WORKING WITH ADVANCED PRACTICE PROVIDERS - Scope of Practice - Key roles and physician relationship

Sep 21, 2026

Working with Advanced Practice Providers defines the scope of practice for advanced practice providers, including physician assistants (PAs) and advanced practice registered nurses (APRNs). The document distinguishes nurse practitioners (NPs) as a primary reference in neurology and outlines how prescriptive authority may require physician involvement and specific written agreements depending on state rules. It explains supervisory versus collaborative physician roles, limits based on training and licensure, and physician–APP meeting and chart review expectations. It also addresses termination when new physician relationships are added and emphasizes educational intent rather than legal advice.

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CategoryHealthcare

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Advanced Practice Providers—Scope of Practice

Physician and Advanced Practice Provider Relationship

Termination of Relationship

WORKING WITH ADVANCED PRACTICE PROVIDERS Advanced Practice Providers—Scope of Practice • “Advanced practice provider” refers to: - Physician assistants (PAs) - Advanced practice registered nurses (APRNs) - Includes: nurse practitioners (NPs), clinical nurse specialists, nurse midwives, nurse anesthetists For simplicity, this document will refer to NPs rather than APRNs, as NPs are the most common APRN in neurology. • In some states, APPs are required to have physician involvement for prescriptive authority. This could include required written agreements. Understand your state’s specific regulations related to scope of practice for APPs (NPs: [https://www.aanp.org/advocacy/state/](https://www.aanp.org/advocacy/state/) state-practice-environment and PAs: [https://www.aapa.org/](https://www.aapa.org/)[ ](https://www.aapa.org/)[advocacy-central/state-advocacy/state-laws-and-regulations/](advocacy-central/state-advocacy/state-laws-and-regulations/) ) - PA/physician relationships are referred to as“supervisory.” The physician is the PA’s “supervising physician.” - NP/physician relationships are referred to as“collaborative.” The physician is the APRN’s“collaborative physician.” • NPs may work under their own license, within their own scope of practice. They may only accept those assignments that consider patient safety and that are commensurate with their own educational preparation, experience, knowledge, and physical and emotional ability. • As an NP, scope of practice is only dictated by formal training, board certification, and licensure, and is not impacted by experience garnered as a registered nurse (RN) . Experiences gained as an RN are not equivalent to and cannot replace formal education in the advanced practice role and population focus. • Each NP is responsible for practicing within the role and population focus, as licensed by the board and appropriate to his/her educational preparation. • A PA shall provide medical services (within his/her education, training, and experience) that are delegated by the supervising physician. • NPs or PAs are responsible for recognizing when they are in danger of exceeding their personal and professional scope of practice. Physician and Advanced Practice Provider Relationship • Regular face-to-face meetings between the supervising or collaborating physician and the APP are required in some states. We recommend monthly face-to-face meetings until the third anniversary, and quarterly meetings thereafter. Face-to-face meetings should be part of the quality assurance and improvement plan. • In many states, physicians need to review charts and cases. This requirement varies state to state, so be sure to check with your state boards of medicine and nursing. Termination of Relationship • The addition of a new supervising or collaborating physician does not terminate any other supervision or collaboration that is currently in place. • Please check with your state boards of medicine and nursing to understand the requirements for termination. Physician Assistant (PA) Advanced Practice Provider Advanced Practice Registered Nurse • Nurse Practitioner • Certified Registered Nurse Anesthetist • Clinical Nurse Specialist • Certified Nurse-midwives These materials are intended for educational purposes only and should not be considered legal advice.

FAQs

Which roles are included under “advanced practice provider” in the document?

The document includes physician assistants (PAs) and advanced practice registered nurses (APRNs). It lists nurse practitioners (NPs), clinical nurse specialists, nurse midwives, and nurse anesthetists.

How does the document describe the physician–APP relationship terms?

PA/physician relationships are referred to as “supervisory,” with the physician as the PA’s “supervising physician.” NP/physician relationships are referred to as “collaborative,” with the physician as the APRN’s “collaborative physician.”

What does the document say about meeting frequency and required involvement?

It states that regular face-to-face meetings between the supervising or collaborating physician and the APP are required in some states. It recommends monthly face-to-face meetings until the third anniversary, then quarterly meetings, and notes that physicians may need to review charts and cases depending on state requirements.

Sep 21, 2026

Upload by Sophia Brooks