APRNs in Ohio Now Licensed

On April 6, advanced practice registered nurses (APRNs) in Ohio welcomed monumental changes to the way in which they practice. Primarily, Ohio’s APRNs will no longer be obtaining Certificates of Authority (COA) or Certificates to Prescribe (CTP) from the Ohio Board of Nursing, but rather a new APRN licensure.

The move is a result of the progressive ‘APRN Modernization Bill,’ or House Bill 216, for which members of Cleveland Clinic’s Nursing Institute Legislative and Health Policy Council were actively involved in promoting.

House Bill 216 passed legislation in December 2016, officially becoming active law on April 6. It aims to address the impending physician shortage by enhancing APRN scope of practice.

Impact on Ohio APRN practice

The new Ohio APRN license includes role designation as a certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), clinical nurse specialists (CNS) or certified nurse practitioner (CNP).

In addition to transitioning to licensure, the new law also encompasses the following APRN practice enhancements and more.

APRNs have the ability to prescribe safer and more efficiently without the need for a separate certificate.

As part of the law, a new exclusionary-only drug formulary has been established to specify the drugs an APRN is not authorized to prescribe. Essentially, if a drug is not listed in the formulary, an APRN may prescribe it. Additionally, the number of APRNs with whom a physician may collaborate (at the same time) regarding prescribing has increased from three to five.

APRNs prescribing Schedule II medications in non-authorized sites have revised conditions.

The new law also includes revisions to a selection of previously established conditions surrounding prescription of Schedule II medications. According to the law, the new conditions are:

• The patient must have a terminal condition.
• The initial Schedule II medication must have been prescribed by a physician; but, the physician does not need to be the collaborating physician, as was required in the past.
• The Schedule II medication may now be written for 72 hours instead of 24 hours.

APRNs can continue to practice under existing standards of care arrangements for 120 days should a physician terminate collaboration with the APRN.

Should a physician choose to discontinue collaboration with an APRN, the new law also allows APRNs the opportunity to continue to practice while searching for another collaborating physician. Upon learning of the termination, APRNs must immediately notify the Ohio Board of Nursing and as soon as the board is notified, the buffer period will begin.

In addition to the above, the new law also includes:

• Establishment of an APRN Advisory Committee that advises the Ohio Board of Nursing on the practice and regulation of APRNs.
• New continuing education requirements of 48 hours every two years for license renewal.
  • In addition to the APRN license, Ohio APRNs must also have an active registered nurse (RN) license.

Major steps toward providing accessible, affordable and timely healthcare

For Ohio’s nurses, the positive impact the new law has is immense and has been a long time coming. It’s a major step in delivering more patients throughout the state high quality, affordable care at the moment it is needed – in inpatient to ambulatory care settings.

A career as an APRN continues to prove a lucrative and desirable choice for many registered nurses. In Ohio specifically, according to data provided by the Ohio Action Coalition, there were nearly 11,000 APRNs in 2013 – and those numbers are rising. Since 2014, at Cleveland Clinic, for example, there have been approximately 450 new APRN positions – taking the total number of APRNs across the system to more than 1,000 for the first time ever.

Spread the word

Nurse leaders throughout Ohio need to make sure they are effectively communicating the changes that accompany the new APRN law to both current and incoming APRNs. While APRNs should thoroughly review all details of the law, the following are some of the most important changes leaders should communicate:

1. APRNs are now licensed, and all APRNs can prescribe (once properly educated).
2. APRNs will have a formulary that is easier to interpret, making patient care safer and more efficient.
3. Psychiatric/mental health nurse practitioners can collaborate with non-psychiatrists, such as family practice physicians and pediatricians.
4. The continuing education requirement for renewal will increase to 48 hours total, 12 of which must be pharmacology.

For more detailed information, visit the Ohio Board of Nursing’s House Bill 216 Summary of Major Provisions as well as the Ohio Association of Advanced Practice Nurses’ House Bill 216 infographic.