By: Jackie Bain
Nearly half of U.S. States have already expanded the scope of nursing practice and several more are analyzing whether it is appropriate. The debate between physicians and nurses regarding how much autonomy a nurse should be given is a political hotbed that will likely be revisited by the legislature in the near future. Until that time, the Board of Medicine and the Board of Nursing will quietly continue to enforce the present requirements. Here’s how they stand today:
Under Florida’s current laws, in addition to the practice of professional nursing, an advanced registered nurse practitioner (“ARNP”) may perform acts of medical diagnosis, treatment and prescription. However, for the most part, such acts must be performed under the general supervision of a physician. The nature of such a supervisory relationship should be identified in a protocol which identifies the medical acts to be performed and the conditions for their performance.
Contents of an ARNP Protocol: With few exceptions, every ARNP must file an original protocol with the Florida Board of Nursing within 30 days of (1) entering into a supervisory relationship with a physician; (2) after a license renewal; or (3) any change to the information contained in an existing protocol. The protocol should set forth:
- The date of the protocol or amendment;
- The nature of the ARNP’s practice and duties of the ARNP;
- The location of the ARNP’s practice;
- The name of the ARNP’s supervising physician(s), along with each physician’s signature, license number and DEA number;
- The duties of each supervising physician; and
- All medications that each supervising physician has agreed that the ARNP may prescribe.
If more than one physician will supervise the ARNP, the ARNP should still file only one protocol, but include signatures, license numbers and DEA numbers of all supervising physicians. A sample ARNP protocol is available on the Board of Nursing’s website at: http://floridasnursing.gov/forms/arnp-protocol-sample.pdf.
Physician Obligations: Every physician who agrees to supervise an ARNP must also file a notice of supervision with the Board of Medicine within 30 days of entering into the relationship, or within 30 days after the relationship terminates.
In the event that the physician supervises an ARNP who is not performing in the same office that the physician primarily practices in, the physician must post in each office location (1) the times when the physician is physically present in each office; and (2) hours when the office is open and the physician is not present. Additionally, if the physician is a primary care provider, the physician may not supervise more than four primary care offices other than his/her primary practice location. If the physician is a specialist, he/she is limited to supervision of two offices other than his/her primary office location. Note that the law contains additional requirements if the ARNP is a dermatologic or skin care services provider.
Evolution: In the last legislative session, House Bill 7113 garnered a significant amount of publicity and sparked heated debate. Had it passed, HB 7113 would have allowed nurse practitioners (ARNPs and Certified Registered Nurse Anesthetists) to practice independently in order to meet rising demand for primary care services. Both physicians and nurses voiced strong opinions about the bill. However, the bill was enveloped into the “Health Train”, a group of health care bills that were arguably related. The Health Train and every bill contained in it did not pass before the end of session. As the law evolves, one thing is clear: anything that supports more access to our healthcare system will be better for doctors, nurses and patients.
Jacqueline Bain will present a live lunch n’ learn webinar on Physician Supervision Issues on August 27th from 12-1pm EST. Registration is FREE and open now! Click here to register.