| Topic | Supervisory Practice | Supervisory Practice | Supervisory Practice |
| List the name of a State that is representative of each regulatory model. | The states characterized by this approach include Texas, Virginia, South, and North Carolina, Missouri, Oklahoma, California, Florida, etc. (American Association of Nurse Practitioners [AANP], 2017). | This model is used in Pennsylvania, New York, Alabama, Arkansas, Utah, Illinois, Kansas, Ohio, and so on (AANP, 2017). | The independent practice model is used in Arizona, Colorado, Nevada, New Mexico, Washington, District of Columbia, and some other states (AANP, 2017). |
| Evaluate how each model affects the NP’s scope of practice? (include, if applicable, the use of protocols, formulary, written agreements, direct versus indirect supervision, referral policy, patient care, review of medical documentation, and payment reimbursement. | This model implies 100% reimbursement for NPs if their care is provided within a team including physicians and/or other healthcare professionals (Stange, 2014). Nurses should request for prescriptions and ask signed forms. | The delivery of services involves teamwork and close collaboration between nurses and other healthcare professionals (Rudner & Kung, 2017). Healthcare professionals sign agreements that identify their roles within the collaborative groups they operate in. | The independent practice model often implies the reimbursement of 85% for nurses who provide care independently (Stange, 2014). When the independent practice model is used, nurses can prescribe drugs, diagnose, evaluate patients, interpret diagnostic tests and order them, as well as manage and develop treatment plans (Rudner & Kung, 2017). |
| How does the model of practice serve as a barrier to access to care? | The supervisory practice model is associated with certain barriers to access to care as fewer people can receive healthcare services. The shortage of staff is considerable, and physicians are not always available (Xue, Ye, Brewer, &Spetz, 2016). Nurses have to wait for other healthcare professionals who will sign certain forms and prescriptions. Patients will be able to receive the necessary services after these procedures. | The collaborative model provides more opportunities and greater access to health care. Nurses provide care with reduced supervision, which enables them to reach more patients (Xue et al., 2016). | This approach is characterized by a significant degree of freedom, which translates to quite significant access to health care. This approach is specifically beneficial for rural areas where the shortage of healthcare professionals is burning (Iglehart, 2013). |
| Compare/contrast the prescriptive privileges of each model and example State. | The supervisory practice model implies that physicians may delegate the prescription of certain medications to advanced practice registered nurses, which still needs close collaboration and regular meetings. The nurse is authorized to request, receive, and distribute prescriptions (AANP, 2017). | In states characterized by the use of collaborative approaches, such as Arkansas, nurses are authorized to administer medications(AANP, 2017). However, they can also prescribe drugs under the supervision of an advanced practice registered nurse who has the corresponding license or other healthcare professionals authorized to prescribe medications(Hoffman &Guttendorf, 2017). | In states using the independent practice approach, such as the District of Columbia, prescribing is one of the major responsibilities of a nurse practitioner. Hence, nurses prescribe medications without any supervision (AANP, 2017). |
| Compare/ Contras how each model impacts payer status for the NP. | In the states using this practice, NPs receive 100% reimbursement if their care was provided within a team including physicians and / or other healthcare professionals (Stange, 2014). | This model uses the same type of reimbursement employed in states characterized by the use of supervisory practice (Stange, 2014). | The independent practice approach implies the use of another reimbursement model. Nurses receive 85% for the services they provide independently (Stange, 2014). |
| Compare/Contrast how these models may impact NP job satisfaction. | This model is associated with quite a significant degree of dissatisfaction as nurses have to wait for signatures and approvals of other healthcare professionals in all cases (Rudner & Kung, 2017). | This practice is characterized by quite a significant degree of dissatisfaction as the supervision is implemented improperly. Rudner and Kung (2017) note that approximately 40% of nurses report that their supervisors do review health records, while 12% have no supervision at all. At that, signatures and collaboration are still necessary. | This model is associated with a significant degree of satisfaction as nurses have the authority to provide care to larger populations. They have the necessary skills and authority to perform this role well. However, nurses are somewhat dissatisfied with reimbursement patterns. |