Advanced Practice Nursing

A nurse with a valid Alabama RN license and an advanced practice specialty certification may apply for Board approval to engage in Advanced Practice Nursing (APN). APN includes the following four categories: Certified Registered Nurse Practitioner (CRNP), Certified Nurse Midwife (CNM), Certified Registered Nurse Anesthetist (CRNA), and Clinical Nurse Specialist (CNS).

REQUIREMENTS

An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse.

CATEGORY EDUCATION CERTIFICATION FEES
CRNP Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse practitioners. Certification as a nurse practitioner in the specialty consistent with NP education from a national certifying agency recognized by the Alabama Board of Nursing.
  • Initial collaboration: $150
  • Add new collaboration: $50
  • Modify an existing collaboration: No fee
  • Terminate a collaboration: No fee
  • Reinstate a Lapsed Approval: $100

For additional information, please reference Chapter 610-X-5 Advanced Practice Nursing – Collaborative Practice in the Laws section.

Chapter 610-X-5 Advanced Practice Nursing - Collaborative Practice


Download Chapter 610-X-5 (PDF)

610-X-5-.01  Definitions
610-X-5-.02  Terms and Functions of the Joint Committee
610-X-5-.03  Qualifications for Approval to Practice as a Certified Registered Nurse Practitioner
610-X-5-.04  Qualifications for Physicians in Collaborative Practice with Certified Registered Nurse Practitioners
610-X-5-.05  Limitations upon Utilization of Certified Registered Nurse Practitioners
610-X-5-.06  Application for Approval to Practice as a Certified Registered Nurse Practitioner
610-X-5-.07  Authorization for Practice as a Certified Registered Nurse Practitioner
610-X-5-.08  Temporary Approval for Practice as a Certified Registered Nurse Practitioner
610-X-5-.09  Requirements for Collaborative Practice by Physicians and Certified Registered Nurse Practitioners
610-X-5-.10  Standards of Practice for the Certified Registered Nurse Practitioner
610-X-5-.11  Functions and Activities of Certified Registered Nurse Practitioners
610-X-5-.12  Prescriptions and Medication Orders by Certified Registered Nurse Practitioners
610-X-5-.13  Reserved
610-X-5-.14  Qualifications for Approval as a Certified Nurse Midwife
610-X-5-.15  Qualifications for Physicians in Collaborative Practice with Certified Nurse Midwives
610-X-5-.16  Limitations upon Utilization of Certified Nurse Midwives
610-X-5-.17  Application for Approval to Practice as a Certified Nurse Midwife
610-X-5-.18  Authorization for Practice as a Certified Nurse Midwife
610-X-5-.19  Temporary Approval as a Certified Nurse Midwife
610-X-5-.20  Requirements for Collaborative Practice by Physicians and Certified Nurse Midwives
610-X-5-.21  Standards of Practice for Certified Nurse Midwives
610-X-5-.22  Functions and Activities of Certified Nurse Midwives
610-X-5-.23  Prescriptions and Medication Orders by Certified Nurse Midwives


NATIONAL CERTIFYING AGENCIES
APPLICATION

Prior to applying for collaborative practice:

  • Visit My Profile to review your information currently on record with the ABN.
  • Communicate with the prospective collaborating physician.

Note: The application for approval to practice as an Advanced Practice Nurse (APN) in the state of Alabama is intended for completion only by the individual applying for APN approval and should not be completed by any third party on behalf of the applicant. The application requires an attestation by the applicant as to the accuracy and completeness of the information to the Alabama Board of Nursing. Please note that any applicant or licensee of the Board who provides incomplete or inaccurate information on an application is subject to discipline against his or her license, and/or denial or withdrawal of APN approval.

Temporary approval for collaborative practice will not be issued until the ABN is notified by the Board of Medical Examiners that the Commencement for Collaborative Practice form and fee has been received. [ABN Administrative Code, § 610-X-5-.04(1)(c)].

For additional information, please reference Chapter 610-X-5 Advanced Practice Nursing – Collaborative Practice in the Laws section.

Chapter 610-X-5 Advanced Practice Nursing - Collaborative Practice


Download Chapter 610-X-5 (PDF)

610-X-5-.01  Definitions
610-X-5-.02  Terms and Functions of the Joint Committee
610-X-5-.03  Qualifications for Approval to Practice as a Certified Registered Nurse Practitioner
610-X-5-.04  Qualifications for Physicians in Collaborative Practice with Certified Registered Nurse Practitioners
610-X-5-.05  Limitations upon Utilization of Certified Registered Nurse Practitioners
610-X-5-.06  Application for Approval to Practice as a Certified Registered Nurse Practitioner
610-X-5-.07  Authorization for Practice as a Certified Registered Nurse Practitioner
610-X-5-.08  Temporary Approval for Practice as a Certified Registered Nurse Practitioner
610-X-5-.09  Requirements for Collaborative Practice by Physicians and Certified Registered Nurse Practitioners
610-X-5-.10  Standards of Practice for the Certified Registered Nurse Practitioner
610-X-5-.11  Functions and Activities of Certified Registered Nurse Practitioners
610-X-5-.12  Prescriptions and Medication Orders by Certified Registered Nurse Practitioners
610-X-5-.13  Reserved
610-X-5-.14  Qualifications for Approval as a Certified Nurse Midwife
610-X-5-.15  Qualifications for Physicians in Collaborative Practice with Certified Nurse Midwives
610-X-5-.16  Limitations upon Utilization of Certified Nurse Midwives
610-X-5-.17  Application for Approval to Practice as a Certified Nurse Midwife
610-X-5-.18  Authorization for Practice as a Certified Nurse Midwife
610-X-5-.19  Temporary Approval as a Certified Nurse Midwife
610-X-5-.20  Requirements for Collaborative Practice by Physicians and Certified Nurse Midwives
610-X-5-.21  Standards of Practice for Certified Nurse Midwives
610-X-5-.22  Functions and Activities of Certified Nurse Midwives
610-X-5-.23  Prescriptions and Medication Orders by Certified Nurse Midwives


APPLICATION DEADLINES

2017 Collaborative Practice Application Deadlines

NOTE: The Joint Committee meets at the office of the Alabama Board of Medical Examiners, Robert Taylor Building, 848 Washington Avenue, Montgomery AL 36104, unless otherwise indicated below.

Collaborative Practice Application
Deadline to the
Alabama Board of Nursing
Joint Committee
Meeting Dates
Board Meeting Dates
December 16, 2016 January 17 ABME: Jan 18
ABN: Jan 19 – 20
January 20, 2017 ABME: Feb 15
ABN: No Meeting
February 17, 2017 March 14 ABME: Mar 15
ABN: Mar 30 – 31
March 24, 2017 ABME: April 13
ABN: No Meeting
April 21, 2017 May 16 ABME: May 17
ABN: May 18 – 19
May 19, 2017 ABME: June 21
ABN: No Meeting
June 23, 2017 July 18 ABME: July 19
ABN: July 20 – 21
July 21, 2017 ABME: Aug 16
ABN: No Meeting
August 25, 2017 September 19 ABME: Sept 20
ABN: Sept 21 – 22
September 22, 2017 ABME: Oct 18
ABN: No Meeting
October 20, 2017 November 15 ABME: Nov 16
ABN: Nov 16 – 17
November 17, 2017 ABME: Dec 13
ABN: No Meeting
December 15, 2017 January 2018 meeting dates have not been set January 2018 meeting dates have not been set
  1. Applications submitted on the deadline date must be received by the ABN no later than 3:00 PM and must be complete.
    Applications that are incomplete or require clarification will be processed for the next scheduled Joint Committee meeting.
  2. All applications received after the deadline date and time listed above will be processed for the next scheduled Joint Committee meeting.
  3. Either Board may object to Temporary Approval of proposed Collaborative Practice.
  4. Either Board may require Joint Committee review of proposed Collaborative Practice for any reason not listed here.
  5. Requests for procedures that are not listed in the Standard Protocol, the on-line collaboration application or one of the Specialty Protocols may delay approval of the collaboration and/or skill. The request must be submitted to the Board of Nursing on the Application for Privilege to Perform Skill or Procedure in Collaborative Practice.
  6. Applications with one or more of the following circumstances will be scheduled for individual review by the Joint Committee for Advanced Practice Nursing of Alabama Board of Nursing and the Alabama Board of Medical Examiners on the dates listed above.
  7. Fast Track applications for collaborative practice do not require Joint Committee review prior to approval by the Alabama Board of Medical Examiners and the Alabama Board of Nursing.

FACULTY APPLICATION

Certified Registered Nurse Practitioners (CRNP) – Faculty

The CRNP – Faculty supervises nurse practitioner students in direct care of patients in clinical settings where a CRNP in an approved collaborative practice or a physician is present to oversee patient care.

CRNP – Faculty applicants must also submit a letter from the Dean/Program Director of the nursing school on institutional letterhead confirming faculty status in the Nurse Practitioner educational program.

Note: The application for approval to practice as an Advanced Practice Nurse (APN) in the state of Alabama is intended for completion only by the individual applying for APN approval and should not be completed by any third party on behalf of the applicant. The application requires an attestation by the applicant as to the accuracy and completeness of the information to the Alabama Board of Nursing. Please note that any applicant or licensee of the Board who provides incomplete or inaccurate information on an application is subject to discipline against his or her license, and/or denial or withdrawal of APN approval.

Faculty Initial Application: Complete the Initial Collaboration application and do not include collaborative practice information.

Faculty Reinstatement Application: Complete the Reinstate a Lapsed Approval.


FEDERAL APPLICATION

Certified Registered Nurse Practitioners (CRNP) – Federal

Nurses who meet all qualifications for collaborative practice and are employed by the US Government in a federal agency may submit an application for approval to practice as a CRNP – Federal, thus requesting exemption from practice with an Alabama-licensed physician. Use the applications listed below if you will be collaborating with a physician who is not licensed in Alabama.

Prior to applying for collaborative practice, communicate with the prospective collaborating physician.

Note: The application for approval to practice as an Advanced Practice Nurse (APN) in the state of Alabama is intended for completion only by the individual applying for APN approval and should not be completed by any third party on behalf of the applicant. The application requires an attestation by the applicant as to the accuracy and completeness of the information to the Alabama Board of Nursing. Please note that any applicant or licensee of the Board who provides incomplete or inaccurate information on an application is subject to discipline against his or her license, and/or denial or withdrawal of APN approval.


NEW SKILL REQUEST

This Application is ONLY for Skills or Procedures that are:

  • Not available in the Standard Protocol
  • Not recognized for RN practice as a Standardized Procedure.
  • Not available on the Collaborative Practice application in the drop-down menu for Additional Skills.

Application for Privilege to Perform Skill or Procedure in Collaborative Practice (fillable PDF)

Supervised Practice Documentation Form


FREQUENTLY ASKED QUESTIONS

CRNP / CNM

CRNP / CNM

How can I or my employer view my Collaborative Practice Detail information?

You may view your information under My Profile. Employers should access this information through the Credentialing Staff AP Profile section.

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As a CRNP or CNM, how much time do I have to practice together with my collaborating physician?

On-site time with the collaborating physician is required for (a) CRNPs and CNMs with fewer than two years (4,000 hours) collaborative practice experience and (b) CRNPs/CNMs with qualifying experience who are moving to an unfamiliar medical specialty. They must be on-site with the physician for 10% of scheduled hours while accumulating two years (4,000 hours) of practice. In other words, if the experienced CRNP enters a new collaboration and does not have clinical experience consistent with the physician’s clinical specialty, the “experience clock” resets to zero. Refer to ABN Administrative Code § 610-X-5-.09 (CRNP) or 610-X-5-.20 (CNM) for details.

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What is the maximum aged patient for which a Pediatric Nurse Practitioner can provide care?

The maximum age for pediatric patient is 21 years old, as stated in the Standards of Practice of the national certifying organizations. In some situations, the age may be irrelevant and care is determined by the diagnosis (for example, cystic fibrosis patients may be provided care by a PNP long past the 21 years of age).

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Can a CRNP be a First Assistant in Surgery?

The CRNP must comply with individual facility policy relating to RNFA practice. See ABN Administrative Code Chapter 610-X-7 for RNFA practice standards. If you have any questions relating to your specific certification, you should refer to the certification handbook from your certifying agency.

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What is included in Quality Monitoring for CRNP and CNM in collaborative practice?

  • Documented evaluation of the CRNP/CNM’s clinical practice.
  • Use of established outcome indicators.
  • Include a summary of findings – reviewed by physician and nurse practitioner.
  • Recommendations for change, if indicated.

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Why can’t a CRNP sign a patient’s application for disability access parking privileges?

Alabama law, through the Alabama Department of Revenue, Motor Vehicle Division, requires a licensed physician to determine long-term disability in order for an individual to acquire disability access placards and/or license plates.

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What if I am only teaching NP students? Do I have to have a collaborative practice?

No. The Board’s rules allow for a “Faculty Only” designation that does not require a collaborative practice. A letter from the Dean of the School or College of Nursing is required prior to designation as “Faculty Only.”

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What if I work as a CRNP/CNM in a federal facility with a physician who is not licensed in Alabama?

The Board’s rules allow for a designation as “Federal Only,” so that you may practice with a physician licensed to practice in another state. As long as you are working in a federal facility, you may practice with the identified collaborating and covering physicians.

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How do I terminate a collaborative practice agreement?

Submit an online Terminate an Existing Collaboration application. Indicate the final date of practice with the physician listed in the online profile. The application is available under the Advanced Practice section of the ABN website.

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How do I add a new collaborative practice?

Submit an online Add New Collaboration application. The application is available under the Advanced Practice section of the ABN website.

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Will my collaborating physician need to notify anyone of our agreement?

Yes. The collaborating physician is required to notify the Alabama Board of Medical Examiners (ABME) of the commencement or termination of collaborative practice with a CRNP or CNM. The Notice of Termination is to be submitted by the physician to the ABME within 14 days of the date of termination of the collaboration.

The ABN notifies the BME of the CRNP/CNM termination immediately upon processing the online Termination application.

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How will I know when I have been approved to practice as a CRNP or CNM?

A Notice of Approval for Practice will be emailed to the applicant’s email address on file with the ABN.

Refer to My Profile to review current approval(s) with the Board.

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How do I request additional duties for my collaborative practice?

Approved additional duties specific to certification specialty may be selected from the online Modify Collaboration Application or Add New Collaboration Application. A drop-down menu will give you a list of skills/procedures previously determined by the ABN and ABME to be permissible for the specific certification specialty. If your skill is not available on the drop-down menu, you must submit a “New Skill Request” form (available on the website).

Note: You must wait until you are approved to train to perform these skills/procedures.

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Do I have to request the Skills/Procedures on the Standard Protocol for my specialty certification?

No. You are approved to do all the procedures listed on the Standard Protocol, if it is consistent with your practice site, your collaborating physician agrees, and you have the knowledge and technical ability.

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Am I approved to do all the skills listed on the Specialty Protocol I was approved for?

The Specialty Protocol is a set of procedures. After receiving approval for the Specialty Protocol, you may perform any of the listed procedures if you and the physician agree they are appropriate to your collaboration, the patient population, and the practice site where you expect to perform the procedure.

Please note: Some Specialty Protocols require specific documentation prior to approval and certain annual numbers of set procedures to demonstrate on-going competency.

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What constitutes a Practice Site?

  • Principal Practice Site – the main location at which the collaborating physician is engaged in the practice of medicine.
  • Remote Site – any approved collaborative practice site without a physician on-site, excluding the physician’s principal practice site and other exempt sites.

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Where may I find detailed information related to the QACSC and the application process?

The Alabama Board of Medical Examiners (ABME) has developed a Frequent Question and Answer page on their website that will help you navigate the process. The link is provided below:
http://www.albme.org/faq-qacscnp.html

In addition, the application information is available at the ABME website. The link is provided below:
http://www.albme.org/qacscupdate.html

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Why do I need to know how many other Advanced Practice Nurses and/or physician assistants are in collaboration with my collaborating physician?

The rules impose a limit on the number of individuals with whom a physician may collaborate. “The physician shall not collaborate with or supervise any combination of certified registered nurse practitioners, certified nurse midwives and/or assistants to physicians exceeding one hundred and sixty ( 160 ) hours per week ( four full- time equivalent positions) unless an exemption is granted under Rule 610-X-5-.05. “One full-time equivalent” (FTE) is herein described as a person/persons collectively working forty hours a week, excluding time on call.

ABN Administrative Code § 610-X-5-.05

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May I apply the Pharmacy education hours awarded for the ABME course for the Qualified Alabama Controlled Substance Certificate (QACSC) toward my Pharmacology CE requirements for RN Renewal?

Yes. The hours awarded for the ABME QACSC course will count toward the Pharmacology hours needed for renewal of the RN license and APN approval.

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What documentation and fees are required by ABME for my collaborative practice?

The ABME requires that the collaborating physician(s) complete an ABME Commencement form, which specifies the fee and requires the signature of the physician for any collaborative practice prior to approval. The form is available on the ABME website. The link is provided below:

http://www.albme.org/Documents/Forms/collpraccommform.pdf

NOTE: The report from the certifying agency is required as primary source verification and may require several days for delivery by email or USPS to the ABN. Personal copies are not accepted documentation, and do not meet the Alabama Board of Nursing requirement for primary source verification.

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What are the requirements for performing physical examinations and medical reports for the DOT and to register with the National Registry of Certified Medical Examiners (NRCME)?

CRNPs are eligible to become Certified Medical Examiners.

Federal Motor Carrier Safety Administration (FMCSA) has established the National Registry of Certified Medical Examiners (NRCME), requiring all healthcare professionals who conduct physical examinations for interstate commercial motor vehicle drivers to:

  • Complete training offered by a nationally recognized organization that meets FMCSA standards, e.g., Medical Association of the State of Alabama.
  • Pass a certification exam to conduct physical examinations for drivers who wish to obtain a Commercial Driver’s License (CDL) and register on the NRCME.
  • Beginning May 21, 2014, commercial drivers must receive Department of Transportation (DOT) physicals and medical reports from DOT Certified Medical Examiners
    listed on the National Registry.

The Medical Association of the State of Alabama now offers online FMCSA DOT Medical Examiner Certification Training. Information is available on the MASA link provided below:

http://www.alamedical.org/DOTCertification

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What is the minimum aged patient for Adult Nurse Practitioner?

Adult Nurse Practitioners may treat “young adults.” The standards adopted by NP education and certifying agencies do not state a minimum age. The ABN recognizes these national standards.

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What happened to the Specialty Formulary?

Standard and Specialty Legend drugs were incorporated into a single Standard Formulary in April 2016. Click on “Formularies” under the CRNP and CNM sections of the website to view the formulary.

Remember, Specialty Legend drugs are still required to be given within the scope of the collaborative practice specialty. To capture the use of Specialty Legend drugs within a collaboration, the medications are listed at the end of the individualized STANDARD PROTOCOLS, also available on the ABN website. The Board strongly encourages you to utilize the standard protocols to document and demonstrate authorized skills/procedures or specialty legend drugs allowed within your collaborative agreement.

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How do I make changes to an existing collaborative practice?

Submit an online Modify an Existing Collaboration application. Use this application to add or delete covering physicians, add or delete practice sites, and make changes to the work hours reflected for the collaboration.

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Am I approved to do all the skills/procedures listed on my certification-specific Standard Protocol?

Yes. You are approved to do all the procedures listed on the Standard Protocol, if it is consistent with your practice site, your collaborating physician agrees, and you have the knowledge and technical ability. An example of a protocol agreement (you may use for your records only) is available on the ABN website under the “Advanced Practice” tab.

The collaborating physician must be qualified to provide medical direction for the procedure. The CRNP or CNM who lacks current proficiency is responsible and accountable for obtaining sufficient guidance, education, and supervision for safe practice prior to performing a new procedure.

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What are “Medical Oversight,” “Readily Available,” and “Direct Medical Intervention”?

Medical Oversight is concurrent and on-going, collaboration between a physician and a CRNP or CNM, and documentation of time together in a practice site; may include but is not limited to direct consultation and patient care, discussion of disease processes and medical care, review of patient records, protocols and outcome indicators, and other activities to promote positive patient outcomes.

Readily Available: Response by the collaborating or covering physician by telephone, telecommunication, or radio for consultation, referral, or direct medical intervention.

Direct Medical Intervention is the physical presence of a physician to attend the patient, as defined in the collaborative practice protocol.

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Can a CRNP or CNM own a practice?

Yes. The rules governing Collaborative Practice in AL do not prohibit a CRNP or CNM from owning a practice. However, CRNPs and CNMs who desire to practice are required to enter into a Collaborative Practice Agreement with a physician licensed in the state of Alabama. Additional requirements are included in ABN Administrative Code 610-X-5, located in the Laws section of the Board website.

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Can a CRNP complete disability paperwork?

Yes, for all forms filed on or after March 27, 2017.

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Can a CRNP do sports physicals in Alabama?

No. The rules of the Alabama High School Athletic Association (AHSSA) require that all physicals be signed by a licensed physician.

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Can a CRNP/CNM write admission orders?

Yes. The CRNP/CNM is permitted to write admission orders for inpatients, as directed by the physician, and subsequent orders, in accordance with established protocols and institutional policies.

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May the 10% of scheduled hours be worked with the collaborating physician or covering physician?

Time on-site with the covering physician counts toward the 10% accumulation. However, the covering physician cannot provide all of the on-site time. The collaborating physician still has primary responsibility for collaboration and medical direction with the CRNP.

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APN General

APN General

Will ABN receive notification when I receive or renew my national certification?

No. Notification of your continued national certification is not automatic.

Visit the website for your certifying agency and follow their instructions to request that written verification be sent directly to the ABN.

Send to melissa.curtis@abn.alabama.gov by email, or by US Postal Service (USPS) to
PO BOX 303900 Montgomery AL 36130-3900.

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When does my Advanced Practice approval lapse or expire?

Advanced Practice approval from the ABN will expire with your RN license (example: 12/31/2018) or on the date of expiration of your national specialty certification, whichever comes first.

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What should I do if my RN license lapses?

Immediately cease and desist from all activities as an RN and an Advanced Practice Nurse. You must reinstate the RN license. You must reinstate the RN license. Reinstatement of APN approval is a two-step process AFTER the RN license is Active. See next question for the two steps.

Unauthorized practice as an Advanced Practice Nurse is subject to disciplinary action against your Registered Nurse license. This may include limitations on future authorizations for Advanced Practice Nursing.

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What should I do if my Advanced Practice certification expires?

Reinstatement of APN approval is a two-step process:

  1. Submit an Application for Reinstatement of Lapsed Approval for Advanced Practice Nursing (this is located in the Advanced Practice Nursing section of the website).
  1. If CRNP or CNM, submit an electronic Add New Collaboration Application.

Unauthorized practice as an Advanced Practice Nurse is subject to disciplinary action against your Registered Nurse license. This may include limitations on future authorizations for Advanced Practice Nursing.

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How do I change or update my address?

This information may be updated in My Profile section of the ABN website at www.abn.alabama.gov.

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What if I fail the certification exam in my specialty of practice?

You must cease and desist from working as an Advanced Practice Nurse immediately and notify the ABN.

Upon successful certification in your Advanced Practice specialty, you may re-apply to ABN for approval of Advanced Practice Nursing. Do not practice in your APN specialty until you receive notice of approval from the Alabama Board of Nursing.

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What does “provisional approval” mean?

Provisional Approval – Your approval is provisional pending receipt of the results of your first writing of the certification examination, as stipulated in ABN Administrative Code for CRNP as a Graduate Registered Nurse Practitioner, CNM as a Graduate Nurse Midwife, and CRNA as a Graduate Registered Nurse Anesthetist.  If you request and receive provisional approval, you may practice only with the on-site supervision of an Advanced Practice Nurse with the same specialty or a qualified physician.

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What is the scope of practice for an Advanced Practice Nurse?

Distinctions between scopes of practice for APNs are closely tied to each specialty certification. For example, by virtue of formal education, clinical training, and national certification, Family Nurse Practitioners (FNPs) are certified to treat patients of either sex across the lifespan, while certification in Adult-Gerontology allows the CRNP to treat patients of either sex, but only from adolescence (depending on the specific certification achieved from the certifying board) through adulthood.

In consultation with national certifying agencies, the ABN staff has confirmed that only formal education qualifies a CRNP to certify for treatment of patients in an additional population-focused area of practice. On the job/in-house training with a physician does not increase the CRNP’s scope of practice and/or allow them to treat patient populations for which they do not hold certification and could leave both the CRNP and facility legally at risk.

If you have any questions relating to your specific certification, you should refer to the certification handbook from your certifying agency.

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Can an Advanced Practice Nurse withhold life-saving treatment [Do Not Resuscitate (DNR) order]?

No. Based on Alabama Natural Death Act 22-8A-4 (d) and 22-8A-11 (a), only a physician licensed to practice medicine or osteopathy in Alabama may activate an advanced directive, or make a determination, in the absence of a written advanced directive, to withhold treatment.

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REQUIREMENTS

An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse.

CATEGORY EDUCATION CERTIFICATION FEES
CNM Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse midwives. Certification as a CNM from the ACNM Certification Council.
  • Initial collaboration: $150
  • Add new collaboration: $50
  • MModify an existing collaboration: No fee
  • Terminate a collaboration: No fee
  • Reinstate a Lapsed Approval: $100

 

 For additional information, please reference Chapter 610-X-5 Advanced Practice Nursing – Collaborative Practice

Chapter 610-X-5 Advanced Practice Nursing - Collaborative Practice


Download Chapter 610-X-5 (PDF)

610-X-5-.01  Definitions
610-X-5-.02  Terms and Functions of the Joint Committee
610-X-5-.03  Qualifications for Approval to Practice as a Certified Registered Nurse Practitioner
610-X-5-.04  Qualifications for Physicians in Collaborative Practice with Certified Registered Nurse Practitioners
610-X-5-.05  Limitations upon Utilization of Certified Registered Nurse Practitioners
610-X-5-.06  Application for Approval to Practice as a Certified Registered Nurse Practitioner
610-X-5-.07  Authorization for Practice as a Certified Registered Nurse Practitioner
610-X-5-.08  Temporary Approval for Practice as a Certified Registered Nurse Practitioner
610-X-5-.09  Requirements for Collaborative Practice by Physicians and Certified Registered Nurse Practitioners
610-X-5-.10  Standards of Practice for the Certified Registered Nurse Practitioner
610-X-5-.11  Functions and Activities of Certified Registered Nurse Practitioners
610-X-5-.12  Prescriptions and Medication Orders by Certified Registered Nurse Practitioners
610-X-5-.13  Reserved
610-X-5-.14  Qualifications for Approval as a Certified Nurse Midwife
610-X-5-.15  Qualifications for Physicians in Collaborative Practice with Certified Nurse Midwives
610-X-5-.16  Limitations upon Utilization of Certified Nurse Midwives
610-X-5-.17  Application for Approval to Practice as a Certified Nurse Midwife
610-X-5-.18  Authorization for Practice as a Certified Nurse Midwife
610-X-5-.19  Temporary Approval as a Certified Nurse Midwife
610-X-5-.20  Requirements for Collaborative Practice by Physicians and Certified Nurse Midwives
610-X-5-.21  Standards of Practice for Certified Nurse Midwives
610-X-5-.22  Functions and Activities of Certified Nurse Midwives
610-X-5-.23  Prescriptions and Medication Orders by Certified Nurse Midwives


NATIONAL CERTIFYING AGENCIES
APPLICATION

Prior to applying for collaborative practice:

  • Visit My Profile to review your information currently on record with the ABN.
  • Communicate with the prospective collaborating physician.

Note: The application for approval to practice as an Advanced Practice Nurse (APN) in the state of Alabama is intended for completion only by the individual applying for APN approval and should not be completed by any third party on behalf of the applicant. The application requires an attestation by the applicant as to the accuracy and completeness of the information to the Alabama Board of Nursing. Please note that any applicant or licensee of the Board who provides incomplete or inaccurate information on an application is subject to discipline against his or her license, and/or denial or withdrawal of APN approval.

Temporary approval for collaborative practice will not be issued until the ABN is notified by the Board of Medical Examiners that the Commencement for Collaborative Practice form and fee has been received. [ABN Administrative Code, § 610-X-5-.04(1)(c)].

 For additional information, please reference Chapter 610-X-5 Advanced Practice Nursing – Collaborative Practice

Chapter 610-X-5 Advanced Practice Nursing - Collaborative Practice


Download Chapter 610-X-5 (PDF)

610-X-5-.01  Definitions
610-X-5-.02  Terms and Functions of the Joint Committee
610-X-5-.03  Qualifications for Approval to Practice as a Certified Registered Nurse Practitioner
610-X-5-.04  Qualifications for Physicians in Collaborative Practice with Certified Registered Nurse Practitioners
610-X-5-.05  Limitations upon Utilization of Certified Registered Nurse Practitioners
610-X-5-.06  Application for Approval to Practice as a Certified Registered Nurse Practitioner
610-X-5-.07  Authorization for Practice as a Certified Registered Nurse Practitioner
610-X-5-.08  Temporary Approval for Practice as a Certified Registered Nurse Practitioner
610-X-5-.09  Requirements for Collaborative Practice by Physicians and Certified Registered Nurse Practitioners
610-X-5-.10  Standards of Practice for the Certified Registered Nurse Practitioner
610-X-5-.11  Functions and Activities of Certified Registered Nurse Practitioners
610-X-5-.12  Prescriptions and Medication Orders by Certified Registered Nurse Practitioners
610-X-5-.13  Reserved
610-X-5-.14  Qualifications for Approval as a Certified Nurse Midwife
610-X-5-.15  Qualifications for Physicians in Collaborative Practice with Certified Nurse Midwives
610-X-5-.16  Limitations upon Utilization of Certified Nurse Midwives
610-X-5-.17  Application for Approval to Practice as a Certified Nurse Midwife
610-X-5-.18  Authorization for Practice as a Certified Nurse Midwife
610-X-5-.19  Temporary Approval as a Certified Nurse Midwife
610-X-5-.20  Requirements for Collaborative Practice by Physicians and Certified Nurse Midwives
610-X-5-.21  Standards of Practice for Certified Nurse Midwives
610-X-5-.22  Functions and Activities of Certified Nurse Midwives
610-X-5-.23  Prescriptions and Medication Orders by Certified Nurse Midwives


APPLICATION DEADLINES

2017 Collaborative Practice Application Deadlines

NOTE: The Joint Committee meets at the office of the Alabama Board of Medical Examiners, Robert Taylor Building, 848 Washington Avenue, Montgomery AL 36104, unless otherwise indicated below.

Collaborative Practice Application
Deadline to the
Alabama Board of Nursing
Joint Committee
Meeting Dates
Board Meeting Dates
December 16, 2016 January 17 ABME: Jan 18
ABN: Jan 19 – 20
January 20, 2017 ABME: Feb 15
ABN: No Meeting
February 17, 2017 March 14 ABME: Mar 15
ABN: Mar 30 – 31
March 24, 2017 ABME: April 13
ABN: No Meeting
April 21, 2017 May 16 ABME: May 17
ABN: May 18 – 19
May 19, 2017 ABME: June 21
ABN: No Meeting
June 23, 2017 July 18 ABME: July 19
ABN: July 20 – 21
July 21, 2017 ABME: Aug 16
ABN: No Meeting
August 25, 2017 September 19 ABME: Sept 20
ABN: Sept 21 – 22
September 22, 2017 ABME: Oct 18
ABN: No Meeting
October 20, 2017 November 15 ABME: Nov 16
ABN: Nov 16 – 17
November 17, 2017 ABME: Dec 13
ABN: No Meeting
December 15, 2017 January 2018 meeting dates have not been set January 2018 meeting dates have not been set

  1. Applications submitted on the deadline date must be received by the ABN no later than 3:00 PM and must be complete.
    Applications that are incomplete or require clarification will be processed for the next scheduled Joint Committee meeting.
  2. All applications received after the deadline date and time listed above will be processed for the next scheduled Joint Committee meeting.
  3. Either Board may object to Temporary Approval of proposed Collaborative Practice.
  4. Either Board may require Joint Committee review of proposed Collaborative Practice for any reason not listed here.
  5. Requests for procedures that are not listed in the Standard Protocol, the on-line collaboration application or one of the Specialty Protocols may delay approval of the collaboration and/or skill. The request must be submitted to the Board of Nursing on the Application for Privilege to Perform Skill or Procedure in Collaborative Practice.
  6. Applications with one or more of the following circumstances will be scheduled for individual review by the Joint Committee for Advanced Practice Nursing of Alabama Board of Nursing and the Alabama Board of Medical Examiners on the dates listed above.
  7. Fast Track applications for collaborative practice do not require Joint Committee review prior to approval by the Alabama Board of Medical Examiners and the Alabama Board of Nursing.

FACULTY APPLICATION

Certified Registered Nurse Midwife (CNM) – Faculty

The CNM – Faculty supervises nurse midwife students in direct care of patients in clinical settings where a CNM in an approved collaborative practice or a physician is present to oversee patient care.

CNM – Faculty applicants must also submit a letter from the Dean/Program Director of the nursing school on institutional letterhead confirming faculty status in the Nurse Midwife educational program.

Note: The application for approval to practice as an Advanced Practice Nurse (APN) in the state of Alabama is intended for completion only by the individual applying for APN approval and should not be completed by any third party on behalf of the applicant. The application requires an attestation by the applicant as to the accuracy and completeness of the information to the Alabama Board of Nursing. Please note that any applicant or licensee of the Board who provides incomplete or inaccurate information on an application is subject to discipline against his or her license, and/or denial or withdrawal of APN approval.

Faculty Initial Application: Complete the Initial Collaboration application and do not include collaborative practice information.

Faculty Reinstatement Application: Complete the Reinstate a Lapsed Approval.


FEDERAL APPLICATION

Certified Registered Nurse Midwife (CNM) – Federal

Prior to applying for collaborative practice, communicate with the prospective collaborating physician.

Note: The application for approval to practice as an Advanced Practice Nurse (APN) in the state of Alabama is intended for completion only by the individual applying for APN approval and should not be completed by any third party on behalf of the applicant. The application requires an attestation by the applicant as to the accuracy and completeness of the information to the Alabama Board of Nursing. Please note that any applicant or licensee of the Board who provides incomplete or inaccurate information on an application is subject to discipline against his or her license, and/or denial or withdrawal of APN approval.


NEW SKILL REQUEST

This Application is ONLY for Skills or Procedures that are:

  • Not available in the Standard Protocol
  • Not recognized for RN practice as a Standardized Procedure.
  • Not available on the Collaborative Practice application in the drop-down menu for Additional Skills.

Application for Privilege to Perform Skill or Procedure in Collaborative Practice (PDF)

Supervised Practice Documentation Form


FREQUENTLY ASKED QUESTIONS

CRNP / CNM

CRNP / CNM

How can I or my employer view my Collaborative Practice Detail information?

You may view your information under My Profile. Employers should access this information through the Credentialing Staff AP Profile section.

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As a CRNP or CNM, how much time do I have to practice together with my collaborating physician?

On-site time with the collaborating physician is required for (a) CRNPs and CNMs with fewer than two years (4,000 hours) collaborative practice experience and (b) CRNPs/CNMs with qualifying experience who are moving to an unfamiliar medical specialty. They must be on-site with the physician for 10% of scheduled hours while accumulating two years (4,000 hours) of practice. In other words, if the experienced CRNP enters a new collaboration and does not have clinical experience consistent with the physician’s clinical specialty, the “experience clock” resets to zero. Refer to ABN Administrative Code § 610-X-5-.09 (CRNP) or 610-X-5-.20 (CNM) for details.

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What is the maximum aged patient for which a Pediatric Nurse Practitioner can provide care?

The maximum age for pediatric patient is 21 years old, as stated in the Standards of Practice of the national certifying organizations. In some situations, the age may be irrelevant and care is determined by the diagnosis (for example, cystic fibrosis patients may be provided care by a PNP long past the 21 years of age).

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Can a CRNP be a First Assistant in Surgery?

The CRNP must comply with individual facility policy relating to RNFA practice. See ABN Administrative Code Chapter 610-X-7 for RNFA practice standards. If you have any questions relating to your specific certification, you should refer to the certification handbook from your certifying agency.

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What is included in Quality Monitoring for CRNP and CNM in collaborative practice?

  • Documented evaluation of the CRNP/CNM’s clinical practice.
  • Use of established outcome indicators.
  • Include a summary of findings – reviewed by physician and nurse practitioner.
  • Recommendations for change, if indicated.

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Why can’t a CRNP sign a patient’s application for disability access parking privileges?

Alabama law, through the Alabama Department of Revenue, Motor Vehicle Division, requires a licensed physician to determine long-term disability in order for an individual to acquire disability access placards and/or license plates.

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What if I am only teaching NP students? Do I have to have a collaborative practice?

No. The Board’s rules allow for a “Faculty Only” designation that does not require a collaborative practice. A letter from the Dean of the School or College of Nursing is required prior to designation as “Faculty Only.”

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What if I work as a CRNP/CNM in a federal facility with a physician who is not licensed in Alabama?

The Board’s rules allow for a designation as “Federal Only,” so that you may practice with a physician licensed to practice in another state. As long as you are working in a federal facility, you may practice with the identified collaborating and covering physicians.

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How do I terminate a collaborative practice agreement?

Submit an online Terminate an Existing Collaboration application. Indicate the final date of practice with the physician listed in the online profile. The application is available under the Advanced Practice section of the ABN website.

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How do I add a new collaborative practice?

Submit an online Add New Collaboration application. The application is available under the Advanced Practice section of the ABN website.

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Will my collaborating physician need to notify anyone of our agreement?

Yes. The collaborating physician is required to notify the Alabama Board of Medical Examiners (ABME) of the commencement or termination of collaborative practice with a CRNP or CNM. The Notice of Termination is to be submitted by the physician to the ABME within 14 days of the date of termination of the collaboration.

The ABN notifies the BME of the CRNP/CNM termination immediately upon processing the online Termination application.

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How will I know when I have been approved to practice as a CRNP or CNM?

A Notice of Approval for Practice will be emailed to the applicant’s email address on file with the ABN.

Refer to My Profile to review current approval(s) with the Board.

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How do I request additional duties for my collaborative practice?

Approved additional duties specific to certification specialty may be selected from the online Modify Collaboration Application or Add New Collaboration Application. A drop-down menu will give you a list of skills/procedures previously determined by the ABN and ABME to be permissible for the specific certification specialty. If your skill is not available on the drop-down menu, you must submit a “New Skill Request” form (available on the website).

Note: You must wait until you are approved to train to perform these skills/procedures.

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Do I have to request the Skills/Procedures on the Standard Protocol for my specialty certification?

No. You are approved to do all the procedures listed on the Standard Protocol, if it is consistent with your practice site, your collaborating physician agrees, and you have the knowledge and technical ability.

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Am I approved to do all the skills listed on the Specialty Protocol I was approved for?

The Specialty Protocol is a set of procedures. After receiving approval for the Specialty Protocol, you may perform any of the listed procedures if you and the physician agree they are appropriate to your collaboration, the patient population, and the practice site where you expect to perform the procedure.

Please note: Some Specialty Protocols require specific documentation prior to approval and certain annual numbers of set procedures to demonstrate on-going competency.

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What constitutes a Practice Site?

  • Principal Practice Site – the main location at which the collaborating physician is engaged in the practice of medicine.
  • Remote Site – any approved collaborative practice site without a physician on-site, excluding the physician’s principal practice site and other exempt sites.

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Where may I find detailed information related to the QACSC and the application process?

The Alabama Board of Medical Examiners (ABME) has developed a Frequent Question and Answer page on their website that will help you navigate the process. The link is provided below:
http://www.albme.org/faq-qacscnp.html

In addition, the application information is available at the ABME website. The link is provided below:
http://www.albme.org/qacscupdate.html

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Why do I need to know how many other Advanced Practice Nurses and/or physician assistants are in collaboration with my collaborating physician?

The rules impose a limit on the number of individuals with whom a physician may collaborate. “The physician shall not collaborate with or supervise any combination of certified registered nurse practitioners, certified nurse midwives and/or assistants to physicians exceeding one hundred and sixty ( 160 ) hours per week ( four full- time equivalent positions) unless an exemption is granted under Rule 610-X-5-.05. “One full-time equivalent” (FTE) is herein described as a person/persons collectively working forty hours a week, excluding time on call.

ABN Administrative Code § 610-X-5-.05

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May I apply the Pharmacy education hours awarded for the ABME course for the Qualified Alabama Controlled Substance Certificate (QACSC) toward my Pharmacology CE requirements for RN Renewal?

Yes. The hours awarded for the ABME QACSC course will count toward the Pharmacology hours needed for renewal of the RN license and APN approval.

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What documentation and fees are required by ABME for my collaborative practice?

The ABME requires that the collaborating physician(s) complete an ABME Commencement form, which specifies the fee and requires the signature of the physician for any collaborative practice prior to approval. The form is available on the ABME website. The link is provided below:

http://www.albme.org/Documents/Forms/collpraccommform.pdf

NOTE: The report from the certifying agency is required as primary source verification and may require several days for delivery by email or USPS to the ABN. Personal copies are not accepted documentation, and do not meet the Alabama Board of Nursing requirement for primary source verification.

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What are the requirements for performing physical examinations and medical reports for the DOT and to register with the National Registry of Certified Medical Examiners (NRCME)?

CRNPs are eligible to become Certified Medical Examiners.

Federal Motor Carrier Safety Administration (FMCSA) has established the National Registry of Certified Medical Examiners (NRCME), requiring all healthcare professionals who conduct physical examinations for interstate commercial motor vehicle drivers to:

  • Complete training offered by a nationally recognized organization that meets FMCSA standards, e.g., Medical Association of the State of Alabama.
  • Pass a certification exam to conduct physical examinations for drivers who wish to obtain a Commercial Driver’s License (CDL) and register on the NRCME.
  • Beginning May 21, 2014, commercial drivers must receive Department of Transportation (DOT) physicals and medical reports from DOT Certified Medical Examiners
    listed on the National Registry.

The Medical Association of the State of Alabama now offers online FMCSA DOT Medical Examiner Certification Training. Information is available on the MASA link provided below:

http://www.alamedical.org/DOTCertification

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What is the minimum aged patient for Adult Nurse Practitioner?

Adult Nurse Practitioners may treat “young adults.” The standards adopted by NP education and certifying agencies do not state a minimum age. The ABN recognizes these national standards.

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What happened to the Specialty Formulary?

Standard and Specialty Legend drugs were incorporated into a single Standard Formulary in April 2016. Click on “Formularies” under the CRNP and CNM sections of the website to view the formulary.

Remember, Specialty Legend drugs are still required to be given within the scope of the collaborative practice specialty. To capture the use of Specialty Legend drugs within a collaboration, the medications are listed at the end of the individualized STANDARD PROTOCOLS, also available on the ABN website. The Board strongly encourages you to utilize the standard protocols to document and demonstrate authorized skills/procedures or specialty legend drugs allowed within your collaborative agreement.

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How do I make changes to an existing collaborative practice?

Submit an online Modify an Existing Collaboration application. Use this application to add or delete covering physicians, add or delete practice sites, and make changes to the work hours reflected for the collaboration.

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Am I approved to do all the skills/procedures listed on my certification-specific Standard Protocol?

Yes. You are approved to do all the procedures listed on the Standard Protocol, if it is consistent with your practice site, your collaborating physician agrees, and you have the knowledge and technical ability. An example of a protocol agreement (you may use for your records only) is available on the ABN website under the “Advanced Practice” tab.

The collaborating physician must be qualified to provide medical direction for the procedure. The CRNP or CNM who lacks current proficiency is responsible and accountable for obtaining sufficient guidance, education, and supervision for safe practice prior to performing a new procedure.

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What are “Medical Oversight,” “Readily Available,” and “Direct Medical Intervention”?

Medical Oversight is concurrent and on-going, collaboration between a physician and a CRNP or CNM, and documentation of time together in a practice site; may include but is not limited to direct consultation and patient care, discussion of disease processes and medical care, review of patient records, protocols and outcome indicators, and other activities to promote positive patient outcomes.

Readily Available: Response by the collaborating or covering physician by telephone, telecommunication, or radio for consultation, referral, or direct medical intervention.

Direct Medical Intervention is the physical presence of a physician to attend the patient, as defined in the collaborative practice protocol.

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Can a CRNP or CNM own a practice?

Yes. The rules governing Collaborative Practice in AL do not prohibit a CRNP or CNM from owning a practice. However, CRNPs and CNMs who desire to practice are required to enter into a Collaborative Practice Agreement with a physician licensed in the state of Alabama. Additional requirements are included in ABN Administrative Code 610-X-5, located in the Laws section of the Board website.

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Can a CRNP complete disability paperwork?

Yes, for all forms filed on or after March 27, 2017.

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Can a CRNP do sports physicals in Alabama?

No. The rules of the Alabama High School Athletic Association (AHSSA) require that all physicals be signed by a licensed physician.

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Can a CRNP/CNM write admission orders?

Yes. The CRNP/CNM is permitted to write admission orders for inpatients, as directed by the physician, and subsequent orders, in accordance with established protocols and institutional policies.

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May the 10% of scheduled hours be worked with the collaborating physician or covering physician?

Time on-site with the covering physician counts toward the 10% accumulation. However, the covering physician cannot provide all of the on-site time. The collaborating physician still has primary responsibility for collaboration and medical direction with the CRNP.

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APN General

APN General

Will ABN receive notification when I receive or renew my national certification?

No. Notification of your continued national certification is not automatic.

Visit the website for your certifying agency and follow their instructions to request that written verification be sent directly to the ABN.

Send to melissa.curtis@abn.alabama.gov by email, or by US Postal Service (USPS) to
PO BOX 303900 Montgomery AL 36130-3900.

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When does my Advanced Practice approval lapse or expire?

Advanced Practice approval from the ABN will expire with your RN license (example: 12/31/2018) or on the date of expiration of your national specialty certification, whichever comes first.

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What should I do if my RN license lapses?

Immediately cease and desist from all activities as an RN and an Advanced Practice Nurse. You must reinstate the RN license. You must reinstate the RN license. Reinstatement of APN approval is a two-step process AFTER the RN license is Active. See next question for the two steps.

Unauthorized practice as an Advanced Practice Nurse is subject to disciplinary action against your Registered Nurse license. This may include limitations on future authorizations for Advanced Practice Nursing.

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What should I do if my Advanced Practice certification expires?

Reinstatement of APN approval is a two-step process:

  1. Submit an Application for Reinstatement of Lapsed Approval for Advanced Practice Nursing (this is located in the Advanced Practice Nursing section of the website).
  1. If CRNP or CNM, submit an electronic Add New Collaboration Application.

Unauthorized practice as an Advanced Practice Nurse is subject to disciplinary action against your Registered Nurse license. This may include limitations on future authorizations for Advanced Practice Nursing.

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How do I change or update my address?

This information may be updated in My Profile section of the ABN website at www.abn.alabama.gov.

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What if I fail the certification exam in my specialty of practice?

You must cease and desist from working as an Advanced Practice Nurse immediately and notify the ABN.

Upon successful certification in your Advanced Practice specialty, you may re-apply to ABN for approval of Advanced Practice Nursing. Do not practice in your APN specialty until you receive notice of approval from the Alabama Board of Nursing.

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What does “provisional approval” mean?

Provisional Approval – Your approval is provisional pending receipt of the results of your first writing of the certification examination, as stipulated in ABN Administrative Code for CRNP as a Graduate Registered Nurse Practitioner, CNM as a Graduate Nurse Midwife, and CRNA as a Graduate Registered Nurse Anesthetist.  If you request and receive provisional approval, you may practice only with the on-site supervision of an Advanced Practice Nurse with the same specialty or a qualified physician.

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What is the scope of practice for an Advanced Practice Nurse?

Distinctions between scopes of practice for APNs are closely tied to each specialty certification. For example, by virtue of formal education, clinical training, and national certification, Family Nurse Practitioners (FNPs) are certified to treat patients of either sex across the lifespan, while certification in Adult-Gerontology allows the CRNP to treat patients of either sex, but only from adolescence (depending on the specific certification achieved from the certifying board) through adulthood.

In consultation with national certifying agencies, the ABN staff has confirmed that only formal education qualifies a CRNP to certify for treatment of patients in an additional population-focused area of practice. On the job/in-house training with a physician does not increase the CRNP’s scope of practice and/or allow them to treat patient populations for which they do not hold certification and could leave both the CRNP and facility legally at risk.

If you have any questions relating to your specific certification, you should refer to the certification handbook from your certifying agency.

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Can an Advanced Practice Nurse withhold life-saving treatment [Do Not Resuscitate (DNR) order]?

No. Based on Alabama Natural Death Act 22-8A-4 (d) and 22-8A-11 (a), only a physician licensed to practice medicine or osteopathy in Alabama may activate an advanced directive, or make a determination, in the absence of a written advanced directive, to withhold treatment.

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REQUIREMENTS

An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse.

CATEGORY EDUCATION CERTIFICATION FEES
CRNA Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse anesthetists. Certification as an CRNA from the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)
  • Initial collaboration: $150
  • Reinstate a Lapsed Approval: $100

 

 For additional information, please reference Chapter 610-X-9 Advanced Practice Nursing

Chapter 610-X-9 Advanced Practice Nursing


Download Chapter 610-X-9 (PDF)

610-X-9-.01  Qualifications for Approval to Practice as a Certified Registered Nurse Anesthetist
610-X-9-.02  Application for Approval to Practice as a Certified Registered Nurse Anesthetist
610-X-9-.03  Authorization for Practice as a Certified Registered Nurse Anesthetist
610-X-9-.04  Standards of Practice for a Nurse Anesthetist
610-X-9-.05  Provisional Approval for Practice as a Graduate Registered Nurse Anesthetist
610-X-9-.06  Notice Requirements
610-X-9-.07  Qualifications for Approval to Practice as a Clinical Nurse Specialist
610-X-9-.08  Application for Approval to Practice as a Clinical Nurse Specialist
610-X-9-.09  Authorization for Practice as a Clinical Nurse Specialist
610-X-9-.10  Standards of Practice for Clinical Nurse Specialists
610-X-9-.11  Notice Requirements
610-X-9-.12  Reinstatement of Lapsed Approval to Practice as a Clinical Nurse Specialist


NATIONAL CERTIFYING AGENCIES
APPLICATION

Prior to applying for approval as an APN, visit My Profile to review your information currently on record with the ABN.

Note: The application for approval to practice as an Advanced Practice Nurse (APN) in the state of Alabama is intended for completion only by the individual applying for APN approval and should not be completed by any third party on behalf of the applicant. The application requires an attestation by the applicant as to the accuracy and completeness of the information to the Alabama Board of Nursing. Please note that any applicant or licensee of the Board who provides incomplete or inaccurate information on an application is subject to discipline against his or her license, and/or denial or withdrawal of APN approval.

Initial CRNA Application

Reinstate a Lapsed APN Approval

 For additional information, please reference Chapter 610-X-9 Advanced Practice Nursing

Chapter 610-X-9 Advanced Practice Nursing


Download Chapter 610-X-9 (PDF)

610-X-9-.01  Qualifications for Approval to Practice as a Certified Registered Nurse Anesthetist
610-X-9-.02  Application for Approval to Practice as a Certified Registered Nurse Anesthetist
610-X-9-.03  Authorization for Practice as a Certified Registered Nurse Anesthetist
610-X-9-.04  Standards of Practice for a Nurse Anesthetist
610-X-9-.05  Provisional Approval for Practice as a Graduate Registered Nurse Anesthetist
610-X-9-.06  Notice Requirements
610-X-9-.07  Qualifications for Approval to Practice as a Clinical Nurse Specialist
610-X-9-.08  Application for Approval to Practice as a Clinical Nurse Specialist
610-X-9-.09  Authorization for Practice as a Clinical Nurse Specialist
610-X-9-.10  Standards of Practice for Clinical Nurse Specialists
610-X-9-.11  Notice Requirements
610-X-9-.12  Reinstatement of Lapsed Approval to Practice as a Clinical Nurse Specialist

FREQUENTLY ASKED QUESTIONS

APN General

APN General

Will ABN receive notification when I receive or renew my national certification?

No. Notification of your continued national certification is not automatic.

Visit the website for your certifying agency and follow their instructions to request that written verification be sent directly to the ABN.

Send to melissa.curtis@abn.alabama.gov by email, or by US Postal Service (USPS) to
PO BOX 303900 Montgomery AL 36130-3900.

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When does my Advanced Practice approval lapse or expire?

Advanced Practice approval from the ABN will expire with your RN license (example: 12/31/2018) or on the date of expiration of your national specialty certification, whichever comes first.

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What should I do if my RN license lapses?

Immediately cease and desist from all activities as an RN and an Advanced Practice Nurse. You must reinstate the RN license. You must reinstate the RN license. Reinstatement of APN approval is a two-step process AFTER the RN license is Active. See next question for the two steps.

Unauthorized practice as an Advanced Practice Nurse is subject to disciplinary action against your Registered Nurse license. This may include limitations on future authorizations for Advanced Practice Nursing.

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What should I do if my Advanced Practice certification expires?

Reinstatement of APN approval is a two-step process:

  1. Submit an Application for Reinstatement of Lapsed Approval for Advanced Practice Nursing (this is located in the Advanced Practice Nursing section of the website).
  1. If CRNP or CNM, submit an electronic Add New Collaboration Application.

Unauthorized practice as an Advanced Practice Nurse is subject to disciplinary action against your Registered Nurse license. This may include limitations on future authorizations for Advanced Practice Nursing.

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How do I change or update my address?

This information may be updated in My Profile section of the ABN website at www.abn.alabama.gov.

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What if I fail the certification exam in my specialty of practice?

You must cease and desist from working as an Advanced Practice Nurse immediately and notify the ABN.

Upon successful certification in your Advanced Practice specialty, you may re-apply to ABN for approval of Advanced Practice Nursing. Do not practice in your APN specialty until you receive notice of approval from the Alabama Board of Nursing.

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What does “provisional approval” mean?

Provisional Approval – Your approval is provisional pending receipt of the results of your first writing of the certification examination, as stipulated in ABN Administrative Code for CRNP as a Graduate Registered Nurse Practitioner, CNM as a Graduate Nurse Midwife, and CRNA as a Graduate Registered Nurse Anesthetist.  If you request and receive provisional approval, you may practice only with the on-site supervision of an Advanced Practice Nurse with the same specialty or a qualified physician.

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What is the scope of practice for an Advanced Practice Nurse?

Distinctions between scopes of practice for APNs are closely tied to each specialty certification. For example, by virtue of formal education, clinical training, and national certification, Family Nurse Practitioners (FNPs) are certified to treat patients of either sex across the lifespan, while certification in Adult-Gerontology allows the CRNP to treat patients of either sex, but only from adolescence (depending on the specific certification achieved from the certifying board) through adulthood.

In consultation with national certifying agencies, the ABN staff has confirmed that only formal education qualifies a CRNP to certify for treatment of patients in an additional population-focused area of practice. On the job/in-house training with a physician does not increase the CRNP’s scope of practice and/or allow them to treat patient populations for which they do not hold certification and could leave both the CRNP and facility legally at risk.

If you have any questions relating to your specific certification, you should refer to the certification handbook from your certifying agency.

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Can an Advanced Practice Nurse withhold life-saving treatment [Do Not Resuscitate (DNR) order]?

No. Based on Alabama Natural Death Act 22-8A-4 (d) and 22-8A-11 (a), only a physician licensed to practice medicine or osteopathy in Alabama may activate an advanced directive, or make a determination, in the absence of a written advanced directive, to withhold treatment.

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CRNA / CNS

CRNA / CNS

Do you accept CRNA endorsement from out of state?

Alabama does not “endorse” AP status from another state.

You must complete the RN endorsement process and obtain your Alabama RN license first, then submit a CRNA application.

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Does a CRNA or CNS have to be in collaborative practice with a physician?

No. Only CRNPs and CNMs are subject to the collaborative practice requirements.

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Can a CRNA own a practice in Alabama?

Yes. The law does not prohibit RNs/CRNAs from owning practices. However, a CRNA is required to practice under the direction of either a dentist or physician licensed to practice medicine, who is immediately available.

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As an CNS can I have an independent contract for practice?

Article 5 of the Nurse Practice Act allows for a CNS to perform nursing services as an independent contractor.

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What can a CNS do in an independent contract?

In addition to all duties and functions that any licensed Registered Nurse may perform, the CNS in a specialty certification demonstrates specialty/advanced practice clinical expertise in caring for diverse patient populations. The CNS’s nursing services may include additional functions determined and specified through the standardized procedures application process, congruent with Alabama law.

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How can I determine specific allowable functions for my CNS role?

Allowable functions approved by the CNS’s certifying agency must be congruent with Alabama law to be permissible. You may submit a standardized procedure application or request clarification through the declaratory ruling process here at the ABN.

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How would the standardized procedure process work for a CNS?

A CNS wishing to add additional duties and functions to their nursing services through either employment or independent contract may work in conjunction with the heath care facility (hospital, physician office, or another heath care facility) to apply for extra privileges, functions, and duties congruent with Alabama law by completing the standardized procedure application and submitting it to the ABN for approval.

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What duties can a CNS not perform?

If the duty/function is considered RN practice, a CNS may perform the duty/function as either an employee or an independent contractor. Additional duties and functions may be requested through the standardized procedure process or clarified through a specific request for a declaratory ruling by the ABN. However, Article 5 of the Nurse Practice Act specifically states that a CNS may not:

  • Perform delegated medical acts or engage in collaborative practice as described in this article.
  • Perform any of the functions of a certified registered nurse practitioner or a certified nurse midwife as described in this article and the regulations adopted under this article, whether or not performed within a collaborative practice relationship.
  • Prescribe drugs of any type.

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How do I know which standardized procedures have been approved for the CNS?

The ABN website includes a listing of previously approved standardized procedures which indicates the licensure status as well as the procedure. The license type column indicates the lowest level of licensee who can perform the procedure (reported to the ABN by the facility) and is not meant to be all-inclusive or to indicate that a certain Advanced Practice nurse cannot perform the procedure. At all times, the nurse must be able to demonstrate the education, training, and competency validation for each skill listed and approved for the facility.

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REQUIREMENTS

An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse.

CATEGORY EDUCATION CERTIFICATION FEES
CNS Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare clinical nurse specialists.. Certification as a CNS from a national certifying agency recognized by the Alabama Board of Nursing.
  • Initial collaboration: $150
  • Reinstate a Lapsed Approval: $100

 

 For additional information, please reference Chapter 610-X-9 Advanced Practice Nursing

Chapter 610-X-9 Advanced Practice Nursing


Download Chapter 610-X-9 (PDF)

610-X-9-.01  Qualifications for Approval to Practice as a Certified Registered Nurse Anesthetist
610-X-9-.02  Application for Approval to Practice as a Certified Registered Nurse Anesthetist
610-X-9-.03  Authorization for Practice as a Certified Registered Nurse Anesthetist
610-X-9-.04  Standards of Practice for a Nurse Anesthetist
610-X-9-.05  Provisional Approval for Practice as a Graduate Registered Nurse Anesthetist
610-X-9-.06  Notice Requirements
610-X-9-.07  Qualifications for Approval to Practice as a Clinical Nurse Specialist
610-X-9-.08  Application for Approval to Practice as a Clinical Nurse Specialist
610-X-9-.09  Authorization for Practice as a Clinical Nurse Specialist
610-X-9-.10  Standards of Practice for Clinical Nurse Specialists
610-X-9-.11  Notice Requirements
610-X-9-.12  Reinstatement of Lapsed Approval to Practice as a Clinical Nurse Specialist


NATIONAL CERTIFYING AGENCIES
APPLICATION

Prior to applying for approval as an APN, visit My Profile to review your information currently on record with the ABN.

Note: The application for approval to practice as an Advanced Practice Nurse (APN) in the state of Alabama is intended for completion only by the individual applying for APN approval and should not be completed by any third party on behalf of the applicant. The application requires an attestation by the applicant as to the accuracy and completeness of the information to the Alabama Board of Nursing. Please note that any applicant or licensee of the Board who provides incomplete or inaccurate information on an application is subject to discipline against his or her license, and/or denial or withdrawal of APN approval.

Initial CNS Application

Reinstate a Lapsed APN Approval

 For additional information, please reference Chapter 610-X-9 Advanced Practice Nursing

Chapter 610-X-9 Advanced Practice Nursing


Download Chapter 610-X-9 (PDF)

610-X-9-.01  Qualifications for Approval to Practice as a Certified Registered Nurse Anesthetist
610-X-9-.02  Application for Approval to Practice as a Certified Registered Nurse Anesthetist
610-X-9-.03  Authorization for Practice as a Certified Registered Nurse Anesthetist
610-X-9-.04  Standards of Practice for a Nurse Anesthetist
610-X-9-.05  Provisional Approval for Practice as a Graduate Registered Nurse Anesthetist
610-X-9-.06  Notice Requirements
610-X-9-.07  Qualifications for Approval to Practice as a Clinical Nurse Specialist
610-X-9-.08  Application for Approval to Practice as a Clinical Nurse Specialist
610-X-9-.09  Authorization for Practice as a Clinical Nurse Specialist
610-X-9-.10  Standards of Practice for Clinical Nurse Specialists
610-X-9-.11  Notice Requirements
610-X-9-.12  Reinstatement of Lapsed Approval to Practice as a Clinical Nurse Specialist

FREQUENTLY ASKED QUESTIONS

APN General

APN General

Will ABN receive notification when I receive or renew my national certification?

No. Notification of your continued national certification is not automatic.

Visit the website for your certifying agency and follow their instructions to request that written verification be sent directly to the ABN.

Send to melissa.curtis@abn.alabama.gov by email, or by US Postal Service (USPS) to
PO BOX 303900 Montgomery AL 36130-3900.

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When does my Advanced Practice approval lapse or expire?

Advanced Practice approval from the ABN will expire with your RN license (example: 12/31/2018) or on the date of expiration of your national specialty certification, whichever comes first.

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What should I do if my RN license lapses?

Immediately cease and desist from all activities as an RN and an Advanced Practice Nurse. You must reinstate the RN license. You must reinstate the RN license. Reinstatement of APN approval is a two-step process AFTER the RN license is Active. See next question for the two steps.

Unauthorized practice as an Advanced Practice Nurse is subject to disciplinary action against your Registered Nurse license. This may include limitations on future authorizations for Advanced Practice Nursing.

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What should I do if my Advanced Practice certification expires?

Reinstatement of APN approval is a two-step process:

  1. Submit an Application for Reinstatement of Lapsed Approval for Advanced Practice Nursing (this is located in the Advanced Practice Nursing section of the website).
  1. If CRNP or CNM, submit an electronic Add New Collaboration Application.

Unauthorized practice as an Advanced Practice Nurse is subject to disciplinary action against your Registered Nurse license. This may include limitations on future authorizations for Advanced Practice Nursing.

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How do I change or update my address?

This information may be updated in My Profile section of the ABN website at www.abn.alabama.gov.

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What if I fail the certification exam in my specialty of practice?

You must cease and desist from working as an Advanced Practice Nurse immediately and notify the ABN.

Upon successful certification in your Advanced Practice specialty, you may re-apply to ABN for approval of Advanced Practice Nursing. Do not practice in your APN specialty until you receive notice of approval from the Alabama Board of Nursing.

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What does “provisional approval” mean?

Provisional Approval – Your approval is provisional pending receipt of the results of your first writing of the certification examination, as stipulated in ABN Administrative Code for CRNP as a Graduate Registered Nurse Practitioner, CNM as a Graduate Nurse Midwife, and CRNA as a Graduate Registered Nurse Anesthetist.  If you request and receive provisional approval, you may practice only with the on-site supervision of an Advanced Practice Nurse with the same specialty or a qualified physician.

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What is the scope of practice for an Advanced Practice Nurse?

Distinctions between scopes of practice for APNs are closely tied to each specialty certification. For example, by virtue of formal education, clinical training, and national certification, Family Nurse Practitioners (FNPs) are certified to treat patients of either sex across the lifespan, while certification in Adult-Gerontology allows the CRNP to treat patients of either sex, but only from adolescence (depending on the specific certification achieved from the certifying board) through adulthood.

In consultation with national certifying agencies, the ABN staff has confirmed that only formal education qualifies a CRNP to certify for treatment of patients in an additional population-focused area of practice. On the job/in-house training with a physician does not increase the CRNP’s scope of practice and/or allow them to treat patient populations for which they do not hold certification and could leave both the CRNP and facility legally at risk.

If you have any questions relating to your specific certification, you should refer to the certification handbook from your certifying agency.

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Can an Advanced Practice Nurse withhold life-saving treatment [Do Not Resuscitate (DNR) order]?

No. Based on Alabama Natural Death Act 22-8A-4 (d) and 22-8A-11 (a), only a physician licensed to practice medicine or osteopathy in Alabama may activate an advanced directive, or make a determination, in the absence of a written advanced directive, to withhold treatment.

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CRNA / CNS

CRNA / CNS

Do you accept CRNA endorsement from out of state?

Alabama does not “endorse” AP status from another state.

You must complete the RN endorsement process and obtain your Alabama RN license first, then submit a CRNA application.

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Does a CRNA or CNS have to be in collaborative practice with a physician?

No. Only CRNPs and CNMs are subject to the collaborative practice requirements.

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Can a CRNA own a practice in Alabama?

Yes. The law does not prohibit RNs/CRNAs from owning practices. However, a CRNA is required to practice under the direction of either a dentist or physician licensed to practice medicine, who is immediately available.

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As an CNS can I have an independent contract for practice?

Article 5 of the Nurse Practice Act allows for a CNS to perform nursing services as an independent contractor.

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What can a CNS do in an independent contract?

In addition to all duties and functions that any licensed Registered Nurse may perform, the CNS in a specialty certification demonstrates specialty/advanced practice clinical expertise in caring for diverse patient populations. The CNS’s nursing services may include additional functions determined and specified through the standardized procedures application process, congruent with Alabama law.

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How can I determine specific allowable functions for my CNS role?

Allowable functions approved by the CNS’s certifying agency must be congruent with Alabama law to be permissible. You may submit a standardized procedure application or request clarification through the declaratory ruling process here at the ABN.

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How would the standardized procedure process work for a CNS?

A CNS wishing to add additional duties and functions to their nursing services through either employment or independent contract may work in conjunction with the heath care facility (hospital, physician office, or another heath care facility) to apply for extra privileges, functions, and duties congruent with Alabama law by completing the standardized procedure application and submitting it to the ABN for approval.

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What duties can a CNS not perform?

If the duty/function is considered RN practice, a CNS may perform the duty/function as either an employee or an independent contractor. Additional duties and functions may be requested through the standardized procedure process or clarified through a specific request for a declaratory ruling by the ABN. However, Article 5 of the Nurse Practice Act specifically states that a CNS may not:

  • Perform delegated medical acts or engage in collaborative practice as described in this article.
  • Perform any of the functions of a certified registered nurse practitioner or a certified nurse midwife as described in this article and the regulations adopted under this article, whether or not performed within a collaborative practice relationship.
  • Prescribe drugs of any type.

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How do I know which standardized procedures have been approved for the CNS?

The ABN website includes a listing of previously approved standardized procedures which indicates the licensure status as well as the procedure. The license type column indicates the lowest level of licensee who can perform the procedure (reported to the ABN by the facility) and is not meant to be all-inclusive or to indicate that a certain Advanced Practice nurse cannot perform the procedure. At all times, the nurse must be able to demonstrate the education, training, and competency validation for each skill listed and approved for the facility.

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FREQUENTLY ASKED QUESTIONS

CRNP / CNM

CRNP / CNM

How can I or my employer view my Collaborative Practice Detail information?

You may view your information under My Profile. Employers should access this information through the Credentialing Staff AP Profile section.

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As a CRNP or CNM, how much time do I have to practice together with my collaborating physician?

On-site time with the collaborating physician is required for (a) CRNPs and CNMs with fewer than two years (4,000 hours) collaborative practice experience and (b) CRNPs/CNMs with qualifying experience who are moving to an unfamiliar medical specialty. They must be on-site with the physician for 10% of scheduled hours while accumulating two years (4,000 hours) of practice. In other words, if the experienced CRNP enters a new collaboration and does not have clinical experience consistent with the physician’s clinical specialty, the “experience clock” resets to zero. Refer to ABN Administrative Code § 610-X-5-.09 (CRNP) or 610-X-5-.20 (CNM) for details.

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What is the maximum aged patient for which a Pediatric Nurse Practitioner can provide care?

The maximum age for pediatric patient is 21 years old, as stated in the Standards of Practice of the national certifying organizations. In some situations, the age may be irrelevant and care is determined by the diagnosis (for example, cystic fibrosis patients may be provided care by a PNP long past the 21 years of age).

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Can a CRNP be a First Assistant in Surgery?

The CRNP must comply with individual facility policy relating to RNFA practice. See ABN Administrative Code Chapter 610-X-7 for RNFA practice standards. If you have any questions relating to your specific certification, you should refer to the certification handbook from your certifying agency.

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What is included in Quality Monitoring for CRNP and CNM in collaborative practice?

  • Documented evaluation of the CRNP/CNM’s clinical practice.
  • Use of established outcome indicators.
  • Include a summary of findings – reviewed by physician and nurse practitioner.
  • Recommendations for change, if indicated.

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Why can’t a CRNP sign a patient’s application for disability access parking privileges?

Alabama law, through the Alabama Department of Revenue, Motor Vehicle Division, requires a licensed physician to determine long-term disability in order for an individual to acquire disability access placards and/or license plates.

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What if I am only teaching NP students? Do I have to have a collaborative practice?

No. The Board’s rules allow for a “Faculty Only” designation that does not require a collaborative practice. A letter from the Dean of the School or College of Nursing is required prior to designation as “Faculty Only.”

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What if I work as a CRNP/CNM in a federal facility with a physician who is not licensed in Alabama?

The Board’s rules allow for a designation as “Federal Only,” so that you may practice with a physician licensed to practice in another state. As long as you are working in a federal facility, you may practice with the identified collaborating and covering physicians.

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How do I terminate a collaborative practice agreement?

Submit an online Terminate an Existing Collaboration application. Indicate the final date of practice with the physician listed in the online profile. The application is available under the Advanced Practice section of the ABN website.

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How do I add a new collaborative practice?

Submit an online Add New Collaboration application. The application is available under the Advanced Practice section of the ABN website.

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Will my collaborating physician need to notify anyone of our agreement?

Yes. The collaborating physician is required to notify the Alabama Board of Medical Examiners (ABME) of the commencement or termination of collaborative practice with a CRNP or CNM. The Notice of Termination is to be submitted by the physician to the ABME within 14 days of the date of termination of the collaboration.

The ABN notifies the BME of the CRNP/CNM termination immediately upon processing the online Termination application.

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How will I know when I have been approved to practice as a CRNP or CNM?

A Notice of Approval for Practice will be emailed to the applicant’s email address on file with the ABN.

Refer to My Profile to review current approval(s) with the Board.

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How do I request additional duties for my collaborative practice?

Approved additional duties specific to certification specialty may be selected from the online Modify Collaboration Application or Add New Collaboration Application. A drop-down menu will give you a list of skills/procedures previously determined by the ABN and ABME to be permissible for the specific certification specialty. If your skill is not available on the drop-down menu, you must submit a “New Skill Request” form (available on the website).

Note: You must wait until you are approved to train to perform these skills/procedures.

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Do I have to request the Skills/Procedures on the Standard Protocol for my specialty certification?

No. You are approved to do all the procedures listed on the Standard Protocol, if it is consistent with your practice site, your collaborating physician agrees, and you have the knowledge and technical ability.

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Am I approved to do all the skills listed on the Specialty Protocol I was approved for?

The Specialty Protocol is a set of procedures. After receiving approval for the Specialty Protocol, you may perform any of the listed procedures if you and the physician agree they are appropriate to your collaboration, the patient population, and the practice site where you expect to perform the procedure.

Please note: Some Specialty Protocols require specific documentation prior to approval and certain annual numbers of set procedures to demonstrate on-going competency.

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What constitutes a Practice Site?

  • Principal Practice Site – the main location at which the collaborating physician is engaged in the practice of medicine.
  • Remote Site – any approved collaborative practice site without a physician on-site, excluding the physician’s principal practice site and other exempt sites.

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Where may I find detailed information related to the QACSC and the application process?

The Alabama Board of Medical Examiners (ABME) has developed a Frequent Question and Answer page on their website that will help you navigate the process. The link is provided below:
http://www.albme.org/faq-qacscnp.html

In addition, the application information is available at the ABME website. The link is provided below:
http://www.albme.org/qacscupdate.html

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Why do I need to know how many other Advanced Practice Nurses and/or physician assistants are in collaboration with my collaborating physician?

The rules impose a limit on the number of individuals with whom a physician may collaborate. “The physician shall not collaborate with or supervise any combination of certified registered nurse practitioners, certified nurse midwives and/or assistants to physicians exceeding one hundred and sixty ( 160 ) hours per week ( four full- time equivalent positions) unless an exemption is granted under Rule 610-X-5-.05. “One full-time equivalent” (FTE) is herein described as a person/persons collectively working forty hours a week, excluding time on call.

ABN Administrative Code § 610-X-5-.05

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May I apply the Pharmacy education hours awarded for the ABME course for the Qualified Alabama Controlled Substance Certificate (QACSC) toward my Pharmacology CE requirements for RN Renewal?

Yes. The hours awarded for the ABME QACSC course will count toward the Pharmacology hours needed for renewal of the RN license and APN approval.

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What documentation and fees are required by ABME for my collaborative practice?

The ABME requires that the collaborating physician(s) complete an ABME Commencement form, which specifies the fee and requires the signature of the physician for any collaborative practice prior to approval. The form is available on the ABME website. The link is provided below:

http://www.albme.org/Documents/Forms/collpraccommform.pdf

NOTE: The report from the certifying agency is required as primary source verification and may require several days for delivery by email or USPS to the ABN. Personal copies are not accepted documentation, and do not meet the Alabama Board of Nursing requirement for primary source verification.

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What are the requirements for performing physical examinations and medical reports for the DOT and to register with the National Registry of Certified Medical Examiners (NRCME)?

CRNPs are eligible to become Certified Medical Examiners.

Federal Motor Carrier Safety Administration (FMCSA) has established the National Registry of Certified Medical Examiners (NRCME), requiring all healthcare professionals who conduct physical examinations for interstate commercial motor vehicle drivers to:

  • Complete training offered by a nationally recognized organization that meets FMCSA standards, e.g., Medical Association of the State of Alabama.
  • Pass a certification exam to conduct physical examinations for drivers who wish to obtain a Commercial Driver’s License (CDL) and register on the NRCME.
  • Beginning May 21, 2014, commercial drivers must receive Department of Transportation (DOT) physicals and medical reports from DOT Certified Medical Examiners
    listed on the National Registry.

The Medical Association of the State of Alabama now offers online FMCSA DOT Medical Examiner Certification Training. Information is available on the MASA link provided below:

http://www.alamedical.org/DOTCertification

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What is the minimum aged patient for Adult Nurse Practitioner?

Adult Nurse Practitioners may treat “young adults.” The standards adopted by NP education and certifying agencies do not state a minimum age. The ABN recognizes these national standards.

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What happened to the Specialty Formulary?

Standard and Specialty Legend drugs were incorporated into a single Standard Formulary in April 2016. Click on “Formularies” under the CRNP and CNM sections of the website to view the formulary.

Remember, Specialty Legend drugs are still required to be given within the scope of the collaborative practice specialty. To capture the use of Specialty Legend drugs within a collaboration, the medications are listed at the end of the individualized STANDARD PROTOCOLS, also available on the ABN website. The Board strongly encourages you to utilize the standard protocols to document and demonstrate authorized skills/procedures or specialty legend drugs allowed within your collaborative agreement.

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How do I make changes to an existing collaborative practice?

Submit an online Modify an Existing Collaboration application. Use this application to add or delete covering physicians, add or delete practice sites, and make changes to the work hours reflected for the collaboration.

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Am I approved to do all the skills/procedures listed on my certification-specific Standard Protocol?

Yes. You are approved to do all the procedures listed on the Standard Protocol, if it is consistent with your practice site, your collaborating physician agrees, and you have the knowledge and technical ability. An example of a protocol agreement (you may use for your records only) is available on the ABN website under the “Advanced Practice” tab.

The collaborating physician must be qualified to provide medical direction for the procedure. The CRNP or CNM who lacks current proficiency is responsible and accountable for obtaining sufficient guidance, education, and supervision for safe practice prior to performing a new procedure.

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What are “Medical Oversight,” “Readily Available,” and “Direct Medical Intervention”?

Medical Oversight is concurrent and on-going, collaboration between a physician and a CRNP or CNM, and documentation of time together in a practice site; may include but is not limited to direct consultation and patient care, discussion of disease processes and medical care, review of patient records, protocols and outcome indicators, and other activities to promote positive patient outcomes.

Readily Available: Response by the collaborating or covering physician by telephone, telecommunication, or radio for consultation, referral, or direct medical intervention.

Direct Medical Intervention is the physical presence of a physician to attend the patient, as defined in the collaborative practice protocol.

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Can a CRNP or CNM own a practice?

Yes. The rules governing Collaborative Practice in AL do not prohibit a CRNP or CNM from owning a practice. However, CRNPs and CNMs who desire to practice are required to enter into a Collaborative Practice Agreement with a physician licensed in the state of Alabama. Additional requirements are included in ABN Administrative Code 610-X-5, located in the Laws section of the Board website.

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Can a CRNP complete disability paperwork?

Yes, for all forms filed on or after March 27, 2017.

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Can a CRNP do sports physicals in Alabama?

No. The rules of the Alabama High School Athletic Association (AHSSA) require that all physicals be signed by a licensed physician.

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Can a CRNP/CNM write admission orders?

Yes. The CRNP/CNM is permitted to write admission orders for inpatients, as directed by the physician, and subsequent orders, in accordance with established protocols and institutional policies.

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May the 10% of scheduled hours be worked with the collaborating physician or covering physician?

Time on-site with the covering physician counts toward the 10% accumulation. However, the covering physician cannot provide all of the on-site time. The collaborating physician still has primary responsibility for collaboration and medical direction with the CRNP.

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APN General

APN General

Will ABN receive notification when I receive or renew my national certification?

No. Notification of your continued national certification is not automatic.

Visit the website for your certifying agency and follow their instructions to request that written verification be sent directly to the ABN.

Send to melissa.curtis@abn.alabama.gov by email, or by US Postal Service (USPS) to
PO BOX 303900 Montgomery AL 36130-3900.

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When does my Advanced Practice approval lapse or expire?

Advanced Practice approval from the ABN will expire with your RN license (example: 12/31/2018) or on the date of expiration of your national specialty certification, whichever comes first.

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What should I do if my RN license lapses?

Immediately cease and desist from all activities as an RN and an Advanced Practice Nurse. You must reinstate the RN license. You must reinstate the RN license. Reinstatement of APN approval is a two-step process AFTER the RN license is Active. See next question for the two steps.

Unauthorized practice as an Advanced Practice Nurse is subject to disciplinary action against your Registered Nurse license. This may include limitations on future authorizations for Advanced Practice Nursing.

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What should I do if my Advanced Practice certification expires?

Reinstatement of APN approval is a two-step process:

  1. Submit an Application for Reinstatement of Lapsed Approval for Advanced Practice Nursing (this is located in the Advanced Practice Nursing section of the website).
  1. If CRNP or CNM, submit an electronic Add New Collaboration Application.

Unauthorized practice as an Advanced Practice Nurse is subject to disciplinary action against your Registered Nurse license. This may include limitations on future authorizations for Advanced Practice Nursing.

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How do I change or update my address?

This information may be updated in My Profile section of the ABN website at www.abn.alabama.gov.

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What if I fail the certification exam in my specialty of practice?

You must cease and desist from working as an Advanced Practice Nurse immediately and notify the ABN.

Upon successful certification in your Advanced Practice specialty, you may re-apply to ABN for approval of Advanced Practice Nursing. Do not practice in your APN specialty until you receive notice of approval from the Alabama Board of Nursing.

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What does “provisional approval” mean?

Provisional Approval – Your approval is provisional pending receipt of the results of your first writing of the certification examination, as stipulated in ABN Administrative Code for CRNP as a Graduate Registered Nurse Practitioner, CNM as a Graduate Nurse Midwife, and CRNA as a Graduate Registered Nurse Anesthetist.  If you request and receive provisional approval, you may practice only with the on-site supervision of an Advanced Practice Nurse with the same specialty or a qualified physician.

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What is the scope of practice for an Advanced Practice Nurse?

Distinctions between scopes of practice for APNs are closely tied to each specialty certification. For example, by virtue of formal education, clinical training, and national certification, Family Nurse Practitioners (FNPs) are certified to treat patients of either sex across the lifespan, while certification in Adult-Gerontology allows the CRNP to treat patients of either sex, but only from adolescence (depending on the specific certification achieved from the certifying board) through adulthood.

In consultation with national certifying agencies, the ABN staff has confirmed that only formal education qualifies a CRNP to certify for treatment of patients in an additional population-focused area of practice. On the job/in-house training with a physician does not increase the CRNP’s scope of practice and/or allow them to treat patient populations for which they do not hold certification and could leave both the CRNP and facility legally at risk.

If you have any questions relating to your specific certification, you should refer to the certification handbook from your certifying agency.

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Can an Advanced Practice Nurse withhold life-saving treatment [Do Not Resuscitate (DNR) order]?

No. Based on Alabama Natural Death Act 22-8A-4 (d) and 22-8A-11 (a), only a physician licensed to practice medicine or osteopathy in Alabama may activate an advanced directive, or make a determination, in the absence of a written advanced directive, to withhold treatment.

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CRNA / CNS

CRNA / CNS

Do you accept CRNA endorsement from out of state?

Alabama does not “endorse” AP status from another state.

You must complete the RN endorsement process and obtain your Alabama RN license first, then submit a CRNA application.

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Does a CRNA or CNS have to be in collaborative practice with a physician?

No. Only CRNPs and CNMs are subject to the collaborative practice requirements.

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Can a CRNA own a practice in Alabama?

Yes. The law does not prohibit RNs/CRNAs from owning practices. However, a CRNA is required to practice under the direction of either a dentist or physician licensed to practice medicine, who is immediately available.

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As an CNS can I have an independent contract for practice?

Article 5 of the Nurse Practice Act allows for a CNS to perform nursing services as an independent contractor.

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What can a CNS do in an independent contract?

In addition to all duties and functions that any licensed Registered Nurse may perform, the CNS in a specialty certification demonstrates specialty/advanced practice clinical expertise in caring for diverse patient populations. The CNS’s nursing services may include additional functions determined and specified through the standardized procedures application process, congruent with Alabama law.

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How can I determine specific allowable functions for my CNS role?

Allowable functions approved by the CNS’s certifying agency must be congruent with Alabama law to be permissible. You may submit a standardized procedure application or request clarification through the declaratory ruling process here at the ABN.

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How would the standardized procedure process work for a CNS?

A CNS wishing to add additional duties and functions to their nursing services through either employment or independent contract may work in conjunction with the heath care facility (hospital, physician office, or another heath care facility) to apply for extra privileges, functions, and duties congruent with Alabama law by completing the standardized procedure application and submitting it to the ABN for approval.

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What duties can a CNS not perform?

If the duty/function is considered RN practice, a CNS may perform the duty/function as either an employee or an independent contractor. Additional duties and functions may be requested through the standardized procedure process or clarified through a specific request for a declaratory ruling by the ABN. However, Article 5 of the Nurse Practice Act specifically states that a CNS may not:

  • Perform delegated medical acts or engage in collaborative practice as described in this article.
  • Perform any of the functions of a certified registered nurse practitioner or a certified nurse midwife as described in this article and the regulations adopted under this article, whether or not performed within a collaborative practice relationship.
  • Prescribe drugs of any type.

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How do I know which standardized procedures have been approved for the CNS?

The ABN website includes a listing of previously approved standardized procedures which indicates the licensure status as well as the procedure. The license type column indicates the lowest level of licensee who can perform the procedure (reported to the ABN by the facility) and is not meant to be all-inclusive or to indicate that a certain Advanced Practice nurse cannot perform the procedure. At all times, the nurse must be able to demonstrate the education, training, and competency validation for each skill listed and approved for the facility.

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CONTACT ADVANCED PRACTICE NURSING

Advanced Practice Nursing Contact Info

ABN Physical Address

RSA Plaza, Suite 250
770 Washington Ave.
Montgomery, AL 36104

ABN Mailing Address

Alabama Board of Nursing
P.O. Box 303900
Montgomery, AL 36130-3900

ABN Contact Info

Phone: 1-800-656-5318Phone: 1-334-293-5201

 Web: www.abn.alabama.gov


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