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APRN Frequently Asked Questions

A:  No.

Oregon Administrative Rule Division 50 provides guidance on the scope of practice for each of the population focus areas for which nurse practitioners (NPs) are licensed by the Board.  There is no “generalist" NP state license as the education programs are focused on specialty populations.  The educational preparation and national certification for the Adult-Gero NP does not include care for children.  Adult-Gero NPs who wish to expand their scope-of-practice to include children should complete an academic program in this area to become a pediatric NP or a family NP and obtain the required national certification and state licensure.  All NPs are responsible for understanding the limits on their scope of practice related to the population focus area and provide care only when the needed knowledge, skills, and abilities are present to proceed safely.

The linked article is a helpful review of scope-of-practice concepts for APRNs: Sentinel Article – What to Consider When Expanding Scope of Practice (May, 2019)
A:  Yes, within the population focus for which you hold licensure and national certification (in this case, pediatrics).

It is not unusual for APRNs to work with a specific client population within their overall population focus.  A PNP may provide care mainly to pediatric oncology clients, for example, and may seek continuing education specific to that specialty after completion of the PNP education and national certification.  Note that additional training beyond the formal educational program must still be linked to the appropriate scope of practice for the NP's population focus as defined by the Nurse Practice Act.  For example, the PNP cannot provide care to adults with oncology diagnoses based on completing continuing education classes on conditions seen in adults nor can this type of NP be trained to care for adults through an employer-based program.

The NP who specializes in an area of care should seek continuing education to ensure the needed knowledge, skills, and abilities to work with a sub-population are present.  Division 45 of the NPA requires NPs to retain documentation of how specialty knowledge has been obtained. 

This concept is supported by the National Council for State Boards of Nursing's Consensus Model for APRN Regulation.  This model notes that specialty preparation cannot replace formal educational preparation in a population focus area and cannot expand the scope of practice beyond the original population focus. 

The linked article is a helpful review of scope-of-practice concepts for APRNs: Sentinel Article – What to Consider When Expanding Scope of Practice (May, 2019)

A:  It depends.

The nurse practitioner must always function within the population focus that links to their academic education and national certification.  Within that population, the NP may engage in a variety of interventions.  The Board has developed a Scope-of-Practice Decision-Making Guideline​ to assist nurses to consider key questions before proceeding with interventions that may be part of care in a given area.

As the first question in the Decision-Making Guideline asks, the NP must examine whether existing laws or rules, that may be within another regulatory board's jurisdiction, prohibits others from being involved in the intervention.  Other boards may have specific requirements for those carrying out interventions and, when present, the NP must be able to show that she/he meets those requirements.  In some cases, other boards have language in their laws/rules that exempt Board of Nursing licensees from their rules.  But, the Nurse Practice Act does not define specific interventions that are within the scope-of-practice, nor those that are prohibited.

The Board of Nursing expects that NPs would be able to show that they have completed requirements comparable to those defined by other regulatory boards or state law for gaining knowledge, skills, and abilities and meeting safety standards (e.g. certifications, continuing education).  For example, the PNP-PC who wants to work with pediatric clients on the Autism spectrum should review the Oregon Health Licensing Office's requirements for Behavioral Analysis Interventionists and plan to meet comparable requirements.

The linked article is a helpful review of scope-of-practice concepts for APRNs: Sentinel Article – What to Consider When Expanding Scope of Practice (May, 2019)
​A:  It depends on individual preparation, current competency and the setting's hiring policies.

An FNP may provide care within the population associated with this type of academic preparation, national certification, and state licensure, which includes providing health care across the lifespan. Most FNP programs prepare primary care providers and the focus of the national certification examinations is on primary care, however.

Employers in acute care may set the expectation for graduate level preparation and national certification as an Acute Care NP. The FNP would need to seek additional training to develop competencies for the provision of care to acutely ill clients or may need to obtain a post-master's certificate in acute care. Should any question of competency arise, the FNP would need to provide evidence of all completed education and competency validation pertinent to the provision of acute care at the advanced practice level.  The FNP is an independent licensed practitioner; therefore, “working under the supervision of a physician" does not replace education and competency validation in the management of acutely ill patients.  A physician works alongside an FNP, but does not supervise the practice of nursing at the advanced level.

​A:  No. NPs are licensed independent practitioners (LIPs) in Oregon and do not function under an agreement with a physician.

Recognition as a LIP means that the NP is accountable for their own diagnostic/treatment decisions.  There is no requirement for a supervisory/collaborative agreement with a physician, nor would such an agreement protect the NP in terms of accountability to the Board.  The NP may not expand their scope of practice outside of the designated population focus/area of licensure based on having oversight from a physician.

Please note that facilities may establish medical staff bylaws and procedures that include a link to a supervising physician for those practitioners with admitting privileges.  The NP seeking privileges would be expected to follow applicable bylaws and facility policies.

​A:  It depends on the type of care facility and the organizational policies for credentialing and privileging.

The Board of Nursing does not define the organizational processes for credentialing and privileging.  Since the NP is a licensed, independent practitioner in Oregon, the Nurse Practice Act does not prohibit NPs from making decisions about the need for a client to be admitted for a particular type of care.

In some cases, state or federal laws limit particular areas of care to physicians, such as certifying/recertifying a client for Hospice care.  Specific organizations may set limitations on scope of practice but may not expand scope of practice beyond that designated by the Board and applicable state and federal laws.  Oregon Revised Statute 441.064 provides more information.

​A:  The best resources are found on the Board's Advanced Practice information page and Division 56 of the Oregon Administrative Rules.
A:  Possibly.

There is currently no prohibition in the Nurse Practice Act to the NP accepting a family member as a client.  Care provided to all clients must be appropriate to the population focus of the NP's state licensure and national certification, and must be based on assessment and appropriate decision-making for management of the client's condition.  Maintenance of professional boundaries requires diligent attention when providing care to a family member.

Treatment of a family member requires the establishment of a client/practitioner relationship.  The family relationship does not negate this responsibility.  Appropriate documentation must exist describing the assessment, conclusions, decision-making, and plan for follow-up.

In addition, the NP is expected to analyze the appropriateness of providing care to a family member based on the particular situation and whether the client's needs would be best met by another practitioner.  Convenient access to the NP is not an appropriate basis for the decision to accept a family member as a client.

Other state and/or federal laws may prohibit the provision of care by the NP to family members in areas such as substance abuse treatment and making a determination of the need for emergency mental health care/involuntary hold. 

​A:  Yes.

 Oregon law includes nurse practitioners in the definition of those who may initiate admission of an individual for emergency mental health care.  See Oregon Revised Statute (ORS) 426.232 and related definitions.  The NP would be expected to follow those laws that define the processes associated with commitment proceedings/involuntary holds.

​A:  Possibly.

The Nurse Practice Act does not use the term “medical director" related to the scope of practice for NPs.  As a licensed, independent practitioner (LIP), the NP may function in a position of authority over the provision of care.  Specific laws and/or facility organizational structure may dictate the level of education, certification, or licensure for those in a “medical director" role or other title with ultimate responsibility for oversight of client care.
​A:  Yes.

The Nurse Practice Act specifically states that the NP is authorized to complete and sign reports of death. The NP is expected to comply with all provisions in this area as defined in state law (Oregon Revised Statute 432.133).

​A:  No.

NPs may not order the medications utilized for an individual who seeks to activate death with dignity protocols per Oregon Revised Statute.  A physician or doctor of osteopathy must be involved in the care of a client asking to pursue this option.

A:  There are several steps to take. 

The Nurse Practice Act sets the following expectations for the NP who terminates a client relationship or closes a practice which come from statements about conduct considered to be derogatory.  The NP needs to:
  • Notify clients of termination of the client relationship or closure of a practice.
  • Review medications and consider maintenance of prescriptions to cover transition time, if appropriate.
  • Arrange for maintenance of records, if closing a practice.  
  • Release medical records to clients within sixty days of receipt of a written request for such release (which may occur after notification of termination of the relationship with the client).
Additional information is found in a Sentinel article on this topic published in September of 2012.

Seeking legal counsel related to the closure of a practice may be appropriate as there are multiple considerations.  LIPs should consider at least these areas:
  • Timely notice of termination – sources recommend at least 60 days notice.  Consideration of availability of other practitioners to assume care may mean a longer notice period is necessary.
  • Length of record retention - seven years is a commonly recommended length of time for record retention.  Record retention for NPs involved in births or care of minors need to consider record retention for seven years past the age of majority.
  • Access to records – establishing a method for archiving records and allowing for access may be set up through a vendor.  Storage needs to be secure and allow for retrieval of records. The Board does not retain records for practitioners.
  • Notify pertinent parties of practice closure – includes the Board, insurance carriers, the Drug Enforcement Agency (if a DEA number exists), insurance panels, and the Center for Medicare/Medicaid Services (National Provider Identifier).
  • Destroy all prescription pads with provider identification.

​A:  Not at this time.

Expectations to hold the DNP are changing in the field; however, many educational institutions offer only a DNP-level exit for APRN programs and national certification bodies may require the DNP for first-time candidates on/after a specific date.  Employers or insurance providers may also expect the DNP for APRNs seeking credentialing/privileging.

​A:  Yes, with clarification that the doctorate is in nursing. 

A doctorate is an academic degree and is separate from the licensure title (e.g. PMHNP).  The nurse who has either a PhD or a DNP degree may introduce themselves as a doctor, because they have academically earned that right.  But, Oregon law requires that individuals in healthcare professions also identify their license type.  An introduction to a client might be: “Hello, I am Dr. Jones, a Family Nurse Practitioner."  Published materials where the title 'doctor' is used, such as business cards or website information, need to include the license type as well as the degree.

​A:  This is not defined by the Nurse Practice Act.

The Nurse Practice Act does not state exact age ranges for those considered to be adolescents or adults.  The Consensus Model for APRN Regulation and certification bodies also refrain from stating exact age ranges. The APRN whose scope of practice includes specific age groups may use current literature to support their decision-making on appropriate clients to include/exclude from their practice.  An analysis of one's own competency to provide care for a particular client may also inform this analysis.  Those APRNs who care for pediatric clients will want to develop processes for transitioning care to an adult-level provider as a client ages.

​A:  No. The CNM has a scope of practice limited to the care of women focusing on pregnancy, childbirth, the postpartum period, care of the newborn, and family planning and gynecological needs of women.  The CNM may see male partners of their clients related to sexually transmitted diseases.

The Nurse Practice Act includes information on the scope of practice for each of the recognized specialty areas for nurse practitioners.  All NPs are expected to limit practice based on their population-focused specialty linked to completed education and national certification.  The Board has developed an interpretive statement to further address this issue

​A:  Yes, if the NP recognizes this is an expanded RN role (rather than an advanced practice role), and if the NP has the needed training as an RNFA.

The NP may have a role in the perioperative period that fits within the NP's population focus area.  This may include involvement in surgical procedures if the NP has completed training in this area.  No academic NP program includes training in surgical procedures.  If the expected role is really the RNFA role, the NP needs to pursue the appropriate training as an RNFA and would not count the hours functioning as an RNFA toward the required hours for renewal of the NP license.  The Nurse Practice Act defines the requirements for those functioning in the RNFA role: (a) completion of an RNFA program that meets the Association of Perioperative Nurses standards; (b) practicing under the direction of the surgeon and not concurrently functioning in multiple roles; and (c) practicing under the direct supervision of the surgeon. 

Please note that to bill separately as an RNFA, the RNFA must be registered as such with the Board of Nursing.  The Board has developed an interpretive statement on the RNFA role to clarify these requirements

​A: No. Oregon Marijuana laws state that any discussion regarding the use of marijuana and marijuana-derived products such as CBD oil, to alleviate symptoms of injury or illness is not recreational use and is limited to physicians.

Oregon Revised Statute (ORS) 475B.015 (28) defines marijuana used to mitigate symptoms or effects of a debilitating medical condition as “medical purpose" marijuana use.  ORS 333-008-0010 defines debilitating medical conditions as: Cancer, Glaucoma, degenerative or pervasive neurological conditions, and HIV status, AIDS status, or a side effect related to the treatment of those medical conditions.  In addition, a medical condition or treatment for a medical condition that produces for a specific patient one or more of the following: Cachexia, severe pain, severe nausea, seizures including, but not limited to, those caused by epilepsy, persistent muscle spasms, Post Traumatic Stress Disorder, or any other disorder or side effect related to the treatment of a medical condition adopted by the Oregon Health Authority by rule or by petition. These rules would identify the use of marijuana for the alleviation of symptoms related to a medical condition as using marijuana for a medical purpose, not recreational.

ORS 333-008-0010 (56) (c) states that the Nurse Practitioner must utilize a physician (either a primary care physician or a specialist) as a consultant who has the legal accountability to review the patient's medical records to determine if the patient's disease or symptoms could be helped through the use of medical marijuana and is authorized to follow Oregon Medical Marijuana laws or procedures regarding the patient's ability to obtain marijuana for medical purposes.  The law, then, prohibits Nurse Practitioners from having the independent decision making authority to recommend the use of marijuana for a medical condition or the alleviation of symptoms associated with a medical condition.

Use of CBD products derived from the cannabis plant for the alleviation of symptoms related to a medical condition is also considered a “medical cannabinoid product," and all laws and rules regarding medical marijuana also apply to CBD.  The concern about CBD is that it is primarily marketed as a supplement and not a medication; as the Federal Food and Drug Administration (FDA) does not regulate supplements, the APRN who recommends CBD as a product for “overall health" rather than to relieve specific symptoms would be accountable for any outcome experienced by the patient based on their recommendation.  This is a very grey area of the law and APRNs are cautioned against the belief that CBD derived from marijuana does not fall into the same category as THC containing marijuana products.

Please see the Sentinel Article published in August 2019.

Additional Advanced Practice FAQ Topics

If you cannot find the information you need at one of the links above, access the OSBN interactive scope-of-practice decision guide (PDF version), the OSBN interpretive practice statements, or the Nurse Practice Act

The Board does not answer any practice questions by phone or questions sent to the general OSBN e-mailbox.  You may submit a written practice question to Board Staff.  However, if your question is answered in the FAQs or in a practice statement, you will be directed back to the website.  Please allow up to four weeks for a response to your inquiry.