Laws Concerning Family Nurse Practitioners in Tennessee

Created by the state legislature, the Board of Nursing accomplishes its mission to safeguard the health, safety and welfare of Tennesseans by overseeing the qualifications of those practicing nursing within Tennessee. The Board adopts state statutes as rules for regulation of the nursing profession, both of which have the force of law. The Board investigates all violations of rules and can revoke the license of or imposes civil penalties on those found guilty.

Certification

• Per state rules, a certified nurse practitioner is a registered nurse with a master's degree or higher in a nursing specialty who has been issued a certificate by the Tennessee Board of Nursing. However, if obtained prior to July 1, 2005, certification does not require a master's degree. The Tennessee Board of Nursing dictates the minimum requirements for all approved nursing programs. Passing the National Council Licensure Examination, available only to those graduating from approved schools of nursing, is required by the Board to receive a certificate of fitness. All nurse practitioners must maintain a current license to practice in Tennessee. The Board requires certification renewal every 2 years. Certified nurse practitioners who meet these requirements can use the title "advanced practice nurse" or "APN."

Physician Supervision

• Tennessee statute requires supervision of all APNs. This supervision does not require the continuous presence of a physician but does require constant accessibility for consultation between the APN and physician, and, if otherwise engaged, the supervising physician must make arrangements for a substitute physician's availability.

Protocols

• The supervising physician must develop clinical guidelines, that is, protocols, in collaboration with the APN. Approved by both the supervising physician and the APN, these protocols delineate the applicable standard of care. Requirements include a biennial review, an accounting for all drugs by appropriate formulary (a list of drugs approved to be prescribed and/or issued by an APN according to statute) and an accounting of the specific population seen. The protocols must be dated and signed, available at the practice site and accessible upon request for inspection by regulatory boards.

Prescriptions and Oversight

• APNs intending to prescribe or administer controlled substances must also acquire and maintain a Drug Enforcement Administration Certificate to Prescribe Controlled Substances. Those eligible must use the numbers assigned to them by the DEA when prescribing controlled substances. The APN must keep accurate patient records, and the dispensing of controlled substances requires maintaining a separate log. A physician review is required when a prescription written by the APN occurs outside the scope of the protocols or after the prescription of a controlled substance. Otherwise, the supervising physician must personally review no less than 20 percent of charts written by the APN and visit any remote site at least every 30 days.

Accountability for Prescriptions

• The APN remains accountable for prescriptions written and signed. The physician must provide preprinted prescription pads reflecting the name, address and telephone number of the physician and the APN. The APN who orders the prescription must sign his own name on each prescription. If the preprinted prescription pad reflects the names of more than one physician, the APN must indicate his supervising physician by placing a circle around, or check mark beside, that physician's name.

Penalties

• The Board of Nursing possesses express powers and duties for suspension or revocation of a license for reported violations by an APN of state rules or statutes, as well as authorization to petition any circuit or chancery court dependent on the egregiousness of the violation.