The scope of nursing practice in various states determines nurses’ options in choosing places of work as well as their functions and responsibilities. In some cases, collaboration with a physician is not required, thus allowing nurses to avoid many conflict situations. In other locations, the dependence of the Nurse Practitioner (NP) on physicians’ choice created issues and barriers to independent practice. In the state of New Jersey, the place of nurses is somewhere in the middle. While NPs are recognized as primary care providers, they cannot prescribe medications on their own (Scope of Practice Policy, 2020). This discussion will consider possible practice agreements in the state as well as some problems in the nurse-physician relationship that arise from them.
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Practice Agreements Description and Physician Collaboration Issues
At the basis of the agreements lies a system that is similar across many states. As Buppert (2018) describes, nurses can be hired “at-will” or with a contract. The main focus of discussion is the practice agreement between an NP and a collaborating physician whose participation is necessary for nurses’ prescriptive authority. Here, the nurses’ scope of practice is described, including their ability to deliver primary care. NPs can assess patients, consult them, coordinate services, and refer to other specialists. Furthermore, the nurse can diagnose and treat patients without any oversight (Scope of Practice Policy, 2020). However, a written protocol is required for prescribing – this document notes whether consultation is necessary and how it should be completed in each scenario.
As one can see, in New Jersey, the main concerns related to NPs practice are related to prescribing authority. While NPs have a high level of autonomy, they cannot be wholly separated from the physician’s supervision. Thus, the first possible conflict is disagreement in treatment options, which may render nurses’ advice to be overlooked. Second, a problem arises out of the fact that physicians do not have to be present during consultations, and the latter may be performed via phone or e-mail (Xue, Ye, Brewer, & Spetz, 2016). Thus, the lack of response, especially in situations that require quick reactions, may introduce tension into the professional relationship.
Barriers to Independent Practice and Plan
The main obstacle to independent practice is legal – nurses do not have the prescribing authority, which limits their autonomy. It is based on the idea that nurses’ level of professionalism is not equal to that of a physician. Thus, nurses with a Doctorate are not called “doctors” by patients, although they may have sufficient knowledge to practice autonomously. To address this issue, nursing advocacy has to be elevated in the state.
It is vital to talk to state representatives and create a bill that would expand the scope of NP practice in New Jersey. Such arguments as the growing shortage of physicians, nurses’ advanced education programs, economic benefits of hiring NPs, and patients’ expanded access to care can be used in this discussion (Chattopadhyay & Zangaro, 2019). Community awareness may also support this idea and explain to patients that their RNs are able to treat them without supervision.
The place of nurses in the United States’ healthcare continuously changes. Currently, NPs have much authority in some states, being able to practice separately or alongside physicians. Nevertheless, in such states as New Jersey, the collaboration still leads to some conflicts and limits nurses’ scope. The main issue lies in nurses’ lack of prescriptive authority, which has to be resolved with advocacy for policy change.
Buppert, C. (2018). Nurse practitioner’s business practice and legal guide (6th ed.). Burlington, MA: Jones & Bartlett.
Scope of Practice Policy. (2020). New Jersey scope of practice policy: State profile. Web.
Chattopadhyay, S., & Zangaro, G. (2019). The economic cost and impacts of scope of practice restrictions on nurse practitioners. Nursing Economics, 37(6), 273-283.
Xue, Y., Ye, Z., Brewer, C., & Spetz, J. (2016). Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review. Nursing Outlook, 64(1), 71-85.