Nurse practitioner practice agreements in Maryland.

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Nurse Practitioner Practice in Maryland: A Summary of Findings

Introduction:

This report summarizes key findings regarding the state of nurse practitioner (NP) practice in Maryland, focusing on regulations, barriers, and surprising discoveries gleaned from research.

Regulations:

• Independent Practice: Maryland is classified as a full practice state, meaning NPs can practice independently without physician collaboration or supervision. However, they must maintain a collaborative agreement with a physician for referrals and consultation as needed (Maryland Board of Nursing, n.d.).
• Certification and Licensure: To become an APRN in Maryland, individuals must hold a current RN license, complete a Master's degree in an APRN program from an accredited institution, and pass the national APRN certification exam (Maryland Board of Nursing, n.d.).
• Maryland's State Board of Nursing Website: The Maryland Board of Nursing website is https://mbon.maryland.gov/Pages/nurse-practice-act.aspx.
• Scope of Practice: Maryland defines an NP's scope of practice as encompassing the assessment, diagnosis, treatment, and management of health problems across the lifespan, including prescribing medications and ordering diagnostic tests (Maryland Board of Nursing, n.d.).
• Practice Agreement: While Maryland does not require a formal practice agreement, it encourages NPs to maintain collaborative relationships with physicians for referrals and consultation (Maryland Board of Nursing, n.d.).
• DEA License: Obtaining a Drug Enforcement Administration (DEA) license is required for NPs who wish to prescribe controlled substances (Drug Enforcement Administration, n.d.).
• Prescription Monitoring Program (PMP): Maryland has a PMP in place, known as the Maryland Prescription Drug Monitoring Program (PDMP), which tracks the prescribing and dispensing of controlled substances (Maryland Department of Health, n.d.).
• Controlled Substance Prescriptive Authority: NPs in Maryland can prescribe all schedules of controlled substances, but they must complete additional training specific to controlled substances (Maryland Board of Nursing, n.d.).

Barriers:

Despite Maryland's full practice status, certain barriers can still limit NPs' practice:

• Hospital credentialing: Even in full practice states, hospitals may have their own credentialing processes that require physician collaboration, potentially hindering NPs' independent practice within these settings.
• Reimbursement restrictions: Some insurance companies may not reimburse for services provided by NPs, limiting patient access to NP care.
• Lack of awareness: Public and healthcare professionals may not be fully aware of the full scope of NP practice, potentially leading to underutilization of their services.

Surprises:

• While Maryland appears to offer a relatively favorable environment for NP practice, the lack of a formal practice agreement requirement may surprise some, as it is common in other states.
• The additional training requirement for NPs to prescribe controlled substances, despite being in a full practice state, may also be unexpected.

Conclusion:

Maryland offers a supportive environment for NP practice with full practice authority, certification requirements, and controlled substance prescribing access. However, specific barriers like hospital credentialing and potential insurance limitations require consideration. Overall, this research provides a snapshot of the current state of NP practice in Maryland, highlighting both empowering regulations and persisting hurdles.