Nurse Practitioners Have to Know These 5 Things in Order to Have a Solid Collaborative Practice Agreement

#1: You Must Have A Primary (Partner) Physician

In order for a nurse practitioner to obtain approval to practice from the NC Medical Board and the NC Board of Nursing, he/she must work with a licensed NC physician under a collaborative practice agreement
Ideally, this primary physician should be someone with whom you have previously worked.
This should also be someone that you would have treat a loved one.
Make sure you discuss the option of having a secondary supervising physician available if the primary supervising physician has an emergency or is otherwise unavailable.
Both the NP and the primary supervising physician (and secondary physician, if applicable) must agree to and sign the collaborative practice agreement.

Your agreement will need to include what tests, procedures, medical treatments may be ordered and performed by the nurse practitioner
The CPA will need to specify how the primary supervising physician will be supervising the nurse practitioner
If the NP is going to prescribe drugs and devices the CPA will need to stipulate what devices and drugs the nurse practitioner is authorized to prescribe*
*There is an exception though. A NP can prescribe a drug or device not included in the CPA But ONLY upon a specific written or verbal order obtained from a primary or back-up supervising physician before the prescription or order is issued by the NP; AND the written or verbal order shall be entered into the patient record with a notation that it is issued on the specific order of a primary or back-up supervising physician and signed by the nurse practitioner and the physician.
Detail your quality improvement process in your CPA
Specify in the CPA if the NP and primary supervising physician are going to be prescribing controlled substances or not. If a primary supervising physician is not going to be prescribing controlled substances, then the NP is not going to be prescribing controlled substances. Same as prescribing non-controlled substance medication

The primary supervising physician and the nurse practitioner shall develop a process for the ongoing review of the care provided in each practice site including a written plan for evaluating the quality of care provided for one or more frequently encountered clinical problems
This plan shall include a description of the clinical problem(s), an evaluation of the current treatment interventions, and, if needed, a plan for improving outcomes within an identified timeframe
Meetings between the primary supervising physician and the nurse practitioner to discuss and review the quality improvement process are required to be conducted every six months
Schedule those meetings in advance and add them to your collaborative practice agreement
Further requirements can be found in 21 NCAC 32M. 0110

The primary or back-up supervising physician(s) and the nurse practitioner shall be continuously available to each other for consultation by direct communication or telecommunication
Stipulate in the agreement the method for conferring with the primary/secondary physician when an issue or question arises that requires their input
Make sure you schedule and conduct the required monthly meetings for the first six months of the collaborative practice agreement as well as the required review meetings every six months the practice is open
Document what is discussed and reviewed at all meetings, have the documents signed by all attendees and date the ‘meeting notes’
I recommend scheduling the meetings in advance and putting that schedule in the collaborative practice agreement

This is required to be done AT LEAST yearly, but can be done more frequently
The review has to be acknowledged by the primary supervising physician and the nurse practitioner in writing, dated, and signed by both parties
Reviews will be appended to the CPA and available for inspection by members or agents of either the North Carolina Board of Medicine or the North Carolina Board of Nursing
Set a schedule in the CPA as to when it will be reviewed by the primary supervising physician and nurse practitioner

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