision. This state level jurisdiction and regulation makes changes difficult and time consuming for advocates and collaborative organizations (like the American Association of Nurse Practitioners).

ARNPs are given the knowledge and training to work independently, but are limited by laws created by politicians sitting in an office. Most of these politicians have no medical training or experience. They do not understand all our hard work, education and dedication to both nursing and medicine. Does anyone in healthcare actually work independently? We learn as fledgling nurses how important each member of the interdisciplinary team is and value their input. It would be thought that physicians, at the top of the healthcare hierarchy, work independently. While physicians do make many important decisions on their own, physicians also discuss and collaborate with their peers and nurses.

It is going to take a concerted effort of all ARNPs to help our profession move forward and earn autonomy in practice. Just because we have autonomy does not mean we won't pool resources with physicians, but we can make more patient specific collaborations.

I challenge you as we move forward in this journey to become ARNPs....what are you going to do to help our profession move forward? What is your platform going to be? How are you going to make changes that will benefit the whole? What's your collaboration going to be?


Oh, Rachel!  It's NOT about ANYTHING but control and the Benjamins ($$).  Physicians want control because it is unfathomable to them that there is another path to learning and providing good, effective and safe primary care, because it cost them more money to get to there attending physician status, and because their ego is bruised by not steering the ship.  Physicians who are NOT in control of NPs will eventually be their competition, and that makes them frightened and resentful.  Like they travelled over the hard road only to arrive and find someone got to the destination more easily (OR IN A WAY PERCEIVED TO BE MORE EASILY).  Besides, collaboration and, ESPECIALLY, supervision, turns NPs into sled dogs.  Florida is the classic example of this.  In Florida NPs and PAs may not prescribe any controlled substances, may not practice without supervision.  SO, what does that mean?  There are NO (as in NONE) requirements for supervision other than filing a protocol agreement with the state.  That agreement usually says that the NP will do any acts permitted by law and within his/her scope.  Then, they need have no other contact.  I have had at least 4 supervising Florida physicians who I have never had any contact, oversight, review, or auditing with beyond signing the protocol supervisory agreement.  Wouldn't know them if they were in line with me at the grocery store. Twice I signed the protocol before a physician to sign it had been identified on the paper, so I didn't know who my supervisor was until the final signed copy was returned to me. But, am I supervised?  Absolutely!  It wouldn't be safe for patients if I wasn't adequately supervised.  What are ya thinkin??

Jeff, occupational medicine - NP, self-employed September 1, 2014 10:04 AM
St. Petersburg FL

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