(A) "Advanced practice registered nurse" means an individual who holds a current, valid license issued under Chapter 4723. of the Revised Code that authorizes the practice of nursing as an advanced practice registered nurse and is designated as any of the following:
(1) A certified registered nurse anesthetist;
(2) A clinical nurse specialist;
(3) A certified nurse-midwife;
(4) A certified nurse practitioner.
(B) "Collaboration" or "collaborating" means:
(1) In the case of a certified nurse practitioner or a clinical nurse specialist, that a podiatrist or physician has entered into a standard care arrangement with the nurse and is continuously available to communicate with the clinical nurse specialist or certified nurse practitioner either in person, or by electronic communication;
(2) In the case of a certified nurse-midwife, that a physician has entered into a standard care arrangement with the nurse and is continuously available to communicate with the nurse either in person, or by electronic communication.
(C) "Dentist" means an individual holding a license issued under Chapter 4715. of the Revised Code to practice dentistry, and who is practicing in Ohio.
(D) "Physician" means an individual holding a certificate issued under Chapter 4731. of the Revised Code authorizing the practice of medicine and surgery or osteopathic medicine and surgery, and who is practicing in Ohio.
(E) "Podiatrist" means an individual holding a certificate issued under Chapter 4731. of the Revised Code authorizing the practice of podiatric medicine, and who is practicing in Ohio.
(F) "Practice of nursing as an advanced practice registered nurse" means providing to individuals and groups nursing care that requires knowledge and skill obtained from advanced formal education, training and clinical experience. Such nursing care includes the care described in section 4723.43 of the Revised Code, and additionally, with respect to certified registered nurse anesthetists, sections 4723.433, 4723.434, and 4723.435 of the Revised Code.
(G) "Nursing specialty" means a specialty in practice as a certified registered nurse anesthetist, clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner.
(H) "Standard care arrangement" means a written, formal guide for planning and evaluating a patient's health care that is developed by a collaborating physician or podiatrist and a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist, and that meets the requirements of section 4723.431 of the Revised Code and this chapter.
(I) "Supervision" means that a certified registered nurse anesthetist is under the direction of a podiatrist, a dentist, or a physician.
Authorized By: 4723.07
Amplifies: 4723.01, 4723.43
--> Five Year Review Date: 10/15/2025
Prior Effective Dates: 4/1/1997, 2/1/2002, 2/1/2014
(A) An advanced practice registered nurse shall provide to patients nursing care that requires knowledge and skill obtained from advanced formal education, which includes a clinical practicum, and clinical experience as specified in sections 4723.41, 4723.43, 4723.433, 4723.434, 4723.435 and 4723.482 of the Revised Code and this chapter.
(B) Except as otherwise precluded by law or rule, each advanced practice registered nurse shall practice in accordance with the following:
(1) The advanced practice registered nurse's education and clinical experience;
(2) The advanced practice registered nurse's national certification as provided in section 4723.41 of the Revised Code; and
(3) Chapter 4723. of the Revised Code and rules adopted under that chapter.
(C) Only a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist holding a current valid license as an advanced practice registered nurse may prescribe drugs. A certified registered nurse anesthetist may order drugs for use in the health care facility where the nurse practices in accordance with sections 4723.434 and 4723.435 of the Revised Code.
(D) Each certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist shall utilize and incorporate into the nurse's practice, knowledge of Chapter 4731. of the Revised Code and rules adopted under that chapter that govern the practice of the nurse's collaborating physician or podiatrist. Each certified registered nurse anesthetist shall utilize and incorporate into the nurse's practice, knowledge of Chapters 4715. and 4731. of the Revised Code and rules adopted under these chapters that govern the practice of the nurse's supervising podiatrist, dentist, or physician.
(E) Nothing in this rule precludes an advanced practice registered nurse from practicing as a registered nurse in accordance with section 4723.01 of the Revised Code and the rules of the board.
Authorized By: 4723.07
Amplifies: 4723.01, 4723.43
--> Five Year Review Date: 10/15/2025
Prior Effective Dates: 4/1/2006, 2/1/2011, 2/1/2014, 1/1/2018
(A) Only a person who holds a current valid license to practice as an advanced practice registered nurse issued in accordance with sections 4723.41, 4723.42 and 4723.482 of the Revised Code and this chapter may use the following titles or initials if designated to do so:
(1) Certified nurse-midwife, or A.P.R.N.-C.N.M., if the individual is authorized to practice in accordance with division (A) of section 4723.43 of the Revised Code;
(2) Clinical nurse specialist, or A.P.R.N.-C.N.S., if the individual is authorized to practice in accordance with division (D) of section 4723.43 of the Revised Code;
(3) Certified nurse practitioner, or A.P.R.N.-C.N.P., if the individual is authorized to practice under division (C) of section 4723.43 of the Revised Code;
(4) Certified registered nurse anesthetist or A.P.R.N.-C.R.N.A., if the individual is authorized to practice in accordance with division (B) of sections 4723.43, 4723.433, 4723.434, and 4723.435 of the Revised Code; or
(5) Advanced practice registered nurse or A.P.R.N. if the individual is authorized to practice under division (A) to division (D) of section 4723.43 of the Revised Code.
(B) Only a person who holds a current valid advanced practice registered nurse license issued in accordance with sections 4723.41, 4723.42 and 4723.482 of the Revised Code and this chapter to practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist shall:
(1) Practice in accordance with section 4723.43, 4723.433, 4723.434, or 4723.435 of the Revised Code, as applicable, and this chapter as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist;
(2) Hold themselves out as being a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, or advanced practice registered nurse;
(3) Use any title or initials implying that the person is a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, or advanced practice registered nurse authorized to practice in accordance with section 4723.03 of the Revised Code and paragraph (A) of this rule.
(C) At all times when an advanced practice registered nurse is providing direct care to a patient within the nurse's respective scope of practice, each certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist shall display and identify the applicable title and designation as set forth in this rule.
(D) No person who is not authorized to do so shall knowingly prescribe or personally furnish drugs or therapeutic devices without holding a current valid license to practice nursing as an advanced practice registered nurse issued under Chapter 4723. of the Revised Code and being designated as a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner according to section 4723.42 of the Revised Code.
Authorized By: 4723.07
Amplifies: 4723.44
--> Five Year Review Date: 10/15/2025
Prior Effective Dates: 2/1/2004, 4/1/2006
(A) Prior to engaging in practice, a standard care arrangement shall be entered into with each physician or podiatrist with whom the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist collaborates.
(1) The standard care arrangement shall be revised to reflect the addition or deletion of a physician or podiatrist with whom the nurse collaborates within that employment setting. Under these circumstances, a new standard care arrangement is not necessary.
(2) A new standard care arrangement shall be executed when the nurse is:
(a) Employed at a different or additional organization or practice; and
(b) Engages in practice with a collaborating physician or podiatrist outside of the primary employing organization.
(B) Except as provided in paragraph (C) of this rule, a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist engaged in the practice of the nurse's specialty, shall enter into a written standard care arrangement with one or more collaborating physicians or podiatrists whose practice is the same or similar to the nurse's practice.
(C) In accordance with division (A)(2)(c) of section 4723.431 of the Revised Code, a clinical nurse specialist certified as a psychiatric-mental health CNS by the American nurses credentialing center or a certified nurse practitioner who is certified as a psychiatric-mental health NP by the American nurses credentialing center, may enter into a standard care arrangement with a physician, but not a podiatrist, if the collaborating physician is practicing in one of the following specialties:
(3) Primary care of family practice.
(D) The standard care arrangement shall include at least:
(1) The signatures of each nurse, and each collaborating physician, or the physician's designated representative, or each podiatrist with whom the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist primarily collaborates indicating review of and agreement to abide by the terms of the standard care arrangement. For purposes of this rule, a physician's designated representative means a physician who serves as the department or unit director or chair, within the same institution, organization or facility department or unit, and within the same practice specialty, that the nurse practices, and with respect to whom the physician has executed a legal authorization to enter collaborating agreements on the physician's behalf;
(2) The date when the arrangement is initially executed;
(3) The date of the most recent review of the arrangement;
(4) The complete name, specialty and practice area, business address, and business phone number or number at which the individual can be reached at any time for:
(a) Each collaborating physician or podiatrist with whom the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist primarily collaborates and who is a party to the standard care arrangement, unless a physician's designated representative has entered the standard care arrangement on the physician's behalf; and
(b) Each certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist who is a party to the standard care arrangement;
(5) A statement of services offered by the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist consistent with section 4723.43 of the Revised Code and this chapter, including a description of the scope of prescriptive practice and authorization to enter consult agreements for patients, if applicable;
(6) A plan for incorporation of new technology or procedures consistent with the applicable scope of practice as set forth in section 4723.43 of the Revised Code and this chapter;
(7) Quality assurance provisions, including at least:
(a) When modification is made to the body of the standard care arrangement, reapproval of the standard care arrangement is required;
(b) Criteria for referral of a patient by the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist to a collaborating physician or podiatrist, including, for the certified nurse-midwife, a plan for referral of breech or face presentation or any other abnormal condition identified as such in the standard care arrangement;
(c) A process for the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist to obtain consultation from a physician or podiatrist; and
(d) A process for chart review in accordance with rule 4723-8-05 of the Administrative Code if the nurse's practice includes any direct patient care;
(8) A plan for coverage of patients in instances of emergency or planned absences of either the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist, or the collaborating physician or podiatrist;
(9) A process for resolution of disagreements regarding matters of patient management; and
(10) Regarding the prescribing component of the clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner's practice, the following quality assurance provisions shall include at least:
(a) Provisions to ensure timely direct, personal evaluation of the patient with a collaborating physician or the physician's designee when indicated;
(b) Prescribing parameters for drugs or therapeutic devices when indicated;
(c) Provisions for the use of schedule II controlled substances;
(d) If the nurse is prescribing to minors, as defined in division (A) of section 3719.061 of the Revised Code, provisions for complying with section 3719.061 of the Revised Code when prescribing an opioid analgesic to a minor; and
(e) Provisions for obtaining and reviewing OARRS reports, and engaging in physician consultation and patient care consistent with section 4723.487 of the Revised Code and rule 4723-9-12 of the Administrative Code.
(11) Quality assurance standards consistent with rule 4723-8-05 of the Administrative Code.
(E) The most current copy of the standard care arrangement, and any legal authorization signed by a physician according to paragraph (D)(1) of this rule, shall be retained on file by the nurse's employer. Upon request of the board, the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist shall immediately provide a copy of the standard care arrangement to the board.
(F) Copies of previously effective standard care arrangements shall be retained by the nurse for three years and provided to the board upon request.
(G) When a hospital negotiates a standard care arrangement in accordance with division (E) of section 4723.431 of the Revised Code and this chapter, the standard care arrangement shall be developed in accordance with paragraph (D) of this rule. Review and approval of the standard care arrangement shall be in accordance with the policies and procedures of the hospital governing body and the bylaws, policies, and procedures of the hospital medical staff.
(H) A certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist shall notify the board of the identity of a collaborating physician or podiatrist not later than thirty days after engaging in practice.
(I) A certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist shall notify the board of any change in the name and business address of a collaborating physician or podiatrist not later than thirty days after the change takes effect, except as provided in division (D) of section 4723.431 of the Revised Code.
Last updated February 1, 2022 at 8:55 AM
Authorized By: 4723.07
Amplifies: 4723.431
--> Five Year Review Date: 10/15/2025
Prior Effective Dates: 4/1/1997, 2/1/2006, 2/1/2011, 2/1/2014, 2/1/2016, 1/1/2018
(A) An advanced practice registered nurse shall comply with all continuing education requirements for registered nurse license renewal and advanced practice registered nurse license renewal set forth in division (C) of section 4723.24 of the Revised Code and national certification requirements set forth in sections 4723.41 and 4723.42 of the Revised Code and this chapter.
(B) Each certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist who is a party to a standard care arrangement shall comply with all quality assurance provisions of the standard care arrangement in accordance with this chapter. Failure to provide, enter into, or to practice in accordance with a standard care arrangement may result in disciplinary action in accordance with section 4723.28 of the Revised Code.
(C) Each practicing certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist who is a party to a standard care arrangement shall participate in a quality assurance process and shall immediately provide documentation satisfactory to the board of such participation upon request of the board. The quality assurance process shall include at a minimum:
(1) Periodic random chart review which includes prescribing patterns and schedule II prescribing, if indicated, at least annually by a collaborating physician, podiatrist, , or a designated member of a quality assurance committee, composed of at least one physician, of the institution, organization, or agency where the nurse has practiced;
(2) An opportunity for the advanced practice registered nurse and the collaborating physician to discuss feedback or issues subsequent to the chart review; and
(3) A process for patient evaluation of care.
(D) Documentation of participation in an ongoing, systematic quality assurance process at an institution, organization, or agency shall satisfy the requirements of paragraph (C) of this rule, provided there is a plan to utilize the results of the quality assurance process to maintain or improve care delivery.
(E) The board may audit, review or investigate, at any time, whether an advanced practice registered nurse has complied with the quality assurance standards set forth in this rule.
Authorized By: 4723.07
Amplifies: 4723.41, 4723.431
--> Five Year Review Date: 10/15/2025
Prior Effective Dates: 2/1/2014, 1/1/2018
[Comment: Information regarding the availability and effective date of the materials incorporated by reference in this rule can be found in paragraph (G) of rule 4723-1-03 of the Administrative Code.]
(A) To be approved by the board, a national certifying organization shall meet all of the requirements set forth in division (A) of section 4723.46 of the Revised Code.
(B) Annually at a time specified by the board, each national nursing certifying organization approved by the board for the prior year shall submit a "Verification Form Organizations Certifying Advanced Practice Registered Nurses: Certified Nurse Midwives (CNMs), Certified Nurse Practitioners (CNPs), Clinical Nurse Specialists (CNSs), and Certified Registered Nurse Anesthetists (CRNAs)," attesting that the organization has met and continues to meet all the requirements contained in section 4723.46 of the Revised Code. The board shall verify compliance of each national nursing certifying organization with the criteria contained in section 4723.46 of the Revised Code. No later than January thirtieth of each year, the board shall publish a list of approved national certifying organizations that meet these requirements. The board may approve additional national nursing certifying organizations or discontinue approval of a national nursing certifying organization based on criteria in section 4723.46 of the Revised Code. At the discretion of the board, it may discontinue approval of a national certifying organization for failure of the organization to return to the board the form indicating compliance with the requirements of section 4723.46 of the Revised Code.
Authorized By: 4723.07
Amplifies: 4723.46
--> Five Year Review Date: 10/15/2025
Prior Effective Dates: 2/1/2011
[Comment: Information regarding the availability and effective date of the materials incorporated by reference in this rule can be found in paragraph (G) of rule 4723-1-03 of the Administrative Code.]
(A) To renew a current valid license to practice as an advanced practice registered nurse, a licensee shall:
(1) Submit a "Certified Registered Nurse Anesthetist Renewal Application," "Certified Nurse Midwife Renewal Application," "Certified Nurse Practitioner Renewal Application," and/or "Clinical Nurse Specialist Renewal Application," that includes:
(a) Except as provided in paragraph (A)(2) of this rule, documentation satisfactory to the board that the licensee has maintained certification in the nursing specialty with a national certifying organization as required by division (B) of section 4723.42 of the Revised Code;
(b) Documentation satisfactory to the board of completion of continuing education required by division (C)(2) of section 4723.24 of the Revised Code and rule 4723-8-10 of the Administrative Code;
(c) A list of the names and business addresses of the holder's current collaborating physicians and podiatrists, if the nurse is a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner; and
(d) The renewal fee set forth in division (A)(8) of section 4723.08 of the Revised Code. If a completed renewal application is not renewed on-line by September fifteenth of odd numbered years, in order to renew the applicant shall pay a late processing fee of fifty dollars in accordance with division (A)(10) of section 4723.08 of the Revised Code. The late processing fee is in addition to the renewal fee specified in division (A)(8) of section 4723.08 of the Revised Code, and is in addition to any late processing fee imposed with respect to renewal of the applicant's registered nurse license; and
(2) A clinical nurse specialist, originally issued a certificate of authority on or before December 31, 2000 in accordance with division (C) of section 4723.41 of the Revised Code, as that division existed prior to March 20, 2013, is not required to provide documentation of having maintained certification in the holder's specialty, but shall submit documentation satisfactory to the board of completion of continuing education in compliance with paragraph (E) of rule 4723-8-10 of the Administrative Code.
(B) A renewed advanced practice registered nurse license is subject to renewal in odd-numbered years. When an advanced practice registered nurse license is first issued by the board on or after July first of an odd numbered year, that license shall be current through the thirty-first of October of the next odd-numbered year.
(C) The board shall provide access to an on-line application to each holder of a current valid advanced practice registered nurse license for renewal of the license, except when the board is aware that an individual is ineligible for renewal for any reason, including those reasons specified in section 4723.24 of the Revised Code.
(D) Within thirty days of recertification by the applicable national certifying organization, an advanced practice registered nurse shall request that the national certifying organization provide, directly to the board, satisfactory documentation of recertification to the board. This requirement does not apply to a clinical nurse specialist, originally issued a certificate of authority on or before December 31, 2000 in accordance with division (C) of section 4723.41 of the Revised Code, as that division existed prior to March 20, 2013.
(E) An advanced practice registered nurse who fails to maintain certification or recertification by the applicable national certifying organization approved by the Board according to section 4723.46 of the Revised Code, may be subject to disciplinary action in accordance with section 4723.28 of the Revised Code. This requirement does not apply to a clinical nurse specialist, originally issued a certificate of authority on or before December 31, 2000 in accordance with division (C) of section 4723.41 of the Revised Code, as that division existed prior to March 20, 2013.
(F) A clinical nurse specialist, originally issued a certificate of authority on or before December 31, 2000 in accordance with division (C) of section 4723.41 of the Revised Code, as that division existed prior to March 20, 2013, who fails to complete the continuing nursing education required by division (B) of section 4723.42 of the Revised Code and rule 4723-8-10 of the Administrative Code, may be subject to disciplinary action in accordance with section 4723.28 of the Revised Code.
(G) A holder of a current valid advanced practice registered nurse license who does not intend to practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist in Ohio may request that the license be placed on inactive status at any time, by submitting a written statement to the board or electronic request asking that the certificate be placed on inactive status.
(H) While on inactive status a nurse shall not represent or imply to the public that the nurse is authorized to practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist or use the titles or designations established by section 4723.03 of the Revised Code and rule 4723-8-03 of the Administrative Code.
(I) An inactive or lapsed advanced practice registered nurse license may be reactivated or reinstated by:
(1) Submitting an "Advanced Practice Registered Nurse Reactivation and Reinstatement Application"; and
(2) Payment of the applicable fees set forth in section 4723.08 of the Revised Code.
(J) An advanced practice registered nurse who is a service member or veteran, as defined in rule 4723-2-01 of the Administrative Code, or who is the spouse or surviving spouse of a service member or veteran, may be eligible for a waiver of the late application fee and the reinstatement fee according to rule 4723-2-03 of the Administrative Code.
Authorized By: 4723.07
Amplifies: 4723.24, 4723.47, 4723.42
--> Five Year Review Date: 10/15/2025
Prior Effective Dates: 2/1/2016