On April 4, 2017, advanced practice nurses (APNs) will see several changes in the regulations affecting their practice thanks to House Bill 216. These changes include revisions to the formulary and prescribing authority and a change in the way APNs are licensed.

As originally proposed, House Bill 216 sought to greatly increase independence for APNs. Among other things, the bill sought to remove physician collaboration requirements in almost all situations and allowed APNs to supervise other APNs providing services in hospitals.

After lengthy revisions, House Bill 216 was signed into law on January 4, 2017 and its provisions will take effect on April 4th. The final version of the bill removed many of the changes that would have allowed APNs greater independence, but APNs can celebrate the small victories that they did receive. Here are the key things to know about the final version of House Bill 216:

  1. The final version of the bill did not remove the physician collaboration requirements. APNs still require a standard care agreement (SCA) with a collaborating physician. The SCA must be on file with the APN’s employer, and the collaborating physician must be authorized to practice in Ohio but need not have an active clinical practice. Further, physicians can have an SCA with prescribing authorization for five APNs rather than just three. Last, the SCA no longer requires a provision for regular review of referrals and chart review nor certain infant care guidelines. If an SCA expires, the APN must notify the board of nursing and the APN will have 120 days in which to secure a new SCA while being allowed to continue practicing.
    • Title/initial requirements are specifically spelled out in the bill as passed. APNs must use the appropriate title as follows:
    • Certified nurse anesthetist: must use either advanced practice registered nurse - clinical nurse specialist or the initials APRN – CRNA
    • Clinical nurse specialist: must use either advanced practice registered nurse - clinical nurse specialist or the initials APRN – CNS
    • Certified nurse midwife: must use either advanced practice registered nurse - clinical nurse midwife or the initials APRN – CNM
    • Nurse practitioner: must use either advanced practice registered nurse - certified nurse practitioner or the initials APRN – CNP
    • Advanced practice nurse: must use either advanced practice nurse or the initials APRN
  2. If an RN wishes not to renew the APRN licensure, the license can be deemed “inactive” with notice to the board on or before the renewal date. Licensure and continuing education requirements in general are more comprehensive. The board of nursing may grant a non-renewable temporary APN permit to those who have satisfied requirements in another jurisdiction but prior to licensure by endorsement.
  3. An APN with a mental health specialty may have an SCA with a similarly-specialized physician, or pediatrician, internist, or family practice physician. This is only for the A.P.R.N.-C.N.S. not the C.N.P. although the OAAPN believes this is just an oversight.
  4. The separate certificate requirements for prescribing are eliminated (the CTP and CTP-e). The Board of Nursing will now have to issue a license within 30 days of an application, and the license will be an APRN license that includes designation as one of the four types of APRNs, instead of a certificate of authority. Also, the APN advisory committee within the Board of Nursing is renamed the committee on prescriptive governance and is tasked with creating an exclusionary formulary for APN prescribing rather than maintaining a formulary of those drugs allowed to be prescribed.

The original intent of the bill was to make APNs truly independent, without the requirement of physician collaboration and other restrictions. However, the bill spent one and a half years in the Ohio legislature before it was passed and the final version of the bill eliminated many of the original provisions. APNs can still celebrate the small victories that the bill provides, like the new streamlined formulary and elimination of the CTP and CTP-e. To learn more about the history of the bill and for a detailed analysis of its provisions, visit https://www.legislature.ohio.gov/legislation/legislation-documents?id=GA131-HB-216.