(1) Board of Medical
Examiners: The State Board of Medical Examiners established pursuant to Code of
Ala. 1975, §
34-24-53.
(2) Board of Nursing: The Board of Nursing
established under Code of Ala. 1975, §
34-21-2.
(3) Advanced Practice Nurse in Collaborative
Practice: A registered nurse who has gained additional knowledge and skills
through successful completion of an organized program of nursing education that
prepares nurses for advanced practice roles and has been approved by the Board
of Nursing to engage in the practice of advanced practice nursing. Two
categories of advanced practice nurses are subject to the requirements of
collaborative practice:
(a) Certified
registered nurse practitioners (CRNP).
(b) Certified nurse midwives (CNM).
(4) Advanced Practice
Nursing-collaborative practice:
The delivery of health care services by registered nurses who
have gained additional knowledge and skills through successful completion of an
organized program of nursing education that prepares nurses for advanced
practice roles as certified registered nurse practitioners or certified nurse
midwives:
(a) Practice as a certified
registered nurse practitioner (CRNP) is the performance of nursing skills by a
registered nurse who has demonstrated by certification advanced knowledge and
skills in the delivery of nursing services within a health care system that
provides for consultation, collaborative management or referral as indicated by
the health status of the client.
(b) Practice as a certified nurse midwife
(CNM) is the performance of nursing skills by a registered nurse who has
demonstrated by certification advanced knowledge and skills relative to the
management of women's health care focusing on pregnancy, childbirth, the
postpartum period, care of the newborn, family planning and gynecological needs
of women, within a health care system that provides for consultation,
collaborative management or referral as indicated by the health status of the
client.
(5)
Collaboration: A formal relationship between one or more certified registered
nurse practitioners or certified nurse midwives and a physician or physicians
under which these nurses may engage in advanced practice nursing as evidenced
by written protocols approved according to the requirements of Code
of Ala. 1975, Section
34-21-80 et seq. or exempted according to requirements of this statute. The term
collaboration does not require direct, on-site supervision of the activities of
a certified registered nurse practitioner or a certified nurse midwife by the
collaborating physician. The term does require such professional medical
oversight and direction as may be required by the rules and regulations of the
Board of Nursing and the State Board of Medical Examiners.
(6) Physician or Collaborating Physician: A
doctor of medicine or a doctor of osteopathy licensed to practice medicine in
Alabama who agrees in writing to practice in collaboration with one or more
certified registered nurse practitioners or certified nurse midwives according
to the rules and regulations adopted by the Board of Nursing and the State
Board of Medical Examiners.
(7)
Joint Committee Of The Board Of Nursing And The State Board Of Medical
Examiners For Advanced Practice Nurses.
The Joint Committee of the Board of Nursing and the State Board
of Medical Examiners for Advanced Practice Nurses is a committee composed of
the following, pursuant to Code of Ala. 1975, section
34-21-80 et seq.
(a) Two physicians licensed to
practiced medicine in the State of Alabama;
(b) One registered nurse licensed to practice
professional nursing in the State of Alabama;
(c) One licensed physician engaged in
collaborative practice with a certified registered nurse practitioner or a
certified nurse midwife in the State of Alabama;
(d) One certified registered nurse
practitioner engaged in advanced practice nursing with a physician in the State
of Alabama; and Nursing
(e) One
certified nurse midwife engaged in advanced practice with a physician in the
State of Alabama.
(8)
Legend Drug: Any drug, medicine, chemical or poison bearing on the label the
words, "Caution, federal law prohibits dispensing without prescription" or
similar words indicating that such drug, medicine, chemical, or poison may be
sold or dispensed only upon the prescription of a licensed practitioner, except
that the term legend drug will not include any drug, substance, or compound
which is listed in Schedules I through V of the Alabama Uniform Controlled
Substances Act.
(9) Prescribe or
prescribing. The act of issuing a prescription for a legend drug.
(10) Prescription: An order for a legend drug
which is issued and signed by a practitioner authorized by law to prescribe and
administer such drugs and is intended to be filled, compounded, or dispensed by
a pharmacist.
(11) Protocol: A
document approved according to Code of Ala. 1975,
Section
34-21-81,
establishing the permissible functions and activities to be performed by
certified registered nurse practitioners and certified nurse midwives and
signed by collaborating physicians and any nurse practitioners or nurse
midwives practicing with those physicians.
(12) Medical Oversight: Concurrent and
on-going collaboration between a physician and a CRNP or CNM and documentation
of time together in a practice site; may include but is not limited to direct
consultation and patient care, discussion of disease processes and medical
care, review of patient records, protocols and outcome indicators, and other
activities to promote positive patient outcomes.
(13) Quality Assurance: Documented evaluation
of the clinical practice of the certified registered nurse practitioner or
certified nurse midwife against defined quality outcome measures, using a
meaningful selected sample of patient records, which will identify areas
needing improvement, set performance goals, and assess progress towards meeting
established goals, with a summary of findings, conclusions, and, if indicated,
recommendations for change. The physician's signature on the patient record
does not constitute quality improvement monitoring.
(14) Principal Practice Site: The main
location at which the collaborating physician is engaged in the practice of
medicine.
(15) Remote Practice
Site: An approved site for collaborative practice without an approved
collaborating or covering physician on-site. The collaborating physician's
principal practice site, acute care hospitals, skilled nursing facilities,
licensed special-care assisted living facilities and licensed assisted living
facilities are not remote practice sites for the purpose of these
rules.
(16) Readily Available:
Response by the collaborating or covering physician by telephone,
telecommunication, or radio for consultation, referral, or direct medical
intervention as indicated by the needs of a patient and based on usual and
customary standards of medical practice.
(17) Direct Medical Intervention: Physical
presence of a physician to attend the patient as defined in the collaborative
practice protocol.
(18) Covering
Physician. A doctor of medicine or a doctor of osteopathy licensed to practice
medicine in Alabama who agrees in writing to be readily available to
collaborate with and provide medical oversight to one or more certified
registered nurse practitioners or certified nurse midwives and, if indicated,
to provide medical intervention to patients during the absence of the
Collaborating Physician. The covering physician shall be either a member of the
same medical practice, practice group, or multidisciplinary medical team, or of
the same or similar practice specialty as the collaborating physician and shall
abide by the rules and regulations adopted by the Board of Nursing and the
Board of Medical Examiners.