This bill makes various changes to the prescribing authority and licensing of advanced practice registered nurses, as described below.
PRESCRIBING PRIVILEGES
Under present law, the board of nursing issues a certificate of fitness to nurse practitioners who meet the qualifications, competencies, training, education, and experience sufficient to prepare such persons to write and sign prescriptions and/or issue drugs within the limitations and provisions set forth by the director of the division of health related boards.
Nurses with such certificates of fitness collaborate with a physician who has control and responsibility for prescriptive services rendered by the nurse practitioner. The nurse practitioner must submit a copy of the formulary describing the categories of legend drugs to be prescribed or issued by the nurse practitioner. The nurse practitioner is authorized to prescribe or issue Schedule II, III, IV, and V controlled substances. However, a nurse practitioner is prohibited from prescribing Schedule II, III, and IV controlled substances unless such prescription is specifically authorized by the formulary or expressly approved after consultation with the collaborating physician before the initial issuance of the prescription or dispensing of the medication.
This bill rewrites the above provisions. Under this bill, an advanced practice registered nurse who holds prescribing authority pursuant to this bill may exercise that authority without supervision by or collaboration with a physician; however, like present law, this bill does require direct supervision of a physician if the advanced practice nurse is performing spine-related procedures.
Under this bill, the board will grant prescribing, ordering, selecting, administering, dispensing, and issuing authority through the advanced practice registered nurse license, as long as the licensee has completed an accredited graduate or postgraduate level advanced practice registered nurse program.
Under this bill, prescribing, ordering, selecting, administering, dispensing, and issuing authority includes:
(1) Prescribing and instituting therapy or referrals of patients to healthcare facilities or healthcare providers;
(2) Prescribing, selecting, administering, dispensing, and furnishing pharmacological agents, including over-the-counter, uncontrolled, and controlled substances. An advanced practice registered nurse may prescribe, order, select, administer, dispense, and issue schedule II, III, IV, and V controlled substances as described in the Tennessee Drug Control Act of 1989 in compliance with the law of this state. This bill grants advanced practice registered nurses prescribing power for buprenorphine, in certain circumstances; and
(3) Planning and initiating a therapeutic regimen that includes ordering and prescribing non-pharmacological interventions, such as durable medical equipment and diagnostic and supportive services, including, but not limited to, home health care; hospice; and physical, speech, and occupational therapy.
This bill requires that each handwritten, typed, or computer-generated prescription order for a Schedule II controlled substance prepared by an advanced practice registered nurse who is authorized by law to prescribe a Schedule II controlled substance be a separate prescription order.
LICENSURE REQUIREMENTS
Present law requires nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists holding education and practice credentials to apply to the board for a certificate to practice as an advanced practice registered nurse. This bill rewrites the present law provisions and creates the following new requirements for practicing as an advance practice registered nurse:
(1) Submit a completed application and appropriate fees as established by the board by rule;
(2) Hold a current, unencumbered license as a registered nurse in this state;
(3) Not hold an encumbered license, certification, or other privilege to practice as a registered nurse in any state or territory of the United States;
(4) Have completed an accredited graduate or post-graduate level advanced practice registered nurse program for and hold a current certification from a nationally certifying body recognized by the board by rule as a:
(A) Certified nurse practitioner;
(B) Certified registered nurse anesthetist;
(C) Certified nurse-midwife; or
(D) Clinical nurse specialist;
(5) Report any criminal conviction, nolo contendere plea, or other plea arrangement in lieu of conviction;
(6) Have committed no acts or omissions that are grounds for professional disciplinary action; and
(7) Provide any other information required by the board by rule.
This bill also creates similar requirements for a license by endorsement for an advanced practice registered nurse licensed under the laws of another state.
This bill authorizes the board to promulgate rules to set renewal fees; establish continuing education requirements, practice standards, and patient care standards; and create a process to use a certification program as a licensure requirement.
Notwithstanding the licensure requirements outlined above, on the effective date of this bill, the board of nursing will issue an advanced practice registered nurse license with prescriptive authority to each person who holds a current national specialty certification as a certified nurse practitioner, certified registered nurse anesthetist, certified nurse-midwife, or clinical nurse specialist, and:
(1) Holds an advanced practice registered nurse certificate issued in this state that is in good standing on the effective date of this bill; or
(2) Holds the equivalent of an advanced practice registered nurse certificate in this state that was issued in another state or territory of the United States and that is in good standing on the effective date of this bill.
TEMPORARY CERTIFICATE
Present law authorizes the board to issue a temporary certificate of fitness to a registered nurse who:
(1) Is licensed to practice in Tennessee;
(2) Has a master's degree in a nursing clinical specialty area with preparation in specialized practitioner skills that includes three quarter hours of pharmacology instruction or its equivalent; and
(3) Has applied for examination and/or is awaiting examination results for national certification as a first-time examinee in an appropriate nursing specialty area. Such temporary certificate remains valid until the examination results are obtained.
This bill deletes this temporary certificate program.
Under this bill, certification as an advanced practice nurse issued under present law nursing provisions that is valid and effective at 11:59 p.m. on June 30, 2021, will remain valid and effective until the certification is retired, revoked, or expired without being renewed.

Statutes affected:
Current Version: 63-7-123, 63-7-126, 53-11-311(b)(1)(D), 53-11-311, 53-11-311(c), 53-11-311(d)(1), 49-4-939(d)(5)(A), 49-4-939, 53-10-101(a), 53-10-101, 53-10-105(a), 53-10-105, 53-10-105(b)(2), 53-10-304(d)(3), 53-10-304, 53-11-309, 55-21-113, 56-7-2408(a), 56-7-2408, 63-1-301(1), 63-1-301, 63-1-313(a), 63-1-313, 63-6-243(b)(1), 63-6-243, 63-6-244(d), 63-6-244, 63-6-802(9), 63-6-802, 63-7-106(g), 63-7-106, 63-7-115, 63-7-122(a)(1), 63-7-122, 63-7-124(c), 63-7-124, 63-7-207(14), 63-7-207, 63-9-121(d), 63-9-121, 63-10-204(42)(A)(i), 63-10-204, 63-10-215(a), 63-10-215, 63-13-303(a), 63-13-303, 63-32-105(a)(18), 63-32-105, 63-32-115(a), 63-32-115, 63-32-115(d), 68-1-128(a)(2), 68-1-128, 68-1-128(b)(1)(A), 68-1-128(e), 68-10-104(c)(2), 68-10-104, 68-11-224(a), 68-11-224