If you’re a nurse practitioner working in a state without full practice authority, you already know that collaborative practice agreements aren’t just paperwork, but they’re also the foundation that allows you to deliver care legally and safely.
Right now, only 30 states grant nurse practitioners full practice authority. In the remaining 20, NPs must work under a formal collaborative practice agreement with one or more physicians to prescribe medications, provide treatment, and operate in compliance with state law.
This guide outlines what a nurse practitioner collaborative practice agreement should include and how to implement one in a way that supports your clinical practice, protects your license, and keeps your focus where it belongs: on your patients.
What Is a Collaborative Practice Agreement?
A collaborative practice agreement (CPA) is a formal, state-required document that outlines how a nurse practitioner or other advanced practice registered nurse works in partnership with a licensed physician to deliver patient care.
It defines responsibilities like prescriptive authority, clinical oversight, chart reviews, and referral protocols, ensuring that services are provided legally and within the practitioner’s scope of practice.
In states without full practice authority, a collaborative practice agreement for nurse practitioners is essential for treating patients, prescribing medications, and operating within healthcare regulations.
How to Set Up a Compliant and Effective Collaborative Practice Agreement
1. Understand Your State’s Requirements First
Before drafting any practice agreement, start by understanding your state’s law. Each state has its own rules regarding how advanced practice registered nurses (APRNs) must collaborate with one or more physicians.
Some states, such as Texas and Florida, require that collaborating physicians perform regular chart reviews and maintain written protocols. Others may limit an NP’s ability to prescribe controlled substances without direct physician supervision.
You’ll also want to verify whether your state’s board of nursing requires formal approval of the CPA document or simply mandates that it be on file.
Helpful resources:
- State pharmacy associations
- Your state’s board of medicine or nursing
- Centers for Medicare and Medicaid Services (CMS) guidelines
Understanding these regulations is the first step in protecting your license and building a scalable, compliant practice.
2. Define Clear Roles and Responsibilities
A strong nurse practitioner collaborative practice agreement must clearly define what each party is responsible for. This includes both the licensed physician and the NP.
Your agreement should outline:
- Prescriptive authority, including any limitations on controlled substances
- Frequency of chart audits or case reviews
- Referral protocols (e.g., when to refer patients back to the physician)
- Scope of services delivered by the NP
- Emergency and backup plans
- Process for continuing education, quality assurance, and peer review
By documenting responsibilities in detail, you reduce confusion, increase efficiency, and stay aligned with Medicare Part B, state law, and pharmacy board requirements.
3. Choose the Right Collaborating Physician
Not every physician is a good fit for your collaborative practice. While legal qualifications matter, the best collaborating physicians offer more than a signature. They provide guidance, flexibility, and clinical alignment.
Look for a physician who:
- Understands your practice setting (e.g., long-term care facilities, health and wellness, stroke prevention, aesthetic medicine)
- Has clinical experience that complements your services
- Is responsive and engaged in quality improvement
- Supports your professional development and scope of practice
4. Draft a Legally Sound Agreement
A proper collaborative practice agreement for nurse practitioners should include the following elements:
- A detailed description of the medical services to be performed
- Guidelines for prescribing and managing drugs and medications
- Protocols for documentation and audits
- Communication expectations between the physician and the advanced practice nurse
- Backup coverage and physician availability
- Termination clause and review schedule
- Alignment with pharmacy, nursing, and medical board rules
Some states, such as Arkansas or New Mexico, also require submitting this document to a state board or using a template that meets consortium recommendations.
Engaging a legal consultant with experience in medicine, pharmacy, or health care law can prevent costly missteps.
5. Operationalize the Agreement
Too often, a CPA becomes a static document that’s filed and forgotten. To implement it properly, you’ll need to build systems that turn the written agreement into day-to-day reality.
This includes:
- Regularly scheduled meetings with the physician
- Automated quality assurance workflows built into your EMR
- Documentation of all referral and review activities
- Scheduled reviews and updates of the CPA as your services evolve
Make it easy for both parties to track and meet their obligations. This reduces risk and ensures accountability across the provider team.
6. Monitor and Update as You Grow
Your collaborative agreement should grow with your practice. If you expand your services, say, into aesthetic medicine, heart disease management, or chronic disease control, your agreement must evolve accordingly.
Review your CPA if you:
- Hire new health care providers or expand to new practice settings
- Begin offering new treatments that require referral or prescribing
- Change your patient population (e.g., from geriatrics to women’s health)
Confidently Start Your Collaborative Practice with Medical Director Co.
Whether you’re establishing your first collaborative practice agreement for nurse practitioners, expanding into new services, or navigating a multi-state model, compliance should never be an afterthought.
At Medical Director Co.,we connect advanced practice nurses with experienced, licensed physicians who are ready to provide the oversight required in your state. Our matches are more than paper-based. They’re strategic partnerships built around access, compliance, and long-term clinical support.
Ready to launch your practice legally and confidently? Get started here.
Frequently Asked Questions
Do all nurse practitioners need a collaborative practice agreement?
No. Only nurse practitioners in states without full practice authority are required to have a nurse practitioner collaborative practice agreement. Always check with your state’s board of nursing or board of medicine for specific requirements.
Who can serve as the collaborating physician in a CPA?
The collaborating physician must be a licensed physician in good standing, typically with clinical experience relevant to the NP’s practice setting. They must meet the state board’s criteria for oversight and be willing to create formal relationships and review clinical activities as required by law.
Can a collaborative practice agreement be used in telehealth or remote settings?
Yes, but the agreement must still comply with state-specific laws. Many telehealth services operated by NPs rely on CPAs to authorize remote prescribing and treatment. The practice agreement should include communication methods, supervisory protocols, and a plan for referrals or emergencies when services are delivered outside traditional clinical settings.
How often should a CPA be reviewed or updated?
At minimum, the collaborative practice agreement should be reviewed annually or whenever your scope of services changes, such as adding aesthetic treatments, expanding into long-term care facilities, or incorporating disease control programs like heart disease or stroke prevention. Some states also require updates based on Medicare Part B billing eligibility or new pharmacy board regulations.
Is a collaborative practice agreement legally binding?
Yes. A collaborative practice agreement is a legally binding document that governs the relationship between an advanced practice nurse (such as a nurse practitioner) and a licensed physician. It ensures compliance with state health care laws, outlines prescriptive authority, and helps define the standard of care in the chosen practice setting.
Blaz Korosec is the CEO and co-founder of Medical Director Co., a nationwide platform that connects aesthetic and wellness professionals with licensed physicians for medical oversight, supervision, and compliance support. With a background that bridges healthcare operations, regulatory compliance, and entrepreneurial growth, Blaz has worked closely with hundreds of nurses, physician assistants, and clinic owners to help them legally launch and scale medical spas, telehealth weight loss clinics, IV hydration businesses, and aesthetic practices.
Blaz holds a degree in finance from Southern Methodist University (SMU) and has built a diverse portfolio of businesses ranging from healthcare to hospitality, including a national network of RV parks and medical clinics. Through MedicalDirector.CO, he’s developed a deep understanding of the state-by-state rules that govern collaborative agreements, PC/MSO structures, telemedicine protocols, and injectable treatments—translating complex legal frameworks into easy-to-implement solutions for clinicians and business owners.
Blaz is particularly passionate about helping nurses and mid-level providers unlock business ownership opportunities, and he’s known for designing systems that streamline operations, boost revenue, and ensure long-term legal protection. His team includes former prosecutors, senior RNs, and physicians who together support a growing number of clinics across all 50 states.
When he’s not working, Blaz enjoys mountain biking, restoring properties, and exploring the outdoors with his wife. He’s based in Texas but works with clients nationwide.
