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Ask the Expert - Archive

Question (August 2017): Does administrative support staff for our NP's have to be LPN's or RN's? Can an MA serve as administrative support to an NP, without administering injections?

Answer: NPs may have MAs as support staff. But to be clear, MAs may not have direction from NPs regarding drugs prescribed for the patient. The Nurse Practice Act states only those people licensed may be directed by an NP in relation to drugs. MAs are not licensed, per the Nurse Practice Act. Therefore MAs may not be ordered by an NP to give an injection or give medicine to a patient. However, an NP may direct an MA to give a patient a bath, take their temperature, check blood pressure, etc.

Question (August 2017): Can an NP in a hospital setting sign a DNR for a hospice patient? I know there is a physician certification/DNR for patients that are unable to speak but can an NP sign that instead?

That is a hospital decision. The hospital will have a rule that will/will not allow NPs to sign DNRs.

Question (June 2017):
Can a nurse practitioner practice at a free clinic and prescribe without a supervising physician?

Answer: The only reason a nurse practitioner (APRN) needs a supervising physician is if they have prescribing authority, and are using it. Otherwise, NPs can and do operate independently. But, you cannot prescribe unless you are licensed with prescriptive authority and you can only prescribe Schedule III-IV medications.

Question (June 2017): Can an FNP work in the hospital setting or do they need to have their Acute Care certification?

Answer: To work in a hospital setting requires acute care certification.

Question (May 2017): 
Can NP's do Welcome to Medicare and Medicare subsequent wellness exams?

Answer: Yes

Question (May 2017):
Can an NP apply for a waiver to Rx Suboxone in OK?

No, an APRN cannot apply or prescribe Suboxone. It is on the exclusionary formula for the State Board of Nursing.

Question (February 2017):
What are the rules for FNP's referring a patient to palliative or hospice care in the state of Oklahoma?

An NP can refer a patient to palliative or hospice care in Oklahoma.

Question (February 2017):
In a hospital setting, is the NP required to have a physician co-sign their charts? If yes, what percentage of charts must be co-signed by a physician?

Absolutely not. The only reason an NP has a supervisory physician is for prescriptive authority. If the hospital allows NP's to have privileges, and many do, there are no requirements for a supervisory physician to sign off for you. You are independent unless the hospital says you must have a physician sign off. The hospital can have its own rules.

Question (February 2017): In a hospital setting, is the NP required to have a physician co-sign their charts? If yes, what percentage of charts must be co-signed by a physician?

Answer: Absolutely not. The only reason an NP has a supervisory physician is for prescriptive authority. If the hospital allows NP's to have privileges, and many do, there are no requirements for a supervisory physician to sign off for you. You are independent unless the hospital says you must have a physician sign off. The hospital can have its own rules.

Question (January 2017):
 If an NP under physician supervision sees a patient who needs a Schedule II script does the supervising physician need to see the patient before writing the script or can they do so on the recommendation of the NP and after signing the orders in the chart?

Answer: The physician needs to make their own decision. The NP has no part in the process.

Question (October 2016): 
I work with two different Cardiologists. They alternate weeks. Do I need to have both as my supervising physician? 

No, you do not have to list both because supervising physicians do not have to be on site, ever. 

Question (September 2016): 
Can an APRN order and inject fillers and botox, if trained?

 NPs can't order or purchase fillers/botox without a supervising physician signature. However, they can inject them if they have been trained.

Question (July 2016):
  My AANC certificate lists my credentials as APRN-BC --- and I'm reading they should be APRN-CNP. Which is correct?

 The correct credential is APRN-CNP.  This is a result of a new Oklahoma law passed a few years ago.

Question (June 2016): 
 Is there a cap on the number of patients an NP can see each day in an office or urgent care setting?

 There is no limit on patients per day in an NP setting.

Question (April 2016): 
I am working in an ortho practice. Am I able to round on patients who have been hospitalized after surgery? Our patients are admitted to a regular nursing floor or the ICU. If in the ICU, they are managed by intensivists for non-orthopedic care issues. 

 That depends on hospital policy. Hospitals make a decision whether to allow NPs floor privileges or not. That is determined by their own board and will be a part of hospital policy.

Question (February 2016):
 Can Nurse Practitioners in Oklahoma have a medical assistant give injections under them?

  No they can not.

Question (February 2016): 
If a physician has 2 full-time NPs that he supervises, could he still supervise who only works PRN and does not work full time or have set hours and only fills in on an as needed? 

Physicians only supervise NPs with prescriptive authority. It wouldn’t matter how much they worked, they can only supervise two. 

Question (November 2015):
Is there a pending rule that will not allow FNP providers to work in acute care or hospital settings? 

Answer: At the present time FNP’s are not allowed to work in an acute care setting. Acute care is not within the scope of practice of a FNP trained APRN.

Question (July 2015):
Is there a limit to the number of ARNPs that one physicians can supervise in Oklahoma?

Answer: A physician may supervise two (2) NPs. That is a Board of Medical Licensure rule and not an Advanced Practice Nurse Act rule. Additionally, Advance Practice Nurses are now referred to as APRN and not ARNP. If they have the ability to write prescriptions the APRN is followed by CNP (example: APRN-CNP). 

Question (May 2015): 
It is common practice for RMAs to be clinic "nurses" as LPNS and RNs are trained predominately for hospital/nursing home settings whereas RMA training is specific to the clinic setting. There is some concern regarding whether as APRNs we are able to work with an RMA as our "nurse" versus needing an actual nurse in our clinics. Can you please clarify according to the nursing act or other legalities how to better navigate this gray area/area of concern?

Answer: NPs cannot delegate to unlicensed personnel, as stipulated by the Nursing Practice Act.  Medical assistants are not regulated by any board since they are not licensed. For further clarification, an APRN can't delegate like a medical administrator would do to unlicensed personnel, but we can assign non-nursing duties, such as urine tests, swabs etc.  If it is a non- licensed person, we have to give our own shots, meds etc. We can't have them do for us - they must be a licensed RN or LPN. 

Question (May 2015): 
 Are there staffing requirements and regulations for Walk In Clinics which are run by APRN's. I am doing a research paper and trying to find what staffing is as far as Medical Assistance, Nurses, etc. Are there differences when there is only one APRN and when there is more? Thanks.

Answer: APRNs cannot give medical assistants orders. Medical assistants can only receive orders from a physician. It is not the Nurse Practice Act that says that, it is the Medical Assistants act that makes physicians the only one that can give medical assistants orders 

Question (April 2015): 
Can doctoral prepared nurses (DNP, DNAP) identify themselves as Doctor So and So to their patients in Oklahoma?

 A distinguishing mark of nursing is the pursuit of lifelong learning. The number of nurses earning advanced degrees, including doctoral degrees, is increasing. The practice of addressing a person with a doctoral degree as "doctor" began many centuries ago as did the tradition of addressing a physician as "doctor." The titles of healthcare professionals with earned doctoral degrees may be confusing to the public and members of the healthcare team. 

The Oklahoma Nursing Practice Act addresses the use of the term “doctor.” All nurses must know and comply with federal, state and local laws and are defined in the Nursing Practice Act [Rule §485:10-13-1 ]. To comply with this law, any practicing nursing shall possess a valid Oklahoma license. The APRN who is practicing in a role that requires APRN licensure must use the title “Advanced Practice Registered Nurse” or “APRN” and the APRN role title, i.e., “Certified Nurse Practitioner” or “CNP”, “Clinical Nurse Specialist” or “CNS”, “Certified Registered Nurse Anesthetist” or “CRNA”, or “Certified Nurse- Midwife” or “CNM” in their representations to the public, which may include, but are not limited to, name tags, signatures in medical records and on prescriptions, and signage. The Oklahoma Nursing Practice Act does not designate the order of the credentials; whether the credentials are to be separated by a dash or a comma; or whether the APRN may add other credentials to their title, such as specialty certifications and educational credentials.

According to the Oklahoma Nursing Practice Act, the use of the term "doctor" must be in accordance with Oklahoma law: 59 O.S. Supp. 2009, §725.1, et seq. which states that doctorally prepared nurses cannot identify themselves as Dr. APRNs must include the academic credentials and licensure level with their appropriate APRN title. 

Question (September 2014):
From the OK Nursing Practice Act and Board of Nursing Rules, I understand that only physicians can purchase drugs in bulk and dispense in bulk. Are VFC bulk medications in multi-dose vials not considered stock meds? Can a NP-managed primary care clinic order Vaccination for Kids (VFC) vaccines without having to go through a physician provider?

A nurse practitioner may not order medications to dispense prescriptions such as antibiotics or anti-hypertensives for resale. Nurse practitioners may procure samples and dispense samples according to DEA and OBNDD. Vaccinations may be purchased or received by state stock and administered in the an NP office. It is important to know OHCA and DHS require participation in the Vaccination for Kids program in order to be contracted as a provider within the medicaid program. The paperwork for the DHS vaccination program is not terribly long but the OHCA contract is. Both survey the clinic annually. Each body comes with a wealth of knowledge for the clinic on updated vaccines, handouts and research. The DHS is very supportive of each clinic and the services we bring to the state.

Question (March 2014):
This question is in regards to Physical Therapy referrals in Oklahoma. My understanding of the legislation regarding this was that NP's could "refer" for PT but could not "order" PT. I have recently been informed by the PT Department at Hastings Indian Medical Center in Tahlequah that NP’s could not refer for PT because of "state Law". I would appreciate some insight and clarification on this issue.

NPs may not refer to PT. The reason is the PT law does not allow PTs to receive referrals from NPs. There is nothing in our law that forbids us from referring patients to PT. It is the PT Act that prohibits it.

Question (September 2013):
May a family nurse practitioner work in an emergency department if trained in competencies by the facility?

Answer: This is a good question, and I will try my best to answer based on information I received from Mindy Whitten, DNP, who is our resident expert on issues. Remember too, AONP is a professional organization and we do not intend to interpret the law, so always check with the Oklahoma State Board of Nursing on all issues such as this.

Whether you can or cannot do any particular function in any health setting depends on your educational background. There are two legal cites in the Nursing Practice Act that should be helpful to you. Specifically, they are in Oklahoma Statutes §567.3a.6, and in the State Board of Nursing Rules, OAC 485: 1015-6(b)(1-5). The State Board of Nursing website should be able to help you find the rules applicable. Hopefully, your employer may have a set of Oklahoma Statutes.

I know that is not the answer you were looking for, but maybe it can help you get down the path a little further.

Question (September 2013):
What is the Medicaid reimbursement rate for NPs in Oklahoma? I work in an ED and the hospital is considering allowing professional providers to see lower acuity patients independently, but are uncertain of the reimbursement rate. Is it only 85% of physician rate?

Answer: No. NPs are reimbursed 100% of the physician rate. However, Medicare and Blue Cross DO reimburse 85% of the physician rate.

Question (September 2013):
Can acute care nurse practitioner work in the office settings?

Answer: It depends on their education and training, A FNP is not trained for "in patient care" in general in their programs, we see people in office, primary care settings therefore we are not prepared to do in-patient care. The same would be true if the focus and education for the ACP was in hospital care not office or primary care.

So it will depend on your program and certifications. Did your program prepare you and do you have the education to see patients in the office or in the hospital? This is based on current educational preparation not "past experience."

Question (September 2013):
What are the rules regarding Nurse Practitioners reading x-rays?

Answer: NP's can order and interpret diagnostic tests. They can access the rules and regs on the OBN website if they choose.

Question (August 2013):
I attended a CME seminar last week and several of us were surprised to hear that a Family Nurse Practitioner can not work in the hospital or any acute care setting. Many of us have 10-15 years of experience, most of which has been in the hospital setting. Is there a grandfather clause for a FNP currently working in the hospital? We were told that we would have to go back to an Acute Care NP program. Can you give us some direction on this?

Answer: You are certainly able to work in a hospital, but because of your status as a FNP you are probably not able to work in an acute care setting, i.e. emergency room, or as an intensifist. It depends on your scope of education and certification whether an acute setting in a hospital is within your scope of practice. That is nothing new, I am told, but has come to the front recently because of some education the BON has done. It has become more known.

Question (March 2013):
Can NP's give more than one refill on a control medication? For example Hydrocodone?

Answer: No. If you check the NP practice act, we are limited to a 30 day supply of schedule III-V, no refills.

Question (November 2012):
I just attended the 2012 AONP Conference and earned CE contact hours. How many years can these CE hours be used for recertification?

Answer: The CE's have to be dated in the last five years prior to certification. You may call AANP for any recertification questions.

Question (July 2012):
Once you are a board certified Nurse Practitioner, can you still work as a staff RN at the same facility as you are an NP without increase risk to your license? I have been told in the past that you are always held to your highest licensure. So, you will still be accountable as an NP even if working as an RN? Is this correct?

Answer: Yes, you are held to your highest certification.

Question (June 2012):
I am hoping to find what information is required on a Nurse Practitioner's prescription pad (in Oklahoma); I looked through the Nurse Practice Act and the Oklahoma Pharmacy Law Book, but did not find anything explicitly stated. I specifically want to know if the following information should be pre-printed when ordering prescription pads:
1. Supervising physician's name - and if so;
a.Physician's address (if different);
b.Physician's DEA #;
c.Physician's NPI #;
2. Nurse Practitioner's DEA #;
3. Nurse Practitioner's NPI #.

Answer: All Rx must include the following:
1. Name, title, address, and telephone number of the advanced practice nurse who is prescribing;
2. Name of physician supervising prescriptive authority;
3. Name of the client;
4. Date of the prescription;
5. Full name of the drug, dosage, route and specific directions for administration;
6. DEA number of advanced practice nurse, if required.

Written prescriptions shall include the signature of the APN. Records of all prescriptions will be documented in client records. This is 485:10-16-8 of the nursing board practice act for prescriptive authority. Basically, the name of clinic, address, phone number, doctor, and APN need to be printed on the prescription.

Question (May 2012):
Would you mind explaining the number of hours & what type of CME a C-NP should have every year? Some of the NP programs list different types of CME (i.e. 14.25 "contact hours" or 15.6 "Category B" CE for Pharmacology).

Answer: The State of Oklahoma requires 15 CEs every two years to maintain perscriptive authority. These are continuing education units and they roughly translate into CME which are continuing medical education units. We don't use the CME title for our Continuing Education as we are nursing. Check the Board of Nursing Rules pages 39-43.

AANP and AACN have separate requirements and you have to check their respective websites for those certifications. They do have restrictions on where those can be obtained and the type. That information is available from them.

Question (April 2012):
How do I find out if my FNP program is approved in Oklahoma? I currently go to St. Joseph College of Maine, an online program.

Answer: Contact the Oklahoma Board of Nursing at 405-962-1800.

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