Public Acts 379 and 499 of 2016 will bring significant changes to the scope of practice of physician’s assistants (“PAs”) and advanced practice registered nurses (“APRNs”) in the state of Michigan. Individual and institutional health care providers should review and update their current policies, procedures, agreements and licenses to insure compliance with these changes.
Written Practice Agreement Required
Effective March 22, 2107, “practice as physician’s assistant” is redefined as the practice of medicine pursuant to a written practice agreement with a physician, eliminating the requirement that a PA practice only pursuant to the delegation and supervision of a physician, but adding a requirement for a written practice agreement. The new legislation enumerates the requirements for a written practice agreement, including many of the delegation and supervision requirements under the current paradigm, and adding some new requirements. Written collaboration agreements currently in use by PAs and their supervising physicians will likely require updating to satisfy the new written practice agreement requirements. Under the new law, practicing outside the scope of a statutorily-compliant written practice agreement may be considered professional misconduct, and may subject the PA and/or the physician to licensure sanctions, including the loss of ability to practice pursuant to a practice agreement.
Additionally, the statutory revisions will eliminate the waiver from the Michigan controlled substance licensure requirement currently available to PAs who prescribe controlled substances as a delegated task. Accordingly, PAs who wish to continue prescribing controlled substances under a practice agreement must obtain their own Michigan controlled substance license.
Clinical Nurse Specialists
The legislation created a new nurse specialty certification for registered nurses—clinical nurse specialist. Clinical nurse specialists are generally involved in treating specific diseases or conditions or specific patient populations. The qualifications and educational requirements for an RN who wishes to be certified as clinical nurse specialists will be specified in Board of Nursing rules.
Expanded Scope of Practice for APRNs
The legislation also expanded the scope of practice for a specific group of specialty certified registered nurses which the legislation calls “advance practice registered nurses” or “APRNs.” The APRN designation includes the following specialty certified nurses: clinical nurse specialists; nurse practitioners; and certified nurse midwives. (Certified registered nurse anesthetists (CRNAs) are not included in the definition of APRN.)
Effective April 9, 2017, APRNs will have the authority, among other things, to prescribe non-controlled substances independently, and will be eligible to obtain a drug control license permitting them to dispense non-controlled substances to their own patients. APRNs will continue to be able to prescribe controlled substances only as a delegated and supervised act of a physician, podiatrist or dentist.
The legislation will also permit an APRN to refer patients to a physical therapist or speech-language pathologist for therapy.