APRN Scope of Practice
Sec. 20-87a. Definitions. Scope of practice. (a) The practice of nursing by a registered nurse is defined as the process of diagnosing human responses to actual or potential health problems, providing supportive and restorative care, health counseling and teaching, case finding and referral, collaborating in the implementation of the total health care regimen, and executing the medical regimen under the direction of a licensed physician, dentist or advanced practice registered nurse.
(b) Advanced nursing practice is defined as the performance of advanced level nursing practice activities that, by virtue of post-basic specialized education and experience, are appropriate to and may be performed by an advanced practice registered nurse. The advanced practice registered nurse performs acts of diagnosis and treatment of alterations in health status, as described in subsection (a) of this section, and shall collaborate with a physician licensed to practice medicine in this state. In all settings, the advanced practice registered nurse may, in collaboration with a physician licensed to practice medicine in this state, prescribe, dispense and administer medical therapeutics and corrective measures and may request, sign for, receive and dispense drugs in the form of professional samples in accordance with sections 20-14c to 20-14e, inclusive, except that an advance practice registered nurse licensed pursuant to section 20-94a and maintaining current certification from the American Association of Nurse Anesthetists who is prescribing and administering medical therapeutics during surgery may only do so if the physician who is medically directing the prescriptive activity is physically present in the institution, clinic or other setting where the surgery is being performed. For purposes of this subsection, "collaboration" means a mutually agreed upon relationship between an advanced practice registered nurse and a physician who is educated, trained or has relevant experience that is related to the work of such advanced practice registered nurse. The collaboration shall address a reasonable and appropriate level of consultation and referral, coverage for the patient in the absence of the advanced practice registered nurse, a method to review patient outcomes and a method of disclosure of the relationship to the patient. Relative to the exercise of prescriptive authority, the collaboration between an advanced practice registered nurse and a physician shall be in writing and shall address the level of schedule II and III controlled substances that an advanced practice registered nurse may prescribe and provide a method to review patient outcomes, including, but not limited to, the review of medical therapeutics, corrective measures, laboratory tests and other diagnostic procedures that the advanced practice registered nurse may prescribe, dispense and administer. An advanced practice registered nurse licensed under the provisions of this chapter may make the determination and pronouncement of death of a patient, provided the advanced practice registered nurse attests to such pronouncement on the certificate of death and signs the certificate of death no later than twenty-four hours after the pronouncement.
Prescriptive Authority Statute
The relationship between a collaborator and an APRN re: prescriptive authority - To respond to recently raised questions.
The prescriptive authority of an APRN is clearly defined in the pharmacy statutes Chapter 420b Sec. 21a-252(e) copied below. This is an authorizing statute, not the nurse practice act.
If APRNs intend to use their prescriptive authority today, the nurse practice act states that the collaborative agreement must be in writing and must reference the level of controlled substances which the practitioner will be prescribing and must indicate that the APRN practice has a method in place for the APRN to review outcomes. So let's address 1. Outcomes and 2. Prescriptive Authority.
1. OUTCOMES - Outcomes for medication use, whether a controlled substance or not, are lab results. The process, or METHOD for all providers is germane to all practice: the prescriber signs off on lab results, to indicate awareness of them. The collaborator does not review the outcomes. That is the responsibility of the APRN. The only time a collaborator might be involved with outcomes would be if the APRN feels that particular case warrants a collaboration, and the collaborator has the necessary expertise. If the APRN decides that collaboration is warranted, the APRN is free to collaborate with any provider deemed appropriate e.g. a specialist.
2. PRESCRIPTIVE AUTHORITY - The collaborator is not involved with the prescribing authority of the APRN. The agreement only notes that schedule II through V medication may be prescribed - what's left out is "in accordance with CGS Chapter 420b Sec. 21a-252(e)". In other words, the APRN has the authority to prescribe and the agreement must note the intention to utilize this authority - but the agreement does not provide the authority to prescribe, nor does the collaborator.
CGS - CHAPTER 420b
Sec 21a-252(e) An advanced practice registered nurse licensed pursuant to section 20-94a, in good faith and in the course of such nurse's professional practice only, may prescribe, dispense, and administer controlled substances in schedule II, III, IV or V, or may cause the same to be administered by a registered nurse or licensed practical nurse under the advanced practice registered nurse's direction and supervision, to the extent permitted by the federal Controlled Substances Act, the federal food and drug laws and state laws and regulations relating to advanced nursing practice.
(All of the above retrieved from http://psychaprn.bravehost.com/details.html)
