Chapter N 8

N 8.10   Care management and collaboration with other health care professionals.

N 8.01 N 8.01 Authority and intent.

N 8.01(1) (1) The rules in this chapter are adopted pursuant to authority of ss. 15.08 (5) (b), 227.11 (2) and 441.16, Stats., and interpret s. 441.16, Stats.

N 8.01(2) (2) The intent of the board of nursing in adopting rules in this chapter is to specify education, training or experience that a registered nurse must satisfy to call himself or herself an advanced practice nurse; to establish appropriate education, training and examination requirements that an advanced practice nurse must satisfy to qualify for a certificate to issue prescription orders; to define the scope of practice within which an advanced practice nurse prescriber may issue prescription orders; to specify the classes of drugs, individual drugs or devices that may not be prescribed by an advanced practice nurse prescriber; to specify the conditions to be met for a registered nurse to administer a drug prescribed or directed by an advanced practice nurse prescriber; to establish procedures for maintaining a certificate to issue prescription orders, including requirements for continuing education; and to establish the minimum amount of malpractice insurance required of an advanced practice nurse prescriber.

N 8.01 History History: Cr. Register, February, 1995, No. 470, eff. 3-1-95.

N 8.02 N 8.02 Definitions. As used in this chapter:

N 8.02(1) (1) “Advanced practice nurse” means a registered nurse who possesses the following qualifications:

N 8.02(1)(a) (a) The registered nurse has a current license to practice professional nursing in this state, or has a current license to practice professional nursing in another state which has adopted the nurse licensure compact;

N 8.02(1)(b) (b) The registered nurse is currently certified by a national certifying body approved by the board as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist; and,

N 8.02(1)(c) (c) For applicants who receive national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist after July 1, 1998, the registered nurse holds a master’s or doctoral degree in nursing or a related health field granted by a college or university accredited by a regional accrediting agency approved by the board of education in the state in which the college or university is located.

N 8.02(2) (2) “Advanced practice nurse prescriber” means an advanced practice nurse who has been granted a certificate to issue prescription orders under s. 441.16 (2), Stats.

N 8.02(3) (3) “Board” means the board of nursing.

N 8.02(4) (4) “Clinical pharmacology or therapeutics” means the identification of individual and classes of drugs, their indications and contraindications, their efficacy, their side-effects and their interactions, as well as, clinical judgment skills and decision-making, based on thorough interviewing, history-taking, physical assessment, test selection and interpretation, pathophysiology, epidemiology, diagnostic reasoning, differentiation of conditions, treatment decisions, case evaluation and non-pharmacologic interventions.

N 8.02(5) (5) “Collaboration” means a process which involves 2 or more health care professionals working together, in each other’s presence when necessary, each contributing one’s respective area of expertise to provide more comprehensive care than one alone can offer.

N 8.02(6) (6) “Health care professional” has the meaning given under s. 180.1901 (1m), Stats.

N 8.02(6m) (6m) “One contact hour” means a period of attendance in a continuing education program of at least 50 minutes.

N 8.02(7) (7) “Patient health care record” has the meaning given under s. 146.81 (4), Stats.

N 8.02 History History: Cr. Register, February, 1995, No. 470, eff. 3-1-95; CR 00-168: cr. (6m), Register August 2001 No. 548, eff. 9-1-01; CR 01-046: am. (1) (a), Register October 2001 No. 550, eff. 11-1-01; CR 16-020: am. (1) (c), (4) Register September 2016 No. 729, eff. 10-1-16.

N 8.03 N 8.03 Certification as an advanced practice nurse prescriber. An applicant for initial certification as an advanced practice nurse prescriber shall be granted a certificate by the board if the applicant complies with all of the following:

N 8.03(1) (1) Submits an application form and the fee under s. 440.05 (1), Stats.

N 8.03(1m) (1m) Provides evidence of holding a current license to practice as a professional nurse in this state or a current license to practice professional nursing in another state which has adopted the nurse licensure compact.

N 8.03(2) (2) Provides evidence of current certification by a national certifying body approved by the board as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist.

N 8.03(3) (3) Provides evidence of a master’s or doctoral degree in nursing or a related health field granted by a college or university accredited by a regional accrediting organization approved by the Council for Higher Education Accreditation. This subsection does not apply to those who received national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist before July 1, 1998.

N 8.03(4) (4) Provides evidence of completion of 45 contact hours in clinical pharmacology or therapeutics within 5 years preceding the application for a certificate.

N 8.03(5) (5) Provides evidence of passing a jurisprudence examination for advanced practice nurse prescribers.

N 8.03 History History: Cr. Register, February, 1995, No. 470, eff. 3-1-95; CR 01-046: am. (1), Register October 2001 No. 550, eff. 11-1-01; CR 16-020: am. (intro.), renum. (1) to (1m) and am., cr. (1), am. (2) to (5) Register September 2016 No. 729, eff. 10-1-16.

N 8.045 N 8.045 Renewal. A person holding an advanced practice nurse prescriber certificate may renew the certificate by doing all of the following:

N 8.045(1) (1) Pay the renewal fee as determined by the department under s. 440.03 (9) (a), Stats., the workforce survey fee, and any applicable late renewal fee.

N 8.045(2) (2) Complete the nursing workforce survey to the satisfaction of the board.

N 8.045(3) (3) Certify completion of the continuing education required under s. N 8.05.

N 8.045(4) (4) Provide evidence of current certification by a national certifying body approved by the board as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist, or clinical nurse specialist.

N 8.045 History History: CR 16-020: cr. Register September 2016 No. 729, eff. 10-1-16; correction in (3) made under s. 35.17, Stats., Register September 2016 No. 729; correction in (intro.) made under s. 35.17, Stats., Register October 2019 No. 766.

N 8.05 N 8.05 Continuing education.

N 8.05(1) (1) Every advanced practice nurse prescriber shall complete 16 contact hours per biennium in clinical pharmacology or therapeutics relevant to the advanced practice nurse prescriber’s area of practice, including at least 2 contact hours in responsible prescribing of controlled substances.

N 8.05(3) (3) Every advanced practice nurse prescriber shall retain for a minimum period of 4 years, and shall make available to the board or its agent upon request, certificates of attendance issued by the program sponsor for all continuing education programs for which he or she claims credit for purposes of renewal of his or her certificate.

N 8.05 History History: Cr. Register, February, 1995, No. 470, eff. 3-1-95; CR 00-168: cr. (3), Register August 2001 No. 548, eff. 9-1-01; CR 16-020: am. (1), r. (2) Register September 2016 No. 729, eff. 10-1-16.

N 8.06 N 8.06 Prescribing limitations. The advanced practice nurse prescriber:

N 8.06(1) (1) May issue only those prescription orders appropriate to the advanced practice nurse prescriber’s areas of competence, as established by his or her education, training or experience.

N 8.06(2) (2) May not issue a prescription order for any schedule I controlled substance.

N 8.06(3) (3) May not prescribe, dispense or administer any amphetamine, sympathomimetic amine drug or compound designated as a schedule II controlled substance pursuant to the provisions of s. 961.16 (5), Stats., to or for any person except for any of the following:

N 8.06(3)(a) (a) Use as an adjunct to opioid analgesic compounds for the treatment of cancer-related pain.

N 8.06(3)(b) (b) Treatment of narcolepsy.

N 8.06(3)(c) (c) Treatment of hyperkinesis, including attention deficit hyperactivity disorder.

N 8.06(3)(d) (d) Treatment of drug-induced brain dysfunction.

N 8.06(3)(e) (e) Treatment of epilepsy.

N 8.06(3)(f) (f) Treatment of depression shown to be refractory to other therapeutic modalities.

N 8.06(4) (4) May not prescribe, order, dispense or administer any anabolic steroid for the purpose of enhancing athletic performance or for other nonmedical purpose.

N 8.06(5) (5) Shall, upon request, present evidence to the nurse or to the administration of the facility where the prescription or order is to be carried out that the advanced practice nurse prescriber is properly certified to issue prescription orders.

N 8.06 History History: Cr. Register, February, 1995, No. 470, eff. 3-1-95; correction in (3) made under s. 13.93 (2m) (b) 7., Stats., Register, October, 2000, No. 538; CR 16-020: am. (3) (c), (5) Register September 2016 No. 729, eff. 10-1-16.

N 8.07 N 8.07 Prescription orders.

N 8.07(1) (1) Prescription orders issued by an advanced practice nurse prescribers shall:

N 8.07(1)(a) (a) Specify the date of issue.

N 8.07(1)(b) (b) Specify the name and address of the patient.

N 8.07(1)(c) (c) Specify the name, address and business telephone number of the advanced practice nurse prescriber.

N 8.07(1)(d) (d) Specify the name and quantity of the drug product or device prescribed, including directions for use.

N 8.07(1)(e) (e) Bear the signature of the advanced practice nurse prescriber.

N 8.07(2) (2) Prescription orders issued by advanced practice nurse prescribers for a controlled substance shall be written in ink or indelible pencil or shall be submitted electronically as permitted by state and federal law, and shall contain the practitioner’s drug enforcement agency number.

N 8.07 History History: Cr. Register, February, 1995, No. 470, eff. 3-1-95; CR 16-020: am. (2) Register September 2016 No. 729, eff. 10-1-16.

N 8.08 N 8.08 Malpractice insurance coverage.

N 8.08(1) (1) Advanced practice nurse prescribers who prescribe independently shall maintain in effect malpractice insurance evidenced by one of the following:

N 8.08(1)(a) (a) Personal liability coverage in the amounts specified in s. 655.23 (4), Stats.

N 8.08(1)(b) (b) Coverage under a group liability policy providing individual coverage for the nurse in the amounts set forth in s. 655.23 (4), Stats. An advanced practice nurse prescriber covered under one or more such group policies shall certify on forms provided by the board that the nurse will independently prescribe only within the limits of the policy’s coverage, or shall obtain personal liability coverage for independent prescribing outside the scope of the group liability policy or policies.

N 8.08(2) (2) Notwithstanding sub. (1), an advanced practice nurse prescriber who practices as an employee of this state or a governmental subdivision, as defined under s. 180.0103, Stats., is not required to maintain in effect malpractice insurance coverage, but the nurse shall certify on forms provided by the board that the nurse will prescribe within employment policies.

N 8.08(3) (3) An advanced practice nurse prescriber who prescribes under the supervision and delegation of a physician or CRNA shall certify on forms provided by the board that the nurse complies with s. N 6.03 (2) and (3), regarding delegated acts.

N 8.08(4) (4) An advanced practice nurse prescriber who prescribes in more than one setting or capacity shall comply with the provisions of subs. (1), (2) and (3) applicable to each setting or capacity. An advanced practice nurse prescriber who is not an employee of this state or a governmental subdivision, and who prescribes independently in some situations and prescribes under the supervision and delegation of a physician or CRNA in other situations, shall meet the requirements of sub. (1) with respect to independent prescribing and the requirements of sub. (3) with respect to delegated prescribing.

N 8.08 Note Note: Forms are available from the board office located at 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708.

N 8.08(5) (5) Every advanced practice nurse who is certified to issue prescription orders shall annually submit to the board satisfactory evidence that he or she has in effect malpractice insurance required by sub. (1).

N 8.08 History History: Cr. Register, February, 1995, No. 470, eff. 3-1-95; r. and recr. (1), renum. (2) to be (5) and cr. (2), (3) and (4), Register, October, 1996, No. 490, eff. 11-1-96.

N 8.09 N 8.09 Dispensing.

N 8.09(1) (1) Except as provided in sub. (2), advanced practice nurse prescribers shall restrict their dispensing of prescription drugs to complimentary samples dispensed in original containers or packaging supplied by a pharmaceutical manufacturer or distributor.

N 8.09(2) (2) An advanced practice nurse prescriber may dispense drugs to a patient at the treatment facility at which the patient is treated.

N 8.09 History History: Cr. Register, February, 1995, No. 470, eff. 3-1-95; CR 16-020: am. (2) Register September 2016 No. 729, eff. 10-1-16.

N 8.10 N 8.10 Care management and collaboration with other health care professionals.

N 8.10(1) (1) Advanced practice nurse prescribers shall communicate with patients through the use of modern communication techniques.

N 8.10(2) (2) Advanced practice nurse prescribers shall facilitate collaboration with other health care professionals, at least 1 of whom shall be a physician or dentist, through the use of modern communication techniques.

N 8.10(3) (3) Advanced practice nurse prescribers shall facilitate referral of patient health care records to other health care professionals and shall notify patients of their right to have their health care records referred to other health care professionals.

N 8.10(4) (4) Advanced practice nurse prescribers shall provide a summary of a patient’s health care records, including diagnosis, surgeries, allergies and current medications to other health care providers as a means of facilitating care management and improved collaboration.

N 8.10(5) (5) The board shall promote communication and collaboration among advanced practice nurse prescribers, physicians, dentists and other health care professionals.

N 8.10(6) (6) The advanced practice nurse prescriber may order treatment, therapeutics, and testing, appropriate to his or her area of competence as established by his or her education, training, or experience, to provide care management.

N 8.10(7) (7) Advanced practice nurse prescribers shall work in a collaborative relationship with a physician or dentist. The collaborative relationship is a process in which an advanced practice nurse prescriber is working with a physician or dentist, in each other’s presence when necessary, to deliver health care services within the scope of the practitioner’s training, education, and experience. The advanced practice nurse prescriber shall document this relationship.

N 8.10 History History: Cr. Register, February, 1995, No. 470, eff. 3-1-95; cr. (6) and (7), Register, October, 2000, No. 538, eff. 11-1-00; CR 16-020: am. (title), (4) to (7) Register September 2016 No. 729, eff. 10-1-16; CR 19-050: am. (2), (5), (7) Register October 2019 No. 766, eff. 11-1-19; correction in (2) made under s. 35.17, Stats., Register October 2019 No. 766.