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A survey of 1,486 nurse practitioners (NPs) in North Carolina suggests that physician supervision often provides little direct clinical interaction, despite the state’s requirements for collaborative practice agreements. The survey was conducted by Jennifer Perry, DNP, APRN, FNP-C, CNE, a family nurse practitioner practicing in urgent care, and Chandra Speight, PhD, APRN, FNP-C, CNE, a professor at East Carolina University, and was presented at the American Association of Nurse Practitioners annual meeting. According to the survey, 34.8% of respondents reported never having their supervising physician at the same practice site over the previous 6 months, while another 9.8% said they rarely see their supervisor. Nearly half (45.2%) of NPs said their supervising physician never reviewed their care plans or clinical notes, and 30.8% reported they were rarely or never able to discuss patient care during encounters. More than 71% of respondents did not share a patient panel with their supervising physician, and 64.9% said they never conduct shared visits. What’s interesting is that when asked whether having a supervising physician “is beneficial to my ability to practice effectively,” 59.8% disagreed with the statement. The other 40% likely agreed, although the survey summary didn’t specify this point explicitly.
The policy landscape: Currently, 30 states allow NPs full practice authority, 15 states allow autonomy with some limitations, and 11 states—including North Carolina—require physician supervision under restricted practice authority. The need for physician collaborative practice agreements can hamper urgent care growth in these states while adding labor costs. Read Supervising Doctors May be Held Liable in Malpractice Suits in JUCM‘s archives for information on potential liability for supervising physicians.