Interprofessional Collaboration: It's All About the Patient
I became a family nurse practitioner after practicing for many years in home health and hospice. When you make house calls, you are a guest in a patient’s home, and “patient-centered care” is what you do. Patients and their caregivers benefit when the advanced practice registered nurse who is assessing the patient has the authority to prescribe needed pain medications, admit patients to hospitals and other facilities, and order needed home health or hospice services.
The Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, recommends removing barriers to care and allowing advance practice registered nurses to practice to the full extent of their education and training. Barriers to care such as requiring physicians to countersign documents add additional steps, increase health care costs, and delay needed care. The IOM report recommends amending the Medicare program to authorize advanced practice registered nurses to perform admission assessments, as well as certification of patients for home health services and for admission to hospice and skilled nursing facilities.
All patients, especially chronically ill patients and their family caregivers, need every member of the health care team to communicate and collaborate to provide high quality coordinated care. Interprofessional collaboration is a partnership that starts with the patient and includes all involved health care providers working together to deliver patient and family centered care. Nurse practitioners and other advanced practice registered nurses are educated and trained to collaborate with and refer to physicians and other health care professionals. But collaboration can have a negative connotation. Restrictive collaboration laws and regulations that require physicians to supervise or sign-off on care provided by nurse practitioners and other advanced practice registered nurses are duplicative and costly barriers to patient and family centered care.
When I moved to Maryland seven years ago, I had to find a job with a physician who was willing to sign a 16-page “collaborative agreement” before I could be licensed to practice. Two years later I changed jobs and joined a nurse practitioner-owned primary care practice in the District of Columbia. My education and training did not change when I changed practice venues from Maryland to DC, but in DC “collaboration agreements” have never been required.
Last year Maryland lawmakers reduced the restrictive collaboration burden by replacing the lengthy collaborative agreement that nurse practitioners (NPs) and physicians had to sign with a single page “attestation form” that NPs fill out and sign with the name of a physician that they will “collaborate and consult with as needed.” Filling out this form was easy. Of course I will collaborate and consult with physicians and other health care providers. It’s all about the patient.
I have a full time position at AARP now so my current NP practice is limited to one Saturday morning a month at a physician-owned practice in Maryland near my home. Because of my education and experience, as well as requests from patients and their families, the office staff schedules “well women” and geriatric visits on my workdays. My physician employer is thrilled that he gets a Saturday off and his patients see the provider they want. In the end, it’s all about the patient.