by Angela Lyttle, CNM
It is difficult to think of other professions where individuals are not allowed to work/practice to the level that they have been trained. In Indiana, I can practice as a nurse-midwife without a collaborative agreement. However, to prescribe medications (which was part of my training and within my scope of practice – and important for providing safe care), I have to have a collaborative agreement. This is a little like telling a mechanic that he can go to school to become a mechanic, own his own shop, but if he wants to use tools, then he needs to go to a dealership and ask the shop manager (his business competitor!) to sign off on his ability to use said tools.
This is definitely a barrier to practice for Advanced Practice Nurses who wish to start their own business. Most physicians now work in large groups, and most of these groups are owned by hospitals/corporations. Even if an individual physician is willing to sign a collaborative agreement, the physician is often blocked by his/her practice partners or the corporation.
Both the Institute of Medicine and the Federal Trade Commission have come out in support of removing barriers for Advanced Practice Nurses. It won’t be long before legislation to remove barriers for APNs is proposed in Indiana.