Some state laws describe scope of practice
succinctly and others go into great detail. Longer is not necessarily better, and vague language should be avoided. Consider Oklahoma’s statute on NP scope of practice.
“Certified Nurse Practitioner” is an Advanced Practice Registered Nurse who performs in an expanded role in the delivery of health care:
a. consistent with advanced educational preparation as a Certified Nurse Practitioner in an area of specialty,
b. functions within the Certified Nurse Practitioner scope of practice for the selected area of specialization, and
c. is in accord with the standards for Certified Nurse Practitioners as identified by the certifying body and approved by the Board.
A Certified Nurse Practitioner shall be eligible, in accordance with the scope of practice of the Certified Nurse Practitioner, to obtain recognition as authorized by the Board to prescribe, as defined by the rules promulgated by the Board pursuant to this section and subject to the medical direction of a supervising physician. This
authorization shall not include dispensing drugs, but shall not preclude, subject to federal
regulations, the receipt of, the signing for, or the dispensing of professional samples to patients.
Citation: OKLA. STAT. ANN. tit. 59, § 567.3a(6).
Under Oklahoma’s statutory definition of NP scope of practice, an NP can prescribe, but it is unclear what else an NP can do. To prove that the NP can make medical diagnoses, the NP would need to produce transcripts and course descriptions, as well as information from the certifying body on their view of scope of practice. Oklahoma’s Administrative Code provides a detailed description of NP scope of practice, however. The Oklahoma Administrative Code states the following:
The Certified Nurse Practitioner’s scope of practice includes the full scope of nursing practice and practice in an expanded role as follows:
1. The Certified Nurse Practitioner (CNP) provides comprehensive
health care to clients across the life span.
2. The CNP is responsible and accountable for the continuous and comprehensive
management of a broad range of health services, which
include, but are not limited to:
A. promotion and
maintenance of health;
B. prevention of illness and disability;
C. diagnosis and prescription of
medications, treatments, and devices for acute and chronic conditions and diseases;
D. management of health care during acute and chronic phases of illness;
E. guidance and counseling services;
F. consultation and/or collaboration with other health care providers and community resources;
G. referral to other health care providers and community resources.
Citation: OKLA. ADMIN. CODE § 485:10–
15.6(b).
An example of a comprehensive description of scope of practice is Pennsylvania’s law:
When acting in collaboration with a physician as set forth in a collaborative agreement and within the CRNP’s specialty, a CRNP may:
1. Perform comprehensive assessments of patients and establish medical diagnoses.
2. Order, perform and supervise diagnostic tests for patients and, to the extent the interpretation of diagnostic tests is within the scope of the CRNP’s specialty and consistent with the
collaborative agreement, may interpret diagnostic tests.
3. Initiate referrals to and consultations with other
licensed professional health care providers, and consult with other licensed professional health care providers at their request.
4. Develop and implement treatment plans, including issuing orders to implement treatment plans. However, only a CRNP with current
prescriptive authority approval may develop and implement treatment plans for
pharmaceutical treatments.
5. Complete admission and discharge summaries.
6. Order blood and blood components for patients.
7. Order dietary plans for patients.
8. Order home health and hospice care.
9. Order durable medical equipment.
10. Issue oral orders to the extent permitted by the health care facilities’ by-laws, rules, regulations or administrative policies and guidelines.
11. Make physical therapy and dietitian referrals.
12. Make respiratory and
occupational therapy referrals.
13. Perform disability assessments for the program providing
temporary assistance to needy families (TANF).
14. Issue homebound schooling certifications.
15. Perform and sign the initial assessment of methadone treatment evaluations, provided that any order for methadone treatment shall be made only by a physician.
Citation: 49 PA. code § 21.251.
See Exhibit 2-1 for a breakdown of elements of NP practice found in various state laws. See Appendix 2-A for the law of each of the states regarding NP scope of practice.
Exhibit 2-1 Specific Functions Included in States’ Definitions of NP Scope of Practice
Diagnose KS NC MA MA
AL AZ CO CT DC DE FL GA HI ID IL IN LA ME MD MA MN MS MT NC ND NE NH NJ
KY LA ME MD MA MS MN MO MT ND NE NV NH NJ NY NC OK OR PA SC SD UT VT WA
ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TX UT VT WA WI WY Admit to Hospital
AL AZ
ME MD MN NC NE NH NJ NV OK OR PA RI SD UT WA Teach
AL CO DE HI ID IL IN LA
MD ME MT NE NJ NC NV PA VT WA WI Perform Procedures
AZ TN WA Remove Epidural Catheter
DE Assist in Surgery
HI Perform Palliative Care
NV NY OK OR PA RI SC SD UT VT WA Treat
AL AZ CO CT DC DE FL GA ID IL IN
Prescribe
AL AZ CO CT DC DE FL GA IA ID IL IN KS KY LA MD MA ME MI MN MO MS
HI OR WA Admit to Psychiatric Institution
MD NH Refer
AL AZ CO DC DE HI IA ID IN KY LA
MA ME MN MT NV NC ND OK OR SD Order Tests
AL AZ CO DC DE FL GA HI IL KY
IL Order Durable Medical Equipment
AZ CA DE MT PA Order Restraints
SD
Certify for Medical Use of Marijuana
MA HI