State Practice Agreements Research Paper

State Practice Agreements Research Paper

Briefly describe the practice agreements for PMHNPs in your state.

  • Explain the two physician collaboration issues that you identified.
  • Explain what you think are the barriers to PMHNPs practicing independently in your state.
  • Outline a plan for how you might address PMHNP practice issues in your state State Practice Agreements Research Paper.

A description of the practice agreements for PMHNPs in Maryland State

A psychiatric mental health nurse practitioner (PMHNP) may perform autonomously and in a range of settings to make a mental health diagnosis, and to assess and manage psychobiological therapy. Maryland has permitted PMHNPs to practice independently of a physician. The nurse practitioner full practice authority permits nurse practitioners to prescribe some medications with no attestation agreement with a physician. Apart from autonomous nurse practitioners not being tied to a collaborative agreement, they are able to open their own private clinics. Some nurse practitioners are required to pay physicians for the formation of collaborative agreements. According to American Medical Association (2017), when a collaborative practice agreement is needed, a nurse practitioner should consult and collaborate with a nurse practitioner or a physician for the first one and a half years of practice.


Two physician collaboration issues that I identified

The first PMNHP- physician collaboration that I identified is a shortage of physicians.  Therefore, PMHNPs are not able to effectively collaborate with physicians to meet the primary care needs of the huge number of the recently insured mental health patients in Maryland. Another PMHNP-physician collaboration issue is opposition from some physician organizations and physicians which hinders extension of PMHNPs’ scope of practice. For instance, the council of medical specialty societies is concern about the issue that the Institute of Medicine. Supports extended scope of nursing practice but fails to specify the standard minimal quantity of overseen clinical experience along with recognized clinical competency that an advanced practice nurse must be achieved before he/ she would be allowed to treat and prescribe drugs without the guidance of a physician(Altman et al, 2016).

Barriers to PMHNPs practicing independently in Maryland

Barriers that hinder the capability of PMHNPs to practice independently include lack of formal marketing or business education, reduced rates of reimbursement, uneven distribution and a shortage of mental health providers and lack of acknowledgment public health professionals on their preparation. Altman et al (2016) argue that even though Maryland has changed its laws to offer nurse practitioners prescriptive and full practice authority, and advanced practice registered nurses have received the necessary training and are capable of providing a range of mental care services, they are hindered from executing their mandate by barriers institutional culture and practices and out of date reimbursement models State Practice Agreements Research Paper.

According to Duncan and  Sheppard(2015), legislative restrictions across the United States presently impede the ability of nurse practitioners to fully practice to their training and educational levels, thus minimizing the capability of the community to access health care. If all PMHNPs in Maryland are permitted to attend to mental health patients under the full practice authority legislation, there would be a dramatic decrease in the scarcity of providers of primary care.

A plan for how I might address PMHNP practice issues in Maryland

I might address the PMHNP practice issue in Maryland by working in the respective legislative conferences to make sure that mental health patients can easily access superior health care services in the state. To ensure PMHNPs are able to work within their level of training and education, I recommend an amendment to the Medicare program to give authority to PMHNPs to undertake admission assessments and certification of mental health patients home care services as well as admission to skilled nursing facilities. To address the issue of reduced rates of reimbursement, recommend for an amendment to regulations and statutes relating to PMHNP reimbursement. Maryland should increase rates of Medicaid reimbursement for primary care physicians incorporated in the Accountable Care Act (ACA) to PMHNPs offering parallel primary care services.


Altman, S., Butler, A., & Shern, L. (2016). Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington, D.C. The National Academies Press.

American Medical Association. (2017). State law chart: Nurse Practitioner Practice Authority. Retrieved on July 6, 2018 from

Duncan, C., & Sheppard, K. (2015).  Barriers to Nurse Practitioner Full Practice Authority (FPA): State of the Science. International Journal of Nursing Student Scholarship, 2: 1-12 State Practice Agreements Research Paper.






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