Not all states in the U.S. require that nurse practitioners have a collaborating provider. In states that require collaborators, there are some things to know when entering a collaborative agreement and interacting with your collaborative provider.
Schools don’t always teach how to interact effectively with your collaborating physician (or nurse practitioner). There is certainly some variation among providers’ preferences, but there are some core similarities all collaborating providers want that you should definitely be aware of.
1. Understand what’s in your collaborative agreement and follow it
This is obvious but often overlooked. You need to read your entire collaborative agreement and know what’s in it to make sure you are following the requirements.
Collaborative agreements can vary from practice setting and state but generally include the following information:
- scope of practice
- quality assurance provisions
- a procedure for regular review of charts
- the scope of prescribing practices and prescriptive authority
- prescribing parameters (including off-label medications)
- policy for coverage of absences
- policy for the resolution of clinical disagreements
Basically, collaborative agreements outline the nature of your relationship and what you are allowed to do. Some collaborative agreements are more robust than others, but they essentially provide written clarification of your obligations.
Important parts of the agreement to keep in mind are how often you will need to follow up with your collaborating provider for chart reviews—will it be annually? Every six months? You should know this and set up reminders to make sure you are meeting these requirements.
You also need to be aware that your collaborating provider needs to have the training to see the patient population you will be treating. For example, if you are expected to see children in your practice but your collaborating provider does not treat children in their practice or have any experience treating children, then you will be unable to treat children in your practice.
Basically, your collaborator needs to have the experience to assist you if needed; if they don’t have the training, you cannot see those types of patients. Annoying, right? The way around this barrier is finding a second collaborating provider who is trained to see children, which will allow you to treat children (or whatever patient population you want to treat).
2. Know that there is a limit to how many NPs a collaborating provider can have
This is not a huge point, but you should know that a collaborating provider can only collaborate with so many NPs at one time. The number of NPs a provider can collaborate with varies by state but is generally five or less.
Sometimes collaborating providers are unaware of this requirement, so encourage them to check with their state medical board (or you can check) to make sure you can work with them. Hopefully, your employer is aware of this rule and does not pair you with a collaborator already at capacity, but you should do your due diligence as well.
3. Respect and appreciate the collaborating relationship
Know that being a collaborating provider is not necessarily the most exciting aspect of being a clinician. It takes time, and it’s often unpaid. Acting as a collaborating provider is an obligation that the collaborator fulfills in their already busy role. Knowing this, make sure to show your appreciation and respect for the provider.
When collaborators go out of their way to impart knowledge or offer insight, definitely show you’re your gratitude. I like to bring my collaborator an occasional coffee or snack when we have meetings. Not a requirement but a way to show my appreciation!
Side note: some collaborative providers are more collaborators “on paper” than reality. Their name is listed at the top of your collaborative agreement, but you see them literally once a year for five minutes to fulfill your collaborative agreement requirements. This is unfortunate, but it’s important not to expect all collaborators to be hands-on. If you’re looking for more support in practice, look into finding a provider to meet with for private supervision.
4. Be on top of following up with your collaborating provider and have a system of communication in place (likely outlined in collaborative agreement)
Some collaborating providers will need to be nudged or reminded about upcoming chart reviews. You’re both busy, and it can be tough to remember these meetings. Remembering a semi-annual review may not be top of mind for your collaborator. Especially if you didn’t establish a clear schedule of meetings regularly ahead of time.
You might work for a hospital or organization that schedules this time in advance for you as required. Others don’t. Make it your responsibility to remember when you must meet, per your collaborative agreement.
It’s also a good idea for your initial meeting with your collaborating provider to ask how they prefer to communicate. Do they want to connect with you via email? Calls? Texts? Do they want to have monthly scheduled meetings with you, or have you just reach out whenever you have questions?
5. Keep a copy/record of your collaborative agreement
It’s a good idea to keep a record or copy of your initial collaborative agreement and each follow-up agreement (i.e., semi-annual follow-up, annual follow-up). Likely follow-up agreements will include your collaborator’s notes, recommendations, and chart review notes for you. These follow-up agreements/chart reviews will be signed by both you and your collaborator and should be kept by you for your records in the event your state board of nursing audits you. It’s a good idea for your collaborator to have a copy on file for themselves.
Keeping these things in mind will help you have a successful relationship with your collaborating provider. A collaborator can be very helpful for new nurse practitioners and utilizing this relationship can help you gain confidence and competence in your new role.
