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Less Protocol, More Collaboration

Lauren Smith
Auburn University/Auburn University Montgomery

Less Protocol, More Collaboration

The Alabama Board of Nursing (2003) has established requirements for collaborating
practice between physicians and certified registered nurse practitioners (CRNP). The
requirements provide that the physician is to be readily available, be practicing in the same site
for a minimum of ten percent of the time, and review at least ten percent of the medical records.
The requirements go on to state that there is to be a protocol approved and signed by the
physician and CRNP. This protocol will provide drugs, medical treatments, tests, and procedures
that may be carried out by the CRNP. The protocol will also include a pre-determined plan for
emergencies and identify a referral process from the CRNP to the collaborating physician or
another physician (Alabama Board of Nursing, 2003). The Alabama Board of Nursing legislation
should inactivate this protocol law in order to provide for collaboration equality, greater access to
care, and increased recruitment of CRNPs for the state of Alabama.
Schadewaldt, McInnes, Hiller, and Gardner (2013) explored the collaboration between
physicians and CRNPs and provided that the lack of a hierarchical arrangement and the
confidence in the competence of the collaborating partner created higher provider and patient
satisfaction. CRNPs felt they had gained mutual respect and/or trust when their collaborating
physician sought advice from them. Physicians have begun to see CRNPs as an extra resource
rather than a threat to their position (Scadelwaldt, McInnes, Hiller, & Gardner, 2013). If mutual
respect and competence is established between the collaborating physician and CRNP, there is no
need for a set protocol which limits the CRNP to work autonomously and to their full scope.
State regulations restrict CRNPs to perform their duties to their fullest potential despite
evidence providing that CRNPs are cost effective, provide quality care, and are safe providers
(Pasaron, 2013). Schadewaldt et al., (2013) provide that collaborative relationships bring better

patient care with decreased wait times, treatment periods, and costs. By decreasing the time and
cost one patient is spending in the clinic it is therefore allowing more patients to be utilizing the
care of the CRNP. Equality in collaboration yields trust between the CRNP and physician and
allows for autonomous practice and more accessible healthcare. Safe, cost-effective, and quality
healthcare is being restricted by the implementation of the protocols.
Pasaron (2013) offers in her article that by increasing job satisfaction, recruitment and
retention are increased which in turn increases the accessibility to quality healthcare. The
findings presented in this study also provided that autonomy of the CRNP created the highest job
satisfaction (Pasaron, 2013). In order to keep the CRNPs that are already employed and to be
attractive to future CRNPs, the use of the restrictive protocol should be ended. Allowing CRNPs
more autonomy will allow for more satisfaction which will be evident to prospective CRNPs and
bring in more CRNPs to the state of Alabama. The idea of working with the collaborating
physician instead of under the collaborating physicians set protocol will present a more
attractive profession for those who may be considering practicing as a CRNP in Alabama.
Hamric, Hanson, Tracy, and OGrady (2014) describe collaboration as a commitment
between two people who work together to solve problems and share knowledge between the two.
The collaborators should hold common values, goals, and opinions (Hamric, Hanson, Tracy, &
OGrady, 2014). The foundation of a shared vision and equality between the collaborating
physician and CRNP will diminish the need for the protocol law to be enacted. By developing a
working relationship they are more likely to use each other as a resource and to allow for more
autonomy. The use of more autonomy allows for more accessible care by providing decreased
patient care time and cost allowing for more patients to be seen. Autonomy also increases job
satisfaction of the CRNPs which will appeal to prospective CRNPs in Alabama.

References
Alabama Board of Nursing. (2003). Advanced practice nursing: Collaborative practice.
Retrieved from Alabama Board of Nursing website:
https://www.abn.alabama.gov/UltimateEditorInclude/ UserFiles/docs/admincode/Chapter%20610-X-5.pdf
Hamric, A.B., Hanson, C.M., Tracy, M.F., & OGrady, E.T. (2014). Advance practice nursing:
An integrative approach (5th ed.). St. Louis: Elsevier.
Pasarn, R. (2013), Nurse practitioner job satisfaction: looking for successful outcomes. Journal
of Clinical Nursing, 22: 25932604. doi: 10.1111/j.1365-2702.2012.04331.x
Schadewaldt, V., McInnes, E., Hiller, J., & Gardner, A. (2013). Views and experiences of nurse
practitioners and medical practitioners with collaborative practice in primary health care an integrative review. BMC Family Practice, 14. doi:10.1186/1471-2296-14-132