Starting your own practice as a nurse practitioner is a thrilling, monumental life event. It’s entrepreneurial and puts you in the front seat of patient care. However, if you practice as an NP in one of the 28 states that don’t confer full autonomy to NPs, you’ll need to create a collaborative practice agreement (CPA) with a physician to practice to the full extent of your license. A well-structured CPA can make the business side of your professional life easier, so you can focus on what you do best: Providing your patients with exceptional care. Here’s why and how to create a collaborative agreement so you can start out on the right foot.
If you're starting your own practice as an NP, chances are good that you'll need to create a collaborative practice agreement with a physician. We'll walk you through how to do this and give you some CPA templates to get you started.
What Is a Collaborative Practice Agreement? Why Do You Need One?
A CPA is a legal document that formalizes the relationship between an NP and a supervising physician. CPA requirements vary by state and are governed by the respective Board of Nursing, but in general, they all require an NP to have some level of oversight by a physician. Julie Nyhus, FNP-BC, explains that the purpose of a CPA is to “allow the two parties involved to be clear about the functions of the NP.” They also allow both parties to define the requirements for a supervising physician’s oversight.
It’s possible that your collaborating physician has a document that you can use as a starting point. If not, check with a lawyer or another nurse entrepreneur to see if they have any sample documents you can tailor for your own use. (Links to examples below.) And, as with any legally binding agreement, you should have the contract reviewed by a lawyer before signing it.
How to Outline the Terms of Your Agreement
Here are the typical sections to include in a collaborating physician contract.
Section #1: Scope of Practice
Name who this agreement covers. Is it between you, an individual, and the physician, or is it larger in scope (i.e., covering all the NPs in a practice, for example)? You’ll also want to use this section to list what each profession within your group will be practicing and the actual locations where the work will be done.
Section #2: Practice Protocols
Outline the guidelines your team will follow for contacting the physician: When, how, and for what purpose. This will most likely be based on your state’s nurse practice act and the type of practice you’re engaged in.
Section #3: Physician Consultation
State the type (e.g., in-person, telephone, etc.) and frequency of consultation expected by your collaborating physician.
Section #4: Record Review
Include the frequency and manner of chart review your physician collaborator will perform.
Section #5: Resolution of Disagreements
Outline how you and your collaborating physician will resolve any differences of clinical opinion.
Section #6: Alteration of Agreement
Define the term (i.e., length) of the agreement and under what circumstances it may be altered or terminated.
Section #7: Compensation
Define payment terms for the physician collaborator. Most collaborating physicians expect to be paid for their services, aside perhaps from a doctor working in a group practice with NPs. Typically, both parties agree on an hourly rate, but annual fees, per-chart-reviewed fees, and profit percentages are common arrangements, as well. You and the collaborating physician can design the compensation structure in any way you find mutually agreeable.
Section #8: Signatures
Provide a space in the document where you and the collaborating physician can both sign and date it.
3 Tips for Creating a Collaborative Practice Agreement That Works
Once the CPA is drafted, Nyhus recommends that both parties review and revise the document together. Prior to signing, it’d be ideal to have your own attorneys review the agreement, too; this can help ensure that you didn’t miss anything, and it’ll give you a chance to have your attorney explain any parts of the document that you didn’t understand. Each person involved in the CPA should consider having their own attorney to help avoid any conflicts of interest.
Here are three additional tips to keep in mind as you go through the process of creating and implementing your collaborative practice agreement.
1) Explicitly detail each person’s responsibilities.
For example, “Physician will visit the NP’s practice site one day in every calendar month.”
2) Make sure to check in regularly with your collaborating physician.
As a professional courtesy, and to maintain the integrity of your CPA, be sure to regularly check in with your collaborating physician.
3) Familiarize yourself with the terms of your agreement.
In addition to ensuring that the document itself is in order and meets the needs of both parties, it’s important to understand and abide by the terms set in the agreement. Place visuals around your practice to remind yourself and your team of proper CPA protocol, and add reminders in your calendar for regular check-ins.
Do All NPs Need to Have a Collaborative Agreement With a Physician?
The short answer is no. You’re only required to create a collaborative practice agreement with a physician if you work in a state that reduces or restricts your practice authority. (Learn more about NP scope by state.) Each state is responsible for defining and articulating the practice requirements that NPs and their collaborating physicians are expected to adhere to. Because each state’s requirements are unique, you should thoroughly familiarize yourself with your state’s applicable laws.
And while your state might not legally require this contractual agreement, you may feel the need to create a contract in order to formalize your relationship with any physician you work with. You might do this in order to outline different responsibilities and further protect yourself and your business.
3 Examples of Nurse Practitioner Collaborative Agreement Templates
Nyhus says the best resource for developing collaborative agreements is the Nurse Practitioner's Business Practice and Legal Guide by Carolyn Buppert. However, you also can find many downloadable templates on the web, including the following examples:
- New York State Education Department
- Upstate University Hospital
- Gerontological Advanced Practice Nurses Association
As you head out on your own, remember that your experience, sharp skills, risk management strategy, and strong team are positioning you for success. And lean on your collaborating physicians whenever you want — that’s why they’re there!