FAQs About Provider to Provider

• What are a physician's responsibilities when working with a nurse practicing in an expanded role?
• What is a physician's responsibility when supervising nurses with prescriptive authority?

• What are a physician's responsibilities when working with a nurse practicing in an expanded role?

  In Massachusetts, nurses practicing in an expanded role include: nurse midwives, nurse practitioners, psychiatric nurses, mental health clinical specialists, and nurse anesthetists.

  Massachusetts is one of several states in which the Boards of Registration in Nursing and Medicine jointly govern the practice of nursing in the expanded role. Nurses practicing in the expanded role must practice in accordance with written guidelines which are developed in collaboration with and mutually acceptable to the individual physician or the appropriate medical and nursing administrative staff.

  Important issues of concern in collaborative relationships include responsibility, quality of care, communication, scope of practice, delegation of authority, patient satisfaction, and conflict resolution. Nurses practicing in an expanded role are responsible for their own actions. If such actions result in a claim, the supervising physician may be named. The best protection is to formulate or adapt written guidelines and practices which address the questions on how best to serve patients under the combined care of physicians and nurses emphasizing a team approach. Regular review of these guidelines and a regular conference/chart review time to review clinical care is an important part of maintaining quality patient care in a collaborative practice.

  Clinicians outside Massachusetts should check with their state medical boards regarding the rules for collaborative practice.

  Additional Resources

  1. Physicians and Nurse Practitioners in Collaborative Practice [PDF]
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• What is a physician's responsibility when supervising nurses with prescriptive authority?

  In Massachusetts, nurses' prescriptive privileges are governed generally by the regulations of the Boards of Registration in Nursing and Medicine, and specifically bythe guidelines developed with a supervising physician. Such guidelines must state the nature and scope of the nurse's practice, any specific limitations on prescriptive powers, and the mechanism for physician supervision. The supervising physician must review the nurse's prescriptive practice at least every three months and provide ongoing direction.

  Physicians deciding whether and how to supervise a nurse with prescriptive authority should consider the geographical proximity, practice setting, volume, and complexity of the patient population for each nurse being supervised, as well as the nurse's and physician's levels of expertise.

  New Hampshire does not require physician supervisors for prescribing nurses.

  In Rhode Island, nurse practitioners' prescribing privileges are defined by formularies written in collaboration with the medical directors or physician consultants of individual entities. These cannot exceed the scope of the formularies promulgated annually by the Rhode Island Department of Health. Physician consultants reviewing these formularies need to keep up to date with any statewide changes.

  As nurses gain increased authority, physicians are advised to keep track of regulatory changes.

  Additional Resources

  1. Supervising Nurse Practitioners with Prescriptive Authority [PDF]
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