Advanced Nursing Practice
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
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, CNM, and CRNA. 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.
Can an Advanced Practice Nurse withhold life- saving treatment (Do not resuscitate 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.
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.
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.
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.
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.
Can 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.
What do “Medical Oversight,” “Readily Available,” and “Direct Medical Intervention” mean?
- Medical Oversight includes:
- Concurrent and ongoing collaboration between a physician and CRNP/CNM
- Written documentation of time together in an approved practice site
- Includes, but not limited to:
- Direct consultation & patient care
- Discussion of disease processes
- Review of records
- 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:
The definition of “direct medical intervention” requires the physical presence of a physician to attend to the needs of the patient as defined in the collaborative practice protocol, as dictated by the needs of the patient, and based on usual and customary standards of medical practice.
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).
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.
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.
Whom do I contact if I have questions related to the approval process for the Qualified Alabama Controlled Substance Certificate (QACSC) classes and process?
The QACSC certificate and required educational classes are offered solely by the Alabama Board of Medical Examiners (ABME). You may contact any of the individuals listed below:
Medical Association of State of Alabama
Judy DeBray
Director of Education
(334) 954-2535 Direct
(334) 954-2500 Main
(800) 239-6272
jdebray@alamedical.org
Margaret McGuire
Coordinator of Provider Services
(334) 954-2519
(800) 239-6272
(334) 269-5200 fax
mmcguire@alamedical.org
ALABAMA BOARD OF MEDICAL EXAMINERS
Pat Ward, RN
Nurse Inspector
Phone 334-242-4116 (direct)
Fax: 334-240-3037 (direct)
ABME Website Information:
You must go to the ABME website to access the QACSC information links available to you.
QACSC Applications
Where can 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
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.”
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.
Can the Pharmacy education hours taken with the ABME course for the Qualified Alabama Controlled Substance Certificate (QACSC) count toward my RN renewal for the Pharmacology CE requirements?
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.
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.
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.
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.
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.
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.
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.
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.
If I currently have approval for a specific Specialty Protocol and change collaborative practice physicians, will I need to request approval again for the same protocol?
Yes. The Specialty Protocol must be requested under the Add New Collaboration Application. Each new collaborating physician must approve the skill/procedure requested.
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.
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.
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.
Does a CRNA have to be in collaborative practice with a physician?
No. Only CRNPs and CNMs are subject to the collaborative practice requirements.
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:
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.
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.
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.
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. 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.
What should I do if my Advanced Practice certification expires?
Reinstatement of APN approval is a two-step process:
- Submit an Application for Reinstatement of Lapsed Approval for Advanced Practice Nursing (this is located in the Advanced Practice Nursing section of the website).
- 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.
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.
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.
What if I fail the national certification exam in my specialty?
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. Do not practice in your APN specialty until you receive notice of approval from the Alabama Board of Nursing.
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.
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.
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.
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.
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.
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.
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 health care facility (hospital, physician office, or another health 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.
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.
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.
How do I apply for initial approval as a CRNP in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse practitioners. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as a nurse practitioner in the specialty consistent with NP education from a national certifying agency recognized by the Alabama Board of Nursing. | You must request that your certifying agency submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
| PRACTICE DOCUMENTS | The CRNP is required to submit signed copies of the Standard Protocol and Quality Management Plan for each collaboration in which they are involved. | Scan and email documents to the ABN at advancedpractice@abn.alabama.gov. NOTE: Incomplete documents will be returned for completion. |
| PHYSICIAN COMMENCEMENT | 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. | Have your collaborating physician submit Commencement Form and fee to the Board of Medical Examiners. |
How do I apply for initial approval as a CNM in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse midwives. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as a CNM from the American Midwifery Certification Board (AMCB). | You must request that AMCB submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
| PRACTICE DOCUMENTS | The CNM is required to submit signed copies of the Standard Protocol and Quality Management Plan for each collaboration in which they are involved. | Scan and email documents to the ABN at advancedpractice@abn.alabama.gov. NOTE: Incomplete documents will be returned for completion. |
| PHYSICIAN COMMENCEMENT | 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. | Have your collaborating physician submit Commencement Form and fee to the Board of Medical Examiners. |
How do I apply for initial approval as a CRNA in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse anesthetists. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as an CRNA from the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). | You must request that NBCRNA submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
How do I apply for initial approval as a CNS in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare clinical nurse specialists. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as a CNS from a national certifying agency recognized by the Alabama Board of Nursing. | You must request that your certifying agency submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
Does a CNS have to be in collaborative practice with a physician?
No. Only CRNPs and CNMs are subject to the collaborative practice requirements.
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
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.
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.
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.
Can a CRNP complete disability paperwork?
Yes, for all forms filed on or after March 27, 2017.
Can a CRNP do sports physicals in Alabama?
The rules of the Alabama High School Athletic Association (AHSAA) state the following (2018-2019 Handbook, ByLaws, Rule 1, SECTION 14. PHYSICAL EXAMS):
In order for a student to be eligible for interscholastic athletics, there must be on file in the principal’s office (or on DragonFly) a current physician’s statement (hard copy or digital copy) certifying that the student has passed a physical exam, and that in the opinion of the examining physician (M.D. or D.O.) the student is fully able to participate in interscholastic athletics (grades 7-12). The AHSAA 2018 Pre-Participation Physical Evaluation Form (Form 5) must be used.
Note: A signed physical (parent signature and M.D. or D.O.) is required to participate in tryouts and/or practice. The M.D. or D.O. must sign/stamp all physicals even if CRNP completed the physical.
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.
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.
Can Nurse Practitioners perform cosmetic injections (i.e. Botox, Restylane, Collagen, and Mesotherapy) in Alabama?
In 2004, the Board of Medical Examiners determined these procedures (Botox, Restylane, Collagen, and Mesotherapy) to be the practice of medicine, requiring that each such procedure must be performed by a licensed physician. The Board of Medical Examiners does not authorize physicians to delegate administration of botox and dermal fillers to CRNPs.
How do I list Home Visits on my collaborative practice application?
Application INSTRUCTIONS for Home Visits:
The first site should be the Physician’s principal practice site, whether you plan to work there or not.
The second site should be the Home Visit Company and physical address.
The third and any additional sites should be Home Visits for each county where you will see patients. You would list a site for each individual county as follows (use a separate entry for each county):
NAME: Home Visits for (company name) – Example: Home Visits for _____________.
ADDRESS: Mark with an X – we realize you cannot list individual home addresses.
CITY: In the City field, list the county in which you will do home visits.
STATE: Alabama
ZIP CODE: 00000
PHONE NUMBER: This would be a number where you can be reached.
How do I find the RX number given to me by the ABN?
Login to the My Profile section of the ABN website at www.abn.alabama.gov. Click “My Advanced Practice. ” Rx Number will be displayed.
Where do I find the Standard Protocol and the Quality Management Plan for each of my collaborations? Do I send copies of the documents to the ABN?
Certification-specific CRNP Standard Protocols are available in the CRNP section. The Quality Assurance Plan is located under the RESOURCES tab. Complete the Protocol and the Quality Assurance Plan in consultation with the collaborating physician, including original signatures.
The CNM Standard Protocol is available here. The Quality Assurance Plan is located under the RESOURCES tab. Complete the Protocol and the Quality Assurance Plan in consultation with the collaborating physician, including original signatures.
Send a copy of each document to advancedpractice@abn.alabama.gov.
Keep a copy of each document on file at each practice site.
What happened to the Expanded Midwifery Protocol?
The Expanded Midwifery Protocol has been consolidated into the Standard Protocol. All CNMs applying for approval in Alabama will practice under the Standard Protocol with the option of requesting additional skills for OB Limited Ultrasound and/or Circumcision (formerly components of the Expanded Protocol).
What does Alabama Act No. 2018-474 allow CRNP/CNM to sign?
NOTE: HB429—Signature Authority Bill was signed by Governor Ivey the last week of March 2018 and became law as Alabama Act No. 2018-474
CRNP / CNM in an active collaboration may sign the following:
| • Certification of disability for patients to receive disabled parking tags or placards | • Forms excusing a potential jury member due to an illness |
| • Authorization for durable medical equipment | |
| • Any of the following which require a complete history and physical exam consistent with the CRNP/CNM scope of practice:
• Physicals for bus drivers • Physicals to verify eligibility for students to participate in Special Olympics • Employment and pre-employment physicals for TSA employees or for governmental employees such as firefighters and law enforcement officers • Adoptive parent applications • College or trade school physicals • Boy or Girl Scout physicals or physical required by similar organizations |
• Forms relating to absenteeism for employment or school purposes, including, but not limited to, documents associated with the federal Family Medical Leave Act (FMLA) |
| • Authorization for diabetic testing supplies | |
| • Authorization for diabetic shoes | |
| • Home health recertification orders after initial certification | |
| • Within the state Medicaid system, any and all forms for the ordering of medications, nutritional supplements, or infant formulas, or referrals to providers of medical specialties, home health services, and physical or occupation therapy | |
| • Death Certificates | |
| • Forms, including physical exam forms, for certification in residential or inpatient dwellings within the Department of Mental Health | |
| • Required documentation allowing a diabetic to renew or obtain a driver’s license | |
| • Forms for ambulance transport | |
| • Forms for donor breast milk |
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.
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.
What are the specific CE requirements for APN renewal with the RN license?
All nurses are required to have 24 continuing education contact hours for license renewal. APNs are required to earn six of those 24 hours in pharmacology. You may review your CE record on My Profile.
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.
What is the Reinstatement fee?
The fee to reinstate one APN role is $150 ($75 APN Reinstatement fee and $75 renewal fee).
I was approved in more than one APN role. What is the fee for more than one?
Each additional APN role costs $75. Example: CRNP & CNS = $225 ($75 Reinstatement fee, $75 to renew CRNP, plus $75 to renew CNS)
What do I need to submit with the application and fee for Reinstatement of Advanced Practice Nursing?
Advanced practice nurses are required to submit documentation of completion of 6 hours of continuing education (CE) credit in pharmacology during the 24 months immediately preceding application.
CRNP Faculty Only 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. 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.
Do I have to reinstate my RN license in addition to the APN?
Yes. An Active RN license is required for APN approval. Submit the Application for Reinstatement of Lapsed License, with the fee and required documentation. CE for Reinstatement must be earned within the 24 months preceding the date ABN receives your application. Six (6) of the required 24 continuing education hours must meet the APN requirement for Pharmacology.
My Alabama Board of Nursing RN license is Active. Do I need to submit 24 contact hours?
If your RN license currently is Active, submit only the 6 Pharmacology credits pertaining to your APN role.
Can I pay the Reinstatement fee online with a credit card?
Online payment for APN Reinstatement is under development. Submit the paper application and a check or money order for the fee.
Is a temporary permit available, while I earn my Pharmacology CE for APN Reinstatement?
No. A temporary permit is not available for Reinstatement applicants.
Can I apply for Reinstatement before earning the contact hours?
No. You must have the contact hours completed prior to submitting the application.
What is the CE earning period for Reinstatement?
Contact hours must be earned within the 24 months prior to the date ABN receives the application. Therefore, it depends on when the Reinstatement is submitted.
How can I tell if the course is acceptable to the Alabama of Nursing?
Program title clearly identifies topic in pharmacology, OR certificate of participation specifies total pharmacology contact hours earned for the program.
What about courses offered by my specialty organization?
The Board of Nursing recognizes continuing education that is approved by national specialty organizations. Program title clearly identifies topic in pharmacology or the certificate of participation specifies total pharmacology contact hours earned for the program.
How do I earn my contact hours?
You may browse through a list of CE opportunities on the Board’s website, www.abn.alabama.gov, under Alabama Nursing Resource Center>Nursing CE. You can also search the internet for continuing education for nurses, to find independent study CEs. [MEDCEU (the online company) contact hours are not accepted by the Alabama Board of Nursing.]
How will Reinstatement affect renewal and effective dates for my RN license and APN?
RN’s reinstating the license between now and 08/31/2018 will receive an active license, with an expiration date of 12/31/2018.
The APN approval will expire with the RN license, 12/31/2018, or on the date your national specialty certification expires, whichever date comes first. After you submit verification of recertification, the Board will update the information, which can be viewed under My Profile on the ABN website.
How much continuing education do I need to renew my RN and APN in 2018?
Nurses whose licenses are reinstated must accrue for license renewal one contact hour for each calendar month remaining in the earning period after Reinstatement; however, no hours will be required if the time remaining in the earning period is six months or less. Please refer to the prorated chart on the Board’s website, www.abn.alabama.gov, under Alabama Nursing Resource Center | Nursing CE | CE Audit & Info. Contact hours earned for Reinstatement of a lapsed license may not be used toward the continuing education requirement for the next license renewal.
APNs are required to earn, as part of the required twenty-four (24) Board-approved or Board-recognized continuing education contact hours for license renewal, six contact hours of pharmacology content pertaining to the area of practice.
How do I pay the fee for Reinstatement?
You may pay by personal check or business check.
Personal checks are acceptable only if imprinted with the name, address, and account number of the applicant or licensee for an Alabama bank.
Business checks are acceptable.
The following forms of payment are not accepted:
- Personal checks by third parties (spouse, friend, parents, etc.)
- Personal checks on out-of-state banks
- Counter checks
License verification fees are not payable by personal check.
Applicants or licensees who have checks returned due to insufficient funds may be prohibited from paying any future fees by personal check and may be subject to disciplinary action. The bad check charge is the maximum allowed by law.
What is a nurse anesthetist, and what does CRNA stand for?
Certified Registered Nurse Anesthetists (CRNAs) are master’s or doctorate prepared advanced practice nurses who enjoy a high degree of autonomy and professional respect. CRNAs provide anesthetics to patients in every practice setting, and for every type of surgery or procedure. They are the sole anesthesia providers in nearly all rural hospitals, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, pain management, and trauma stabilization services. CRNAs are the main provider of anesthesia to the men and women serving in the U.S. Armed Forces. Last year, CRNAs delivered over 43 million anesthetics nationwide.
How did the Nurse Anesthesia profession begin?
Nurses first provided anesthesia to wounded soldiers during the Civil War. Alice Magaw is the most famous anesthetist of the 19th century. She was the first nurse anesthetist to publish in a scientific journal, and was anesthetist for the Mayo brothers, two of the seven founders of the Mayo Clinic. Agnes McGee founded the first educational program for nurse anesthetists in 1909 and, over the next decade, nurses founded 19 nurse anesthesia schools. In 1931, Agatha Hodgins founded the National Association of Nurse Anesthetists (NANA) and the Alabama Association of Nurse Anesthetists (ALANA) became a charter member. The first meeting of the NANA was held in 1933, and the name of the organization was changed to the American Association of Nurse Anesthetists, or AANA. The AANA’s first certification exam became available in 1945, and mandatory continuing education was established in 1978. In 1986, Congress passed legislation providing CRNAs direct reimbursement under Medicare Part B, making nurse anesthesia the first nursing specialty to be accorded direct reimbursement rights under Medicare. Also in 1986, a bachelor’s degree was required for admission to anesthesia school, and by 1998 all schools were required to award a master’s degree. As of August 2017, there were 120 accredited nurse anesthesia programs in the U.S. using more than 2,200 active clinical sites. Of those 120 programs, over half (62) of the nation’s nurse anesthesia programs award doctoral degrees for entry into nurse anesthesia practice. By 2025, all nurse anesthesia students will graduate with a doctoral degree.
How long does it take to become a CRNA?
It takes a minimum of 7-8.5 years of education and training specific to nursing and anesthesiology to become a CRNA. A candidate for nurse anesthesia program admission must possess a baccalaureate degree in nursing and adequate prerequisite critical care practice experience, which averages almost three years prior to gaining admission into a nurse anesthesia program. Once accepted into a nurse anesthesia program, students spend between 24 and 40 months, depending upon the degree sought, a master’s degree or a doctoral degree. By 2025, all nurse anesthesia students will graduate with a doctoral degree. Once the nurse anesthesia program is complete, the graduate must sit for – or take – the CRNA national certification examination. Overall, a CRNA receives over 8,600 hours of training, prior to initial certification.
Is it difficult to get into anesthesia school?
Admission to nurse anesthesia school is very competitive. There are always many more qualified applicants than there are student positions within any given school. Only the best and brightest applicants are chosen for admission. Applicants have a better chance of being accepted to anesthesia school if they maintain an excellent grade point, particularly in science classes. Applicants will also need to earn good scores on standardized testing and have excellent letters of recommendation. The minimum requirement for ICU experience is one year, but more ICU experience is seen favorably by admission committees, particularly if the applicant was in a clinical decision-making or leadership position. Many programs also look to see if the applicant has spent time shadowing a CRNA. Every nurse anesthesia program has their own entrance requirements, so applicants should consider multiple schools and plan accordingly.
Do CRNAs have to work with an anesthesiologist?
No, there is no requirement in any state in the country that a CRNA must work with an anesthesiologist. Seventeen (17) states have no physician supervision requirement, and the remaining states have their requirements spelled out in state law. In Alabama, a CRNA works under the direction of a licensed physician or dentist who is immediately available. You will find CRNAs working solo in office settings with plastic surgeons, endoscopy clinics with gastrointestinal (GI) specialists, busy rural hospitals that offer Obstetrical services, and many own their own businesses and employ physicians and other providers.
Are CRNAs safe providers?
Numerous studies from unbiased sources, including the Institute of Medicine (“IOM”, now National Academy of Medicine), have found that the quality of care is no different, whether the anesthetic is performed by a CRNA, an anesthesiologist, or a CRNA and an anesthesiologist working together in a care team setting. Data that has been studied regarding safety and outcomes from the seventeen (17) states that do not require physician supervision of nurse anesthetists reinforces what the IOM reported. CRNAs are required to obtain 100 hours of continuing education every four years. Anesthesia care is nearly 50 times safer than it was in the 1980’s, primarily due to advances in monitoring, technology, anesthesia drugs, provider education, and standards of care.
How do CRNAs fit into the future of healthcare?
Research shows that CRNAs are the most cost-effective anesthesia providers, and they have an exceptional safety record. A solo CRNA delivering anesthesia care costs less than the same CRNA practicing in a care team setting under the direction of an anesthesiologist. The United States has an aging patient population and limited resources for healthcare. CRNAs are educated and trained to provide anesthesia care for complicated medical procedures and to handle emergency situations. A vast number of rural hospitals would not be able to offer surgical services, obstetrics, pain management, or trauma stabilization without the CRNA that was willing to move to their rural areas and provide anesthesia care for these services. CRNAs are the primary providers of anesthesia in the United States.
Why should I consider becoming a CRNA?
A recent survey by the American Association of Nurse Anesthetists (AANA) found that greater than 90% of CRNAs are pleased with their career choice, which is one of the highest numbers reported for any career. In addition, the U.S. Bureau of Labor Statistics is predicting the profession—which earned a median salary of $157,140 in 2015 – is poised to grow by 19% by 2024, which translates into 7,400 new job openings.
Advanced Practice
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
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, CNM, and CRNA. 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.
Can an Advanced Practice Nurse withhold life- saving treatment (Do not resuscitate 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.
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.
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.
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.
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.
Can 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.
What do “Medical Oversight,” “Readily Available,” and “Direct Medical Intervention” mean?
- Medical Oversight includes:
- Concurrent and ongoing collaboration between a physician and CRNP/CNM
- Written documentation of time together in an approved practice site
- Includes, but not limited to:
- Direct consultation & patient care
- Discussion of disease processes
- Review of records
- 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:
The definition of “direct medical intervention” requires the physical presence of a physician to attend to the needs of the patient as defined in the collaborative practice protocol, as dictated by the needs of the patient, and based on usual and customary standards of medical practice.
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).
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.
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.
Whom do I contact if I have questions related to the approval process for the Qualified Alabama Controlled Substance Certificate (QACSC) classes and process?
The QACSC certificate and required educational classes are offered solely by the Alabama Board of Medical Examiners (ABME). You may contact any of the individuals listed below:
Medical Association of State of Alabama
Judy DeBray
Director of Education
(334) 954-2535 Direct
(334) 954-2500 Main
(800) 239-6272
jdebray@alamedical.org
Margaret McGuire
Coordinator of Provider Services
(334) 954-2519
(800) 239-6272
(334) 269-5200 fax
mmcguire@alamedical.org
ALABAMA BOARD OF MEDICAL EXAMINERS
Pat Ward, RN
Nurse Inspector
Phone 334-242-4116 (direct)
Fax: 334-240-3037 (direct)
ABME Website Information:
You must go to the ABME website to access the QACSC information links available to you.
QACSC Applications
Where can 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
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.”
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.
Can the Pharmacy education hours taken with the ABME course for the Qualified Alabama Controlled Substance Certificate (QACSC) count toward my RN renewal for the Pharmacology CE requirements?
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.
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.
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.
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.
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.
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.
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.
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.
If I currently have approval for a specific Specialty Protocol and change collaborative practice physicians, will I need to request approval again for the same protocol?
Yes. The Specialty Protocol must be requested under the Add New Collaboration Application. Each new collaborating physician must approve the skill/procedure requested.
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.
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.
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.
Does a CRNA have to be in collaborative practice with a physician?
No. Only CRNPs and CNMs are subject to the collaborative practice requirements.
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:
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.
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.
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.
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. 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.
What should I do if my Advanced Practice certification expires?
Reinstatement of APN approval is a two-step process:
- Submit an Application for Reinstatement of Lapsed Approval for Advanced Practice Nursing (this is located in the Advanced Practice Nursing section of the website).
- 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.
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.
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.
What if I fail the national certification exam in my specialty?
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. Do not practice in your APN specialty until you receive notice of approval from the Alabama Board of Nursing.
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.
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.
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.
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.
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.
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.
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 health care facility (hospital, physician office, or another health 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.
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.
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.
How do I apply for initial approval as a CRNP in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse practitioners. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as a nurse practitioner in the specialty consistent with NP education from a national certifying agency recognized by the Alabama Board of Nursing. | You must request that your certifying agency submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
| PRACTICE DOCUMENTS | The CRNP is required to submit signed copies of the Standard Protocol and Quality Management Plan for each collaboration in which they are involved. | Scan and email documents to the ABN at advancedpractice@abn.alabama.gov. NOTE: Incomplete documents will be returned for completion. |
| PHYSICIAN COMMENCEMENT | 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. | Have your collaborating physician submit Commencement Form and fee to the Board of Medical Examiners. |
How do I apply for initial approval as a CNM in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse midwives. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as a CNM from the American Midwifery Certification Board (AMCB). | You must request that AMCB submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
| PRACTICE DOCUMENTS | The CNM is required to submit signed copies of the Standard Protocol and Quality Management Plan for each collaboration in which they are involved. | Scan and email documents to the ABN at advancedpractice@abn.alabama.gov. NOTE: Incomplete documents will be returned for completion. |
| PHYSICIAN COMMENCEMENT | 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. | Have your collaborating physician submit Commencement Form and fee to the Board of Medical Examiners. |
How do I apply for initial approval as a CRNA in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse anesthetists. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as an CRNA from the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). | You must request that NBCRNA submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
How do I apply for initial approval as a CNS in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare clinical nurse specialists. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as a CNS from a national certifying agency recognized by the Alabama Board of Nursing. | You must request that your certifying agency submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
Does a CNS have to be in collaborative practice with a physician?
No. Only CRNPs and CNMs are subject to the collaborative practice requirements.
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.
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.
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. 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.
What should I do if my Advanced Practice certification expires?
Reinstatement of APN approval is a two-step process:
- Submit an Application for Reinstatement of Lapsed Approval for Advanced Practice Nursing (this is located in the Advanced Practice Nursing section of the website).
- 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.
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.
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.
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.
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.
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.
What are the specific CE requirements for APN renewal with the RN license?
All nurses are required to have 24 continuing education contact hours for license renewal. APNs are required to earn six of those 24 hours in pharmacology. You may review your CE record on My Profile.
CRNA
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.
Does a CRNA have to be in collaborative practice with a physician?
No. Only CRNPs and CNMs are subject to the collaborative practice requirements.
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.
How do I apply for initial approval as a CRNA in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse anesthetists. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as an CRNA from the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). | You must request that NBCRNA submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
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.
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.
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).
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.
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.
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.”
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.
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.
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.
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.
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.
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.
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.
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.
If I currently have approval for a specific Specialty Protocol and change collaborative practice physicians, will I need to request approval again for the same protocol?
Yes. The Specialty Protocol must be requested under the Add New Collaboration Application. Each new collaborating physician must approve the skill/procedure requested.
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.
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
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.
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.
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.
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:
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.
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.
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.
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.
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.
Can a CRNP complete disability paperwork?
Yes, for all forms filed on or after March 27, 2017.
Can a CRNP do sports physicals in Alabama?
The rules of the Alabama High School Athletic Association (AHSAA) state the following (2018-2019 Handbook, ByLaws, Rule 1, SECTION 14. PHYSICAL EXAMS):
In order for a student to be eligible for interscholastic athletics, there must be on file in the principal’s office (or on DragonFly) a current physician’s statement (hard copy or digital copy) certifying that the student has passed a physical exam, and that in the opinion of the examining physician (M.D. or D.O.) the student is fully able to participate in interscholastic athletics (grades 7-12). The AHSAA 2018 Pre-Participation Physical Evaluation Form (Form 5) must be used.
Note: A signed physical (parent signature and M.D. or D.O.) is required to participate in tryouts and/or practice. The M.D. or D.O. must sign/stamp all physicals even if CRNP completed the physical.
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.
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.
Can Nurse Practitioners perform cosmetic injections (i.e. Botox, Restylane, Collagen, and Mesotherapy) in Alabama?
In 2004, the Board of Medical Examiners determined these procedures (Botox, Restylane, Collagen, and Mesotherapy) to be the practice of medicine, requiring that each such procedure must be performed by a licensed physician. The Board of Medical Examiners does not authorize physicians to delegate administration of botox and dermal fillers to CRNPs.
How do I list Home Visits on my collaborative practice application?
Application INSTRUCTIONS for Home Visits:
The first site should be the Physician’s principal practice site, whether you plan to work there or not.
The second site should be the Home Visit Company and physical address.
The third and any additional sites should be Home Visits for each county where you will see patients. You would list a site for each individual county as follows (use a separate entry for each county):
NAME: Home Visits for (company name) – Example: Home Visits for _____________.
ADDRESS: Mark with an X – we realize you cannot list individual home addresses.
CITY: In the City field, list the county in which you will do home visits.
STATE: Alabama
ZIP CODE: 00000
PHONE NUMBER: This would be a number where you can be reached.
How do I apply for initial approval as a CRNP in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse practitioners. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as a nurse practitioner in the specialty consistent with NP education from a national certifying agency recognized by the Alabama Board of Nursing. | You must request that your certifying agency submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
| PRACTICE DOCUMENTS | The CRNP is required to submit signed copies of the Standard Protocol and Quality Management Plan for each collaboration in which they are involved. | Scan and email documents to the ABN at advancedpractice@abn.alabama.gov. NOTE: Incomplete documents will be returned for completion. |
| PHYSICIAN COMMENCEMENT | 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. | Have your collaborating physician submit Commencement Form and fee to the Board of Medical Examiners. |
How do I apply for initial approval as a CNM in Alabama?
| REQUIREMENT | INFORMATION | ACTION ITEM |
|---|---|---|
| ACTIVE ALABAMA RN LICENSE | An unencumbered license as a Registered Nurse in Alabama is required for initial approval as an advanced practice nurse. | None. |
| EDUCATION | Master’s or higher degree in nursing from an educational institution in a curriculum designed to prepare nurse midwives. | You must request that your nursing program submit an official transcript to the ABN in a sealed envelope or through an electronic transcript service. Faxed transcripts are not accepted. |
| CERTIFICATION | Certification as a CNM from the American Midwifery Certification Board (AMCB). | You must request that AMCB submit an official verification of certification to the ABN electronically or by USPS. |
| ELECTRONIC APPLICATION | 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 Application and Fee ($175). |
| PRACTICE DOCUMENTS | The CNM is required to submit signed copies of the Standard Protocol and Quality Management Plan for each collaboration in which they are involved. | Scan and email documents to the ABN at advancedpractice@abn.alabama.gov. NOTE: Incomplete documents will be returned for completion. |
| PHYSICIAN COMMENCEMENT | 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. | Have your collaborating physician submit Commencement Form and fee to the Board of Medical Examiners. |
How do I find the RX number given to me by the ABN?
Login to the My Profile section of the ABN website at www.abn.alabama.gov. Click “My Advanced Practice. ” Rx Number will be displayed.
Where do I find the Standard Protocol and the Quality Management Plan for each of my collaborations? Do I send copies of the documents to the ABN?
Certification-specific CRNP Standard Protocols are available in the CRNP section. The Quality Assurance Plan is located under the RESOURCES tab. Complete the Protocol and the Quality Assurance Plan in consultation with the collaborating physician, including original signatures.
The CNM Standard Protocol is available here. The Quality Assurance Plan is located under the RESOURCES tab. Complete the Protocol and the Quality Assurance Plan in consultation with the collaborating physician, including original signatures.
Send a copy of each document to advancedpractice@abn.alabama.gov.
Keep a copy of each document on file at each practice site.
What happened to the Expanded Midwifery Protocol?
The Expanded Midwifery Protocol has been consolidated into the Standard Protocol. All CNMs applying for approval in Alabama will practice under the Standard Protocol with the option of requesting additional skills for OB Limited Ultrasound and/or Circumcision (formerly components of the Expanded Protocol).
What does Alabama Act No. 2018-474 allow CRNP/CNM to sign?
NOTE: HB429—Signature Authority Bill was signed by Governor Ivey the last week of March 2018 and became law as Alabama Act No. 2018-474
CRNP / CNM in an active collaboration may sign the following:
| • Certification of disability for patients to receive disabled parking tags or placards | • Forms excusing a potential jury member due to an illness |
| • Authorization for durable medical equipment | |
| • Any of the following which require a complete history and physical exam consistent with the CRNP/CNM scope of practice:
• Physicals for bus drivers • Physicals to verify eligibility for students to participate in Special Olympics • Employment and pre-employment physicals for TSA employees or for governmental employees such as firefighters and law enforcement officers • Adoptive parent applications • College or trade school physicals • Boy or Girl Scout physicals or physical required by similar organizations |
• Forms relating to absenteeism for employment or school purposes, including, but not limited to, documents associated with the federal Family Medical Leave Act (FMLA) |
| • Authorization for diabetic testing supplies | |
| • Authorization for diabetic shoes | |
| • Home health recertification orders after initial certification | |
| • Within the state Medicaid system, any and all forms for the ordering of medications, nutritional supplements, or infant formulas, or referrals to providers of medical specialties, home health services, and physical or occupation therapy | |
| • Death Certificates | |
| • Forms, including physical exam forms, for certification in residential or inpatient dwellings within the Department of Mental Health | |
| • Required documentation allowing a diabetic to renew or obtain a driver’s license | |
| • Forms for ambulance transport | |
| • Forms for donor breast milk |
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