Nurse practioners (NPs) and physician assistants (PAs) work in highly collaborative roles with physicians. Both may have similar responsibilities that include taking patient histories, performing physicals, prescribing medicine, providing immunizations and assisting in surgery.

PAs work with the supervision of a physician, who delegates tasks and responsibilities to them. “It’s a collaborative relationship and a partnership between the PA and the physician. What that looks like after they’ve been in practice a couple of years is variable,” Anita Duhl Glicken, associate dean for PA studies and director of the physician assistant program at the University of Colorado School of Medicine in Denver told Clinical Advisor. “Often, the physician is just as likely to come to the PA to discuss a challenging case as the PA is to seek consultation from the physician.”

Like PAs, NPs practice in a variety of settings. But unlike PAs, NPs can practice independently in some states. Other states require NPs to have a collaborative practice agreement with a physician. An NP can practice in a different physical location than the physician regardless of whether a collaborative practice agreement is needed.

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American Association of College of Nursing (AACN) states that nurses do not merely “assist” physicians and other healthcare providers. Instead, “they practice independently within their own defined scope of practice. Nursing roles range from direct patient care to case management, establishing nursing practice standards, developing quality assurance procedures, and directing complex nursing care systems.”

NPs’ responsibilities include conducting physical exams, diagnosing and treating common acute illnesses and injuries, providing immunizations, managing high blood pressure, diabetes and other chronic problems, as well as ordering and interpreting X-rays and other lab tests.

As the need for high-quality care grows, NPs are increasingly assuming independent provider roles. “There’s absolutely no evidence that outcomes are better in a state that requires NPs to have written agreements or oversight by another professional,” said Julie Stanik-Hutt, PhD, ACNP-BC, FAAN, director of the master’s program at Johns Hopkins University School of Nursing, in Baltimore. “That mandated collaboration doesn’t in reality consist of very much. The physician isn’t really ‘supervising’ anything and is busy seeing their own panel of patients all day.”

Susan Schooleman is a freelance medical writer living in the greater Denver area.