Collaboration vs. Supervision: Understanding NP Scope of Practice

As a nurse practitioner, I would probably describe my relationships with the physicians with whom I work as collaboration. In most cases I see my own patients independently. The charts for these encounters are signed by a physician as required by state law. When I do have a question, the MDs I work with are happy to help. On the other hand, when a lower acuity patient walks through the door of the emergency department, I see the patient so physicians can focus on those of a higher acuity level. This structure represents teamwork, a collaborative and cooperative workplace environment. 

Scope of practice laws for nurse practitioners are perhaps best know for the way in which they outline such relationships between physicians and NPs. Some states allow nurse practitioners to practice without physician oversight, or ‘independently’. Other states require physician oversight for nurse practitioner practice, prescribing, or both. States differ in the language they use to describe oversight. Some refer to this relationship as ‘collaboration’ and some to the relationship as ‘supervision’. As a nurse practitioner, I’ve always wondered about the technical differences between scope of practice regulations in states with ‘collaboration’ versus those with ‘supervision’. 

The word ‘collaboration’ is the one most commonly used to describe the relationship between NPs and MDs in state laws. The structure by which collaboration is accomplished varies by state. From the nursing perspective, the American Nurses Association defines collaboration as physicians and nurses or NPs “working together as colleagues, working interdependently within the boundaries of their scope of practice”. In contrast, the American Medical Association does not have an official definition for the term collaboration. Rather, medical literature tends to adhere to the term ‘supervision’ when addressing the relationship between NPs and MDs and often alludes to the requirements of such relationships as outlined by the Centers for Medicare and Medicaid Services (CMS). 

While nurse practitioner organizations decry the term ‘supervision’, preferring the more amiable word ‘collaboration’, in practice the difference between the two is really just semantics. States each outline a set of regulations for nurse practitioners. The terms ‘collaboration’ and ‘supervision’ do not directly correlate with the stringency of these laws. Rather, specific clauses outline the arrangement within which collaboration or supervision must occur. 

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If you’re a nurse practitioner trying to determine the status of scope of practice in your state, it’s imperative to look at the specifics related to these guidelines. The requirements for oversight vary in each state and it’s up to you to make sure you’re in compliance regardless of the overarching language used to describe the MD-NP relationship. 


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2 thoughts on “Collaboration vs. Supervision: Understanding NP Scope of Practice”

  1. I practice in a full practice state. No co-signatures, no collaboration required Collaboration implies at the will of the NP. Supervision is pejorative implying an inability to provide the services for which we are educated. It’s amazing to me the level of perception that NP’s have about themselves in states with supervisory requirements, further the level to which NP programs train students in restricted states.

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