Currently in Maryland, nurse practitioners (CNPs) are required to sign an attestation and nurse anesthetists (CRNAs) an affirmation of collaboration

Both these requirements are in contradiction of the 2010 IOM mandate for full practice authority.

The CNP attestation is a document containing the name and license number of a Maryland licensed physician who is the collaborator of record.

The CRNA affirmation of collaboration is a document containing the name and license number of a Maryland collaborating anesthesiologist, physician or dentist.

Amended regulations have eliminated the collaborative plan and requirement for an attestation for Maryland nurse midwives and for Clinical Nurse Specialists granting them independent and autonomous practice (Maryland Board of Nursing [MBoN], 2014).