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The Practice Agreements for NPs in Alabama State

The Practice Agreements for NPs in Alabama State

Sample Answer 

The Practice Agreements for NPs in Alabama State

The American Association of Nurse Practitioners defines the practice authorities that are observed nationwide depending on the regulations governing practice in different states. The practice authority statutes include different levels of practice. Full practice refers to the statute in which the practice and licensure laws allow NPs to evaluate patients, diagnose, order, and interpret patient tests (AANP, 2017). In this case, the NP also initiates and manages treatments. According to reduced practice, the ability of the NP is reduced to allow only engagement in at least a single element of their practice through collaborative agreements. Finally, restricted practice limits the NP by requiring supervision, team management, or delegation in the provision of patient care. The state of Alabama practices reduced practice where nurses are required to be regulated by collaborative agreements to provide patient care within their scope of practice.

According to the practice authority in Alabama, a professional physician provides direction and oversight to certified nurse practitioners in accordance with the provisions of the Board of Nursing and State Board of Medical Examiners (Hain & Fleck, 2014)). According to the scope of practice, the agreement must include prescription orders, practice sites, and quality assurance. However, it does not include direct supervision onsite by the collaborating physician (Martin and Reneau, 2020). This implies that in Alabama, Nursing Practitioners are not recognized as the primary caregivers. As opposed to the education and training of Nurse Practitioners, which places them as the primary caregivers, collaborative agreements limit their ability to be responsible for patients’ physical and emotional care. It instead transfers this responsibility to the collaborating physician.

In collaborative agreements, the Nurse Practitioner can only prescribe drugs to patients once a collaborating physician has approved, authorized, and signed. Even so, the prescriptions are limited to drugs that are on the list of medicines recommended by the joint committee and must be adopted by the Board of Nursing and the State Board of Medical Examiners (Hart, Ferguson, and Amiri, 2020). In this regard, collaborative physicians make the prescriptions indirectly through the Nurse Practitioners.

Identified Issues

The issues identified in collaborative practice in Alabama State are practice sites. There are different practice site types, including principal and remote practice sites. The principal practice site refers to the main site or location where the collaborating physician conducts the onsite practice of medicine. They have offices in the clinic or facility where Certified Registered Nurse Practitioners work alongside them. These could include community clinics, physician offices, healthcare centers, or long-term care hospitals.

On the other hand, the remote site collaboration site refers to an approved collaborative site in which a Certified Registered Nurse Practitioner (CRNP) is allowed to see patients without an onsite physician. In these remote sites, a covering or collaborative physician is not physically present in the office, clinic, or facility. The collaborative time requirements in this care imply that the collaborative physician must visit the remote practice site at least twice annually (Barber et al. 2017). However, the collaborative agreement practice is observed despite the absence of the physician in the facility. Nevertheless, such arrangements do not apply to acute care hospitals, principal care sites, assisted living facilities, skilled nursing facilities, patient homes, and end-stage renal treatment facilities.

Barriers to Independent Practice in My State

In my state, where all the Nursing Practitioners are practicing under collaborative agreements, NPs practicing autonomously might face several challenges, including reduced reimbursement rates, unavailability of formal marketing or business education for the nurses, and lack of recognition from other health professionals and the public about the preparation of these professionals (Hain & Fleck, 2014). The legislation put in place by the state of Alabama limits the Nurse Practitioners’ ability to practice at the full level of their knowledge, skills, and preparation.

Therefore, insurance reimbursements might fail to recognize their existence in Alabama, which impedes practice since they are bound to receive very few reimbursements. Swimming upstream to undo the public stereotype that recognizes NP work under collaborative agreements requires a collaborative effort of all healthcare stakeholders. Additionally, principal practice sites are unlikely to employ autonomous nurses in Alabama, which means that they can only practice to some extent that does not include facilities with a practicing collaborative physician.

Addressing NP Practice Issues in Alabama State

The main aim of the Full Practice Authority is to reduce the shortage of providers in the United States to increase access to healthcare. Limiting the ability of Nurse Practices to provide primary care through collaborative agreements is a legislative issue that can be addressed through the Senate and other legislative and political offices. In addressing this issue, I would petition the political representatives and Nurse Practitioner representatives to champion a policy review to accommodate full, reduced, and restricted practice. If the Senate could allow Nurse Practitioners to provide primary care without necessarily working through collaborative agreements, access to healthcare would be increased in Alabama as well as countrywide.


Barber, R. M., Fullman, N., Sorensen, R. J., Bollyky, T., McKee, M., Nolte, E., & Abd-Allah, F. (2017). Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015. The Lancet390(10091), 231-266.

Hain, D., & Fleck, L. (2014, May 31). Barriers to NP Practice that Impact Healthcare Redesign. The Online Journal of Issues in Nursing, 19(2), Manuscript 2. doi:10.3912/OJIN.Vol19No02Man02

Hart, L., Ferguson, R., & Amiri, A. (2020). Full Scope of Practice for Alabama Nurse Practitioners: Act Now. The Journal for Nurse Practitioners16(2), 100-104.

Martin, B., & Reneau, K. (2020). How Collaborative Practice Agreements Impede the Administration of Vital Women’s Health Services. Journal of Midwifery & Women’s Health.


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The Practice Agreements for NPs in Alabama State

This week you will have an opportunity to evaluate state practice agreements in your state Alabama and examine issues related to NP practice.

To prepare:

The Practice Agreements for NPs in Alabama State

The Practice Agreements for NPs in Alabama State

  • Review practice agreements in your state Alabama
  • Identify at least two physician collaboration issues in your state

By Day 3

Post a brief description of the practice agreements for NPs in your state Alabama and the two physician collaboration issues that you identified. Explain what you think are the barriers to NPs practicing independently in your state. Finally, outline a plan for how you might address NP practice issues in your state.

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