The Written Practice Agreement

In the state of Maryland, and a number of other states, there is a pesky little thing called a written practice agreement. When a midwife, or any advanced practice nurse, wants to hang out their shingle and go to work, the board which governs their practice, in this case,the Board of Nursing, requires then to have a written agreement with their collaborating/consulting physician. A series of meetings take place about six weeks after that agreement hits the BON. Then a letter is sent to the midwife/AP nurse, and only then, may she function outside of the RN role. This translates into months ticking by after passing boards during which you must sit on your hands and not be able to orient fully to your new job.
While this seems like maybe it would be a benign little document there are a number of problems with it other than the one listed above. First, it's a supervisory document which is superfluous for those licensed professionals who have passed their board exams in their field of expertise and demonstrated competency. Second, it drives up the malpractice insurance for that physician with whom the AP nurse or midwife is collaborating. It is for this reason, and, frankly, a financially understandable one, that physicians often will not have a collaboration with a midwife. It is also for this reason that many midwifery practices wind up closing. No one can afford to be their collaborating physician.

This greatly limits a woman's right to choose her caregiver when she is seeking well woman,family planning, intrapartum and postpartum care. Women deserve the right to choose their caregiver.Why on earth would a ursing organization seek to limit that choice?
There is a bill in the MD state congress right now to prohibit the BON from requiring a written practice agreement, as so many other states have done. If you live in the state of Maryland, please do take the time to write or call your legislator and ask for their support on HB 1407. There will be a hearing on this bill mid- March.