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Nursing and Collaboration

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Over 25 states require advanced practice nurses – nurse practitioners, nurse midwives, nurse anesthetists or clinical nurse specialists – to have some form of collaboration with physicians. States have embedded these requirements into state licensure laws. Initially, the expectation was that physicians would collaborate willingly, without fees with nurses as such had been the professional practice for years. With the expansion and evolution of APN practice, physicians began charging for these services, and without regulation of such, the fees have been used as an impede the growth of independent practice.

NCSBN conducted a survey of advanced practice registered nurses (APRNs) to determine the economic burden and practice restrictions placed on them by state laws. This study was the first comprehensive national review of collaboration price costs. The study determined that APRNs working in rural areas and APRN-managed private clinics were one and a half to six times more likely to be assessed CPA fees, often exceeding $6,000 and up to $50,000 annually. Similarly, APRNs subject to minimum distance requirements, fees to establish a CPA, and supervisor turnover reported a 30 percent to 59 percent uptick in restricted care. iIn 2015, an informal survey of members represented by the Pennsylvania Coalition of Nurse Practitioners (PCNP) reveals these mandated contracts cost CRNPs an average of $500 to $1,000 a month. And online, others have reported charging upward of 4,500 per month.1

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