Examination and Treatment

A nurse may not:

  • treat chronic pain (even at the direction of a supervising physician);

  • examine a new patient, or a current patient with a major change in diagnosis or treatment plan, unless the patient is seen and examined by a supervising physician within a specified period of time;

  • set a simple fracture or suture a laceration;

  • perform:

    • cosmetic laser treatments or Botox injections,

    • first-term aspiration abortions,

    • sigmoidoscopies, or

    • admitting examinations for patients entering skilled nursing facilities; or

  • provide anesthesia services unless supervised by a physician, even if she has been trained as a certified registered nurse anesthetist.

Prescriptive Authority

A nurse may not:

  • have her name on the label of a medication as prescriber;

  • accept and dispense drug samples;

  • prescribe:

    • some (or, in a few jurisdictions, any) scheduled drugs, and

    • some legend drugs;

  • prescribe even those drugs that she is permitted to prescribe except as follows:

    • as included in patient-specific protocols,

    • with the cosignature of a collaborating or supervising physician,

    • if the drugs are included in a specific formulary or written protocol or practice agreement,

    • if a specified number or percentage of charts are reviewed by a collaborating or supervising physician within a specified time period,

    • if the physician is on site with the APRN for a specified percentage of time or number of hours per week or month,

    • if the APRN is practicing in a limited number of satellite offices of the supervising physician,

  • if the prescription is only for a sufficient supply for 1 or 2 weeks or provides no refills until the patient sees a physician,

    • if a prescribing/practice agreement is filed with the state board of nursing and/or board of medicine and/or board of pharmacy both annually and when the agreement is modified in any way,

    • pursuant to rules jointly promulgated by the boards named above, and

    • if the collaborating or supervising physician’s name and Drug Enforcement Administration (DEA) number are also on the script; or

  • admit or attend patients in hospitals

    • if precluded from obtaining clinical privileges or inclusion in the medical staff,

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