Frequently asked questions about NP practice in Tennessee
What can a Nurse Practitioner (NP) do?
Must the supervising MD be on site?
What are MD responsibilities for supervising NPs?
Are there sample protocols for reviewing that would help in writing protocols?
What do I do with completed protocols and formulary?
What is the average salary of NPs in Tennessee?
What credentials must an NP have in order to practice?
How many NPs may a physician supervise?
How often must the supervising physician sign the charts?
When did the physician supervisory rules go into effect?
Can NPs receive and dispense samples?
What can a Nurse Practitioner (NP) do?
(Board of Nursing (BON) Rule 1000-1-.04(3) Responsibility)
NPs in Tennessee perform a variety of specific functions within a given practice, based on patient population and individual education. NPs are educated to diagnose and treat common illness, both acute and chronic. NPs also emphasize health promotion and illness prevention in their practices. Generally, NPs practice in a primary care setting, but some choose to provide services to patients in specialty practices, such as allergy, cardiology, or women’s health.
Must the supervising MD be on site?
(Board of Medical Examiners (BME) Rules Chapter 0880-6)
No, but NPs need 24-hour-a-day access to the supervising physician or the substitute supervisory physician for consultation or referral. The rules do not require the continuous and constant physical presence of the supervising physician, but do require the physicians to visit the nurse practitioner’s practice site every 30 days and review a minimum of 20 percent of the patient charts.
What are MD responsibilities for supervising NPs?
(BME Rule 0880-6-.03 and BON Rule 1000-1-.04(3) and (4)) Nurse Practitioners in Tennessee practice under a broad definition of nursing (TCA 63-7-103). We recommend that the NP and supervising MD develop a specific plan for their collaboration on patient care when medically indicated. This plan should include:
a)how to reach MD or MD designate 24 hours per day;
b)when specific charts are to be discussed; and
c)when co-signing of charts with prescriptions written will be done.
Many practices also implement quality assurance processes for random reviewing of patient charts. Then, based on developed outcome criteria, continuous quality improvement can be achieved.
Are there sample protocols for reviewing that would help in writing protocols?
There are several texts that describe easy to follow formats for writing protocols. One available text is Nurse Practitioner Protocols 2000, Third Edition, M.M. Cohen and A. Lanigan, available from Sunbelt Medical Publishers, P.O. Box 13512 Dept. G59, Tallahassee, Florida 32317-3512.
Click here to order online.
Also, TNA recommends that you order the following ANA document: Scope and Standards of Advanced Practice Registered Nursing (TNA Member Price: $13.45. Non-member price is $16.45. Publication number is: ADVICM4). Charge your order toll-free at 800/637-0323 from the American Nurses Publishing. M
What do I do with completed protocols and formulary?
Copies of NP/MD jointly developed protocols for prescriptive practice must be maintained on site. A nurse who has been issued a Certificate of Fitness to prescribe or a Temporary Certificate of Fitness to prescribe shall file a “Notice and Formulary” form with the Board of Nursing pursuant to TCA õ63-7-123(b). This form can be obtained from the Board of Nursing or can be accessed on the Board of Nursing website at www.state.tn.us/health.
What is the average salary of NPs in Tennessee?
Current salary ranges vary and may be available at the TNA office. The compensation package for NPs we recommend includes profit sharing options, continuing education benefits, and TNA professional dues, as well as health and malpractice insurance and on-call reimbursement.
What credentials must an NP have in order to practice?
(BON Rule 1000-4-.03 and .04)
Each NP must maintain a current Tennessee RN license and evidence of completion of an education program as an NP. If the NP will be writing prescriptions, a master’s degree in nursing and a Certificate of Fitness to prescribe from the Board of Nursing are required. A Temporary Certificate of Fitness may be issued to newly graduated NPs with qualifications listed in Rule 1000-4-.03. This requires supervision on site by an MD or another NP. It also requires registration for the next available national certification exam (TCA õ63-7-123). If the NP fails to pass or does not take the first available certifying exam, the Temporary Certificate of Fitness must be returned to the Board of Nursing. Caution: disciplinary action will be taken against the NP who fails to relinquish a Temporary Certificate of Fitness under these circumstances and the NP will be subject to a civil penalty.
How many NPs may a physician supervise?
The law does not address this issue. Clearly, good patient care requires the ability to be available for consultation or referral whenever a patient’s condition demands it.
How often must the supervising physician sign the charts?
Requirements for chart review are addressed in the Rules of the Tennessee Board of Medical Examiners in Chapter 0880-6-.02(7) and (8).
When did the physician supervisory rules go into effect?
These rules became effective June 1, 1999. Nurse practitioners, who have a Certificate of Fitness, may now obtain DEA numbers to prescribe Schedule II-V controlled drugs.
Can NPs receive and dispense samples?
Yes, the intent of the law, which was passed in 1980, was that the word “issue” drugs would cover handing out samples and/or prepackaged prescription drugs. Additionally, the new administrative Board of Nursing rules found in this package include the word “dispense” in (1000-4).