State Practice Agreement (Maryland State)

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State Practice Agreement

Every state has practice agreements in the issues regarding nurse practitioner to guide them in their work. It is important for the nurse practitioners to understand the practice agreements in their localities to enhance compliance (Buppert, 2015). The essay focuses on Maryland State and provides a discussion of the practice agreements for nurse practitioners and physician collaboration issues identified in the region. Also discussed are the barriers to nurse practitioners practicing independently in Maryland State and a plan to address the practice issues.

The practice agreement for nurse practitioners in Maryland State allows the full-practice authority law. The legislation allows the patients in all areas of the state to receive the full scope of services that the practitioner nurse is educated for and clinically trained to offer. The patients have access to high-quality health care and enhance distribution of the health care workforce. The mandate of “attestation agreements” is not operational since the nurse practitioners do not have to collaborate with physicians as a pre-condition of licensure and practice (Rubenfire, 2015). The agreement initially discouraged nurse practitioners from practicing in the rural regions of the state. For a full practice agreement, the licensure law provides for all the nurse practitioners to assess patients, diagnose, order, and interpret the diagnostic tests. They can also initiate and manage treatments.

The physician collaboration issues identified are a lack of adequate training and experience by the nurse practitioners to practice independently, the barriers of Nurse Practitioners in finding collaborators, and the need to address the primary care crisis faced by the state. There is an argument that many nurse practitioners lack the necessary training and experience required to practice independently which is not valid. The nurses ought to have three years of experience for them to practice without a collaborator who is adequate to offer them the necessary experience. The challenge of providing primary care services to the rural regions has been an issue that hinders access to health care services. The physicians and nurse practitioners can work together, but the unnecessary constraints of collaborative agreement should be abolished.

The barriers to Nurse Practitioners to practice independently include the state practice and Licensure, the payer policy, and the physician-related barriers. The licensure and state practice barrier has been addressed by the adoption of the full practice state environment that allows the nurse practitioners to offer most of the nursing services (Rubenfire, 2015). The major obligation is the requirement of serving for three years to be licensed, maintain the national certification, and be accountable to the standards of care in practice. The physician-related issues include the belief that physicians have longer, and rigorous training than the nurse practitioners and nurse practitioners are incapable of providing quality and safe care to physicians. For the payer policies, many nurse practitioners report that they have an effect on their ability to practice to the full extent of their licensure and training (Hain & Fleck, 2014).

The NP practice issues in Maryland are a call for action to address them and enhance the efficiency of service delivery. Policy initiatives can be effective in addressing the need for primary care providers in the rural areas to decrease the disparities. The policies ought to advocate for nurse practitioners to work to the full scope of their education and training. The elimination of barriers to the independent practice is necessary for the provision of the needed primary care. The standardization of the Advanced Registered Nurse Practitioner regulation can help to promote nationwide consistency and quality of nurse practitioner education programs (Hain & Fleck, 2014). Thus, they can provide quality and cost-effective care in independent practice environments. Nurse practitioners should be at the front line in transforming the health care sector through establishing relationships with other specialties.



Buppert, C. (2015). The employed nurse practitioner: In Nurse Practitioner’s Business Practice     and Legal Guide (5th ed.) (323 – 336) Burlington, MA: Jones & Bartlett.

Hain, D., Fleck, L., (May 31, 2014) “Barriers to Nurse Practitioner Practice that Impact     Healthcare Redesign” OJIN: The Online Journal of Issues in Nursing Vol. 19( 2),   Manuscript 2.

Rubenfire A. (2015) Maryland allows nurse practitioners to practice independently of a     physician; Modern Healthcare, Retrieved from

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