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Advanced Practice Registered Nursing

All APRNs are reminded to submit a copy of their current APRN certification to the Board each time the certification is renewed. APRNs are required to have their current certification submitted to the Board in order to practice as an APRN in Minnesota. Failing to inform the Board of current certification is a violation of the Nurse Practice Act and may result in assessment of a fee.

Who may practice advanced practice registered nursing?
If you are a Minnesota registered nurse and certified as a clinical nurse specialist, nurse anesthetist, nurse-midwife, or nurse practitioner, you may practice advanced practice registered nursing and prescribe drugs without obtaining a separate license. However, you must determine whether you meet the statutory requirements and have the knowledge and ability to practice and prescribe competently.

You must practice within a health care system that provides for consultation, collaborative, management, and referral as indicated by the status of the patient.

Current certification by a national nurse certification organization acceptable to the Board is required to practice as a clinical nurse specialist, nurse anesthetist, nurse-midwife, or nurse practitioner.

Who may practice advanced practice registered nursing without certification?

If you are a Minnesota registered nurse you may practice for six months after you have completed an advanced practice registered nurse course of study and you are in the process of meeting the requirements for certification. However, if you fail the certification examination, you must stop practicing as an advanced practice registered nurse even if the failed exam occurs during the six-month period. See Minnesota Statute Section 148.284. Note: You may not enter into a prescribing agreement until you are certified as an APRN. Please see below for the requirements for prescribing.

What is the definition of advanced practice registered nursing?

Advanced practice registered nursing is defined as the performance of clinical nurse specialist practice, nurse-midwife practice, nurse practitioner practice, or registered nurse anesthetist practice as defined elsewhere in the statute. The practice includes functioning as a direct care provider, case manager, consultant, educator, and researcher. The practice also includes accepting referrals from, consulting with, cooperating with, or referring to all other types of health care providers, including but not limited to physicians, chiropractors, podiatrists, and dentists, provided that the APRN and other provider are practicing within their scopes of practice as defined in state law. The APRN must practice within a health care system that provides for consultation, collaborative management, and referral as indicated by the health status of the patient.

Does the Nurse Practice Act define the scopes of practice for clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners?

Yes. The clinical nurse specialist practice, nurse anesthetist practice, nurse-midwife practice, and nurse practitioner practice are stated in Minnesota Statutes, section 148.171. Advanced practice registered nurses must practice within the specific field of nursing for which they are certified.

How does an advanced practice registered nurse identify authority to practice?
As an advanced practice registered nurse, you may use the following designations:

Certified clinical nurse specialist RN, CNS
Certified registered nurse anesthetist

RN, CRNA

Certified nurse-midwife RN, CNM

Certified nurse practitioner

RN, CNP

These designations must be used for personal identification and in documentation of services provided. Identification of educational degrees and specialty fields may be added. No other abbreviations or designations are acceptable and only qualified APRNs may use these designations.

Does a collaborative management plan between an APRN and a physician have to be in writing?
No. Collaborative management is a system used by an advanced practice registered nurse and one or more physicians or surgeons to identify the scope of collaboration mutually agreed upon as necessary for managing the care of a group of patients.

You and the physician must have experience in providing care to patients with the same or similar medical problems. For example, if you are a nurse practitioner certified in gerontology, you may have a collaborative practice with a physician who cares for geriatric patients but should not have a collaborative practice with a pediatrician.

Are CRNAs required to have a collaborative management plan with an anesthesiologist?
No. A CRNA may provide anesthesia in collaboration with physicians, including surgeons, podiatrists, and dentists. However, the CRNA must provide the anesthesia services at the same hospital, clinic, or health care setting as the physician, surgeon, podiatrist or dentist. The law does not require the collaborating practitioners to be in the same facility at the same time.

How do I document the requirements to practice as an APRN to the Board of Nursing?
You must maintain current licensure as a registered nurse and provide the Board of Nursing with a copy of your current certificate issued by one of the national nurse certification organizations acceptable to the Board. You are responsible for submitting a copy of your current certificate each time it is issued to you by your certifying organization.

Do I need special authority from the Board of Nursing to prescribe?
No. All certified APRNs may prescribe drugs and therapeutic devices within the authorized scope of practice. The requirements for prescribing vary slightly for each of the four categories as follows:

Certified Nurse-Midwives

Certified Nurse Practitioners

  • Certification by a national nurse certification organization acceptable to the Board
  • Written agreement with a physician based on standards established by the Minnesota Nurses Association and the Minnesota Medical Association in a Memorandum of Understanding that defines the delegated responsibilities related to the prescription of drugs and therapeutic devices.
  • Model form for the development of a prescribing agreement

Certified Registered Nurse Anesthetists

  • Certification by the Council on Certification of Nurse Anesthetists
  • Written agreement with a physician based on standards established by the Minnesota Nurses Association and the Minnesota Medical Association in a Memorandum of Understanding that defines the delegated responsibilities related to the prescription of drugs and therapeutic devices. A written agreement is not required in order to recommend or administer a drug or therapeutic device perioperatively.
  • Model form for the development of a prescribing agreement

Certified Clinical Nurse Specialists in Psychiatric and Mental Health Nursing

  • Certification by a national nurse certification organization acceptable to the Board
  • Completion of no less than 30 hours of formal study in the prescribing of psychotropic medications and medications to treat their side effects which included instruction in health assessment, psychotropic classifications, psychopharmacology, indications, dosages, contraindications, side effects, and evidence of application
  • Written agreement with a Minnesota psychiatrist or other Minnesota physician based on standards established by the Minnesota Nurses Association and the Minnesota Psychiatric Association in a Memorandum of Understanding that defines the delegated responsibilities related to the prescription of drugs in relationship to the diagnosis
  • Model form for the development of a prescribing agreement

Other Certified Clinical Nurse Specialists

  • Certification by a national nurse certification organization acceptable to the Board
  • Completion of no less than 30 hours of formal study from a college, university health care institution, which included the following: instruction in health assessment, medication classifications, indications, dosages, contraindications, and side effects; supervised practice; and competence evaluation, including evidence of the application of knowledge pertaining to prescribing for and therapeutic management of the clinical type of patients in the certified clinical nurse specialist's practice
  • Written agreement with a physician based on standards established by the Minnesota Nurses Association and the Minnesota Medical Association in a Memorandum of Understanding that defines the delegated responsibilities related to the prescription of drugs and therapeutic devices
  • Model form for the development of a prescribing agreement

The written agreement pertaining to prescribing authority must be maintained at the primary practice site of the APRN and the collaborating physician.

Does the Board issue a prescribing document?
No.

Is the prescribing, procuring, dispensing, and administering of controlled substances within the scope of practice of an APRN?
Yes. You may prescribe controlled substances appropriate to your scope of practice, included in your prescribing agreement, and you have been issued a DEA number from the Drug Enforcement Administration (DEA). You must apply for a DEA number.

What national nurse certification organizations are acceptable to the Board?
Based upon criteria established by the Board, the following national nurse certification organizations have been determined to be acceptable as certifying organizations:

Do I need to inform the Board I am certified as an APRN to practice as an APRN?

Yes. You must submit a copy of your initial certification and a copy of your certificate each time you renew. The grounds for disciplinary action (25) authorizes the Board to consider disciplinary action for "Failure to inform the board of the person's certification status as a nurse anesthetist, nurse-midwife, nurse practitioner, or clinical nurse specialist."

Minnesota Statute Section 148.284 indicates: "An advanced practice registered nurse who practices advanced practice registered nursing without current certification or current waiver of certification as a clinical nurse specialist, nurse midwife, nurse practitioner, or registered nurse anesthetist, or practices with current certification but fails to notify the board of current certification, shall pay a penalty fee of $200 for the first month or part of a month and an additional $100 for each subsequent month or parts of months of practice. The amount of the penalty fee shall be calculated from the first day the advanced practice registered nurse practiced without current advanced practice registered nurse certification or current waiver of certification to the date of last practice or from the first day the advanced practice registered nurse practiced without the current status on file with the board until the day the current certification is filed with the board."

Does the law require an APRN must practice within the area for which they are certified?

Yes. The Nurse Practice Act Practicing requires the APRN to practice within the specific field of nursing practice for which an advanced practice registered nurse is certified unless the practice is authorized under section 148.284. See Minnesota Statute Section 148.261, subdivision 1 (22).



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