Legal Authority
RNs who apply for Board of Nursing (BON) authorization in advanced nursing practice (NPs, NAs, psychiatric CNSs, and CNMs) must have satisfactory completion of a formal education program that has been approved by a national professional nurses accrediting body that the BON recognizes and which has as its objective the preparation of nurses to perform as an NP, CNS, NM, or NA. Advanced practice R&R governing the ordering of tests, therapeutics, and prescribing are promulgated by the BON in conjunction with the BOM. All other areas of SOP are exclusively under the BON. All APNs shall practice in accordance with written guidelines developed in collaboration with the nurse and physician. In all cases, the written guidelines shall “designate a physician who shall provide medical direction as is customarily accepted in the specialty area.” If practicing in an institution, the nursing and medical administrative staff must approve the guidelines. If there is no nursing and medical administrative staff, the guidelines must be approved by the BON. Credentialing for hospital privileges varies according to hospital policies.

Reimbursement
Psychiatric CNSs, midwives, CRNAs, and NPs are reimbursed according to state law. This law only includes indemnity plans, not HMOs and other managed care arrangements. BC/BS credentials NPs in private practice settings to receive individual NP provider numbers. An HMO protection bill allows “other providers” to be listed on panels; however, the law does not specifically address APNs or require them to be listed as providers. FNPs, PNPs, and ANPs are reimbursed at 100% of physician payment for Medicaid unless the NP is employed by the hospital in a hospital-based practice.

Prescriptive Authority
NPs, CNMs, and psychiatric CNSs have Rx authority for Schedules II–VI controlled substances. Authorized APNs must apply to the state Department of Public Health for a state DEA number; they then apply for a federal DEA number. Authorized APNs have (1) prescribing guidelines mutually developed and agreed on by the nurse, employer, and supervising physician; guidelines need not be submitted to the BON unless requested (the guidelines pertaining to Rx practice shall include a defined mechanism to monitor prescribing practices, including review with a supervising physician every 3 months); and (2) proof of 24 hours of pharmacology content. The Rx pad has the name of supervising physician; the authorized APN signs the Rx.