1) Maintains the current requirement that APNs must have a collaborative agreement with a physician, podiatrist or dentist if they are practicing outside of a hospital, hospital affiliate or ASTC where they would be required to be credentialed by the medical staff. However, in the hospital affiliate setting a physician committee may recommend and the governing board may approve appropriate prescriptive authority.
2) Makes no changes whatsoever to the Nurse Practice Act with respect to the provision of anesthesia services by CRNAs.
3) Makes no changes to the law requiring delegation of prescriptive authority by a physician, or podiatrist. Under a written collaborative agreement, an APN can only prescribe medications if the collaborating physician delegates authority to do so. Additional limitations exist on an APN’s ability to prescribe Schedule II controlled substances including specific identification of the controlled substance and a prohibition on any delivery method other than oral, topical or transdermal application.
4) Makes the following changes in the section of the Nursing Act, which specifically defines the content of a written collaborative agreement:
a. Replace current language in the Act limiting the physician or podiatrist and APN from freely determining which services each shall provide and replacing with the restriction that APNs may only practice in the area of nursing practice of their national certification;
b. Limit APNs to the specialty area of practice of the collaborating physician or podiatrist;
c. Removing the restrictions that the APN can only provide services the collaborating physician or podiatrist provides so that APNs may provide services the collaborating physician or podiatrist may but chooses not to provide;
d. Maintain requirement for communication, but remove requirement for monthly communication with the exception of prescribing controlled substances for longer than 30 days.
5) Another issue the APNs have raised is that Medicaid contractors are not contracting with PNs unless the collaborating physician also contracts with the plan. No such limit exists in the law currently. APNs have been participating in Medicaid for many years. Therefore, the proposal removes barriers to APNs serving Medicaid patients.
6) Where a written collaborative agreement is abruptly terminated for any reason by the collaborating physician, APNs could be faced with allegations of abandonment or negligence because an APN cannot legally practice without a written collaborative agreement outside a hospital, hospital affiliate or ambulatory surgical treatment center. These potential allegations of abandonment and negligence potentially not only affect APNs, but also the collaborating physician. Therefore, the proposal provides a 90-day transition period to allow the APN time to enter into a new written collaborative agreement or transition to another practice setting.
7) The proposal would also delete references in approximately 28 different Acts where APNs and physician assistants are allowed to perform various functions only if they are specifically mentioned in the collaborative agreement or the supervisory agreement with physician assistants. These areas include such functions as school physicals; school employee physical examinations; school sick leave or inability to attend certifications; school notes on self-administration of medications; requests for clinical lab tests; performance of breast exams, prenatal HIV and AIDS and HIV tests; transmitting orders to respiratory care; referrals to a genetic counselor; performance of perinatal mental health assessments, lead screening, minor’s services, prenatal and newborn care and sexually transmitted disease services; certifications for license plates, placards, drivers licenses and state identification cards; provision of alcohol and drug abuse services; ordering home health services, occupational therapy, orthotics, prosthetics and pedorthics, physical therapy services.