1. Independent practice

2.  Assessing clients  Synthesizing & analyzing data, understanding & applying nursing principles at an advanced level  Providing expert teaching & guidance  Working effectively with clients, families, health care team  Managing clients’ physical & psycho-social health-illness  Utilizing research skills  Analyzing multiple sources of data, differential diagnosis, selecting appropriate treatment  Independent decisions in solving complex client care problems  Diagnosing, prescribing, administering & dispensing therapeutic measures  Recognizing limits of knowledge & experience, planning for situations beyond expertise, consulting with or referring to other health care providers as appropriate

3.  NPs earned the right to practice independent of physicians in ME in the mid-1990s  NP must complete at least 24 months of supervised work  NPs can now be credentialed as participating providers  NPs can be primary care providers in managed care organizations  A new grad can be supervised by another NP who is independently licensed.

5. Physician supervision required Physician supervision not required

6.  1088 NPs in ME in 2011  Most are independently licensed  Fewer than 50 practice independently

7.  Distribution of NPs and primary care similar  Majority of NPs in ME in Primary Care  From the ME NP Association web site: ◦ Overall 25% of NPs in rural areas of ME ◦ In primary care about 40% rural (most in FM)  Rural distribution of NPs almost identical to FPs  NPs, PAs and Physicians are all leaving primary care at about the same rate (AHRQ and Robert Graham Center data)