I. Collaborative Practice
According to New York State Education Law § 6902, a nurse practitioner (NP) diagnoses illnesses and physical conditions and performs therapeutic and corrective measures within the specialty area of practice in which the NP is certified. New York certifies NPs to practice in the following specialty areas: Adult Health; Family Health; Gerontology; Neonatology; Obstetrics; Oncology; Pediatrics, Perinatology; Psychiatry; School Health; Women’s Health; Holistic; and Palliative Care.
New York State Education Law holds NPs independently responsible for the diagnosis and treatment of their patients and does not require an NP to practice under physician supervision. As described in more detail below, this law requires each NP to practice in accordance with written practice protocols and a written practice agreement with a collaborating physician. However, an NP with more than 3600 hours of qualifying NP practice experience can opt to:
- continue to practice pursuant to a written practice protocols and a written practice agreement with a collaborating physician, as described in Section II “Practicing in Accordance with a Written Practice Agreement with a Collaborating Physician”, below; or,
- practice and have collaborative relationships with one or more qualified physicians or New York State Health Department licensed health care facility (i.e., hospital, nursing home, ambulatory surgery center, or diagnostic and treatment center), as described in Section III, “Collaborative Relationships”, below.
II. Practicing in Accordance with a Written Practice Agreement with a Collaborating Physician
New York State Education Law requires all nurse practitioners (NPs) to practice in accordance with written practice protocols and a written practice agreement with a collaborating physician, unless the NP practices and has collaborative relationships as allowed by law and as described in more detail in Section III, “Collaborative Relationships”, below.
This section describes the New York State Education Law specific requirements for practicing in accordance with written practice protocols and a written practice agreement with a collaborating physician. This law requires that the NP collaborate with a physician who is qualified to collaborate in the NP’s specialty area of practice. The NP must practice in accordance with written practice protocols and a written practice agreement with the collaborating physician.
Written Practice Agreements
In order to practice, a nurse practitioner (NP) must enter into a written collaborative practice agreement with a physician qualified to practice in the NP’s specialty area of practice. Written collaborative practice agreements include provisions addressing:
- Patient referral and consultation.
- Coverage for emergency absences of either the NP or the collaborating physician.
- Resolution of disagreements between the NP and the collaborating physician regarding diagnosis and treatment. If the agreement doesn’t address this, the collaborating physician’s diagnosis or treatment shall prevail.
- Peer review by the collaborating physician of patient records in a timely fashion, but no less often than every 3 months. New York Law does not specify the number of charts that must be reviewed by the collaborating physician. That decision is left to the judgment of the NP and collaborating physician, and may vary depending on such factors as: the NP’s experience, the collaborating physician’s knowledge of the NP’s abilities, the population to be served and the practice setting.
- Identification of written practice protocols that the NP will use.
- Additional provisions as agreed to by the NP and the collaborating physician.
A copy of the collaborative practice agreement must be kept at the NP’s practice setting(s) and made available for inspection by the New York State Education Department (SED). A copy can be found at (Sample) Collaborative Practice Agreement. You may use that as a model.
Many NPs work for 2 or more health care providers or at a facility with patients who are being cared for by several different physicians. The Education Law does not necessarily require that the NP to enter into multiple collaborative agreements in such situations. For example:
- If an OB-GYN NP works at an obstetrician’s practice 3 days a week and at Planned Parenthood for 2 days a week, the NP could enter into a collaborative practice agreement with the obstetrician. The collaborative practice agreement could identify a physician (other than the obstetrician) at Planned Parenthood to review the charts of the NP’s Planned Parenthood patients, or, alternatively, the obstetrician could review the NP’s charts at Planned Parenthood. The NP is not required to enter into a second collaborative agreement.
- If an NP works in a nursing home, the medical director may serve as the collaborating physician. In case of a disagreement between the NP and an attending physician, the medical director could mediate the dispute and make the final treatment decision. The NP is not legally required to have written collaborative practice agreements with all of the attending physicians.
Written Practice Protocols
Nurse practitioners (NPs) are required to practice pursuant to written protocols reflecting the specialty area(s) of practice in which the NP is certified. The protocols must also reflect current, accepted medical and nursing practice. Additional protocols in subspecialty areas (i.e., hematology, orthopedics, dermatology) that are appropriate to the NP’s practice may be used but need not be reflected in the collaborative practice agreement.
A list of many, but not all recommended Practice Protocols can be found at Nurse Practitioner: Approved Protocol Texts.
Form 4NP “Verification of Collaborative Agreement and Practice Protocol”
A newly certified nurse practitioner (NP) is required file with the New York State Education Department (SED) Form 4NP-“Verification of Collaborative Agreement and Practice Protocol” within 90 days after starting professional practice. The NP is not required to file any additional Form 4NP with SED. A completed Form 4NP is not equivalent to a collaborative practice agreement. Copies of Form 4NP can be downloaded from SED’s website at License Application Forms: Nurse Practitioner.
Note: The Education Law does not require physicians to supervise the NP or to co-sign the NP’s orders or medical records. It does require the collaborating physician to review the NP’s patient records at least every three months.
III. Collaborative Relationships
New York State Education Law allows certain experienced nurse practitioners (NPs) to practice more autonomously. Each NP with more than 3,600 hours of qualifying NP practice experience can opt to:
- practice in accordance with a written practice agreement with a collaborating physician, as described above in Section II “Practicing in Accordance with a Written Practice Agreement with a Collaborating Physician”; or,
- practice and have collaborative relationships with a qualified physician or a New York State Health Department licensed health care facility (i.e., hospital, nursing home, ambulatory surgery center, or diagnostic and treatment center), as described in more detail in this section.
New York State Education Law defines “collaborative relationships” as when an NP communicates, by phone, in person in writing or electronically with a physician qualified to collaborate in the specialty involved or in the case of a licensed health care facility, communicates with a physician qualified to collaborate in specialty involved who has privileges at such health care facility for the purpose of exchanging information in order to provide comprehensive care or to make referrals, as necessary.
The NP may practice and have collaborative relationships, provided that the following criteria below are met:
- The NP must have more than 3,600 hours of experience practicing as a licensed or certified NP pursuant to the laws of New York or another state or practicing as an NP while employed by the United States veteran’s administration, the United States armed forces or the Unites States public health service.
- The NP must have collaborative relationships with one or more physicians qualified to collaborate in the specialty involved or with a New York State Health Department licensed health care facility (i.e., hospital, nursing home, ambulatory surgery center, or diagnostic and treatment center). The health care facility must provide services through physicians qualified to collaborate in the specialty involved and who have professional privileges at the health care facility.
- The NP has filled out and signed a “Collaborative Relationships Attestation Form” prepared by the State Education Department (SED), which describes the NP’s current collaborative relationships. VisitFORM NP-CR – Collaborative Relationships Attestation Form to download a copy of the form.
- The NP must maintain documentation in written or electronic form that supports his or her collaborative relationships. Such documentation may include, but is not limited to, the following:
- documentation of an agreement or an arrangement with a hospital or physician practice, pursuant to which an NP may transfer or refer patients for care;
- documentation of communication between the NP and a physician qualified to collaborate in the specialty involved relating to the care of the NP’s patients or referral of the NP’s patients;
- documentation of an employment relationship between an NP and a physician practice or a hospital, hospice program, licensed home care services agency or licensed mental health care facility with a physician medical director; or,
- documentation of a contractual relationship with a physician, physician practice or a hospital pursuant to which the NP provides professional services.
- The NP must make the “Collaborative Relationships Attestation Form” and documentation in support of collaborative relationships available to SED for inspection.
New York State Education Law does not require NPs who practice and have legally authorized collaborative relationships to:
- sign an agreement with a physician;
- practice in accordance with a written agreement or written practice protocols;
- be supervised by a physician; or,
- have a physician to co-sign or review any of the NP’s orders, prescriptions, or other clinical records.
New York State Education Law does not prohibit NPs who practice and have legally authorized collaborative relationships from:
- practicing pursuant to clinical guidelines, policies or protocols;
- entering into agreements or other clinical or business arrangements;
- communicating with purveyors of health care services; or
- engaging in any quality assurance or other care related activities.
Newly certified NPs are NOT required file with the New York State Education Department (SED) Form 4NP¬“Verification of Collaborative Agreement and Practice Protocol” if the NP opts to practice and have collaborative relationships consistent with the new law.
IV. Financial Arrangements between a Nurse Practitioner and a Collaborating Physician
A variety of New York and federal laws affect financial relationships between health care practitioners. Some types financial relationships between nurse practitioners (NPs) and collaborating physicians are prohibited by the Education Law or professional misconduct regulations (See, e.g., Education Law § 6513, 8 NYCRR § 29.1) or other state or federal laws.
New York State Education Law and professional misconduct regulations prohibit a collaborating physician and an NP from engaging in “fee-splitting” or “kick-backs”. These legal prohibitions on “fee-splitting” and “kick backs” are designed to ensure that medical and nursing decisions are based on sound clinical judgment, uncompromised by economic or business considerations.
A “kick-back” typically occurs when a person gives or receives or agrees to give or receive money or other consideration to or from a third party in exchange for the referral of patient services. For example, if a physician pays a NP $100 each and every time the NP refers a patient to the physician for medical care, then it is very likely that the physician is giving and the NP is receiving “kick-backs”.
“Fee splitting” can occur if an NP shares his or her practice income or fees with a physician who is not the NP’s employer. “Fee splitting” also includes arrangements or agreements in which the NP pays the collaborating physician an amount of money that constitutes a percentage of, or is otherwise dependent upon the income or receipts of the NP in exchange for the collaborating physician’s services. For example, if an NP pays 20% of the NP’s professional income to the collaborating physician (who works at a separate medical practice) in exchange for the collaborating physician’s services, the NP and the physician are probably engaging in illegal “fee splitting”.
The Education Laws prohibiting “fee-splitting” or “kick-backs” do not prohibit a NP from paying a collaborating physician the fair market value of the physician’s personal services (i.e., chart review and consultation), unless:
- the payment includes remuneration for the referral of patient services;
- the NP is required to refer patients to the physician; or
- the payment is based on a percentage of or dependent on the NP’s professional fees or income.
NPs may refer patients to their collaborating physicians when medically necessary, provided that the NP receives nothing in exchange for the referral. New York law does not require that a collaboration agreement include a payment provision.
Questions about collaborative relationships, collaborative practice agreements or practice protocols may be referred to the Nursing Board Office by e-mailing firstname.lastname@example.org or by calling 518-474-3817 ext. 120. It is not within the purview of the Nursing Board Office to interpret laws governing financial relationships between NPs and collaborating physicians.
The questionnaires were administered to attendees at two large national NP conferences in 2004; a total of 562 questionnaires were completed and used in the analysis. Conclusions: Ten percent of the sample perceived that they were very well prepared for practice as an NP after completing their basic NP education.Is NY a full practice state for NP? ›
New York State Education Law holds NPs independently responsible for the diagnosis and treatment of their patients and does not require an NP to practice under physician supervision.
- You graduated from a New York State Education Department (NYSED) registered NP education program or an NP program that is equivalent to an NYSED registered NP education program, as determined by NYSED. ...
- You are currently NP certified by an acceptable national certifying organization.
So, the short answer is yes – a DNP nurse may be referred to as "doctor," however, some states have legislation surrounding this. For example, Arizona and Delaware forbid nurses, pharmacists, and other professionals from using the "doctor" title, unless they immediately clarify their role.How many times can you fail NP boards? ›
What happens if I fail the exam? ANCC: If you fail the ANCC FNP exam you will have the ability to retake the test after 60 days of the last testing date; however, you cannot take the exam more than three times in any 12 month period.How hard is the NP board exam? ›
Is the FNP exam hard? Becoming a Certified Nurse Practitioner isn't easy, and yes, both the AANP and ANCC certification exams are challenging — very challenging. They will take a great deal of analytical thought, clinical judgement, and preparation.How many US states have full practice authority for nurse practitioners? ›
Where are NPs able to practice independently? Currently, NPs can now practice independently in 27 states and in Washington, D.C. In other states, while NPs may perform many of their job functions with a high level of independence, they must work in collaboration with or under the supervision of a physician.What is the best state to practice nurse practitioner? ›
- New York. Nurse practitioners in the Empire State earn an average of $126,440 a year. ...
- Arizona. Arizona is among the states where nurse practitioners enjoy full practice authority. ...
- Maryland. ...
- Washington. ...
- Oregon. ...
- 6. California. ...
- Colorado. ...
- New Jersey.
Restricted practice states: According to the AANP, restricted-practice states as of January 2020 were California, Florida, Georgia, Massachusetts, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Virginia.What are the 2 NP certifications? ›
There are currently two recognized certifying boards for NPs: The American Nurses Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP).
|Years of experience||Per year|
|Less than 1 year||$117,036|
|1 to 2 years||-|
|3 to 5 years||$142,411|
|6 to 9 years||-|
It typically takes 6 to 8 weeks to receive your New York nursing license. Timeframe will vary based upon the volume of applications currently under submission.Can a DNP call herself doctor? ›
Nurses With a Doctorate in Nursing Practice (DNP) Should Not Call Themselves “Doctor” in a Clinical Setting.What is the salary of a DNP in New York? ›
|Annual Salary||Monthly Pay|
Doctor of Medicine (MD) and Doctor of Nursing Practice (DNP) programs are two post-graduate degree options for medical professionals. While an MD is suited for students who want to start their careers as doctors, a DNP is designed for registered nurses looking to advance in their careers.How long should you study for NP boards? ›
Allow a minimum of 4 to 6 weeks of planned study after you complete the review course to maximize your likelihood of success on this important high-stakes exam.What percentage of people pass the NP exam? ›
AANP and ANCC recently published their certification statistics for 2022. The AANP FNP pass rate dropped from 85% in 2021 to 75% in 2022. The ANCC FNP pass rate remained steady with a pass rate of 85.9%, down slightly from 86.6% in 2021.What is the difference between FNP C and FNP BC? ›
Perhaps most importantly, the certification exams have different scopes. The FNP-C is meant for FNPs who plan to go into clinical practice. The FNP-BC is aimed at nurse practitioners who want to make an impact on the profession as a teacher or policymaker (although they are still licensed to practice).What is the hardest part of NP school? ›
- Clinical hour requirement. ...
- Clinical Placements. ...
- Certification Exam. ...
- Demanding and complex schedule. ...
- Continuing to work full time. ...
- Coursework. ...
- Specialization. ...
- Graduate Requirements.
Plan to start studying for the FNP exam about six months prior to taking your exam. Starting 6 months in advance will allow you to make sure that you're completely prepared for the exam. Sit down with your calendar and develop a study schedule. Try to plan to study 2 to 3 hours a day 5 to 6 days a week.
Denial of eligibility of an individual to take the certification examination may be appealed. The candidate shall assume responsibility for providing adequate documentation to support the appeal.
|State||Employment (1)||Employment per thousand jobs|
- Alaska. Alaska offers FPA to all NPs, including the ability to prescribe class II – V controlled substances. ...
- Arizona. NPs are granted FPA and full prescriptive authority through the Arizona State Board of Nursing. ...
- Delaware. ...
- Hawaii. ...
- Idaho. ...
- Iowa. ...
- Maryland. ...
- 1. California. According to data from the U.S. Bureau of Labor Statistics, California is the highest paying state for nurse practitioners. ...
- New Jersey. ...
- Washington. ...
- New York. ...
- Massachusetts. ...
- Nevada. ...
- Minnesota. ...
Critical Care Nurse Practitioner
Possibly one of the most difficult nurse practitioner specialties, a critical care nurse practitioner has to learn to deal with life and death situations daily due to treating the most acutely ill or traumatized patients.
As a hospitalist NP, you can expect to have one of the highest-paying nurse practitioner jobs. The average yearly wage is about $117,880. And while hourly rates vary based on region and specific hospitals, it is $56.67 on average.What type of nurse practitioner is in highest demand? ›
- Family (70.3%)
- Adult-Gerontology Primary Care (8.9%)
- Psychiatric/Mental Health (6.5%).
The lowest-paying states are Tennessee ($95,120), Alabama ($102,410), South Carolina ($102,850), Missouri ($103,490), and West Virginia ($104,750). NP salaries vary significantly across the country.Does a PA or NP have more autonomy? ›
Overall, nurse practitioners have more autonomy than physician assistants. PAs typically work under the supervision of a physician, but the level of supervision can vary by state. They are generally not able to practice independently or make decisions about patient care without the oversight of a physician.Have six states made it a felony for nurse practitioners? ›
Six states have made it a felony for nurse practitioners, despite their doctoral education, to refer to themselves as “doctor.” Nine states require nurse practitioners to follow their introduction with a clarifying statement, such as, “I am Dr. DeCapua, a psychiatric nurse practitioner.”
NPs can obtain multiple degrees across multiple specialties, or they may choose to just focus on one area. Depending on your geographic region, knowledge about specialty NPs may be fairly uncommon, or a specialty certification may be the only way to get a job in a particular area.Do all NPs have DNP? ›
No, a DNP is a Doctor of Nursing Practice degree and a nurse practitioner (NP) is the title bestowed on a nurse who has at least an MSN degree and has completed the nurse practitioner clinical and didactic requirements.Which one is better AANP or ANCC? ›
If you want to show your assessment and diagnosis skills, the AANP might be the better fit. Think about the ANCC exam if you want to show your prowess with theory and professional issues. It's not unheard of to take both; you could also apply to test for both and stop after passing one if that feels right to you.How much does an NP at urgent care make in NY? ›
Average WellNow Urgent Care Nurse Practitioner hourly pay in New York State is approximately $82.76, which is 29% above the national average.Do nurse practitioners make 6 figures? ›
Can Nurses Make Six Figures? Yes, you can 100% make six figures as a nurse. The disclaimer is that working in some states may make this easier than working in other states. Geographic location is a huge indicator of starting salary and can be a reason why some of you are not as close to others when looking at raw data.What is the highest paid nurse in NYC? ›
NYC Nursing Salary by Occupation
Nurse anesthetists earn the highest RN salary in NYC, with an average of $218,380, compared to the national average of $189,190.
Fees. The fee for licensure and first registration is $143. The fee for a limited permit is $35.How many times can you take the NP exam? ›
Before being allowed to retake the exam, candidates must complete 15 hours of continuing education credit in the area or areas of weakness identified on the score report. The AANP certification exam may not be taken more than two times in any calendar year. Which nurse practitioner certification exam will you take?How long is NP school in NY? ›
Full-time students should be able to complete the degree in 2.5 years; part-time students will take 3.5 years. Both the adult Adult-Gerontology Nurse Practitioner and Family Nurse Practitioner tracks consist of 46 credits and 625 to 675 clinical hours.What credentials do DNPs have after their name? ›
The educational degrees earned by NPs entering practice today are master's in nursing (MSN) or doctoral degrees (doctor of nursing practice, DNP).
More than 64% of today's nursing workforce is prepared at the baccalaureate and higher-degree level, but only 1.2% have a DNP degree and 0.6% a PhD, according to American Association of Colleges of Nursing (AACN) statistics.Is a DNP higher than an NP? ›
While all nurses in advanced roles have graduate degrees, DNP graduates inherently have a higher level of education than an NP with only a master's degree. Professionals with a DNP degree can hold leadership positions in management or education, as well as advanced clinical roles.How much does a new grad NP earn in New York? ›
|Years of experience||Per hour|
|Less than 1 year||$49.83|
|1 to 2 years||$59.86|
|3 to 5 years||$60.62|
|6 to 9 years||-|
Of these positions, nurse anesthetists are the highest paid, earning a median annual wage of nearly $200,000, and the most competitive, requiring a master's or DNP and CRNA certification. Other jobs with higher DNP salaries include: Medical and Health Services Manager. Nurse Manager.What is the highest paid DNP? ›
The average income of all DNPs is $157,750 with a ceiling of $205,360 for certain specializations, such as nurse anesthetists.What states can a DNP not be called a doctor? ›
So, the short answer is yes – a DNP nurse may be referred to as "doctor," however, some states have legislation surrounding this. For example, Arizona and Delaware forbid nurses, pharmacists, and other professionals from using the "doctor" title, unless they immediately clarify their role.Can a DNP diagnose? ›
Depending on state laws and regulations, nurse practitioners are afforded a wide amount of autonomy in practice, meaning they can prescribe, diagnose and treat on their own without the direct physician supervision other types of nurses are subject to.Which is better DNP or PhD in nursing? ›
Typically, nurses with a DNP degree have a higher annual salary than those with their PhD. That's in part due to the settings in which they work; since DNPs often practice clinically and see patients, they have a higher earning capacity than nurses in higher education or governmental positions.How do researchers measure NP performance? ›
NP performance is evaluated on several levels: productivity, utilization, and patient satisfaction, as well as quality of clinical decision making.Are Leik questions harder than AANP? ›
- The AANP FNP Exam: The questions were similar to a mixture of Leik and Hollier. There were questions verbatim that I had seen while studying questions. The test is much easier than leik or hollier.
Outcomes included measures such as patient satisfaction; patient perceived health status; functional status; hospitalizations; emergency department visits; and biomarkers such as blood glucose, serum lipids and blood pressure. Newhouse, et al., conclude that NP patient outcomes are comparable to those of physicians.What is the pass rate for the NP exam? ›
AANP and ANCC recently published their certification statistics for 2022. The AANP FNP pass rate dropped from 85% in 2021 to 75% in 2022. The ANCC FNP pass rate remained steady with a pass rate of 85.9%, down slightly from 86.6% in 2021.Why NP is better than MD? ›
MD school includes more rigorous upper-division science coursework. you're seeking a faster way to advanced practice. If better work-life balance is important to you, a NP has more flexibility and more options for accelerated training than a MD. you want to practice more autonomously.Are NPs as good as MDs? ›
How does an NP compare with a physician? NPs provide a very similar healthcare service, but MDs are in another category. NPs and physicians perform many of the same tasks, which can include the prescription of certain medications, and the diagnosis and treatment of various illnesses.What performance measures are used for NP productivity? ›
Hence, the health care industry typically uses acuity as well as total patients seen. Acuity is measured by relative value units, or RVUs. Thus, the NP who saw 20 high-RVU patients in 12 hours could be considered more productive than the NP who saw 20 low-RVU patients.Which NP board is easier? ›
The AANP is rumored to be the easier of the two exams, specifically for those seeking their FNP certification since it has a 5% higher pass rate than that of the ANCC FNP exam. Using the pass rate as a basis for difficulty then you can reasonably say that the AANP exam is easier than the ANCC.What is the pass rate for AANP vs ANCC? ›
The pass rates are not very different; for 2021, the AANP pass rate was 84% (for FNP), and the pass rate for the ANCC was 87% (for FNP). The cost is similar; as of this writing, the AANP test is $315, and the ANCC test is $395, and both organizations offer a discount to their members.What are the three types of outcome measure? ›
3 Types of Outcome Measures: Performance-Based, Self-Reported, and Hybrids.How do you evaluate outcomes to inform nursing practice? ›
Standard 7 Evaluates outcomes to inform nursing practice:
I would: communicate findings to patient; reassess BP again at appropriate timeframe; compare past/future BP readings to current reading; use reading to inform future care.
Researchers reviewed the health services, outcomes, and care costs of Medicare patients with Type 2 diabetes who were seen by either NPs or primary care physicians. Overall, patients who saw only NPs, had better outcomes than those who saw physicians.
Graduate program acceptance rate
A university's acceptance rate into a nurse practitioner program is definitely a reason why it's so difficult to get into a nurse practitioner school.
There are currently two recognized certifying boards for NPs: The American Nurses Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP).