Practice
 
 
Can an APRN Perform physical exams for law enforcement personnel, Sign death certificates,  Sign for reinstatement of drivers license for individuals who have been seizure free for 3 months,   Sign for seat belt waivers for those unable to wear a seat belt for medical reasons, and   Add APRNs to the interdisciplinary team of professionals who participate in the evaluation of an individual for guardianship.  

As of 2016 the answer to all these questions I YES!

 

 

  

Geriatric Patient Information links.
 
 
Can an APRN delegate to...?
 
 
 
August 27, 2013 With the withdrawal of the KBN regulation on the delegation of insulin injections in schools by UAPs, there is no longer a specific regulatory prohibition against  APRNs delegating injections to Certified Medical Assistants (CMAs) in the clinic setting. The KBN advisory opinion is still in place which directs all nurses to verify the competence of an individual prior to delegating any task. Therefore, before delegating injections to a CMA it is the responsibility of an APRN to ensure the CMA's competence. When an APRN delegates an injection (or any task) to a CMA, because the CMA is not a licensed individual, the APRN bears full responsibility and accountability for the actions of the CMA. If there is a problem or bad outcome, the APRN is responsible, not the CMA. KBN has approved a revised and very narrowly written regulation change on delegation that will accommodate administration of insulin in the schools. This new regulation will now have to proceed through the regulatory approval process.   KBN will be convening a task force to examine delegation to UAPs in the community setting and a recommendation from this new task force is expected to come before the full Board of Nursing possibly in October, but more likely in December.

Kentucky High School Athletic Association and KHSAA Member Schools
IMPLEMENTATION OF NFHS PLAYING RULES CHANGES RELATED TO CONCUSSION AND CONCUSSED ATHLETES
Released: June, 2010, Commissioner Julian Tackett

 


APRNs may have admitting privileges at hospitals. The type of privilege is determined by the "medical staff "and must be described in the hospital by laws. Kentucky hospital regulation 902 KAR 20:016 states that a physician must "assume full responsibility for diagnosis and care" of the patient but, "…Other qualified personnel may complete medical histories, perform physical examinations, record findings and compile discharge summaries, in accordance with their scope of practice and the hospital's protocols and by laws." (Section 4. Provision of Services) Medical staff is defined in the regulation as physicians and dentists. The regulation also states that orders and exams must be signed by the health care provider giving the order or performing the exam.

 

The medical staff may grant other health care providers hospital privileges and the range of privileges must be defined in the hospital by laws. Because of this, hospital by- laws vary on the privileges granted to APRNs. The medical staff may determine how often or when the hospitalized patient must be seen by a physician and what the relationship between the physician and the APRN is to be. This is frequently based on how accepting the medical staff is of APRNs.  However, since the regulation says that the physician must assume full responsibility for the patient; NPs cannot have independent hospital privileges.

 

Here is the link to the hospital regulation  http://www.lrc.ky.gov/kar/902/020/016.htm   It may be helpful for you to read through this.Oct 2009


Also of interest, a white paper Removing Barriers to Advanced Practice RegisteredNurse Care: Hospital Privileges by Andrea Brassard, AARP Public Policy Institute and Mary Smolenski, Consultant

Where can I find the latest evidence-based treatment options for chronic conditions?

The Agency for Healthcare Research and Quality (AHRQ) and its Effective Health Care Program, has developed a library of chronic disease-related materials. Nearly half (45 percent) of all Americans report at least one chronic illness, and 7 out of 10 deaths among Americans each year are from chronic diseases.Given the prevalence of chronic diseases, registered nurses and patients need to know the treatment options that are available to them, the associated costs, and the bottom-line facts on which treatments may help or harm. AHRQ's Effective Health Care Program is a leading resource on evidence-based research on a variety of chronic disease including cancer; heart and blood vessel conditions; diabetes; and muscle, bone and joint conditions, in addition to others.

 

May APRNs order Home Health Services?

This is a federal regulation. There have been bills filed in Congress for the past 3 years to change this, but they have not passed. AANP is working on this. (Updated February 2014)

Medicare does not allow APRNs to certify or order home health services. Most of the Home health agencies are certified through Medicare; therefore, these agencies follow Medicare Rules.

Medicaid does not prohibit APRNs from ordering, providing or being reimbursed for home health services. However, if a patient has Medicare, the Medicare rule prohibiting APRNs from ordering home health services applies. 

Kentucky Regulations governing APRN Medicaid services are:

907 KAR 1:102 Advanced registered nurse practitioner services and

907 KAR 1:104 Reimbursement for advanced registered nurse practitioner services

Also, under regulations governing home health services (907 KAR 1:030), Section 4(6) specifically states, "Except for the first week following a home delivery, a newborn or postpartum service without the presence of a medical complication shall not be covered.” This regulatory rule applies to all health care providers. 
 
 

Must a physician review or co-sign APRN charts?

In summary, the laws governing APRN practice (both regulations and statutes) do not require a physician review or co-sign APRN charts. The Kentucky Nursing Laws allow APRNs to practice autonomously. There is a legal requirement for a collaborative agreement for prescriptive authority (CAPA-NS and CAPA-CS), but these agreements only apply to prescribing and do not require any chart review or co-signature.

However, individual hospitals, facilities or community mental health centers may develop policies that require physician review of APRN charts. Also, the rural health clinic regulation requires the physician and APRN to "periodically" review the patient records. The regulation does not stipulate how often this review must take place, how many charts are to be reviewed, or how the review is to be conducted. The regulation does require an annual clinic meeting and the chart review may take place at that meeting. If you want to review the entire rural health clinic regulation, go to: http://www.lrc.ky.gov/kar/902/020/145.htm

Should I carry my own malpractice insurance policy if I'm already covered on my employer's policy?

Carrying your own malpractice insurance is dependent on a number of factors. Generally speaking, it is better to carry your own policy so that you are protected if you should leave a practice. The statute of limitations for certain problems can be many years, allowing an individual the option to suefor a long time.Tail coverage can be very expensive and you would need to purchase tail coverage if you left a practice and the practice did not provide that benefit. Most practices cover employees with claims made policies, rather than an occurrence policy, as this type of policy is less expensive. If you leave a practice, it would be necessary to purchase tail insurance to cover any suits involving past careAND purchase another liability policy to cover your current practice.

Insurance policies provided by many practices cover you as long as you are employed at that practice. If you should have an adverse event, and the practicedecided to let you go, you would have no coverage. They also don't cover you for any care you provide outside of the practice. Further, thepractice could decide to settle a case that you felt you could win at trial. You would not have the option to go to trial if the practice decided to settle out of court.

Another possibility for obtaining liability insurance coverage is to negotiate payment of your personal liability policy in your contact negotiations. 


Who can I purchase malpractice insurance from?

 

Cotterell, Mitchell & Fifer, Inc (CM&F Group)
http://www.cmfgroup.com
1-800-221-4904

Nurses Service Organization
http://www.nso.com/
159 E. County Line Road
Hatboro, Pennsylvania 19040
Phone: 1-800-247-1500

Marsh - Seabury & Smith/Proliability
www.proliability.com/ahc


 

Can WHNPs treat male patients?

The WHNP who is educationally prepared and clinically competent may diagnose and treat males for reproductive issues. According to WOMEN'S HEALTH NURSE PRACTITIONER: GUIDELINES FOR PRACTICE AND EDUCATION, 6th edition, it is clearly stated within the Guidelines and this has been taught for a long time in the WHNP education programs: 

V. Male Reproductive Health Needs/Problems, Including but Not Limited to:

Reproductive anatomy, physiology, and endocrinology
Reproductive pathophysiology
Physical assessment
Diagnostic and screening tests
Fertility control
Infertility
Sexually transmitted infections

I hope this will correct the misinformation that has been given. Please feel free to contact me if there should be any additional questions. 

Sharon Eli Mercer, MSN, RN  NEA, BC
Nursing Practice Consultant
Kentucky Board of Nursing
312 Whittington Parkway, Suite 300
Louisville, KY    40222-5172
Phone: 502-429-3307 Toll Free: 800-305-2042 x3307
Fax: 502-696-3937
SharonE.Mercer@ky.gove-mail: kbn.ky.gov


1.  To provide DUI services the facility must first have an AODE license.  The application and regulations are on the KY website.
2.  Once you have your AODE license (which includes an onsite survey) then you can apply for a DUI Certificate.
3.  To provide DUI assessments you must complete a training (located on the Department for Behavioral Health's website) and pass an exam.  To be a qualified assessor you have to have a minimum number of practice hours in substance abuse
4.  To provide DUI classes (20 hours of PRI) - you must complete an additional training - also on the Division of behavioral healt's website.

I have included the links:

AODE Regulations

AODE Licensure Application



DUI Training and Certificate Applications



Jessica Estes DNP PMHNP
March 1, 2016

 

As of 04/11/2017 from Nathan Goldman (KBN Counsel) via Beth Partin 

 

 

 

 

 

 


 

An APRN may hire a locum APRN to cover the practice temporarily when he or she is away. The billing for Medicaid would be under the regular provider' number, but with a modifier.. 

 

more Calendar

12/4/2017
Regional Meeting Danville

12/5/2017
Regional Meeting Owensboro

12/5/2017
Regional Meeting London/Corbin

12/6/2017
Regional Meeting Louisville

12/7/2017
Regional Meeting Northern KY

4/18/2018 » 4/21/2018
Annual Conference 2018/ Lexington

4/24/2019 » 4/27/2019
Annual Conference 2019/ Covington

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