PRAC 6670: Assignment: Week 9 Practicum Journal: State Practice Agreements

Challenges and Solutions for PMHNPs: Optimizing Practice Independence in Arizona

Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults

Assignment: Week 9 Practicum Journal: State Practice Agreements

The Practice Agreements for PMHNPs in Arizona

PMHNPs in Arizona have the authority to practice independently without the requirement to collaborate with or be supervised by a physician. As such a PMHNP is not mandated to have a practice agreement with a physician to be able to practice or prescribe medications. According to Phillips (2020), NPs in Arizona have full autonomous authority and practice under the licensure authority of the Arizona nursing boars rather than the authority of a licensed doctor. Nurse practitioners have the authority to admit patients to healthcare facilities, manage the care of these paints, and also discharge them.

PHMPs in Arizona have full dispensing and prescribing authority. The state nursing board permits NPs to dispense and prescribe devices and drugs within the population focus of the nurse practitioner. A NP is also permitted to prescribe scheduled drugs.  According to Phillips (2020), a NP with dispensing and prescribing authority who wants to prescribe controlled substances is mandated to apply for a DEA number and present it to the Arizona Board of Pharmacy and Board of Nursing. Additionally, NPs who want to have or are already in possession of a DEA number must also register with the board of nursing to be issued with a controlled substance prescription monitoring program.

The Two Physician Collaboration Issues I Identified

The first physician collaboration I identified is that the requirement for a collaborative agreement negatively impacts the number of PHMHPs available to deliver care.   Requiring a PHMP to collaborate with and be supervised by a physician reduces the effectiveness of the PMHNP to provide care because a nurse practitioner does not have the ability to provide any nursing services without a collaborative agreement. As indicated by Barnes et al (2016), for NPs working in states where they are mandated to have collaborative agreements, if the collaborating physician relocates to another state or decides to terminate the agreement, the NP is not able to render any services to patients.

The second collaboration issue I identified is that the requirement for a PMHNP to collaborate with a physician makes it hard for the PHHNP, particularly those working in rural to meet the collaborative agreement requirement because of a shortage of physicians in rural regions.  In some instances, collaborative agreements require a NP to be in geographic proximity with the physician she/ he is collaborating with. This is problematic for NPs working in rural regions because there are fewer physicians working in remote regions, with the majority of them being concentrated in urban and suburban regions. Therefore, PMHNPs are not able to provide health care services in remote areas due to failure to easily locate a physician to collaborate with (Chapman et al., 2019).

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What I think are Barriers to PMHNPs Practicing Independently in Arizona

Financial concerns are a significant barrier to independent practice for PMHNPs in Arizona.  According to Duncan and Sheppard, (2015), startup costs usually dissuade NPs from practicing independently. Some NPs spend over 50, 000 dollars in startup costs. Office utilities, taxes, lease payments, and personnel costs add to the costs of operating their own clinics.  Reduced reimbursement rates are another barrier to the independent practice of PMHNPs in Arizona. Nurse practitioners are reimbursed at a reduced rate for the services they provide which makes them unable to keep their business afloat due to financial constraints. As Cabbabe (2016) indicates, Medicare reimburses NPs 75 to 95 percent of the physician fee for the same services.

Institutional or organizational policies are another barrier to independent practice by PMHNPs.  Some healthcare facilities have policies that deny clinical privileges or hospital admitting privileges to NPs.  According to Phillips (2020), the Arizona Department of Health policies necessitates an attending doctor to be present for hospitalized patients in acute care facilities.   These facilities use this citation to deny autonomous hospital and admitting privileges to NPs.  With no clinical privileges in a healthcare facility, NPs cannot go on treating their clients who are admitted

Lack of recognition from other health care provides, particularly physicians and the general public is another barrier to PMHNPs practicing independently in Arizona. Although consumers and other providers believe that NPs play crucial roles in interprofessional teams, they perceive that they are not adequately educated and trained to provide the same services provided by physicians (Duncan & Sheppard, 2015).

A  Plan for How I Might Address PMHNP Practice Issues in AZ

I might address the PMHNP practice issues in Arizona by recommending legislators to make amendments to both private and public payment regulations and craft and enact laws that will permit equitable autonomous reimbursement for NPs delivering care in all every care setting.  I would also advocate for consumer-based organizational and local nursing associations to work jointly to educate consumers on the duties and role of PMHNPs so that the public can see PMHNPs as competent providers capable of providing safe, quality, and cost-effective care.

I would also hospitals to relax their regulations to remove barriers to hospital privileges and recommend that NPs, including PMHNPs, be allowed to provide care to admitted patients in the absence of a physician since they are already recognized as primary care providers. Lastly, I would urge physicians to recognize NPs are competent members of the interprofessional care team instead of competitors.


Barnes, H., Maier, C. B., Sarik, D. A., Germack, H. D., Aiken, L. H., McHugh, M.D. (2016). Effects of Regulation and Payment Policies on Nurse Practitioners’ Clinical Practice. Medical Care Research and Review, 74(4), 431-451. doi: 10.1177/1077558716649109

Cabbabe, S. (2016). Should Nurse Practitioners Be Allowed to Practice Independently? Missouri Medicine, 113(6), 436-437).

Chapman, S. A., Toretsky, C., & Phoenix, B. J.  (2019). Enhancing Psychiatric Mental Health Nurse Practitioner Practice: Impact of State Scope of Practice Regulations. Journal of Nursing Regulation, 10(1): 35-43.

Duncan, C. G., & Sheppard, K. G.  (2015). Barriers to Nurse Practitioner Full Practice Authority (FPA): State of the Science. International Journal of Nursing Student Scholarship, 2, 8.

Phillips, S. J. (2020). 32nd Annual APRN Legislative Update: Improving access to high-quality, safe, and effective healthcare.  The Nurse Practitioner, 45(1), 28-55. doi: 10.1097/01.NPR.0000615560.11798.5f