Scope of practice laws are those passed by state governments that regulate nurses in one of three ways: Restricted Practice: The nurse is prevented from participating in one or more elements of clinical practice, and physician supervision is required for patient care. Comprehensive Practice: The nurse can work without supervision and provide clinical care, including patient assessment and diagnosis, ordering and interpreting tests, initiating and managing treatment, and prescribing medications. How does patient consultation and referral take place in your office? Reduced practice: The nurse can provide certain services independently and must have a cooperative agreement with a physician for other elements of patient care. For nurses, it is important to note that in the event of a change of practice location, employment or cooperating physician, the practice agreement must be updated and a new agreement submitted to the state nursing office. Some states also require that the cooperation agreement be posted in a place visible to patients in practice. Overall, NPs and physicians need to familiarize themselves with the scope of practice guidelines to ensure that they practice both individually and as a team in accordance with state law. What are your minimum standards for consultation between you as a nurse and your primary attending physician, as described in 21 NVC 36.0810(e)(1)(A)-(B)(2)(3)(A)-(C) and 21 NVC 32M(e)(1)(A)-(B)(2)(3)(A)-(C)? This nurse practitioner and physician consultation will be different for the new graduate, the new nurse practitioner admitted for the first time in North Carolina, than a subsequent collaborative practice agreement between a nurse practitioner previously admitted to North Carolina and another senior supervising physician. While the exact requirements of a collaborative relationship vary from state to state, some level of medical involvement or surveillance is required for the NP to provide clinical care. A cooperation agreement is a written contract that establishes an employment relationship between the nurse and the doctor. Often this means that the doctor provides supervision and advice and is available for consultations with the NP. Some States may require regular face-to-face meetings or set a quota for the examination of files. How will you establish the minimum standards for consultation between the nurse/senior physician or the supporting physician(s), as outlined in the Quality Assurance Standards for a Cooperation Agreement? How and what will your documentation contain? What medications and equipment will you prescribe at each practice? You can list by specific drugs or categories of drugs. A general description of the categories of drugs and devices used to treat the most common health problems in your particular practice can be developed.

For example: categories of drugs, such as convulsions, hypoglycemic drugs – oral / insulin, oral hormones and contraceptives, cephalosporins, aminoglycosides, antivirals, antiasthmatics, diuretics, antihypertensive drugs, etc. may be indicated. Derogations may be prescribed by class of medicinal products or by certain medicinal products of a class or by route of administration. Is there anything a pharmacist cannot do once they have been licensed to enter into a cooperation agreement? The scope of practice laws may, for example, prohibit nuclear power plants from prescribing controlled substances. Or these laws may require nurses to complete a certain number of hours of medical training to practice. The most common requirement in state scope of practice laws is that NPs work with a physician or practice under the supervision of a physician. The specifics of these laws vary from state to state. Here we describe the specifics of cooperation agreements for nuclear power plants and the most important protective measures for doctors and ODs who wish to sponsor a nuclear power plant. A cooperation agreement usually includes the following information: Nurses who provide virtual care should be aware that, depending on where they practice and the services they provide, they may need medical supervision to treat patients. Laws vary, so it`s important to make sure you comply with your state`s regulations. By finding a cooperating physician, establishing a cooperative agreement, and ensuring that the physician has adequate liability protection, NPs are well positioned to set up a successful virtual practice.

Cooperation agreements should cover activities that fall within the scope of activity of each NP, including: the types of services that can be provided, the types of conditions that can be treated, the services and conditions that require medical consultation, whether the NP can perform or interpret laboratory tests, X-rays or ECGs, and whether the NP can prescribe and manage medications. In particular, in a virtual nursing practice where it is advantageous to have multiple state licenses, a nurse will likely need to participate in a cooperative agreement to provide care in a particular state. Currently, there are about 21 states that allow nurses to practice and prescribe without medical intervention. .