Changes in the Scpe f Practice Envirnment fr Nurse Practitiners in Michigan It has been an exciting and interesting year in the plicy wrld fr NP practice in Michigan. The changes that have ccurred happened n the bth the legislative (statute) and regulatry (rules) frnts here in Michigan. T start the explanatin, we will explre the relatinship between legislatin (statutes r law) and regulatin (i.e. Bard f Nursing (BON) rules). When bills are passed int law that impact a prfessin such as nursing, it requires that the Bard f Nursing write rules that crrespnd t the statutes as passed. Interestingly, this year we had three things happen within a shrt perid f time: 1. The Bard f Medicine (BOM), rewrte their regulatins (rules) fr the MDs in Michigan t allw them t delegate t APRNs the ability t prescribe Scheduled II-V medicatins, effective December 6, 2016. The change in the rule pertained specifically t the ability fr APRNs t be allwed t write Schedule II medicatins under MD delegatin fr up t a 30-day supply (which is all that is allwed anyway). This is cnsistent with what Physician Assistants are allwed t d. The Bard f Ostepathic Medicine & Surgery (BOMS) passed the same rules fr DOs, and it was apprved at the same time the Bard f Nursing rule changes ccurred, n December 20, 2016. 2. The Bard f Nursing (BON), rewrte regulatins regarding RNs and APRNs. Under the general requirements they made new requirements fr licensure, definitins f activities undertaken by APRNs and mre. Here are the highlights f the changes: Increase in license fees. Nw $60.00 fr RN license. N change in specialty certificatin cst. R 338.10105 Training standards fr identifying victims f human trafficking must get training in identifying human trafficking in health care, it can be nline, live, printed r electrnic media. Must have prf f cmpletin with a certificate including name and what was cvered. Can be a self-certificatin statement. R 338.10401 Definitin, (c) Nurse practitiner means an individual wh is licensed under part 172 f the cde as a registered nurse, wh is certified by the bard t use the title nurse practitiner, and wh fcuses n the perfrmance f cmprehensive assessments; prviding physical examinatins and ther health assessments and screening activities; and diagnsing, treating, and managing patients with acute and chrnic illnesses and diseases. Nursing care prvided by a nurse practitiner includes rdering, perfrming, supervising, and interpreting labratry and imaging studies; prescribing pharmaclgical and nnpharmaclgical interventins and treatments that are within the nurse practitiner s specialty rle and scpe f practice; health prmtin; disease preventin; health educatin; and cunseling f patients and families with ptential, acute, and chrnic health disrders. R 338.10401a Temprary certificatin. Rule 401. Temprary certificatin in a nursing specialty field is nt available in this state.
R 338.10404b Specialty certificatin qualificatins; nurse practitiner. Rule 404b. A specialty certificatin fr nurse practitiner shall be granted t a registered prfessinal nurse wh satisfies all f the fllwing requirements: (a) Hlds a current and valid license t practice nursing in this state. (b) Submits an applicatin fr certificatin as a nurse practitiner, n a frm prvided by the department with the required fee. (c) Pssesses advanced practice certificatin frm 1 f the fllwing certificatin rganizatins, r successr rganizatins: (i) The American Nurses Credentialing Center. (ii) The Pediatric Nursing Certificatin Bard. (iii) The Natinal Certificatin Crpratin fr Wmen s Health Care Nurse Practitiner and Nenatal Nurse Practitiner. (iv) The American Academy f Nurse Practitiners fr Adult Nurse Practitiners, Family Nurse Practitiners, and Adult-Gerntlgy Primary Care Nurse Practitiners. (v) The Onclgy Nursing Certificatin Crpratin. (vi) The American Assciatin f Critical Care Nurses Certificatin Crpratin fr Acute Care Nurse Practitiner. R 338.10405b Nurse practitiner specialty certificatin renewal r reregistratin; schedule; requirements; maintenance f evidence f cmpliance. (a) An applicant wh hlds natinal certificatin as a nurse practitiner shall have btained recertificatin r maintained certificatin within the 2-year perid immediately preceding the applicatin frm 1 f the fllwing rganizatins r successr rganizatins: (i) The American Nurses Credentialing Center. (ii) The Pediatric Nursing Certificatin Bard. (iii) The Natinal Certificatin Crpratin fr Wmen s Health Care Nurse Practitiner and Nenatal Nurse Practitiner. (iv) The American Academy f Nurse Practitiners fr Adult Nurse Practitiners, Family Nurse Practitiners, and Adult-Gerntlgy Primary Care Nurse Practitiners. (v) The Onclgy Nursing Certificatin Crpratin. (vi) The American Assciatin f Critical Care Nurses Certificatin Crpratin fr Acute Care Nurse Practitiner. (b) An applicant wh btained Michigan bard certificatin as a nurse practitiner befre 1991 shall have cmpleted 40 cntinuing educatin hurs in the nursing specialty field within the 2-year perid immediately preceding the applicatin. The bard apprves and adpts by reference in this rule the standards listed in R 338.10602 fr apprving cntinuing educatin activities fr the nurse practitiner. (c) An applicant r licensee shall maintain evidence f his r her cmpliance with the requirements f this rule fr a perid f 4 years after the date f applicatin, during which time the bard may require the licensee t submit such evidence fr audit.
R 338.10602 Acceptable cntinuing educatin; requirements; limitatins. They updated the types f acceptable CEU s that can be used. Many rule changes were specific t RN licensure and educatin: i.e. Changes t hw nursing prgrams are apprved in MI, curriculum, wh can serve as faculty, preceptrs and their educatin level requirements, and allw fr up t 50% f clinical hurs t be simulatin. 3. Public Act 499 f 2016 (HB 5400) The passage f HB 5400 (signed by Gvernr Snyder n January 9, 2017 with new terms effective April 9, 2017) imprves nurse practitiner practice in Michigan in the fllwing ways: Defined Advanced Practice Registered Nurse (APRN): CNM, NP, CNS. Authrized NPs t prescribe nn-scheduled pharmaceuticals independently. Authrized NPs t rder Physical Therapy, Speech Therapy and restraints (there is nthing included abut Occupatinal Therapy, because current statute in Michigan allws NPs t rder OT. Thus, there was n need t make a change). Authrized NPs t prescribe Scheduled II-V medicatins with a delegated agreement with a physician. (This is a delegated act) i. Bth names will appear n the prescriptin and bth DEA numbers will be used, recrded r indicated. Authrizes APRNs t rder, receive, and dispense a nn-scheduled cmplimentary starter dse drug withut delegatin frm a physician. Only the name f APRN is recrded. Authrizes APRNs wh have a delegated agreement with a physician fr scheduled medicatins t give cmplimentary starter dses. Authrizes APRN t make calls, rund in private hmes, public institutins, emergency vehicles, Ambulatry care clinics, hspitals, intermediate r extended care facilities, HMO, Nursing hmes r ther health care facilitates, withut restrictins n the time r frequency f visits by a physician r APRN. Added language abut APRNs in nursing hmes, and added APRNs t the language regarding the rights f nursing hme residents. Added Clinical Nurse Specialists (CNS) t Public Health Cde as APRNs. Changed the number f members n Bard f Nursing t 24, by adding 1 CNS t bard. Once 1 f the public members has served their term the bard will return t 23 members, with nly 7 public members instead f the current 8. Scpe f practice fr NPs is based n three things: Educatin (Certificatin); Statute (law) and Regulatins (BON rules). These three aspects f scpe f practice fr NPs wrk in cncert and yu shuld be aware f the requirements fr all three. The changes that were made t the Bard f Medicine and Bard f Ostepathic Medicine & Surgery were necessary with the passage f HB 5400, as they anticipated that it wuld be passed. The Bard f Nursing will have t have further changes made t add Clinical Nurse
Specialists t the APRN rle in Michigan, which includes rules regarding what a CNS can and cannt d. Finally, it is up t yu t understand what the limits are f yur certificatin, state laws and regulatins. The changes described here all wrk in cncert with the cntinued effrt t get authrizatin t practice t the full extent f ur educatin and clinical training in MI. There is still mre wrk t d but we are n the right track t mve frward. What is required f yu t practice under the new statute (law) and BON administrative regulatins (rules): yu will pay mre fr yur RN license when it cmes up fr renewal; yu need t update yur prescriptive authrity agreement t delegate nly schedule II-V medicatins; if yu dn t have a DEA, yu will need t apply fr ne t have the authrizatin t write fr Schedule II-V medicatins (https://www.deadiversin.usdj.gv/nline_frms_apps.html) if yu currently have a DEA number but it desn t include Schedule II medicatins yu will need t amend yur DEA license: -Yu must submit a frm request that yu wuld like t mdify yur registratin t include schedules II and IIN. Click HERE fr frm. This frm must be signed by the Nurse Practitiner and delegating physician. In additin, the DEA will need a new cpy f the delegatin f prescriptive authrity fr verificatin that the supervising physician is allwing t additin f II and IIN. Yu can fax, r mail this request. Last name A-L: Fax t 313-226-7546 Attentin Teresa Adams-Blair They may nt always be able t respnd t every submissin t acknwledge receipt, hwever yu may call Teresa within a few days after submissin t cnfirm/check n the status fax at 313-226-7522. Last name M-Z: attn: Kristen Katcherian They may nt always be able t respnd t every submissin t acknwledge receipt, hwever yu may call Kristen within a few days after submissin t cnfirm/check n the status fax at 313-226-7536. Mail t: DEA, 211 W. Frt St, Suite 610, Detrit, MI 48226 (attentin abve based n last name) Fr questins, email detritdiversinreg@dea.usdj.gv r call the abve numbers based n yur last name. yu will need t ensure that yu meet the human trafficking requirements fr renewal f yur RN license. Be aware, that yur institutins/clinics can be mre restrictive than the Michigan statutes and rule require, s yu will need t wrk with them t understand what they are ging t require. There is nthing in statute that requires yu t have a cllabrative agreement. Hwever, mst indemnifiers (insurers) require NPs t have a cllabrative agreement. Currently, CMS has such a requirement. Yu will find links t examples f the types f
agreements that yu need in the FAQ dcuments after yu lg in t the members-nly sectin f the MICNP database.