Advanced Practice Nurse Prescribers in Assisted Living
PDF Version of DQA 09-001 (PDF,
43 KB)
| Date: |
January 7, 2009 |
| To: |
Community-based Residential Facilities
CBRF 01
- OBSOLETED by 09-007
Adult Family Homes AFH 01 |
| From: |
Kevin Coughlin, Director
Bureau of Assisted Living |
| Via: |
Otis Woods, Administrator
Division of Quality Assurance
|
Advanced Practice Nurse Prescribers in Assisted Living
This memo addresses some general issues related to advanced practice
nurses (APNs) and advanced practice nurse prescribers (APNPs) practicing in
assisted living facilities. Additionally, this memo creates a general
variance to specific rules that may have limited APNPs from fully practicing
in certain assisted living facilities.
Wis. Admin. Code § N 8.02(1) and (2), defines "advance practice
nurse" and "advance practice nurse prescriber" as follows:
(1) "Advanced practice nurse'' means a registered nurse who
possesses the following qualifications:
- The registered nurse has a current license to practice professional
nursing in this state, or has a current license to practice professional
nursing in another state which has adopted the nurse licensure compact;
- The registered nurse is currently certified by a national certifying
body approved by the board as a nurse practitioner, certified
nurse-midwife, certified registered nurse anesthetist or clinical nurse
specialist; and,
- For applicants who receive national certification as a nurse
practitioner, certified nurse-midwife, certified registered nurse
anesthetist or clinical nurse specialist after July 1, 1998, the
registered nurse holds a master's degree in nursing or a related health
field granted by a college or university accredited by a regional
accrediting agency approved by the board of education in the state in
which the college or university is located.
(2) "Advanced practice nurse prescriber'' means an advanced practice
nurse who has been granted a certificate to issue prescription orders under
s. 441.16 (2), [of the Wisconsin Statutes].
There are two groups of advanced practice nurses (APNs): those that can
issue prescription orders and those who cannot. Within these two groups,
many APNs may specialize, e.g., in wound care, psychiatric care and other
areas. Advance practice nurses generally practice independently in their
area of expertise.
In practicing independently, APNs may assess and direct care within their
scope of practice. Advanced practice nurses who are also advanced practice
nurse prescribers (APNPs) are authorized to write prescriptions for
medications; however, APNPs may not be fully recognized in the current rules
governing the operation of an assisted living facility. For example, Wis.
Admin. Code § HFS 83.33(2)(h)1., indicates that a "physician's written
order" is required for medications. Another example can be found in §
HFS 88.07(3)(d), which requires a "written order from a physician"
for staff to administer medications in an Adult Family Home.
In light of the authority under Wis. Admin. Code ch. N 8, and the
limiting language in Wis. Admin. Code chs. HFS 83 and 88, the Division of
Quality Assurance (DQA) is issuing a general variance for chs. HFS 83 and
HFS 88 that specifically allows advance practice nurse prescribers to
practice within the scope of their license as that practice relates to the
issuing of prescription orders in these two types of assisted living
facilities. The details of the general variance are in the grid that
follows.
|
Applicable Administrative Code Provision |
Current Language |
Variance |
|
HFS 83.33(2)(h)1 |
Each CBRF shall ensure that there is a physician's
written order for nursing care, medications, rehabilitation services
and therapeutic diets provided or arranged by the CBRF. |
A "practitioner," as defined in Wis. Admin.
Code § HFS 83.04(48), is authorized to issue prescription orders for
medications under this section. (A "practitioner" means a
person licensed in this state to prescribe and administer drugs or
licensed in another state and recognized by this state as a person
authorized to prescribe and administer drugs.) |
|
HFS 88.07(3)(d) |
Before a licensee or service provider dispenses or
administers a prescription medication to a resident, the licensee
shall obtain a written order from the physician who prescribed the
medication specifying who by name or position is permitted to
administer the medication, under what circumstances and in what dosage
the medication is to be administered. The licensee shall keep the
written order in the resident's file. |
|
|
HFS 88.10(3)(q) |
Medication. To receive all prescribed medications in
the dosage and at the intervals prescribed by the resident's
physician, and to refuse medication unless there has been a court
order under s. 51.61(1)(g), Wis. Stats., with a court finding of
incompetency |
A practitioner is authorized to issue prescription
orders under these sections. (A "practitioner" means a
person licensed in this state to prescribe and administer drugs or
licensed in another state and recognized by this state as a person
authorized to prescribe and administer drugs.) |
In addressing the authority of an advanced practice nurse in
assisted living facilities, the Division of Quality Assurance has been asked
about advanced practice nurse prescribers and collaborative agreements with
physicians. The DQA refers facilities and APNPs to Wis. Admin. Code § N
8.10(7), which requires APNPs to document their collaborative relationships
with a physician. In this regard, DQA's expectation is that all applicable
assisted living facilities using APNPs have some type of written agreement
or memorandum of understanding that is consistent with the requirements of
Wis. Admin. Code chs. HFS 83 or 88, and N 8.
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