• States Ease Requirements for Nurse Practitioners -- A Review of Colorado’s New Advanced Practice Nurse Law
  • August 30, 2010 | Author: Patrick W. Pocock
  • Law Firm: Barnes & Thornburg LLP - Chicago Office
  • The State of Colorado has come out with a new law and Board of Nursing rule that significantly increases the ability of advance practice nurses to practice independently. With the increased attention on the rising costs of health care, this new law may represent a trend in states toward permitting non-physician practitioners to perform more services independent of physicians as an opportunity to encourage non-physician practices, increase access to limited health services and provide affordable health care alternatives.

    Advance Practice Nurses (APNs), also known as Nurse Practitioners, are nurses who have undergone significant extra training to enable them to perform advanced diagnostic and treatment services.  States regulate the nature and scope of the relationship each APN must have with a licensed physician. In most states, APNs can prescribe drugs and perform medical diagnosis and treatment under only general supervision of physicians, who may or may not be on site during the patient encounter. Many states allow physicians and APNs to establish standing protocols and only require physicians to review patient charts on a limited basis. However, in nearly all states, an APN’s authority to prescribe medications is delegated by the physician. That is, the APN does not have the independent authority to prescribe on his/her own.

    Colorado is now part of a small but growing number of states that have amended its APN laws and rules to grant to APNs independent prescriptive authority. The new law and rule require APNs to undergo training and establish what is called an “articulated plan” with a collaborating physician. This new “articulated plan” is a written document that includes a strategy for safe prescribing and outlines how the APN intends to maintain ongoing collaboration with physicians and other health care professionals in connection with the APN’s practice of prescribing medications. This is different from a traditional collaborative practice agreement because, although initially approved by a physician mentor, does not require physician approval or even physician collaboration going forward. The APN is solely responsible for updating, modifying and maintaining this Articulated Plan.

    APNs seeking this status in Colorado must become listed on the state’s Advanced Practice Registry and participate in a preceptorship program with at least 1800 hours of clinical training with a physician preceptor. After the preceptorship, the APN can receive provisional prescriptive authority, which will become final only after the APN completes a mentorship program involving an additional 1800 hours of experience with a physician mentor.  Upon completion of the mentorship program, the development of an Articulated Plan and the completion of the necessary Board of Nursing paperwork, the APN may then obtain full independent prescriptive authority.