Chapter 410-11 REGULATION OF ADVANCED PRACTICE REGISTERED NURSES
| (1) |
Purpose.
| (a) |
To promote, preserve, and protect public
health, safety, and welfare by regulating advanced nursing practice. |
|
| (2) |
Definitions:
| (a) |
The advanced practice registered nurse is
a certified nurse-midwife (CNM), nurse practitioner (NP), certified registered
nurse anesthetist (CRNA), clinical nurse specialist (CNS) or clinical nurse
specialist in psychiatric/mental health (CNS/PMH), and is authorized to
practice by the Georgia Board of Nursing ("the Board"). |
| (b) |
"Advanced nursing practice" means practice
by a registered professional nurse who meets those educational, practice,
certification requirements, or any combination of such requirements, as
specified by the Board and includes certified nurse-midwives, nurse
practitioners, certified registered nurse anesthetists, clinical nurse
specialists in psychiatric/mental health, and others required by the
Board. |
|
| (3) |
Title.
| (a) |
Advanced practice registered nurses are
authorized to practice in the categories of certified nurse-midwife, nurse
practitioner, certified registered nurse anesthetist, clinical nurse specialist
and clinical nurse specialist in psychiatric/mental health. Each advanced
practice registered nurse shall use the category designation for purposes of
identification and documentation. |
|
| (4) |
Authority to Practice:
| (a) |
Only a registered professional nurse
authorized to practice according to these rules shall use the specified title,
and practice or offer to practice, as a certified nurse-midwife, nurse
practitioner, certified registered nurse anesthetist clinical nurse specialist
or clinical nurse specialist, psychiatric/mental health unless otherwise
authorized to do so by the Board. |
| (b) |
The advanced practice registered nurse is
authorized to perform advanced nursing functions and certain medical acts which
include, but are not limited to, ordering drugs, treatments, and diagnostic
studies as provided in O.C.G.A. § 43-34-26.1 and Chapter 410-11. |
|
| (1) |
Definition.
| (a) |
A certified nurse-midwife is a registered
professional Nurse who has completed/graduated from a post-basic educational
program for nurse midwives which included theoretical and practical components
and evidence of advanced pharmacology within the curriculum or as a separate
course. The certified nurse-midwife is certified by the ACNM Certification
Council and is authorized to practice by the Board. |
|
| (2) |
Scope and Standards of Practice for the
Certified Nurse-Midwife.
| (a) |
The certified
nurse-midwife (CNM) provides independent management of women's health care,
focusing particularly on pregnancy, childbirth, the postpartum period, care of
the newborn, and the family planning and gynecological needs of women. The
certified nurse-midwife practices within a health care system that provides for
consultation, collaborative management, or referral as indicated by the health
status of the client. The certified nurse-midwife must practice in accordance
with the Board-approved American College of Nurse-Midwives' current Standards
for the Practice of Nurse-Midwifery. |
|
| (3) |
Requirements to Practice as a Certified
Nurse-Midwife:
| (a) |
Prior to January 1, 1999,
and applicant who submits the following items may be authorized to practice as
a certified nurse-midwife:
| 1. |
Evidence of
current licensure as a registered professional nurse in Georgia; |
| 2. |
A completed Board application with required
fee; |
| 3. |
Official transcript which
verifies graduation from a post-basic educational program for nurse-midwives
which includes theoretical and practical components and evidence of advanced
pharmacology within the curriculum or as a separate course, and; |
| 4. |
Verification of current national
certification from the ACNM Certification Council. If certified prior to
January 1, 1996, evidence of enrollment in the Continuing Competency Assessment
Program of the American College of Nurse-Midwives, which bears current cycle
dates, must be provided. |
|
| (b) |
Beginning January 1, 1999, for initial
authority to practice as a certified nurse midwife, and applicant must submit
an official transcript which verifies completion/graduation with a master's or
higher degree in nursing or a graduate degree with a concentration in
nurse-midwifery, evidence of advanced pharmacology within the curriculum or as
a separate course, in addition to the requirements stated in
410-11-.02(3)(a)1., 2. and 4. |
|
| (4) |
Biennial Renewal of
Board Authorization to Practice as a Certified Nurse-midwife:
| (a) |
The date for renewal of Board
authorization as a certified nurse-midwife will coincide with the renewal of
the registered professional nurse license. |
| (b) |
Authorization to practice as a certified
nurse-midwife shall expire on January 31st of odd-numbered years and shall be
administratively revoked if not renewed. |
| (c) |
For continued authority to practice, the
certified nurse-midwife must submit:
| 1. |
A
completed renewal application for advanced nursing practice; |
| 2. |
A copy of current national certification
with expiration date from the ACNM Certification Council. If certified prior to
January 1, 1996, evidence of enrollment in the Continuing Competency Assessment
Program of the American College of Nurse-Midwives, which bears current cycle
dates must be provided. |
| 3. |
Payment
of the renewal fee. |
|
| (d) |
A renewal application, received with a postmark date after January 31 of odd
numbered years, will be returned to the applicant. Thereafter, the applicant
must apply to reinstate the authorization. |
|
| (1) |
Definition.
| (a) |
A nurse practitioner is a registered
professional nurse who is recognized by the Board to engage in advanced
practice registered nursing. |
| (b) |
The nurse practitioner practices in a manner consistent with Chapter 410-13 of
the Georgia Board of Nursing Rules and Regulations. |
|
| (2) |
Scope and Standards of Practice for the
Nurse Practitioner:
| (a) |
The nurse
practitioner provides advanced practice nursing care and medical services
specific to the nurse practitioner respective specialty to individuals,
families and groups, emphasizing health promotion and disease prevention as
well as the diagnosis and management of acute and chronic diseases. The nurse
practitioner collaborates as necessary with a variety of individuals to
diagnose and manage clients' health care problems. |
| (b) |
The nurse practitioner practices in a
manner consistent with the nationally recognized nursing practice standards for
the respective nurse practitioner specialty that is consistent with the
Board-recognized national certification organization identified in Rule
410-11-.12. |
|
| (3) |
Requirements for initial authority to
Practice as a Nurse Practitioner:
| (a) |
Evidence of current licensure as a registered professional nurse in
Georgia; |
| (b) |
A completed Board
application with required fee; |
| (c) |
Official transcript which verifies graduation with a master's or higher degree
in nursing for the respective nurse practitioner specialty or a graduate level
post-master's certificate in an advanced practice registered nurse practitioner
specialty and evidence of advanced pharmacology within the curriculum or as a
separate course, advanced physical assessment, and pathophysiology. |
| (d) |
Nerification of current national
certification from the respective Board-recognized certifying
organization. |
|
| (4) |
The
applicant must document one of the following within in four (4) years
immediately preceding the date of current application:
| (a) |
500 hours of practice as an advanced
practice registered nurse; |
| (b) |
Graduation from a nursing education program or a graduate level post-master's
certificate in an advanced practice registered nurse practitioner specialty;
or |
| (c) |
Completion of a Georgia
Board-approved advanced practice registered nurse reentry/refresher
program. |
|
| (5) |
An
applicant who is unable to meet the requirements of (4)(a), (b), or (c) must
satisfactorily complete the following:
| (a) |
40
hours of study relevant to advanced registered nursing practice within one (1)
year of the date of application. Relevant advanced practice registered nurse
study must include at least four (4) Different content areas. The Board may
waive the 40 hours of study if the applicant has passed a national recognized
certification organization examination within the four (4) years immediately
preceding the date of current application. |
| (b) |
Current health care provider course of
cardio-pulmonary resuscitation unless completed within one (1) year of the date
of application with a Georgia Board of Nursing approved RN reentry; |
| (c) |
Study of the Georgia Registered
Professional Nurse Practice Act, O.C.G.A. §§ 43-26-1et seq.
and Board rules; and |
| (d) |
160 hours of relevant advanced practice registered nursing supervised by an
advanced practice registered nurse in a comparable specialty area and in
accordance with other Board criteria. |
|
| (6) |
Biennial Renewal of Board Authorization
to Practice as a Nurse Practitioner:
| (a) |
The
date for renewal of Board authorization as a nurse practitioner will coincide
with the renewal license period. Authorization shall be administratively
revoked if not renewed. |
| (b) |
For
continued authority to practice, the nurse practitioner must:
| 1. |
Renew licensure as a registered
professional nurse in Georgia; |
| 2. |
Submit a completed renewal application for
advanced nursing practice; |
| 3. |
Attest
to advanced practice registered nurse practice in accordance with applicable
Georgia laws and rules; and |
| 4. |
Submit payment of the renewal
fee. |
|
| (c) |
Any licensee
who fails to renew authorization must apply to reinstate the
authorization. |
|
| (1) |
Definition
| (a) |
A certified registered nurse anesthetist
is a registered professional nurse who has completed/graduated from a
post-basic educational program for nurse anesthetists which includes
theoretical and practical components and evidence of advanced pharmacology, is
currently certified/recertified by the National Board of Certification and
Recertification for Nurse Anesthetists, and is authorized to practice by the
Board. |
|
| (2) |
Scope and
Standards of Practice for the Certified Registered Nurse Anesthetist. The
certified registered nurse anesthetist (CRNA) provides anesthesia and related
care services in four general categories:
| (a) |
Preanesthetic preparation and evaluation; |
| (b) |
Anesthesia induction, maintenance, and
emergence; |
| (c) |
Perianesthetic and
clinical support functions; and |
| (d) |
Postanesthesia care.
The certified registered nurse anesthetist must practice in
accordance with Board approved American Association of Nurse Anesthetists'
current Guidelines and Standards for Nurse Anesthesia Practice.
|
|
| (3) |
Requirements to practice as a Certified Registered Nurse Anesthetist.
| (a) |
An applicant who has graduated from an
approved nurse anesthesia educational program prior to January 1, 1999, who
submits the following items may be authorized to practice as a certified
registered nurse anesthetist:
| 1. |
Evidence of
current licensure as a registered professional nurse in Georgia; |
| 2. |
A completed Board application with
required fee; |
| 3. |
Official transcript
which verifies completion/graduation from a post-basic educational program for
certified registered nurse anesthetists which includes theoretical and
practical components and evidence of advanced pharmacology; and |
| 4. |
Verification of current national
certification/recertification from the National Board of Certification and
Recertification for Nurse Anesthetists. |
|
| (b) |
An applicant who graduates from an
approved nurse anesthesia education program on or after January 1, 1999, who
submits the following items may be authorized to practice as a certified
registered nurse anesthetist:
| 1. |
Evidence of
current licensure as a registered professional nurse in Georgia; |
| 2. |
A completed Board application with required
fee; |
| 3. |
Official transcript which
verifies completion/graduation with a master's or higher degree in nursing with
a concentration in anesthesia and evidence of advance pharmacology or a
graduate degree with a concentration in anesthesia and evidence of advance
pharmacology; and |
| 4. |
Verification of
current national certification/recertification from the National Board of
Certification and Recertification for Nurse Anesthetists |
|
|
| (4) |
Biennial Renewal of
Board authorization to practice as a Certified Registered Nurse Anesthetist.
| (a) |
The data for renewal of Board
authorization as a certified registered nurse anesthetist will coincide with
the renewal of the registered professional nurse license. |
| (b) |
Authorization to practice as a certified
registered nurse anesthetist shall expire on January 31st of odd-numbered years
and shall be administratively revoked if not renewed. |
| (c) |
For continued authority to practice, the
certified registered nurse anesthetist must submit:
| 1. |
A completed renewal application for
advanced nursing practice; |
| 2. |
A copy
of current national certification/recertification as a certified registered
nurse anesthetist which bears the expiration date; and |
| 3. |
Payment of the renewal fee. |
|
| (d) |
A renewal application, received
with a postmark date after January 31 of odd numbered years, will be returned
to the applicant. Thereafter, the applicant must apply to reinstate the
authorization. |
|
| (1) |
Definition
| (a) |
A clinical nurse specialist,
psychiatric/mental health, is a registered professional nurse who has graduated
from a program of graduate study and supervised practice; has demonstrated
depth and breadth of knowledge, competence and skill in the advanced practice
of psychiatric/mental health nursing; and is authorized to practice by the
Board. |
|
| (2) |
Scope and
Standards of Practice for the Clinical Nurse Specialist, Psychiatric/Mental
Health.
| (a) |
The clinical nurse specialist,
psychiatric/mental health, (CNS/PMH), is an advanced practice registered nurse
who provides a full range of nursing services from mental health promotion to
mental illness rehabilitation. As a primary mental health care provider, the
clinical nurse specialist, psychiatric/mental health, provides psychotherapy,
clinical supervision, consultation, and liaison services. The clinical nurse
specialist, psychiatric/mental health, must practice in accordance with the
Board-approved current standards of the American Nurses Association's A
Statement on Psychiatric-Mental Health Clinical Nursing Practice and Standards
of Psychiatric-Mental Health Clinical Nursing Practice. |
|
| (3) |
Requirements to Practice as a
Clinical Nurse Specialist, Psychiatric/Mental Health.
| (a) |
Prior to January 1, 1999, an applicant
who submits the following items may be authorized to practice as a clinical
nurse specialist in psychiatric/mental health:
| 1. |
Evidence of current licensure as a
registered professional nurse in Georgia; |
| 2. |
Completed Board application with required
fee; and |
| 3. |
Official transcript
which verifies a master's or higher degree in nursing with specialization in
psychiatric/mental health nursing which includes a minimum of two (2) graduate
courses in psychiatric/mental health nursing, supervised practice for each of
the two (2) graduated courses and evidence of advanced pharmacology within the
curriculum or as a separate course; or verification of current national
certification as a clinical nurse specialist in psychiatric/mental health from
the American Nurses Credentialing Center and evidence of advance
pharmacology. |
|
| (b) |
Beginning January 1, 1999, an applicant requesting initial authority to
practice as a clinical nurse specialist, psychiatric/mental health must submit
the following:
| 1. |
Evidence of current licensure
as a registered professional nurse in a Georgia; |
| 2. |
A completed Board application with required
fee; |
| 3. |
Official transcript which
verifies a master's or higher degree in nursing with specialization in
psychiatric/mental health nursing which includes a minimum of two (2) graduate
courses in psychiatric/mental health nursing, supervised practice for each of
the two (2) graduate courses and evidence of advanced pharmacology within the
curriculum or as a separate course; and |
| 4. |
Verification of current national
certification as a clinical nurse specialist in psychiatric/mental health from
the American Nurses Credentialing Center. |
|
|
| (4) |
Biennial renewal of Board Authorization
to Practice as a Clinical Nurse Specialist, Psychiatric/Mental Health:
| (a) |
The date for renewal of Board
Authorization as a clinical nurse specialist, psychiatric/mental health, will
coincide with the renewal of the registered professional nurse
license. |
| (b) |
Authorization to
practice as a clinical nurse specialist, psychiatric/mental health, shall
expire on January 31 of odd-numbered years and shall be administratively
revoked if not renewed. |
| (c) |
For
continued authority to practice, the clinical nurse specialist,
psychiatric/mental health, must submit:
| 1. |
A
completed renewal application for advanced nursing practice; |
| 2. |
A copy of current national certification as
a clinical nurse specialist, psychiatric/mental health which bears the
expiration date, if initial authorization was based on national certification;
and |
| 3. |
Payment of the renewal
fee. |
|
| (d) |
A renewal
application, received with a postmark date after January 31 of odd numbered
years, will be returned to the applicant. Thereafter, the applicant must apply
to reinstate the authorization. |
|
| (1) |
Definition:
A clinical nurse specialist ("CNS") is a registered
professional nurse who has graduated from a program of graduate study and
supervised practice; who holds a master's degree or other graduate degree from
an approved nursing education program; who holds national board certification
in his or her area of specialty; and is authorized to practice as an advanced
practice registered nurse by the Board.
|
| (2) |
Scope and Standards of Practice for the
Clinical Nurse Specialist.
The clinical nurse specialist ("CNS") is an advanced practice
registered nurse who provides a full range of nursing services from health
promotion to illness rehabilitation. The clinical nurse specialist provides
clinical supervision, consultation, and liaison services to nurses, patients
and healthcare systems. The clinical nurse specialist must practice in
accordance with the current standards of the national certifying organizations
listed in Rule 410-11 -.12 by which clinical nurse specialists are currently
certified.
|
| (3) |
Requirements
to Practice as a Clinical Nurse Specialist.
| (a) |
Beginning January 1, 2012, all applicants
seeking initial authorization as an advance practice registered nurse to
practice as a clinical nurse specialist ("CNS") shall meet the following
requirements:
| 1. |
Evidence of current licensure
as a registered professional nurse in Georgia; |
| 2. |
Completed Board authorization application
with required fee; |
| 3. |
Official
transcript which verifies a master's or higher degree in nursing or a
post-masters certificate from an approved nursing education program with
specialization as a Clinical Nurse Specialist that includes evidence of
advanced pharmacology, advanced physical assessment, and advanced
pathophysiology within the curriculum or as a separate course. |
| 4. |
Verification of current national
certification as a clinical nurse specialist from the American Nurses
Credentialing Center or approved national certifying body listed in Rule
410-12-.12. |
|
| (b) |
All applicants must document one of the
following within four (4) years immediately preceding the date of the current
authorization application:
| 1. |
500 hours of
practice as a CNS; |
| 2. |
An official
transcript which verifies a masters or higher degree in nursing or a post
master's certificate from an approved nursing education program with a
specialization as a Clinical Nurse Specialist; or |
| 3. |
Completion of a Board approved advanced
practice registered nurse reentry/refresher program consisting of forty (40)
hours of study and one hundred and sixty hours (160) hours of supervised
clinical practice within the four (4) years immediately preceding the date of
application. |
|
| (c) |
Biennial renewal of board authorization to practice as a clinical nurse
specialist:
| 1. |
The date for renewal of board
authorization as a clinical nurse specialist will coincide with the renewal of
the registered professional nurse license. |
| 2. |
Authorization to practice as a clinical
nurse specialist shall be administratively revoked if not renewed prior to the
date of expiration. |
| 3. |
For renewal
of APRN-CNS authority to practice, the clinical nurse specialist must submit:
| (i) |
A completed authorization renewal
application for advanced nursing practice; |
| (ii) |
Maintain current national certification
as a clinical nurse specialist; |
| (iii) |
Upon notification of Board audit,
submit proof of current national certification as a clinical nurse specialist
which bears the certification expiration date; and |
| (iv) |
Payment of the authorization renewal
fee. |
|
| 4. |
A renewal
application, received with a postmark date after the date of authorization
expiration, will not be accepted by the Board for renewal purposes. Thereafter,
the applicant must apply to reinstate the authorization. |
| 5. |
Renewal of a license to practice as a
registered professional nurse shall not constitute renewal of authorization to
practice as a CNS. |
|
|
An applicant who fails the national certification examination
shall not engage in advanced nursing practice until such time as all
requirements are met and written authorization to practice as a certified
nurse-midwife, nurse practitioner, certified registered nurse anesthetist,
clinical nurse specialist or clinical nurse specialist in psychiatric/mental
health is issued by the Board.
| (1) |
Temporary authority to practice as a
certified nurse-midwife, nurse practitioner, certified registered nurse
anesthetist, clinical nurse specialist or clinical nurse specialist in
psychiatric/mental health may be issued to a registered nurse who is an
applicant for authorization for advanced practice nursing under the following
circumstances:
| (a) |
The Applicant has met all
requirements for Board authorization but the Board review of the application is
delayed due to an investigation of a possible period of questionable
unauthorized nursing practice; or |
| (b) |
The Applicant has met all the
requirements for Board authorization except current national certification
because such certification has expired, and the applicant must meet specific
practice requirements for recertification. |
|
| (2) |
Temporary authorization may be issued for
a period of up to six (6) months, and may be renewable once for a period of up
to six (6) months. |
An applicant who is employed or engaged in advanced nursing
practice as a certified nurse-midwife, nurse practitioner, certified registered
nurse anesthetist, clinical nurse specialist or clinical nurse specialist in
psychiatric/mental health in Georgia prior to Board authorization for such
practice shall be in violation of
410-11-.01(4). Such conduct may
result in action taken by the Board which may include a reprimand and fine as
follows:
| (a) |
A private or public
reprimand and |
| (b) |
A fine:
| 1. |
Of $50.00 per month (up to $250.00) for
practice between two (2) and six (6) months, or any portion thereof; |
| 2. |
Of $75.00 per month each additional month,
or portion thereof, between seven (7) and twelve (12) months; |
| 3. |
At the Board's discretion for unauthorized
practice extending over one (1) year. |
|
As provided on O.C.G.A. §§ 43-1-19 and
43-26-11, the Board my revoke,
suspend, or otherwise discipline the registered professional nurse license
and/or the authority to practice as a certified nurse-midwife, nurse
practitioner, certified registered nurse anesthetist, clinical nurse specialist
in psychiatric/mental health, or anyone so authorized who demonstrates
unprofessional conduct according to
410-10-.03, fails to comply with
current scope and standards of practice according to
410-11-.02(2),
410-11-.03(2),
410-11-.04(2), or
410-11-.05(2), or who fails to
maintain national certification and/or continuing competency
requirements.
| (1) |
An advanced practice registered nurse
whose authorization has expired may be eligible for reinstatement of
authorization. |
| (2) |
The applicant
must:
| (a) |
Submit a completed reinstatement
application, photograph and required fee; |
| (b) |
Request the appropriate national
certifying organization to verify current certification on a form provided by
the Board; and |
| (c) |
Be able to
document three (3) months or 500 hours of licensed practice as a registered
nurse (or advanced practice registered nurse) during the four (4) years
immediately preceding the date of current application. |
|
| (3) |
An applicant who is unable to meet the
requirement of 410-11-(2)(c) must comply with similar requirements of
410-4-.04 for an advanced practice
registered nurse. |
| (1) |
The Board recognizes certification by: The
American Midwifery Certification Board; American Academy of Nurse
Practitioners; National Certification Corporation; Pediatric Nursing
Certification Board; National Board of Certification and Recertification for
Nurse Anesthetists; American Nurses Credentialing Center; and the American
Association of Critical-Care Nurses Certification Corporation for titles
recognized in Rules Chapter 410-11. |
| (2) |
The Board may discontinue recognition of
a certifying organization if it deems that the respective certification process
does not provide an accurate evaluation of the individual's ability to engage
in advanced nursing practice. |
| (1) |
The general purpose of these rules is to
assist in protecting and safeguarding the public by regulating the practice of
advanced practice registered nurses who use protocols as authorized by O.C.G.A.
§ 43-34-23. |
| (2) |
An advanced practice registered
professional nurse who uses a protocol as authorized by O.C.G.A. § 43-34-23 shall:
| (a) |
Hold a current license to practice as a
registered nurse in Georgia; |
| (b) |
Hold a current authorization as an advanced practice registered nurse in
Georgia; |
| (c) |
Adhere to a written
nurse protocol which is a written document mutually agreed upon and signed by
the nurse and licensed physician which specifies delegated medical acts
delegated by the physician to the nurse and provides for immediate consultation
with the delegating physician or a physician designated in the absence of the
delegating physician; and |
| (d) |
Document preparation and performance specific to each medical act authorized by
a written nurse protocol, including the ordering and administering of
controlled substances, ordering and dispensing of dangerous drugs, and ordering
medical treatments and diagnostic studies in accordance with O.C.G.A. § 43-34-23. |
|
| (3) |
The nurse protocol agreement used by an
advanced practice registered nurse under the provisions of O.C.G.A. § 43-34-23 shall comply with the
following criteria:
| (a) |
Shall be in writing
and signed by the advanced practice nurse and the delegating
physician; |
| (b) |
Shall be dated,
available upon request and specify parameters under which medical acts
delegated by the physician may be performed; |
| (c) |
Shall include provisions for periodic
review of patient records by the delegating physician; |
| (d) |
Shall be reviewed, revised or updated
annually; |
| (e) |
Shall include a
provision for immediate consultation with the delegating physician or a
physician designated in the absence of the delegating physician; |
| (f) |
Shall contain written provisions
regarding the procedure for dispensing dangerous drugs which comply with
O.C.G.A. §§ 43-34-23(a)(3),
(3.1), (4), and (5), if the dispensing of dangerous drugs is included as a
delegated medical act in the nurse protocol agreement; and |
| (g) |
Shall contain written provisions
regarding the procedure for ordering controlled substances which comply with
paragraph (b)(1) of O.C.G.A. § 43-34-23, if the ordering of
controlled substances is included as a delegated medical act in the nurse
protocol agreement. |
|
| (1) |
An advanced practice registered nurse
("APRN") who uses a protocol authorized by O.C.G.A. § 43-34-25 shall:
| (a) |
Hold a current license to practice as a
registered professional nurse in Georgia; |
| (b) |
Hold a current authorization to practice
as an advanced practice registered nurse in Georgia; |
| (c) |
Adhere to a written nurse protocol
agreement that is dated and signed by the APRN, the delegating physician, and
any other designated physician(s); the APRN's area of practice shall be in the
same or comparable specialty as that of the delegating physician; the protocol
shall specify the medical acts delegated to the APRN as provided by O.C.G.A.
§ 43-34-25 and shall provide for
immediate consultation with the delegating physician or a designated physician
if the delegating physician is not available; and |
| (d) |
Document preparation and performance
specific to each medical act authorized by the written nurse protocol agreement
including ordering drugs, medical treatments or diagnostic studies, medical
devices, or, in life threatening situations, radiographic imaging tests.
|
|
| (2) |
An APRN may practice
under a nurse protocol agreement authorized by O.C.G.A. § 43-34-25 if the nurse protocol
agreement adheres to the following criteria:
| (a) |
Shall bear a current review date; be
available upon request; and specify parameters under which delegated medical
acts may be performed to include kinds of diagnostic studies which may be
ordered, the extent to which radio logic image tests may be ordered, provisions
for the reading and interpretation of such tests by a physician who is trained
in the reading and interpretation of the tests, circumstances under which
prescription drugs orders may be executed, number of refills which may be
ordered, include a frequency of follow up review of the patient by the
physician, including patients who are on controlled substances; |
| (b) |
Shall include a schedule for periodic
review of patient records by the delegating physician, which records review may
be achieved with a sampling of such records as determined by the delegating
physician; |
| (c) |
Shall be reviewed,
revised or updated annually by the APRN, the delegating physician, and any
designated physician; |
| (d) |
Shall
include a provision for immediate consultation with the delegating physician or
a physician designated in the absence of the delegating physician;
and |
| (e) |
Shall comply with the
provisions of O.C.G.A. § 43-34-25 regarding prescription
drug orders placed by an APRN for a drug or medical device including, but not
limited to, the following:
| 1. |
No prescription
drug orders submitted by an APRN for Schedule I or II controlled
substances; |
| 2. |
No refills of any
drug for more than 12 months from the date of the original Order, except in the
case of oral contraceptives, hormone replacement therapy, or prenatal vitamins,
which may be refilled for a period of 24 months; |
| 3. |
No drug order or medical device that may
result in the performance or occurrence of an abortion, including the
administration, prescription or issuance of a drug order that is intended to
cause an abortion to occur pharmacologically; |
| 4. |
Written prescription drug orders shall be
signed by the APRN, be written on forms that comply with the nurse protocol
agreement, and such forms shall contain the information required by paragraph
(d) of O.C.G.A. § 43-34-25; |
| 5. |
A written provision in the nurse protocol
agreement authorizing the APRN to request, receive, and sign for professional
samples, and to distribute them to patients in accordance with a list of
professional samples approved by the delegating physician that is maintained by
the office or facility where the APRN works and that requires the documentation
of each sample received and dispensed; and |
| 6. |
Compliance with applicable state and
federal laws and regulations pertaining to the ordering, maintenance, and
dispensing of drugs. |
|
|
| (3) |
Only four (4) advanced practice
registered nurses may enter into a nurse protocol agreement with a delegating
physician at any one time under O.C.G.A § 43-34-25, except this limitation
shall not apply to an APRN that is practicing in the following settings:
| (a) |
In a hospital licensed under Title
31; |
| (b) |
In any college or
university as defined in Code Section
20-8-1; |
| (c) |
In the Department of Public
Health; |
| (d) |
In any county board of
health; |
| (e) |
In any free health
clinic; |
| (f) |
In a birthing
center; |
| (g) |
In any entity:
| 1. |
Which is exempt from federal taxes pursuant
to Section 501(c)(3) of the Internal Revenue Code, as defined in Code Section
48-1-2, and primarily serves
uninsured or indigent Medicaid and Medicare patients; or |
| 2. |
Which has been established under the
authority of or is receiving funds pursuant to
42 U.S.C. Section 254 b or 254c of the United States Public
Health Service Act; |
|
| (h) |
In any local board of education which has a school nurse program; or |
| (i) |
In a health maintenance organization that
has an exclusive contract with a medical group practice and arranges for the
provision of substantially all physician services to enrollees in health
benefits of the health maintenance organization. |
|
