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New Maryland Law a Victory for NPs, Patients


The future of nurse practitioners’ role in Maryland took a dramatic change April 13 when Gov. Martin O’Malley signed legislation to help NPs start practicing more quickly and disentangle what some describe as a clumsy and unnecessary written agreement between NPs and physicians.

The new law is expected to increase the number of NPs in the state and improve access to healthcare for patients, especially those in rural areas.

As opposed to the current process of having an NP fill out an 18- to 19-page collaborative agreement that ties him or her to a particular physician — which can take up to six months to be approved — the new law, which takes effect Oct. 1, will require an NP only to sign a simple document stating that he or she agrees to collaborate with a physician.

For those who worked with state legislators to make this change become a reality, such as University of Maryland School of Nursing Associate Professor and Assistant Dean of the Master’s Program Jane Kapustin, seeing O’Malley sign the legislation was an emotional experience.

“I was elated,” says Kapustin, CRNP, PhD, BC-ADM, FAANP. “We plotted this strategy for more than 10 years. This was the first time we went for elimination of the collaborative agreement. We thought we’d have to lose this year, go back next year, probably lose again and have to keep going back, keep going back.

“We won the first time. We couldn’t believe it.”

Kapustin says NPs did a good job of getting the word out about what it is they do and making legislators understand the importance of their work. “The public knows us. They trust us,” Kapustin says. “They like our care, and I think that’s why it went through so easily this year.”

Sandi Nettina, ANP, BC, MSN, president of the Nurse Practitioner Association of Maryland, says the cooperation of so many nurse groups played an important role. She credits NPAM, the Maryland Nurses Association, the Maryland Board of Nursing, the Maryland Coalition of Nurse Practitioners, specialty NP groups and other NPs at major institutions for their ability to work for a common cause.

She says the legislation was introduced jointly by NPAM and MCNP.

“We just kept trying to get the word out and get people to work together,” Nettina says. “When everything is working together, then great things can happen.”

Kapustin says NPs long have considered the collaborative agreement with physicians unnecessary and burdensome. She says collaboration is something NPs and physicians do naturally.

“Any NP in his or her right mind who doesn’t collaborate with someone really should not be practicing,” she says. “And I would say the same is true for any physician.” Nettina agrees, and the proof she says, lies in the fact that so many other states that provide safe, quality healthcare do not have collaborative agreements.

“To so many people, it sounds so scary — ‘Oh, my goodness. There’s not going to be a written agreement’ — but it’s a piece of paper that wasn’t reflecting the reality of practice,” Nettina says. “In reality, everybody does collaborate, consult, refer, do what’s necessary. Other states have been doing it for years without any problems, so I think we’ll have the same experience.”

Kapustin believes Maryland’s move away from collaborative agreements is part of a trend that other states soon will follow.

“I’ve received a lot of phone calls from other boards of nursing and other state organizations asking us how we did it, because they’re going to go after it, too,” Kapustin says. “It’s going to be a real national trend.”

Tom Clegg is a member of the editorial team at Nursing Spectrum.


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