Prescribing
Nurse practitioners (NPs) in 50 states and the District of Columbia have the legal authority to prescribe. The independence of NPs’ prescriptive authority varies widely, and, in several states, words other than “prescribe” are used.
In 13 states, NPs have explicit legal authority to “prescribe,” with no requirement for physician involvement. In one state, Utah, NPs need physician involvement only when prescribing Schedules II-III. In 33 states, NPs have explicit legal authority to prescribe but must have a collaborative relationship with a specific physician. In one state (Michigan), NPs do not have specific legal authority to prescribe, but the law permits physicians to delegate medical functions (Exhibit 5-1). In 46 states, NPs may prescribe controlled substances. (See Exhibit 5-2 for the states that fall into this category.) Appendix 5-A presents laws on prescriptive authority for each state.
▪ Controlled Substances
Controlled dangerous substances are narcotics, depressants, stimulants, and hallucinogenic drugs covered under the Controlled Substances Act, a federal law. In 49 states and the District of Columbia, NPs may prescribe controlled substances.
Classification of Controlled Substances
There are five “schedules” of controlled substances:
Schedule I: Schedule I substances have little or no accepted medical use in the United States and have high abuse potential. Examples are heroin, LSD, marijuana, mescaline, methaqualone, and peyote.
Schedule II: Schedule II drugs have a high abuse potential with severe psychic or physical dependence liability and in general are substances that have therapeutic utility. Schedule II narcotics include morphine, codeine, fentanyl, hydromorphone (Dilaudid), levorphanol, meperidine (Demerol), methadone, oxycodone,
and opium. Stimulants such as amphetamines are in Schedule II, as well as depressants such as pentobarbital.
Schedule III: Schedule III drugs are stimulants and depressants with an abuse potential. Schedule III narcotics include mixtures of limited specified quantities of codeine with noncontrolled active ingredients, mixtures of amobarbital, pentobarbital, or secobarbital with other noncontrolled medicinal ingredients, and anabolic steroids.
Schedule IV: Schedule IV drugs are: (a) depressants such as: alprazolam, clonazepam, diazepam, and flurazepam; (b) stimulants such as phenteramine; and other substances such as pentazocine.
Schedule V: The schedule V drugs include narcotic drugs not listed in another schedule, stimulants not listed in another schedule, and narcotic drugs containing nonnarcotic medicinal ingredients.
EXHIBIT 5-1 Forms of Prescriptive Authority
Explicit Legal Authority to Prescribe/No Physician Involvement Required | Connecticut |
Delaware | |
Alaska | Florida |
Colorado | Hawaii |
District of Columbia | Illinois |
Idaho | Indiana |
Iowa | Kentucky |
Maine | Louisiana |
Maryland | Massachusetts |
Montana | Minnesota |
New Hampshire | Mississippi |
New Mexico | Missouri |
Oregon | Nebraska |
Utah—except for Schedules II-III | Nevada |
Washington | New Jersey |
Wyoming | New York |
Authority to “Furnish” Drugs/Physician Delegation Required | North Carolina |
North Dakota | |
California | Ohio |
Physician May Delegate Authority to Prescribe | Oklahoma |
Pennsylvania | |
Rhode Island | |
Georgia | South Carolina |
Michigan | South Dakota |
Virginia | Tennessee |
Explicit Legal Authority to Prescribe/Physician Collaboration Required | Texas |
Vermont | |
Alabama | Virginia |
Arizona | West Virginia |
Arkansas | Wisconsin |
A complete listing of the drugs controlled under the Controlled Substances Act may be found in Title 21, Code of Federal Regulations, Part 1300 to end, Sections 1308.11 through 1308.15. Prescribing references usually provide the class of each drug listed.
DEA Registration
The federal go vernment—the Drug Enforcement Administration (DEA)—oversees NPs’ prescribing of controlled substances. To prescribe controlled substances, an NP must register with the DEA and obtain a DEA number. The NP must use the DEA number on prescriptions for scheduled drugs.
DEA registration is one method of tracking healthcare providers’ prescribing practices related to controlled substances. The DEA number is also a method of minimizing unauthorized prescribing: that is, a person who is not authorized to prescribe but who wants to write a prescription for a controlled substance, has a prescription pad, and signs the name of an authorized prescriber will be unable to get the prescription filled if it does not include a DEA number.
Federal registration is based on the applicant’s complying with state and local laws. If a state requires a separate controlled substances license, an NP must obtain that license and submit a copy with the application for a DEA number. If state law does not authorize NPs to prescribe controlled substances, the DEA will not issue DEA numbers.
EXHIBIT 5-2 Stage Regulations of NP’s Prescriptive Activity
NP May Prescribe Controlled Substances | Nebraska |
Nevada | |
Alaska | New Hampshire |
Arizona | New Jersey |
Arkansas (not Schedule I-II) | New Mexico |
California | New York |
Colorado | North Carolina |
Connecticut | North Dakota |
Delaware | Ohio |
District of Columbia | Oklahoma (not Schedule I-II) |
Georgia (not Schedule I-II) | Oregon |
Idaho | Pennsylvania |
Illinois | Rhode Island |
Indiana | South Carolina (not Schedule I-II) |
Iowa | South Dakota |
Kansas | Tennessee |
Louisiana (not Schedule I-II, except for Attention Deficit Disorder) | Texas (not Schedule I-II) |
Utah | |
Maine | Vermont |
Maryland | Virginia |
Massachusetts | Washington |
Michigan | West Virginia (not Schedule I-II) |
Minnesota | Wisconsin |
Mississippi | Wyoming |
Montana |
DEA registration costs $551 for a three-year term. States may charge for registration as well. To apply for DEA registration, visit www.deadiversion.usdoj.gov/drugreg. Once a DEA number is issued, a renewal application is automatically issued 45 days prior to expiration. Registrants must report, in writing, any change in business location to the DEA. DEA registration is issued in the NP’s name at the business address.
▪ Guidelines for Prescribing Legally
NPs should follow these general guidelines when prescribing:
Prescribe the right medicine at the right time for the right indication for the right patient.
If there is a practice protocol or guidelines in the facility, follow it.
If there is no facility-wide protocol, adhere to the standard of care in prescribing. The standard of care for prescribing may be assumed to be the Physician’s Desk Reference or www.epocrates.com.
Before prescribing, ask a patient:
Are you pregnant?
Are you breastfeeding?
Are you allergic to any medications?
Have you taken [this medicine] before? Did it work? Did it give you any ill effects?
Do you have any liver or kidney problems?
What other medications are you on?
What other medical problems do you have?
Address any cross-sensitivities. For example, if a patient is allergic to penicillin, an NP probably should not prescribe Keflex, which has cross-sensitivities with penicillin.
Address any contraindications. For example, a patient with chronic hepatitis should not be prescribed a medication that has potential for liver damage unless it is a life-and-death situation and there is no other choice.
Address any drug interactions. For example, theophylline is antagonized by phenytoin and potentiated by macrolide antibiotics.
Inform the patient of potential side effects, and ask whether the patient wants to accept the risk of experiencing those side effects.
Inform the patient to call or return if he or she notices any adverse change in his or her condition.
Other considerations when prescribing are:
Can the patient afford the medication? If not, the NP should not count on the patient getting the prescription filled.
Is the drug to be prescribed in the for mulary for the agency or health maintenance organization?
Is there potential for abuse of the medication? For example, a depressed patient may overdose on a prescribed medication, and a patient with a history of substance abuse may be seeking to continue the habit through a request for pain medication.
Resources
Buppert, C. Prescribing: Avoiding Legal Pitfalls for NPs (2010). Law Office of Carolyn Buppert, P.C. http://www.buppert.com.
Appendix 5-A
State-by-State Law Prescriptive Authority
Alabama
[The] joint committee shall recommend model practice protocols to be used by certified registered nurse practitioners and certified nurse-midwives and a formulary of legend drugs that may be prescribed by these advanced practice nurses, subject to approval by both the State Board of Medical Examiners and the Board of Nursing. The joint committee shall also recommend rules and regulations to establish the ratio of physicians to certified registered nurse practitioners and certified nurse-midwives; provided, however, that the rules and regulations shall not limit the ratio to less than two nurse practitioners or midwives to one physician or one certified registered nurse practitioner and one certified nurse-midwife to one physician and shall provide for exceptions. The joint committee shall also recommend rules and regulations that establish the manner in which a collaborating physician may designate a covering physician when temporarily unavailable as the collaborating physician.
Citation: ALA. § 34-21-87.
Certified registered nurse practitioners, engaged in collaborative practice with physicians may be granted prescriptive authority upon submission of evidence of an academic course in pharmacology … CRNPs practicing under protocols…. may prescribe legend drugs to their patients, subject to the following conditions:
The drug type, dosage, quantity prescribed, and number of refills shall be authorized in an approved protocol signed by the collaborating physician and the CRNP; and
The drug shall be on the formulary recommended by the joint committee and adopted by the State Board of Medical Examiners and the Board of Nursing.
A certified registered nurse practitioner or a certified nurse-midwife may not initiate a call-in prescription in the name of a collaborating physician for any drug, whether legend or controlled substance, which the nurse practitioner or certified nurse-midwife is not authorized to prescribe under the protocol signed by the collaborating physician and certified registered nurse practitioner or certified nurse-midwife and approved under this section unless the drug is specifically ordered for the patient by the physician, either in writing or by a verbal order which has been reduced to writing, and which has been signed by the physician within a time specified in the rules and regulations approved by the State Board of Medical Examiners and the Board of Nursing.
Registered nurses and licensed practical nurses are authorized to administer any legend drug that has been lawfully ordered or prescribed by an authorized practitioner including certified registered nurse practitioners, certified nurse-midwives, and/or assistants to physicians.
Citation: ALA. CODE § 34-21-86.
Certified registered nurse practitioners engaged in collaborative practice with physicians may be granted prescriptive authority upon submission of evidence of completion of an academic course in pharmacology or evidence of integration of pharmacology theory and clinical application in the certified registered nurse practitioner curriculum.
Certified registered nurse practitioners practicing under protocols approved in the manner prescribed by Code of Ala. 1975, Section 34-21-80 et seq. may prescribe legend drugs to their patients, subject to the following conditions:
The drug type, dosage, quantity prescribed, and number of refills shall be authorized in an approved protocol signed by the collaborating physician and the certified registered nurse practitioner. This requirement may be met if written prescriptions adhere to the standard recommended doses of legend drugs as identified in the Physician’s Desk Reference or Product Information Insert, not to exceed the recommended treatment regimen periods.
The drug shall be included in the formulary recommended by the Joint Committee and adopted by the Board of Nursing and the State Board of Medical Examiners.
A certified registered nurse practitioner shall not initiate a call-in prescription in the name of a collaborating physician for any drug, whether legend or controlled substance, which the certified registered nurse practitioner is not authorized to prescribe under the protocol
signed by the collaborating physician and certified registered nurse practitioner and approved under this section unless the drug is specifically ordered for the patient by the physician, either in writing or by a verbal order which has been transcribed in writing, and which has been signed by the physician within seven working days or as otherwise specified by the Board of Nursing and the State Board of Medical Examiners.
A written prescription for any drug that the certified registered nurse practitioner is authorized to prescribe may be called in to a pharmacy, provided the prescription is entered into the patient’s record and signed by the certified registered nurse practitioner.
The certified registered nurse practitioner in collaborative practice with prescriptive privileges shall not engage in prescribing for:
Self
Immediate family members
Individuals who are not patients of the practice
The certified registered nurse practitioner who is in collaborative practice and has prescriptive privileges may receive and sign for samples of legend drugs that are authorized in the approved formulary for the collaborative practice, provided the certified registered nurse practitioner complies with all applicable state and federal laws and regulations.
Citation: ALA. ADMIN. CODE r. 610-X-5-.11.
Alaska
The Board will, in its discretion, authorize an advanced nurse practitioner or “ANP” to prescribe and dispense legend drugs in accordance with applicable state and federal laws …
An advanced nurse practitioner who applies for authorization to prescribe and dispense drugs … shall provide evidence of completion of 15 contact hours of education in pharmacology and clinical management of drug therapy within the 2-year period immediately before the date of application.
Citation: ALASKA ADMIN. CODE tit. 12, § 44.440.
There is no requirement for physician collaboration.
Arizona
The Board shall authorize an RNP to prescribe and dispense (P & D) drugs and devices within the RNP’s scope of practice only if the RNP:
Obtains authorization by the Board to practice as a registered nurse practitioner.
Applies for prescribing and dispensing privileges …
Submits a completed application on a form provided by the Board that contains all of the following information:
Name, address, and home phone number;
Arizona registered nurse license number;
Nurse practitioner specialty;
Nurse practitioner certification number issued by the Board;
Business address and phone number;
Applicant’s sworn statement verifying the truthfulness of the information provided.
Submits evidence of completion of a minimum of 45 contact hours of education within the three years immediately preceding the application, covering one or both of the following topics—pharmacology or clinical management of drug therapy.
An applicant who is denied medication P & D authority may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order denying the application for P & D authority. Board hearings shall comply with 41 A.R.S. 6, Article 10, and 4 A.A.C. 19, Article 6.
Citation: ARIZ. ADMIN. CODE R4-19-511.
An RNP granted P & D authority by the Board may:
Prescribe drugs and devices;
Provide for refill of prescription-only drugs and devices for one year from the date of the prescription.
An RNP with P & D authority who wishes to prescribe a controlled substance shall obtain a DEA registration number before prescribing a controlled substance. The RNP shall file the DEA registration number with the Board.
An RNP with a DEA registration number may prescribe:
A Class II controlled substance as defined in the federal Uniform Controlled Substances Act, 21 U.S.C. § 801 et seq., or Arizona’s Uniform Controlled Substances Act, A.R.S. Title 36, Chapter 27, but shall not prescribe refills of the prescription;
A Class III or IV controlled substance, as defined in the federal Uniform Controlled Substances Act or Arizona’s Uniform Controlled Substances Act, and may prescribe a maximum of five refills in six months; and
A Class V controlled substance, as defined in the federal Uniform Controlled Substances Act or Arizona’s Uniform Controlled Substances Act, and may prescribe refills for a maximum of one year.
An RNP whose DEA registration is revoked or expires shall not prescribe controlled substances. An RNP whose DEA registration is revoked or limited shall report the action to the Board.
In all outpatient settings or at the time of hospital discharge, an RNP with P & D authority shall personally provide a patient or the patient’s representative with the name of the drug, directions for use, and any special instructions, precautions, or storage requirements necessary for safe and effective use of the drug if any of the following occurs:
A new drug is prescribed or there is a change in the dose, form, or direction for use in a previously prescribed drug;
In the RNP’s professional judgment, these instructions are warranted; or
The patient or patient’s representative requests instruction.
An RNP with P & D authority shall ensure that all prescription orders contain the following:
The RNP’s name, address, telephone number, and specialty area;
The prescription date;
The name and address of the patient;
The full name of the drug, strength, dosage form, and directions for use;
The letters “DAW”, or “dispense as written”, “do not substitute”, “medically necessary” or any similar statement on the face of the prescription form if intending to prevent substitution of the drug;
The RNP’s DEA registration number, if applicable; and
The RNP’s signature.
Citation: ARIZ. ADMIN. CODE R4-19-512.
Arkansas
An advanced practice nurse with a certificate of prescriptive authority may receive and prescribe drugs, medications, or therapeutic devices appropriate to an advanced practice nurse’s area of practice in accordance with rules established by the Board.
Citation: ARK. CODE ANN. § 17-87-310(b)(1).
An advanced practice nurse may prescribe Schedule III-V drugs.
Citation: ARK. CODE ANN. § 17-87-310(b)(2).
Prescriptive authority requires:
Proof of completion of a board-approved advanced pharmacology course that includes preceptorial experience in the prescription of drugs, medicine, and therapeutic devices;
A collaborative practice with a physician, who has a practice comparable in scope, specialty or expertise to that of the advanced practice nurse on file with the board.
Citation: ARK. CODE ANN. § 17-87-310(a).
California
Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and his or her supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the nurse practitioner’s educational preparation or for which clinical competency has been established and maintained.
The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or his or her designee.
The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioner may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioner’s competence, including peer review, and review of the provision of the standardized procedure.
In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include: (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act … and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
When Schedule III controlled substances … are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioner’s standardized procedure relating to controlled substances shall be provided upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
The Board has certified that in accordance with Section 2836.3 the nurse practitioner has satisfactorily completed at least 6 month’s physician and surgeon-supervised experience in the furnishing or ordering of drugs or devices and a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
Nurse practitioners, who are certified by the Board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the US Drug Enforcement Administration, should complete, as part of their continuing education requirements, a course including Schedule II controlled substances based on the standards developed by the Board. The Board shall establish the requirements for satisfactory completion of this subsection.
Use of the term “furnishing” in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
“Drug order” or “order,” for purposes of this section, means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to “prescription” in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on the drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
Citation: CAL. BUS. & PROF. CODE § 2836.1.
Colorado
An advanced practice nurse who is listed on the advanced practice registry, has a license in good standing without disciplinary sanctions issued pursuant to Section 12-38-111, and has fulfilled requirements established by the Board pursuant to this section may be authorized by the Board to prescribe controlled substances or prescription drugs as defined in Article 22 of this title.
Citation: COLO. REV. STAT. ANN. § 12-38-111.6(1).
For detailed requirements, see the Colorado Board of Nursing Rules, Ch. XV.
Connecticut
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….
Citation: CONN. GEN. STAT. ANN. § 20-87a(b).
Delaware
Those individuals who wish to engage in independent practice without written guidelines or protocols and/or wish to have independent prescriptive authority shall apply for such privilege or privileges to the Joint Practice Committee and do so only in collaboration with a licensed physician, dentist, podiatrist, or licensed healthcare delivery system. This does not include those individuals who have protocols and/or waiver approved by the Board of Medical Practice.
Citation: DEL. CODE ANN. tit. 24, § 1902(b)(2).
The Joint Practice Committee, with the approval of the Board of Medical Practice, shall have the authority to grant, restrict, suspend, or revoke practice or independent practice authorization, and the Joint Practice Committee, with the approval of the Board of Medical Practice, shall be responsible for promulgating rules and regulations to implement the provisions of this chapter regarding “advanced practice nurses” who have been granted authority for independent practice and/or independent prescriptive authority.
Citation: DEL. CODE ANN. tit. 24, § 1906(20).
District of Columbia
An advanced practice registered nurse (APRN) may initiate, monitor, and alter drug therapies.
Citation: D.C. STAT. DIV. 1, TITLE 3, Subtitle I, Ch. 12, Subchapter VI § 3-1206.4(1).
The APRN may perform actions of medical diagnosis, treatment, prescription, and other functions authorized by this subchapter.
Citation: D.C. STAT. DIV. 1, TITLE 3, Subtitle I, Ch. 12, Subchapter VI § 3-1206.1.
Florida
The scope of practice for all categories of advanced registered nurse practitioner (ARNP) shall include those functions which the ARNP has been educated to perform including the monitoring and altering of drug therapies and initiation of appropriate therapies, according to the established protocol and consistent with the practice setting.
Citation: FLA. ADMIN. CODE Ch. 64B9-4.009.
Georgia
In addition to and without limiting the authority granted pursuant to Code Section 43-34-26.1, a physician may delegate to an advanced practice registered nurse in accordance with a nurse protocol agreement the authority to order drugs, medical devices, medical treatments, diagnostic studies, or in life-threatening situations, radiographic imaging tests.
Citation: GA. CODE ANN. § 43-34-26.3(15)(b).
“Nurse protocol agreement” means a written document mutually agreed upon and signed by an advanced practice registered nurse and a physician, by which document the physician delegates to that advanced practice registered nurse the authority to perform certain medical acts pursuant to this Code section, and which acts may include, without being limited to, the ordering of drugs, medical devices, medical treatments, diagnostic studies, or in life-threatening situations, radiographic imaging tests. Such agreements shall conform to the provisions set forth in Subsection (c) of this Code section.
“Order” means to prescribe pursuant to a nurse protocol agreement which drug, medical device, medical treatment, diagnostic study, or in life-threatening situations, radiographic imaging test is appropriate for a
patient and to communicate the same in writing, orally, via facsimile, or electronically.
patient and to communicate the same in writing, orally, via facsimile, or electronically.
Citation: GA. CODE ANN. § 43-34-26.3(a)(10) and (11).
Hawaii
The Board shall grant prescriptive authority to qualified advanced practice registered nurses and shall designate the requirements for advanced nursing practice related to prescriptive authority.
Citation: HAW. STATUTES § 457-8.6(a).
To be eligible for prescriptive authority, an APRN shall submit a completed application prescribed by the department and shall submit evidence of satisfying the following requirements:
Current and unencumbered recognition as an APRN by the board of nursing in accordance with Chapter 457, HRS, and Chapter 16-89;
An official transcript of a master’s degree in clinical nursing or nursing science sent directly from the school to the department;
Current certification in the nursing practice specialty sent directly to the department from a recognized national certifying body, or if currently licensed by the state department of health, in accordance with Chapter 321, HRS, and Chapter 11-141, evidence of a valid unencumbered license;
Successful completion of one of the following within the 3-year time period immediately preceding the date of application for prescriptive authority:
At least 30 contact hours, as part of a master’s degree program from an accredited college or university, of advanced pharmacology education, including advanced pharmacotherapeutics that is integrated into the curriculum; or
At least 30 contact hours of advanced pharmacology, including advanced pharmacotherapeutics, from an accredited college or university; or
At least 30 contact hours of continuing education approved by board-recognized national certifying bodies in advanced pharmacology, including advanced pharmacotherapeutics related to the applicant’s scope of nursing practice specialty;
Verification of 1000 hours of clinical experience in an institution as a recognized APRN practitioner in the applicant’s nursing practice specialty, within a 3-year time period immediately preceding the date of application;
A collegial working relationship agreement in compliance with Section 16-89C-10, between a physician, who is currently licensed in the state where such license is unencumbered and where such license excludes a limited or temporary license, and a recognized APRN to be granted prescriptive authority; and
Payment of a nonrefundable application fee….
(c) Nothing in this section shall preclude a registered nurse or an APRN from carrying out the prescribed medical orders of a licensed dentist, physician, osteopath, or podiatrist licensed in accordance with Chapters 448, 453, 460, or 463E, HRS, or the orders of a recognized APRN granted prescriptive authority in accordance with this chapter.
Citation: HAW. ADMIN. R. § 16-89C-5.
The board of medical examiners shall determine the drugs or categories of drugs listed in the exclusionary formulary for recognized APRNs granted prescriptive authority and shall review or revise the formulary at least every 2 years. The formulary, entitled “Exclusionary Formulary,” dated January 9, 1998, attached to this chapter as Exhibit A and made a part of this chapter, lists the drugs or categories of drugs that shall not be prescribed by the APRN recognized to prescribe by the department.
The Exclusionary Formulary, and any revised formularies, shall be made available to licensed pharmacies at no cost.
Recognized APRNs with prescriptive authority shall not prescribe any substance included in Schedules I, II, III, IV, or V of Chapter 329, HRS.
The recognized APRN with prescriptive authority shall comply with all applicable state and federal laws and rules relating to prescribing, administering, dispensing, and distributing of drugs.
Prescriptions ordered by a recognized APRN with prescriptive authority shall be filled according to the terms of the prescription. In addition to the requirements of Section 328-16(b)(1), HRS, a prescription shall also provide the APRN-Rx designation and number of the recognized APRN with prescriptive authority as assigned by the department and the name and phone number of the collegial working relationship physician. Drugs shall be dispensed in accordance with all applicable laws.
Citation: HAW. ADMIN. R. § 16-89C-15.
Prescriptive authority renewal for recognized advanced practice registered nurses.
Prescriptive authority for recognized APRNs shall expire on December 31 of every odd-numbered year and shall be renewed biennially. In each
odd-numbered year, the department shall make available an application for renewal of license before the deadline set forth by the department to every person to whom prescriptive authority was issued or renewed during the biennium. In addition to satisfying the renewal requirements of a APRN in Section 16-89-87, the APRN seeking renewal of prescriptive authority shall also submit the following:
Evidence of current certification in the nursing practice specialty by a recognized national certifying body, or if licensed by the state department of health in accordance with Chapter 321, HRS, and Chapter 11-141, evidence of current licensure;
Documentation of successful completion, during the prior biennium, of 30 contact hours of continuing education in the practice specialty area, and 8 contact hours in pharmacology, including pharmacotherapeutics, related to the applicant’s practice specialty area, approved by board recognized national certifying bodies, the American Nurses Association, the American Medical Association, or accredited colleges or universities. Verification of successful completion of continuing education required for recertification by a recognized national certifying body, within the current renewal biennium, may be accepted in lieu of the 30 hours of continuing education required for renewal;
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