North Carolina nurse practitioner perspectives on physician supervisory requirements: Regulation and reality

Background: Nurse practitioners (NPs) improve health care access and provide high-quality care, yet 11 U.S. states continue to require physician supervision. Little is known about how statutory supervision functions in routine practice. Purpose: To describe NPs' experiences with physician supervision in North Carolina and examine associations between supervisory relationship characteristics and perceived benefit of supervision. Methodology: A descriptive, correlational survey was conducted among NPs practicing in NC. A researcher-developed electronic survey assessed demographics, supervisory characteristics, and perceptions of physician supervision. Descriptive statistics summarized responses, and chi-square analyses examined associations between supervisory characteristics and perceived supervision benefit. Results: A total of 1,486 NPs participated. Supervisory relationships varied considerably. Nearly half (44.6%) rarely or never practiced at the same site as their supervising physician, 64.9% never participated in shared patient visits, and 45.2% reported no physician review of plans of care or clinical documentation. Overall, 59.8% disagreed that having a supervising physician was beneficial to practicing effectively. Greater clinical interaction, including shared practice location, real-time consultation, physician review of plans of care, shared patient visits, and shared patient panels, was significantly associated with greater perceived benefit of supervision (all p < .001). More experienced NPs were less likely to perceive supervision as beneficial. Conclusions: Statutory physician supervision often occurs with limited direct clinical interaction. Perceived value appears associated with meaningful clinical collaboration rather than supervisory requirements. Implications: These findings provide empirical evidence to inform policy discussions and suggest models emphasizing collaboration rather than mandatory supervisory agreements may better reflect contemporary NP practice.