Across the United States, the regulation of conduct of nurses slightly differs in accordance with the different states (Buttaro, 2013) . Although there exists a couple of federal legislations which regulate nurses at a federal level, each state has its own regulations which stipulate how nurse practitioners can conduct their activities. A good example of such a difference would be the collaborative health practice in Virginia vis-à-vis the primary caregiver practice in North Carolina (Buttaro, 2013) .
In Virginia, nurse practitioners cannot practice as primary care givers compared to the state of North Carolina where they can. This means that in Virginia, it is a legal requirement for a nurse to practice as part of a patient care team (Blake, 2013). This entails working in close collaboration and consultation with a physician. The same must be I form of an agreement which might either be written or electronic. The practice agreement must contain a concise prescriptive authority of the nurse practitioner (Blake, 2013).
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This is in comparison with the practice in North Carolina where a nurse practitioner is allowed to run his/her own personal health facility (Varnam, 2016). However, similar to the practice in Virginia, a nurse in this state is also required to have a practicing agreement which mandates a physician to supervise over the nurse (Varnam, 2016). The supervision in this case is not as restrictive as the one in Virginia since it is not a mandatory requirement for the supervising physician to be physically present where the nurse practices. Consultation in this case can thus be through direct communication or telecommunication (Varnam, 2016).
The Virginia Acts of Assembly 2012 is the enabling legislation that requires collaborative health care services by nurse practitioners (Blake, 2013). The law provides for the establishment of accountable care organizations which should be composed of physicians, nurses and other health practitioners. The rationale behind this is to provide cost-conscious, quality coordinated care to patients.
According to the Virginia Board of Nursing, requiring a nurse practitioner to practice as part of a care team is meant to maintain a high code of conduct among the nurses (Blake, 2013). This in turn, according to the board, raises the level of health services. This notion is, however, disputable owing to the fact that statistics indicate that quality healthcare has increased with an increase in popularity of nurses as primary caregivers (Blake, 2013). A report by the American Association of Nurse Practitioners indicates that over 900 million visits are usually made to nurses owned health facilities where nurses offer primary care giving services (Blake, 2013).
The collaboration practice requires all nurses to have clearly defined patient care roles. The collaboration in itself entails frequent communication with the physician with regards to treatment and care of a patient and sharing of clinical observations and assessments (Buttaro, 2013) . This particular practice, however, faces some challenges such as establishing the scope of a physician liability in case of any malpractice case under the principle of vicarious liability, billing with regards to medical services offered and whether collaboration between certain clinicians violates antitrust laws (Buttaro, 2013) .
The collaborative health practice has also numerously been criticized of its anti-competitive nature. In a state such as North Carolina where nurses can provide primary health care services, nurses are allowed to independently offer services that in a state such as Virginia a nurse cannot offer without the guidance of a physician (Varnam, 2016). This means that the scope of services for a nurse in Virginia is more limited than that of an equivalent nurse in North Carolina.
The primary care provider policy in North Carolina has been reported to improve the quality of health care services immensely (Varnam, 2016). For instance, before the adoption of the full practice authority, there was a reported shortage of health practitioners across the state. This improved within 18 months of the state allowing nurse practitioners to deliver care autonomous of a physician (Varnam, 2016).
References
Blake, V. (2013). Scope of Practice in Team-Based Care: Virginia and Nationwide. Virtual Mentor,15 (6), 518-521. Retrieved from http://journalofethics.ama-assn.org/2013/06/hlaw1-1306.html
Buttaro, T. M. (2013). Primary care: A collaborative practice . St. Louis, Mo: Elsevier/Mosby. North Carolina Scope of Practice Policy - State Profile. (n.d.). Retrieved from http://scopeofpracticepolicy.org/states/nc/
Varnam, D. C. (2016, March 10). Autonomy for nurse practitioners one answer to NC doctor shortage. Retrieved January 04, 2018, from http://www.newsobserver.com/opinion/op-ed/article65268977.html
Virginia Scope of Practice Policy - State Profile. (n.d.). Retrieved January 04, 2018, from http://scopeofpracticepolicy.org/states/va/
