FNP Admission Privileges

akoster · Oct 1, 2008

I lived in Arizona for 4 years and worked family practice and had admitting privleges at the local hospital. I also worked in the ER. You need to fill out privleges forms usually for each area of the hospital you want to work in as the forms designate certain skill sets you are asking to cover. I had inpatient peds, inpatient adult, ER and ICU areas I could admit and follow patients. The ICU patients I was usually just writing admit orders until the doc got to see them but for my family practice pts I would admit, round and discharge. For the hospital Medicare usually makes the hospital assign you a "supervising" physician. IIt was more of a paperwork formality. ts not required by the state though but some insurances and medicare want it for inpatient.

Dr. Tammy, FNP/GNP-C · Oct 3, 2008

Generally, in the US can FNPs admit?

Not in California. AB 1436, which would have provided a scope of practice for NP's, including admitting, died in committee. California still remains the only state where NP's do not have a scope of practice that differs from that of RN's.

Unfortunately, with the powerful lobby of medical-based professional associations coupled with the belief by many NP's that their practice involves the practice of medicine and not advanced practice nursing, the powers in California, rightly so, see NP's as nothing more than RN's with a few extra hours of training who can not and should not provide advanced nursing care without the supervision by someone outside of nursing.

Advanced Practice Columnist / Guide · Oct 3, 2008

Admitting priviledges are not as simple as just having a state nurse practice act that allows for full autonomy for the practice of nurse practitioners. I live in state that is permissive of independent NP practice with the exception of prescriptions and yet many NP's do not have admitting priviledges independent of having to state the name of a collaborating physician who should also have admitting priviledges in the facility in question.

Hospitals, through the Board of Governors and the Medical Affairs Board, can easily put restrictions on who gets independent admitting privledges within a given hospital. Insurance companies can also get in the way of allowing NP's the ability to admit their own patients as many companies do not even empanel NP's primary care provider status. Finally, regulatory bodies also have rules that restrict independent admitting priviledges for NP's. JCAHO, for instance enforces the Medicare rule that every single patient admitted to a hospital be under the care of a physician.

ANPFNPGNP · Oct 7, 2008

Not in California. AB 1436, which would have provided a scope of practice for NP's, including admitting, died in committee. California still remains the only state where NP's do not have a scope of practice that differs from that of RN's.
Unfortunately, with the powerful lobby of medical-based professional associations coupled with the belief by many NP's that their practice involves the practice of medicine and not advanced practice nursing, the powers in California, rightly so, see NP's as nothing more than RN's with a few extra hours of training who can not and should not provide advanced nursing care without the supervision by someone outside of nursing.

I believe that admitting privileges vary across hospitals, not states. I don't have admitting privileges in the hospitals where I'm credentialed, but this has to do with the hospital and certainly not the Board of Nursing rules. Also, I can't write or order controlled substances for patients in one of the hospitals, even though I can legally write them. It has to do with the various hospitals and not the Board of Nursing.

You stated that NP's have the same scope of practice as RN's in California. This doesn't make sense to me...can RN's write prescriptions and bill for their services? I don't get it, b/c I've known NP's who practice in California and they basically do the same thing I do here in TX. My scope of practice is very different from that of a RN.

Dr. Tammy, FNP/GNP-C · Oct 8, 2008

You stated that NP's have the same scope of practice as RN's in California. This doesn't make sense to me...can RN's write prescriptions and bill for their services? I don't get it, b/c I've known NP's who practice in California and they basically do the same thing I do here in TX. My scope of practice is very different from that of a RN.

DCA, California Board of Registered Nursing; "The Certified Nurse Practitioner" Form NPR-B-23 (12/04) provides:

"Legal Authority for Practice

The NP does not have an additional scope of practice beyond the usual RN scope and must rely on standardized procedures for authorization to perform overlapping medical functions (CCR Section 1485). Section 2725 of the Nursing Practice Act (NPA) provides authority for nursing functions that are also essential to providing primary health care which do not require standardized procedures. Examples include physical and mental assessment, disease prevention and restorative measures, performance of skin tests and immunization techniques, and withdrawal of blood, as well as authority to initiate emergency procedures.

Unfortunately, due to the influence related to the power structures of medical model-based professional associations coupled with the fragmented system of beliefs of many NP's in that they feel they are practicing medicine instead of advance nursing, it remains unclear if NP's will ever have their own scope of practice. Hopefully, one day when all NP's appreciate the fact their practice is nursing-informed, is nursing based, is nursing-directed, and is nursing-guided perhaps NP's will then have their own scope of practice.

Incidentally, in California, NP's are not allowed to prescribe medications, because this is a medical function in the eyes of California Law. Of course, dentists, optometrists and others may prescribe, NP's may only "furnish" medications--that is to make preparations available to patients.

JDCitizen · Oct 8, 2008

DCA, California Board of Registered Nursing; "The Certified Nurse Practitioner" Form NPR-B-23 (12/04) provides:
"Legal Authority for Practice
The NP does not have an additional scope of practice beyond the usual RN scope and must rely on standardized procedures for authorization to perform overlapping medical functions (CCR Section 1485). Section 2725 of the Nursing Practice Act (NPA) provides authority for nursing functions that are also essential to providing primary health care which do not require standardized procedures. Examples include physical and mental assessment, disease prevention and restorative measures, performance of skin tests and immunization techniques, and withdrawal of blood, as well as authority to initiate emergency procedures.

MAC (Medical association of California) is probably laughing about this all the way to the bank...

Unfortunately, due to the influence related to the power structures of medical model-based professional associations coupled with the fragmented system of beliefs of many NP's in that they feel they are practicing medicine instead of advance nursing, it remains unclear if NP's will ever have their own scope of practice. Hopefully, one day when all NP's appreciate the fact their practice is nursing-informed, is nursing based, is nursing-directed, and is nursing-guided perhaps NP's will then have their own scope of practice.

Over simplification (but still some truth).....

Does that mean when I order a test, a medication or a procedure I am not acting like a nurse?? Nurses are patient advocates and if nurses have to bump up the care they give to a higher level to be that advocate, so be it.

I don't believe I have to live by an outdated ideology that it's medicine's (doctor's) sole purview to be the only ones that can diagnose and prescribe...

Incidentally, in California, NP's are not allowed to prescribe medications, because this is a medical function in the eyes of California Law. Of course, dentists, optometrists and others may prescribe, NP's may only "furnish" medications--that is to make preparations available to patients.

Wow; I thought California was supposed to be the trend sitter? In this case I hope not.

Admission privileges: I myself don't want them. Will help with them but hot the whole thing...

Editorial Team / Admin · Oct 9, 2008

Incidentally, in California, NP's are not allowed to prescribe medications, because this is a medical function in the eyes of California Law. Of course, dentists, optometrists and others may prescribe, NP's may only "furnish" medications--that is to make preparations available to patients.

Prescription privileges are allowed in all 50 states.

Here is the updated link to prescribing practices of NPs in California:

California
General authority to prescribe is evidenced by inclusion on the prescription of the prescriber's title and state-issued Rx #
State pharmacy law requires that Rx labels show collaborating physician's name
Authority to prescribe controlled substances includes Schedule II-V as specified in collaborative practice agreement

http://www.medscape.com/viewarticle/440315

ANPFNPGNP · Oct 9, 2008

Incidentally, in California, NP's are not allowed to prescribe medications, because this is a medical function in the eyes of California Law. Of course, dentists, optometrists and others may prescribe, NP's may only "furnish" medications--that is to make preparations available to patients.

So, NP's can't even write prescriptions in California?? I thought NP's had prescription privileges in every state. This is news to me.

Editorial Team / Admin · Oct 9, 2008

Note above post ANPFNPGNP.

Dr. Tammy, FNP/GNP-C · Oct 9, 2008

So, NP's can't even write prescriptions in California?? I thought NP's had prescription privileges in every state. This is news to me.

Unfortunately, no--California Statute and Regulation does not provide that NP's may "prescribe." I have read, however, many authority position articles and paper that indicate that NP's have prescription privileges in all 50 states.

In California, making meds and devices available is called "furnishing"

It sure seems to me that if something smells like, walks like, and talks like a duck, it should be called a duck, but in California, they call it a pigeon.

Please let me know if you find any provision that provides "prescription" authority for NP's in California other than the the term "furnishing".

Here's an excerpt from the BRN's form NPR-B-23, as cited above:

"Furnishing

B&P Code Section 2836.1 authorizes NPs to obtain and utilize a "furnishing number" to furnish drugs

and/or devices. Furnishing is defined as "the act of making a pharmaceutical agent or agents available

to the patient in strict accordance with a standardized procedure." Furnishing is carried out according to

a standardized procedure and a formulary may be incorporated. The furnishing or ordering of drugs and

devices occurs under physician and surgeon supervision. B&P Code Section 2836.1 extends the NP,

who is registered with the United States Drug Enforcement Administration, the furnishing authority to

include Schedule II through V Controlled Substances under the Uniform Controlled Substance Act and.

(AB 1196 Montanez, Chapter 748 effective January 1, 2004).

Drugs and/or devices furnished by a NP may include Schedule II through Schedule V controlled substances

under the California Uniform Controlled Substances Act (Division 10 commencing with Section 11000) of the

Health and Safety Code and shall be further limited to those drugs agreed upon by the NP and physician and

specified in the standardized procedure.

When Schedule II or III controlled substances, as defined in Section 11055 and 11056 of the Health and Safety

Code, are furnished or ordered by a NP, the controlled substance shall be furnished or ordered in accordance

with a patient-specific protocol approved by the treating or supervising physician. For Schedule II controlled

substances protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis

of illness, injury, or condition for which the Schedule II controlled substance is to be furnished. A copy of the

section for the NP's standardized procedure relating to controlled substances shall be provided upon request to

any licensed pharmacist who dispenses drugs or devices when there is uncertainty about the furnishing

transmittal order.

The nurse practitioner with an active furnishing number, who is authorized by standardized procedure or

protocols to furnish Schedule II controlled substances, and are registered with the United States Drug

Enforcement Administration, shall complete, as part of their continuing education requirements, a course

including Schedule II controlled substances based on the standards developed by the BRN.

Business and Professions Code Section 2725.1 extends the NP's furnishing authority to dispense drugs,

including controlled substances, pursuant to standardized procedures or protocols in primary,

community, and free clinics. Also amended into Section 2836.1 is the term "order". The law changes

furnishing to mean "order" for a controlled substance, and can be considered the same as an "order"

initiated by the physician. This law requires the NP who has a furnishing number to obtain a DEA

number to "order" controlled substances, Schedule II, IV, V. (AB 1545, Chapter 914 (Correa) and SB

816, Chapter 749 (Escutia). Effective January 1, 2000)

A prescription pad may be used as transmittal order forms as long as they contain the furnisher's name

and furnishing number. Pharmacy law requires a physician's name on the drug and/or device container

label. The DEA number is required for controlled substances. Therefore, inclusion of this information

on the transmittal order form will facilitate dispensing of the drug and/or device by the pharmacist.

Effective January 1,2003, B&P Code Section 2836.1 Furnishing is amended to allow NPs to use their furnishing

authority in solo practice per Senate Bill 933 (Figueroa) Chapter 764 signed by Governor Gray Davis on

September 20, 2002.

JDCitizen · Oct 9, 2008

Unfortunately, no--California Statute and Regulation does not provide that NP's may "prescribe." I have read, however, many authority position articles and paper that indicate that NP's have prescription privileges in all 50 states.
In California, making meds and devices available is called "furnishing"
It sure seems to me that if something smells like, walks like, and talks like a duck, it should be called a duck, but in California, they call it a pigeon.
Please let me know if you find any provision that provides "prescription" authority for NP's in California other than the the term "furnishing".
Here's an excerpt from the BRN's form NPR-B-23, as cited above:
"Furnishing
B&P Code Section 2836.1 authorizes NPs to obtain and utilize a "furnishing number" to furnish drugs
and/or devices. Furnishing is defined as "the act of making a pharmaceutical agent or agents available
to the patient in strict accordance with a standardized procedure." Furnishing is carried out according to
a standardized procedure and a formulary may be incorporated. The furnishing or ordering of drugs and
devices occurs under physician and surgeon supervision. B&P Code Section 2836.1 extends the NP,
who is registered with the United States Drug Enforcement Administration, the furnishing authority to
include Schedule II through V Controlled Substances under the Uniform Controlled Substance Act and.
(AB 1196 Montanez, Chapter 748 effective January 1, 2004).

Drugs and/or devices furnished by a NP may include Schedule II through Schedule V controlled substances
under the California Uniform Controlled Substances Act (Division 10 commencing with Section 11000) of the
Health and Safety Code and shall be further limited to those drugs agreed upon by the NP and physician and
specified in the standardized procedure.

When Schedule II or III controlled substances, as defined in Section 11055 and 11056 of the Health and Safety
Code, are furnished or ordered by a NP, the controlled substance shall be furnished or ordered in accordance
with a patient-specific protocol approved by the treating or supervising physician. For Schedule II controlled
substances protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis
of illness, injury, or condition for which the Schedule II controlled substance is to be furnished. A copy of the
section for the NP's standardized procedure relating to controlled substances shall be provided upon request to
any licensed pharmacist who dispenses drugs or devices when there is uncertainty about the furnishing
transmittal order.

The nurse practitioner with an active furnishing number, who is authorized by standardized procedure or
protocols to furnish Schedule II controlled substances, and are registered with the United States Drug
Enforcement Administration, shall complete, as part of their continuing education requirements, a course
including Schedule II controlled substances based on the standards developed by the BRN.

Business and Professions Code Section 2725.1 extends the NP's furnishing authority to dispense drugs,
including controlled substances, pursuant to standardized procedures or protocols in primary,
community, and free clinics. Also amended into Section 2836.1 is the term "order". The law changes
furnishing to mean "order" for a controlled substance, and can be considered the same as an "order"
initiated by the physician. This law requires the NP who has a furnishing number to obtain a DEA
number to "order" controlled substances, Schedule II, IV, V. (AB 1545, Chapter 914 (Correa) and SB
816, Chapter 749 (Escutia). Effective January 1, 2000)

A prescription pad may be used as transmittal order forms as long as they contain the furnisher's name
and furnishing number. Pharmacy law requires a physician's name on the drug and/or device container
label. The DEA number is required for controlled substances. Therefore, inclusion of this information
on the transmittal order form will facilitate dispensing of the drug and/or device by the pharmacist.

Effective January 1,2003, B&P Code Section 2836.1 Furnishing is amended to allow NPs to use their furnishing
authority in solo practice per Senate Bill 933 (Figueroa) Chapter 764 signed by Governor Gray Davis on
September 20, 2002.

So it's all about semantics? Any other profession allowed to furnish?

I must say it's interesting and more than a bit frustrating to read about the never ending mosaic (mishmash) groups of laws NP's must wade through....