supervision of nurse practitioners and other health professionals.

Respond to at least two of your colleagues on three different days in one or more of the ways listed below.
Suggest additional actions to take
Validate an idea with your own clinical experiences with the support of an additional literature search.
Must include:
-Response exhibits critical thinking and application to practice settings
-responds to questions posed by faculty
-the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives
-Communication is professional and respectful to colleagues
-Provides clear, concise opinions and ideas that are supported by two or more credible sources

Practice Agreements
Nurse practitioner (NP) practice agreements define the collaborative practice of an advanced practice registered nurse (APRN) and the supervising physician outlining the rights, responsibilities, and services the NP scope of practice will include (Buppert, 2018). This discussion aims to describe the practice agreements for APRN’s in the state of Missouri, two physician collaboration issues, and a plan to address the said collaboration issues.
Practice Agreements in Missouri
The APRN in the state of Missouri have restrictive practices and prescriptive privileges and they are regulated by the Missouri State Board of Nursing (MSBN, 2018, Pearson, 2014). APRN’s can practice without the collaborating physician. However, they are limited to practice in locations within 75 miles of their collaborating physician (MSBN, 2018). APRNs in Missouri must practice on site with the collaborating physician for 30 days (MSBN, 2018). Missouri APRN’s must also have immediate access for consultation at all times with the collaborating physician, and the collaborating must review the work and records of the APRN minimally every two weeks, signing ten percent of the APRN’s overall charts (MSBN, 2018). APRN’s also must have guidelines for consultation and referral, as well as the authority to administer, dispense, or prescribe medications, and methods of treatment and authority delineated within the practice agreement (MSBN, 2018). Missouri physicians are limited to only collaborate with a limited number of nurse practitioners at one time (MSBN, 2018).
Collaboration Issues
Sometimes the lack of availability, costs, and willingness of a required collaborating physician can detour an APRN for practicing in a particular area disrupting the distribution of health care professionals decreasing access to care and increasing healthcare costs (Ritter, Bowles, O’Sullivan, Carthon, & Fairman, 2018). Many billing models (including Medicare) limit reimbursement influencing costs and the delivery of health care services and requiring the supervision to bill at a higher rate preserving the need for supervision and collaboration not independent practice (Buppert, 2018, Ritter et al., 2018).
As a future APRN in the state of Missouri, I will be advocating for less restrictive practices to our State Board of Nursing and the legislators in Missouri. I am a member of the American Association of Nurse Practitioners (AANP) and have a dual membership giving me the membership to the Missouri Nurses Association. After I graduate, I will also join Advance Practice Nurses of the Ozarks (APNO). A neighboring state with restrictive practices similar to Missouri is Tennessee. Tennessee NP’s are joining forces to advocate for full practice authority, meaning they are fighting to have the opportunity to practice as NPs to the full extent of their education and training (Tennessee Nurse Practitioner Association, 2016). I foresee the APRN’s of Missouri uniting to do the same, we have already convinced the state to increase the distance of practice locations from 30 to 75 miles from a collaborating physician over the last few years (MSBN, 2018).

Buppert, C. (2018). Nurse practitioner’s business practice and legal guide (6th ed.). Sudbury, MA: Bartlett & Jones Learning.
MidlevelU: The Online Hub for Midlevels. (2013, September 16). Nurse practitioner scope of practice: Missouri. [Blog post]. Retrieved from
Pearson, L. (2014). 2014 Pearson Report. Burlington, MA: Jones & Bartlett. Retrieved from
Ritter, A. Z., Bowles, K. H., O’Sullivan, A. L., Carthon, M. B., & Fairman, J. A. (2018). Legally required supervision of nurse practitioners and other health professionals. Nursing Outlook.
Tennessee Nurse Practitioner Association. (2016). Uniting for full practice. [Blog post]. Retrieved from