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NPs Push Legislation to Reduce Barriers, Increase Access to Care


Nurse practitioners provide about 40% of primary care services in Maryland. They also work in acute and specialty care and are certified nationally in an area of specialty, such as adult, family, pediatric, geriatric, acute care, women’s health, psychiatric or neonatal, as well as licensed and regulated as advanced practice nurses by the state board of nursing.

However, the greatest barrier to utilizing NPs efficiently in Maryland is the written collaborative agreement that must be filed with the board of nursing and board of physicians before an NP starts a job.

“Maryland NPs are still tied to physicians through the antiquated collaborative agreement — a 19-page document that is unsurpassed in its inefficiency in any other state,” says Susan Delean-Botkin, NP, a practice owner at Family Care of Easton (Md.).

Legislation has been proposed to eliminate the written agreement and have NPs solely regulated by the board of nursing. HB 361/SB 484 is called Nurse Practitioner: Authority to Practice.

Currently, NPs must have a physician in their area of practice sign the agreement, even though NPs naturally collaborate with a variety of professionals in the healthcare system. Problems with the written agreement have arisen, including NPs in rural areas not being able to find physicians to sign, physicians charging NPs to sign on as collaborators, psychiatrists not wanting to enter into an agreement with psychiatric NPs, and the length of the approval process, which prevents NPs from moving into new jobs in a timely manner. The approval process can be a minimum of two months, but often can stretch to four or six months.

NPs have become essential to the health of Maryland citizens and can be a large part of the solution to the healthcare crisis. In Maryland, there are an estimated 810,000 uninsured citizens and a serious shortage of primary care physicians, especially in rural areas. The impact also has been felt in southern Maryland (87% shortage), on the state’s eastern shore (67% shortage), and in the western part of the state (60% shortage).

NPs diagnose and prescribe, are listed as primary care providers on HMO panels, have hospital privileges, bill insurance companies, and may own their own practices.

Sandi Nettina is president of the Nurse Practitioners Association of Maryland.


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