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 advancedpractice@abn.alabama.gov by email, or by US Postal Service (USPS) to PO BOX 303900 Montgomery AL 36130-3900.
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.
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.
You must complete the following steps:
- Submit an Application for Reinstatement of Lapsed Approval for Advanced Practice Nursing (this is located in the Advanced Practice Nursing section of the website).
- Request recertification be sent to advancedpractice@abn.alabama.gov by your national certifying agency
- Await Eligible for Collaboration status notification from the ABN ABN licensing specialist
- Submit Add New Collaboration Application to re-establish collaboration(s) if CRNP or CNM
This information may be updated in My Profile section of the ABN website at www.abn.alabama.gov.
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.
Your provisional approval becomes null and void, and you must cease & desist from practice 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.
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.
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.
All APNs are required to document six (6) hours of continuing education in pharmacology for each biennial renewal.
You may view your information under My Profile. Employers should access this information through the Credentialing Staff AP Profile section.
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.
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).
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.
- 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.
The QACSC certificate and required educational classes are offered solely by the Alabama Board of Medical Examiners (ABME). You may contact the ABME’s Advanced Practice Provider department at (334) 242-4116 or via email at QACSC@albme.gov and APPDept@albme.gov. You must go to the ABME website to access the QACSC information links available to you. QACSC Applications
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.”
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.
Submit an online Terminate an Existing Collaboration application. Indicate the final date of practice with the physician listed in the online profile. Termination applications cannot be back-dated by the APRN. The application is available under the Advanced Practice section of the ABN website.
Submit an online Add New Collaboration application. The application is available under the Advanced Practice section of the ABN website.
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.
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.
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. Please note: The approved procedure(s) must be checked or initialed as permitted on the Standard Protocol signed by you and your collaborating physician.
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. You may perform the skill for which you received approval to perform within the specialty protocol.
Yes. The Specialty Protocol must be requested under the Add New Collaboration Application. Each new collaborating physician must approve the skill/procedure requested.
- 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.
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
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 three hundred and sixty ( 360 ) hours per week ( nine full-time equivalent positions ) unless an exemption is granted under Rule 610-X-5-.05. “One full-time equivalent” (FTE) is herein described as a person/persons collectively working forty hours a week, excluding time on call. ABN Administrative Code § 610-X-5-.05
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.
The ABME requires that the collaborating physician(s) complete an electronic application of Commencement of Collaborative Practice, which specifies the fee, prior to approval. The application is available on the ABME website through the collaborating physician’s licensee portal. The link is provided below: (https://www.albme.gov/licensing/crnp-cnm/collaboration#how-to-apply)
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.
- 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.
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.
Submit an online Modify an Existing Collaboration application. Use this application to add or delete covering physicians, add or delete practice sites, request additional skills, and make changes to the work hours reflected for the collaboration.
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.
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.
Yes, for all forms filed on or after March 27, 2017.
The rules of the Alabama High School Athletic Association (AHSAA) state the following (2019-2020 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. 2019 – 2020 AHSAA Handbook
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.
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.
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.
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.
Information on applying for initial approval as a CRNP can be found here.
Information on applying for initial approval as a CNM can be found here.
Login to the My Profile section of the ABN website at www.abn.alabama.gov. Click “My Advanced Practice. ” Rx Number will be displayed.
Certification-specific CRNP Standard Protocols and Quality Assurance Plan are located here. 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.
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).
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 Scout 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 certification and recertifications for Medicare patients | |
| • 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 |
No. Alabama law reserves pronouncement of death to physicians licensed in the state of Alabama, per Sections 22-31-1 and 22-31-2, Code of Alabama 1975.
The information regarding birth certificates is found in § 22-9A-7, Code of Alabama 1975, and depends on location of the birth. CRNPs and CNMs are not prohibited from signing birth certificates. However, remember that facility policies may be more restrictive than government regulations so don’t hesitate to consult local facility policies and procedures.
Article 5 of the Nurse Practice Act allows for a CNS to perform nursing services as an independent contractor.
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.
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.
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.
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.
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.
| 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). |
No. Only CRNPs and CNMs are subject to the collaborative practice requirements.
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.
No. Only CRNPs and CNMs are subject to the collaborative practice requirements.
Yes, The law does not prohibit RNs and CRNAs from owning practices. However, the CRNA is required to work under the direction of or in coordination with a physician licensed to practice medicine, a podiatrist, or a dentist.
| 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). |
For AL SSL or MSL: The reinstatement fee is $75 per APN role. However, nurses who lapsed due to failure to renew APN approval during the RN Renewal period are required to pay both the $75 reinstatement fee and the $75 renewal fee, for a total of $150. Transaction fees apply. For Non-Alabama MSL: The reinstatement fee is $150 per APN role. However, nurses who lapsed due to failure to renew APN approval during the RN Renewal period are required to pay both the $150 reinstatement fee and the $75 renewal fee, for a total of $225. Transaction fees may apply.
If your APN approval is based on your Alabama RN license (SSL or MSL), Yes. You must reinstate the Alabama RN license. 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 the ABN receives your application. Six (6) of the required 24 continuing education hours must meet the APN requirement for Pharmacology. If your APN approval is based on your Non-Alabama RN license, Yes. You must hold a current RN license in your Primary State of Residence (PSOR). Once that license is current, you may reinstate your AL AP approval. Submit the Application for Reinstatement of Lapsed AP Approval, with the fee and required documentation. Document six hours of continuing education in Pharmacology earned within the 24 months immediately preceding the date of this application.
For APs with a 1-xxxxxx Number: Submit the paper application. Staff will post your fee for online payment, which includes a transaction fee. For APs with a 3-xxxxxx Number: Online payment for AP Reinstatement is under development. Submit the paper application and a check or money order for the fee.
No. A temporary permit is not available for Reinstatement applicants.
No. You must have the contact hours completed prior to submitting the application.
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.
Program title clearly identifies topic in pharmacology, OR certificate of participation specifies total pharmacology contact hours earned for the program.
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.
You may browse through a list of CE opportunities on the Board’s website, www.abn.alabama.gov, under Education>AL 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.]
For APs with an SSL 1-xxxxxx Number: AP approval will expire with the SSL RN at the end of the even-numbered year, or on the date your national specialty certification expires, whichever date comes first. For APs with an MSL 1-xxxxxx Number: AP approval will expire with the MSL RN at the end of the odd-numbered year, or on the date your national specialty certification expires, whichever date comes first. For APs with a 3-xxxxxx Number: AP approval will expire the end of the odd-numbered year, with the Non-AL MSL RN at the end of the odd-numbered year, or on the date your national specialty certification expires, whichever date comes first.
AL nurses (SSL or MSL) whose license is reinstated must accrue for license renewal one contact hour for each calendar month remaining in the license period. Please refer to the prorated chart on the Board’s website. Contact hours earned for reinstatement of a lapsed license may not be used toward the continuing education requirement for the next license renewal. Non-AL nurses whose license is reinstated must earn six contact hours in pharmacology pertaining to the area of practice.
For AL SSL or MSL: Staff will post the Reinstatement fee(s) upon receipt of the application. Payment is made online through My Profile. Transaction fees apply. For Non-Alabama MSL: Payment may be made by cashier’s check, business check, money order, certified check, or personal check, provided that the licensed nurse’s name is imprinted on the check. Please note: The Board cannot accept personal checks drawn on out of state banks.
Applicants for Initial Approval:
- Complete the Initial Collaboration application on the ABN website and select the standard protocol for your specialty.
- Complete the Limited Protocol – Long Term Care Facilities.
- Scan the completed limited protocol and email it, along with a completed Standard Protocol and Quality Assurance Plan, to advancedpractice@abn.alabama.gov.
- Board staff will record the Limited Protocol selection, upon receipt.
- Complete the Add New Collaboration application on the ABN website. The application will automatically select the standard protocol for your specialty.
- Complete the Limited Protocol – Long Term Care Facilities.
- Scan the completed limited protocol and email it, along with a completed Standard Protocol and Quality Assurance Plan, to advancedpractice@abn.alabama.gov.
- Board staff will record the Limited Protocol selection, upon receipt.
- Complete the Limited Protocol – Long Term Care Facilities.
- Scan the completed limited protocol and email it to advancedpractice@abn.alabama.gov.
- Board staff will record the Limited Protocol selection, upon receipt.
Yes. Complete the Referral Process and Emergency Plan. Scan and email the completed document, as well as your Quality Assurance Plan, to advancedpractice@abn.alabama.gov. The completed document and Quality Assurance Plan require signatures from you and your collaborating physician.
Yes. All collaborative practice requires quality assurance review.