Monday, June 30, 2008


I thought that I'd start this post with a definition of collaborate (via Merriam-Webster On-Line):

Main Entry: col·lab·o·rate
Function: intransitive verb
Inflected Form(s): col·lab·o·rat·ed; col·lab·o·rat·ing
Etymology: Late Latin collaboratus, past participle of collaborare to labor together, from Latin com- + laborare to labor
Date: 1871
1 : to work jointly with others or together especially in an intellectual endeavor

Working jointly with others or together. Isn't that what most providers do when caring for our patients? NPs collaborate with physicians, other NPs, physical therapists, pharmacists, nurses, etc. Physicians also collaborate amongst themselves and with other members of the health care team. I bring this up because the majority of states require a collaborative relationship between an NP and MD. (Conversely, some states use an independent practice model while others use a supervisory one). The regulations among models can vary significantly from state to state. In NY, a written collaborative agreement must exist between the two parties. "Practice agreements must include provisions for referral and consultation, coverage for emergency absences of either the nurse practitioner or collaborating physician, resolution of disagreements between the nurse practitioner and collaborating physician regarding matters of diagnosis and treatment, and the review of patient records at least every three months by the collaborating physician; and may include such other provisions as determined by the nurse practitioner and collaborating physician to be appropriate." Here is a link to a sample collaborative practice agreement.

I came across a relatively new website called, Sermo has been dubbed a networking site for physicians and claims 65,000 members. For example, MDs & DOs can register and log in to post questions, network and get assistance from others when it comes t0 difficult cases. In essence, this allows physicians to collaborate with one another. I think this is a wonderful idea and a great use of technology to better care for patients. In fact, the AMA has even encouraged physicians to utilize this new tool. Unless you are an MD or DO, you won't get very far with this site since it is currently limited to those degrees only.

So my point to this post is: clinicians collaborate with one another. I don't think we necessarily need a mandate in the way of strict regulation to do this nor should we be limited to any one provider. Ideally, we would have access to a network of experts and specialists (when needed) to better care for patients. (And I think those experts can be across many different disciplines). Collaboration shouldn't be a dirty word when it comes to nurse practitioner practice. We are generally good at recognizing "what we don't know" and getting our patients the correct treatment needed. Wouldn't it be nice if all professions recognized and embraced this concept? Maybe they are starting to.....


Rick said...

There's a few doctor's I've been seen by that certainly should be using

I had excruciating backpain, and a doctor told me to go back to work. When I said I couldn't walk right, he said that "if you can't walk at home, what's the difference if you stay there?' When I asked about medication for the pain he said that I was exhibiting narcotic-seeking behavior. I changed physicians... like five minutes later.

Went to the E.R. about the same problem right after that fiasco. An NP collaborated with a radiologist and neurologist and in a few hours I had medicine, a followup, and a physical therapy sessions for 2 months.

Turns out the "drug seeking behavior" was due to the pain from three herniated disks.

Collaboration is definitely better than an M.D. on a power trip saying what he will and won't do.

Anonymous said...

so i am a new nurse practitioner with ~ 6 mos of experience. I just started a new position and the MD i am working with is very reluctant to sign a collaborative practice agreement. It is my understanding that this is necessary for a NP to practice in NYS. please comment.

Stephen Ferrara, NP said...

Yes, indeed. This is a requirement of NYS. Without it, a NP cannot legally practice. In addition, you need to have Form 4NP
on file with the New York State Office of Professions for the first time you file your collaborative agreement.
I suggest that you become a member of the Nurse Practitioner Association of New York State ( as they have wonderful resources for new NPs in their Practice Resource Guide.
Good luck,