Excerpts of Law Regulating the Practice of Nursing
Every registered nurse should have a copy of the Law Regulating the Practice of Nursing-T.C.A. 63-7-101 through 63-7-209-(commonly known as the Nurse Practice Act) and a copy of the Administrative Rules and Regulations (1000-1 through 1000-4). These documents also can be obtained from the Tennessee Board of Nursing in Nashville. Printed below are specific excerpts affecting the practice of nurse practitioner/prescription writers.
Definition of Professional Nursing
63-7-103. “Practice of professional nursing” defined. -(a)(1) “Practice of professional nursing” means the performance for compensation of any act requiring substantial specialized judgment and skill based on knowledge of the natural, behavioral and nursing sciences, and the humanities, as the basis for application of the nursing process in wellness and illness care.
(2)”Professional nursing” includes:
(A)Responsible supervision of a patient requiring skill and observation of symptoms and reactions and
accurate recording of the facts;
(B)Promotion, restoration and maintenance of health or prevention of illness of others;
(C)Counseling, managing, supervising and teaching of others;
(D)Administration of medications and treatments as prescribed by a licensed physician, dentist, podiatrist
or nurse authorized to prescribe pursuant to õ63-7-123;
(E)Application of such nursing procedures as involve understanding of cause and effect; and
(F)Nursing management of illness, injury or infirmity including identification of patient problems.
(b)Notwithstanding the provisions of subsection (a), the practice of professional nursing does not include acts of medical diagnosis or the development of a medical plan of care and therapeutics for a patient, except to the extent such acts may be authorized by õ õ63-1-132, 63-7-123 and 63-7-207. [Acts 1967, ch. 78, õ12; 1972, ch. 523, õ1; T.C.A., õ63-740; Acts 1990, ch. 651, õ 2.]
Certificate of Fitness
63-7-123. Certified nurse practitioners. -(a) The board shall issue a certificate of fitness to nurse practitioners who meet the qualifications, competencies, training, education and experience, pursuant to õ63-7-207(14), sufficient to prepare such persons to write and sign prescriptions and/or issue drugs within the limitations and provisions of õ63-1-132.
(b)(1)A nurse who has been issued a certificate of fitness as a nurse practitioner pursuant to õ63-7-207 and this section shall file a notice with the board containing the name of the nurse practitioner, the name of the licensed physician having supervision, control and responsibility for prescriptive services rendered by the nurse practitioner, and a copy of the formulary describing the categories of legend drugs to be prescribed and/or issued by the nurse practitioner. The nurse practitioner shall be responsible for updating this information.
(2)The nurse practitioner who holds a certificate of fitness shall be authorized to prescribe and/or issue controlled substances listed in Schedules II, III, IV, and V of Tennessee Code Annotated, Title 39, Chapter 17, Part 4, upon joint adoption of physician supervisory rules concerning controlled substances pursuant to Section (d) of this act.
(3) Any prescription written and signed or drug issued by a nurse practitioner under the supervision and control of a supervising physician shall be deemed to be that of the nurse practitioner. Every prescription issued by a nurse practitioner pursuant to this section shall be entered in the medical records of the patient and shall be written on a preprinted prescription pad bearing the name, address and telephone number of the supervising physician and of the nurse practitioner, and the nurse practitioner shall sign each prescription so written. Where the preprinted prescription pad contains the names of more than one (1) physician, the nurse practitioner shall indicate on the prescription which of those physicians is the nurse practitioner’s primary supervising physician by placing a checkmark beside or a circle around the name of that physician.
(4)The nurse practitioner shall maintain a copy of the protocol the nurse practitioner is using at the nurse practitioner’s practice location and shall make the protocol available upon request by the Board of Nursing, the Board of Medical Examiners or the authorized agents of either board. [Acts 1980, ch. 851, õ 4; T.C.A., õ 63-760; Acts 1985, ch. 120, õ 9; 1992, ch. 822, õ 1; 1994, ch. 569, õ 2; 1995, ch. 358, õ 1; 1996, ch. 659, õ 2; 1997, ch. 507, õ 2; 1998, ch. 842, õõ 2, 3; 2003, ch. 259, õ 1.]
Temporary Certificate of Fitness
(c)(1) The board may issue a temporary certificate of fitness to a registered nurse who:
(A)Is licensed to practice in Tennessee;
(B)Has a master’s degree in a nursing clinical specialty area with preparation in specialized practitioner
skills which includes three (3) quarter hours of pharmacology instruction or its equivalent; and
(C)Has applied for examination and/or is awaiting examination results for national certification as a first-
time examinee in an appropriate nursing specialty area.
(2)Such temporary certificate shall remain valid until the examination results are obtained. The holder of a temporary certificate issued under the provisions of this subsection, who has not received the results of the examination, shall work only under the supervision and control of a certified nurse practitioner or physician.
Physician Supervision
(d)Any rules which purport to regulate the supervision of nurse practitioners by physicians shall be jointly adopted by the board of medical examiners and the board of nursing. [Acts 1980, ch. 851, õ 4; T.C.A., õ 63-760; Acts 1985, ch. 120, õ 9; 1992, ch. 822, õ 1; 1994, ch. 569, õ 2.]
Advanced Practice Nurses
63-7-126. Advanced practice nurses.
(a) “Advanced practice nurse” means a registered nurse with a Master’s degree or higher in a nursing specialty and national specialty certification as a nurse practitioner, nurse anesthetist, nurse midwife, or clinical nurse specialist.
(b) Nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists holding such education and practice credentials shall apply to the board for a certificate to practice as an advanced practice nurse including authorization to use the title “advanced practice nurse” or the abbreviation “APN.” No other person shall assume such title or use such abbreviation or any other words, letters, or signs to indicate that the person using the same is an advanced practice nurse.
(c) An applicant for a certificate to practice as an advanced practice nurse shall pay an initial fee as set by the board as well as a biennial renewal fee as set by the board.
(d) A nurse practitioner, nurse anesthetist, nurse midwife or clinical nurse specialist who holds a Tennessee registered nurse license in good standing and current national specialty certification in the advanced practice specialty shall be eligible for a certificate to practice as an advanced practice nurse on May 22, 2002, and shall be exempt from the requirement of a Master’s degree or higher in the nursing specialty if licensed in Tennessee and holding national specialty certification prior to July 1, 2005.
(e) Nothing in this section shall be interpreted to alter or change the current law as it existed on May 22, 2002, regarding prescriptive rights, supervision, or scope of practice for nurse anesthetists regulated under this title, nurse midwives as described in õ 56-7-2407, clinical nurse specialists, or certified nurse practitioners as defined in õ 63-7-123. Nor shall anything in this section be interpreted to allow any board or any other entity to promulgate rules that would alter or change the law as it existed on May 22, 2002, act regarding such prescriptive rights, supervision, or scope of practice. [Acts 2002, ch. 768, õ 1; 2003, ch. 111, õ 1.]