MN501 Unit 5 seminar reflection example

Should Indiana Drop Its Collaboration Requirement? Testing Three Seminar Arguments Against the Statute and the Evidence

[Student Name]

Purdue University Global

MN501: Advanced Nursing Roles

Unit 5 Seminar Reflection

[Instructor Name]

[Date]

Seminar participants are identified by role only. No classmate or instructor is named or quoted as policy.

The Question and Where I Started

The seminar question was whether Indiana should remove the requirement that a nurse practitioner with prescriptive authority keep a signed agreement with a physician or other collaborating practitioner. I came into the session in favor of removal. My reasons were mostly loyalty to the profession and a general sense that nurse practitioners are safe, and I could not have cited a single study to support that view. I also assumed, without ever checking, that I understood what the Indiana requirement actually says.

Argument 1: Nurse Practitioner Care Is Comparable in Quality

A classmate who works in a federally qualified health center argued that nurse practitioner care is as good as physician care, so collaboration adds nothing. The evidence supports part of this. Kurtzman and Barnow (2017) compared nurse practitioners, physician assistants and primary care physicians in health centers across a range of quality measures and found largely similar patterns of practice and quality. The National Academies report on the future of nursing concluded that scope-of-practice restrictions limit access to care and recommended that states remove them (National Academies of Sciences, Engineering, and Medicine, 2021).

The limit is in what the studies measured. They compared care in primary care settings, mostly for common conditions, using process and quality measures. They do not show equivalence in every setting or for every patient population, and they do not isolate the effect of a collaboration requirement itself. A study showing similar quality under current rules cannot tell us what would happen to quality if the rules changed, because the nurse practitioners in those samples were already practicing under whatever collaboration their states required. The argument survives, but in a narrower form than it was made: the evidence supports comparable quality in primary care, not equivalence everywhere.

Argument 2: Full Practice States Have Better Access

A second classmate, who works for a rural health system, argued that states without collaboration requirements have better access to care. The American Association of Nurse Practitioners makes this argument, pointing to nurse practitioners practicing in rural and underserved areas in full practice states (American Association of Nurse Practitioners, n.d.). The association has a direct stake in the question, since its members' scope is what is being debated, and physician organizations that oppose removal have a stake in the other direction. The National Academies report, which has no professional stake of this kind, reaches a similar conclusion about access, which gives the argument more weight than the association's statement alone. It is still weaker than argument 1, because access differs between states for many reasons besides practice law, and the sources I found describe associations rather than establishing that removing the requirement causes better access.

Argument 3: The Law Requires a Physician on Site

A third participant argued that collaboration in Indiana means a physician must be physically present, which makes rural nurse practitioner practice impossible. This argument rests on a misreading. The statute describes collaboration through a written practice agreement or through hospital privileges that set out how the practitioners will cooperate, coordinate and consult with each other; it does not require the collaborating practitioner to be on site (Ind. Code § 25-23-1-19.4, 2025). Much of the real burden lies in finding a willing collaborator, the terms of the agreement and any fees, not in physical presence. Correcting the argument does not settle the policy question, but it moves the debate to the right problem. I realized during the session that I had half-believed the same thing, which is a reminder that practice law is often learned from colleagues rather than from the text.

Where I Land

I still favor removing the requirement, but my position is narrower and better supported than it was. The evidence I found supports comparable quality in primary care and a plausible link to access, and the practical barrier is the difficulty of securing and maintaining an agreement rather than supervision on site. The piece of evidence that moved me most was the Kurtzman and Barnow comparison, because it measured care in the settings where I plan to practice and did not rely on any organization's interest. As a future family nurse practitioner who hopes to work in rural Indiana, I will be practicing under whatever rule the legislature keeps, and I now know which parts of the argument I could defend in front of a legislator and which I could not.

References

American Association of Nurse Practitioners. (n.d.). Issues at a glance: Full practice authority [Policy brief]. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief

Ind. Code § 25-23-1-19.4 (2025). https://law.justia.com/codes/indiana/title-25/article-23/chapter-1/section-25-23-1-19-4/

Kurtzman, E. T., & Barnow, B. S. (2017). A comparison of nurse practitioners, physician assistants, and primary care physicians' patterns of practice and quality of care in health centers. Medical Care, 55(6), 615-622. https://doi.org/10.1097/MLR.0000000000000689

National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982