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Commentary: Why nurse practitioners should not practice independently - The  San Diego Union-Tribune

How Many Nurse Practitioners Can A Physician Supervise?

Nurse practitioners (NPs) can analyze and treat patients, but they cannot practice independently. A new study examined the rates of hospital visits, emergency department visits, and unscheduled physician contacts in some states where NP-led clinics were closed. The number of NP encounters was compared to the number of physician encounters in some states where NP-led clinics remained open.

Nurse Practitioners (NPs) are a valuable resource in today’s healthcare environment. They provide unique and complementary services to the traditional medical system. Despite this, there is an uneven distribution of NPs. They remain underutilized due to lack of access to post-grad education, difficulty obtaining employment outside of hospitals, administrative barriers, and low pay. Nevertheless, they are an essential component of the healthcare team that physicians can supervise with appropriate training.

Who Are Nurse Practitioners?

Nurse practitioners are trained & registered nurses who have achieved advanced education in primary care and then become credentialed by the American Nurses Credentialing Center.

Nurse practitioners provide health care to patients through various nursing specialties, including family practice, pediatrics, geriatrics, obstetrics, and gynecology. They additionally operate with other healthcare providers such as physicians, dentists, pharmacists, social workers, physical therapists, dietitians, and psychiatrists.

The main goal of nurse practitioners is to provide direct patient care in settings such as hospitals or clinics that typically lack the capacity for full-time physician coverage or where physicians cannot afford to see all their patients due to financial constraints.

Who Are Physicians?

Physicians are professionals who are licensed to provide health care. Physicians are health care professionals who have completed medical school and received a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.

They provide diagnosis, treatment, and prevention of diseases to patients. Physicians can be either specialists or generalists, depending on the area of expertise they have in their field.

They study medicine and go through rigorous training programs to become board certified. They then specialize in a particular area of treatment such as internal medicine, pediatrics, OB/GYN, or emergency medicine.

After this, they work in a hospital or other facility where they perform procedures and offer treatment for patients suffering from various diseases and conditions.

Does an NP require a supervising physician?

Yes, it is required that a nurse clinician works under a supervising physician’s supervision. Either can supervise a nurse clinician:

  • A licensed registered nurse who is certified as a generalist or
  • A licensed physician who has been approved to practice by the laws of their state.

A supervising physician provides advice or direction on how to practice medicine. They usually have more experience than their colleagues. They can decide which patients should receive specific treatments or procedures.

The benefit of having a supervising physician is that they will know when you make mistakes. They would provide guidance and help you avoid doing something wrong.

How Many Nurse Clinicians Can Be Supervised By A Physician?

A doctor can supervise a maximum of four nurse practitioners if the services are appropriate for the individuals being seen. Physician supervision is required in emergency department settings because there is a higher concentration of patients with complex needs, and nurses may be unfamiliar with them. In other locations where less complex care is provided, such as clinics or private practices, the doctor only needs to be available by pager or phone for a consultation.

In 2012, the American Association of Nurse Practitioners (AANP) endorsed a position statement that encouraged state boards to permit a physician to supervise no more than eight nurse practitioners at a time. In addition, the AANP believes that physicians should not oversee any new nurse practitioner applicants for 24 months after their initial license is issued.

The qualifications that nurse practitioners must have

Nurse practitioners are healthcare providers that specialize in providing primary care. They are trained to diagnose and treat common illnesses, provide health education, and prescribe medications. To evolve a nurse clinician, you must first graduate from an accredited nursing program, pass the National Council Licensure Examination (NCLEX), and complete a post-graduate degree in nurse-practitioner studies.

Nurse practitioners must hold a Master of Science in Nursing, typically a 3-4 year degree. They must also complete an accredited Nurse Practitioner program and pass the National Certification Examination. The requirements for becoming a nurse clinician vary by state and employer.

The following are required and desired qualifications for a nurse clinician:

  • The candidate must be certified as a documented nurse in the state of practice.
  • A master’s degree from an accredited institution is preferred but not required.
  • Minimum experience requirement varies by jurisdiction.
  • Candidates should provide documentation that they have completed all applicable requirements for licensure in their state.

What characteristics can be handled by an NP herself below a physician’s supervision?

NP is a healthcare professional who works under the supervision of a physician. They work as independent health care providers and specialize in certain areas of medicine like pediatrics, geriatrics, obstetrics and gynecology, and psychiatry.

A general practice NP can do the below things with a physician’s supervision:

  • Perform office-based procedures.
  • Provide obstetric care and manage complicated pregnancies.
  • Perform emergency medicine.
  • Order and interpret laboratory tests and x-rays, perform physical examinations, administer injections, apply local anesthesia, monitor vital signs and other clinical signs of patient illness or injury.
  • An NP may also provide diagnostic services such as interpreting radiological images (such as X-rays) or ultrasound results.
  • An NP can handle many aspects independently under a physician’s supervision.

Some of the essential things that they can handle include:

  • A physician’s order for a medical history and physical examination, including vital signs and other assessments
  • Plan of care, including medications and dosages
  • Diagnosis, treatment, or referral to other providers as needed
  • Instructions on how to manage symptoms or conditions (e.g., instructions on a diet)

Nurse Supervision Under Physician Policy

An example of a nurse supervision policy under physician policy is “Nurse Supervision- Two Hours.”

It would be necessary for the nurse to be supervised by a physician for at least two hours each day. The superintendent may not be the same person as the supervisee, but they must be on-site during those two hours.

The term “supervision” means that the physician and nurse are together when discussing the medical care of patients or other matters that arise in patient care. The term does not refer to simply providing education or training.

For instance, if an emergency arises, such as an acute problem with a patient’s heart rate, blood pressure, respiratory rate, etc., it is essential for communication between the doctor and nurse about what needs to happen next about care for that patient.


In conclusion, the NP is in charge of prescribing medications, ordering tests, and providing diagnoses.

A physician-only need to supervise one NP.

A single NP can manage three or four patients at once if well-managed.

NPs are beneficial to the healthcare system because they can see patients when physicians are unavailable.

Before you see an NP, it may be wise to know their limitations about the practice of medicine.

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