APRN Licensure in Massachusetts

Certification and Licensure

Once a nursing student completes an advance nurse practitioner program, the next steps are to obtain certification and licensure. The specific certification will be based on the individual’s preference and educational focus. There are two types of certifications in which an advanced practice registered nurse (APRN) student may choose; the American Nurse Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP). Although certification may not be required for all states, it is nationally required for the APRN to participate in Medicare and Medicaid (Phillips, 2020). Once the certification process is completed, the APRN must obtain licensure to practice in the state of work. If the APRN is considering moving to a different state requiring reciprocity, RN reciprocity must be obtained prior. The purpose of this discussion is to explore the APRN licensure process in the Massachusetts (MA) and understanding the scope of practice and regulations in the state.

APRN Licensure in Massachusetts

The state of MA requires the APRN to apply for licensure to practice. According to the Commonwealth of Massachusetts’ website (2021a), the APRN student must possess a valid registered nurse license in good standing, certification from an approved national certification organization, submit official transcripts, provide acknowledgment of good moral character, and an application fee of $150. The APRN student seeking licensure can apply online via the Commonwealth of MA website https://www.mass.gov/how-to/apply-for-aprnauthorization or by mail (Commonwealth of Massachusetts, 2021a). Massachusetts authorizes five APRN clinical categories: Nurse Practitioners (CNP), Certified Nurse-midwives (CNM), Certified Nurse Anesthetists (CRNA), Psychiatric Clinical Nurse Specialists (PCNS), and Clinical Nurse Specialists (CNS). However, a CNS does not have the authority to order medications, treatments, and therapeutics for their patients (Commonwealth of Massachusetts, 2021c).

The scope of practice for the APRN in MA states that each APRN is responsible and accountable for their nursing judgments, actions, and competency. APRN scope of practice consists of a collaborative practice agreement with a physician and requires the APRN to have physician supervision throughout their career. The physician supervision is allowed in the following: the overseeing physician is not required to be on site, but must be available by phone or in person to ensure safe patient care; the MA APRN has prescriptive authority under the practice agreement with the physician and requires separate Drug Enforcement Agency (DEA) license which gives authority to prescribe controlled substances in schedules II through V and the APRN must enroll in the Massachusetts Prescription Monitoring Program (Commonwealth of Massachusetts, 2021b). However, as of September 3, 2021, some changes have been incorporated. Phillip (2021), highlights these changes as outlined in 244 CMR 4.07 (2):
(a) CRNAs, CNPs, PNMHCSs with a minimum of two years of supervised practice may engage in prescriptive practice without supervision upon submission of an attestation to the Board that the CRNA, CNP or PNMHCS has completed a minimum of two years of supervised practice by a Qualified Healthcare Professional.
Per 244 CMR 4.07 (d), a Qualified Healthcare Professional is defined for APRNs as:
2. a CRNA, CNP or PNMHCS who holds:
a. a valid Registered Nurse license in good standing issued by the Board; and
b. advanced practice authorization issued by the Board that it is in the same clinical category as the person being supervised or advanced practice authorization in an area appropriately related to the practice of the person being supervised; and

3. a controlled substance registration issued by the U.S. Drug Enforcement Administration, or the Department of Public Health, or both, for a minimum of one year;
and
four. either:
a. a combination of supervised practice for a minimum of two years plus independent practice authority for a minimum of one year; or
b. three years of independent practice authority (Massachusetts Coalition of Nurse Practitioners, n.d.).

APRN Independent Practice: The Impact of Regulations and Barriers in Massachusetts

Massachusetts was formerly the most restrictive practice setting in the United States, however with the recent changes in place, it is granting more APRNs in MA the ability to provide independent care and practice with full authority, creating the ability to full autonomy in the care of patients (Massachusetts Coalition of Nurse Practitioners, n.d.).

Conclusion

            After researching the MA APRN practice laws and regulations, I was pleasantly surprised to learn about the changes to independent practice and I am looking forward to the new authority that will be forthcoming.

References

Commonwealth of Massachusetts. (2021a). Apply for APRN authorization. https://www.mass.gov/how-to/apply-for-aprn-authorization.

Commonwealth of Massachusetts. (2021b). Apply for APRN prescriptive authority. https://www.mass.gov/how-to/apply-for-aprn-prescriptive-authority.

Commonwealth of Massachusetts. (2021c). Learn about advanced practice registered nurses (APRN): Information about APRN practice and clinical categories.

https://www.mass.gov/service-details/learn-about-advanced-practice-registered-nursesaprn.

Massachusetts Coalition of Nurse Practitioners. (n.d.). https://www.mcnpweb.org/.

Phillips, S. J. (2020). 32nd Annual APRN Legislative Update: Improving access to high-quality, safe, and effective healthcare. Nurse Practitioner45(1), 28–55.             https://doi.org/10.1097/01.NPR.0000615560.11798.5f

Phillips, S. J. (2021). 33rd Annual APRN Legislative Update: Unprecedented changes to APRN practice authority in unprecedented times. The Nurse Practitioner, 46(1), 27.             https://doi.org/10.1097/01.NPR.0000724504.39836.69

Identify Whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.

In the state of Massachusetts a nurse practitioner or psychiatric nurse mental health clinical specialist shall have independent practice authority to issue written prescriptions and medication orders and order tests and therapeutics without the supervision described in this subsection if the nurse practitioner or psychiatric nurse mental health clinical specialist has completed not less than 2 years of supervised practice following certification from a board-recognized certifying body; provided, however, that supervision of clinical practice shall be conducted by a health care professional who meets minimum qualification criteria promulgated by the board, which shall include a minimum number of years of independent practice authority. The board may allow a nurse practitioner or psychiatric nurse mental health clinical specialist to exercise such independent practice authority upon satisfactory demonstration of not less than 2 years of alternative professional experience; provided, however, that the board determines that the nurse practitioner or psychiatric nurse mental health clinical specialist has a demonstrated record of safe prescribing and good conduct consistent with professional licensure obligations required by each jurisdiction in which the nurse practitioner or psychiatric nurse mental health clinical specialist has been licensed.

How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in MA?

What is the application process for certification in your state?

  • Complete the Massachusetts APRN Authorization Application online
  • Request official transcript(s) from your educational program(s)
  • Request a APRN verification from all jurisdictions that you hold or have ever held a nursing license
  • Request your transcript and verification documents to be sent to an agent at the Massachusetts Board of Registration in Nursing.

   What is your state’s board of nursing website?

https://www.mass.gov/

How does MA define the scope of practice of a nurse practitioner?

Traditionally, APRNs have had to received certain permissions from physicians to deliver certain types of patient care. More recently, nationwide medical professional shortages have helped make the case for expanded scope of practice. NPs can practice at the top of their licenses; the professionals say they can deliver more care to more patients. Governor Charlie Baker recently signed a law that allows nurse practitioners to practice independently, no longer requiring supervision by a physician. Research shows that states with Full Practice Authority maintain strong safety and quality outcomes and improve both access to care and cost savings.

How do you get a DEA license?

Logging onto Mass.gov to apply for a DEA license. Submitting a DEA application including

  • A check or money order in the amount of $150 made payable to the Commonwealth of Massachusetts.
  • A copy of current practitioner license

Does your state have a prescription monitoring program (PMP)?

State law requires that all Massachusetts prescriber’s request the state Prescription Monitoring Program (PMP) database prior to every prescription for a Schedule II or III narcotic medication or a benzodiazepine (Mc Michael, 2021). All prescriber’s in Massachusetts must create a new account with this new system (even if you have an account in the current PMP) and can presently create this new required account by accessing the MassPAT website.  

How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

Guidelines are required, written instructions and procedures describing the methods that a certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), or psychiatric clinical nurse specialist (PCNS) with prescriptive authority is to follow when managing medications. The guidelines specify the instances in which referral to or consultation with a physician is required for appropriate medication management (Mc Michael, 2021). When appropriate, guidelines also address procedures for the ordering of tests and therapeutics. NPs to have prescriptive authority in Massachusetts he/she must sign a collaborative agreement specifying the NP’s scope of practice.  The nurse practitioner’s charts must be reviewed at least once every three months regarding prescribing, but no specific quantity of chart reviews is required. Prescribing authority ranges from Schedule II to Schedule IV drugs (Mc Michael, 2021).  However, if the NP prescribes Schedule II drugs, the chart must be reviewed within 96 hours. On all prescriptions, the physician’s name must be present.

What is included in your state practice agreement?

A collaborative practice agreement is a written contract that establishes a working relationship between the nurse practitioner and the physician. Often this means that the physician will provide supervision and guidance and be available for consultations with the NP. Some states may require regular face-to-face meetings or set a chart review quota. Massachusetts is a full practice state that allows Nps to work without supervision and provide clinical care to patients.

References

MCMICHAEL, B. J. (2021). Nurse Practitioner Scope-of-Practice Laws and Opioid Prescribing. The Milbank Quarterly, 99(3), 721. https://doi.org/10.1111/1468-0009.12524

https://www.mass.gov/how-to/apply-for-aprn-authorization

https://www.mass.gov/mcsr-for-individuals

ou stated that the state of Massachusetts guidelines helps with the shortage of providers. I can see where those guidelines could help; I wish the state of Texas allowed their NP’s to be more independent with their care when it comes to prescribing medications (Texas Board of Nursing, 2020). It would be interesting to compare the different states and the number of errors created with this type of authority versus the states that don’t have as much.

            I don’t know about you, but I find it interesting how states can make it so different in their rules when we all have the same education and sit for the same boards (American Association of Nurse Practitioners, 2020). One would think we all would have the same authority across the board when prescribing medications.    

            I look forward to reading more of your work throughout the next eleven weeks; good luck with your future assignments.

References:

American Association of Nurse Practitioners. (2020). State practice environment. Retrieved January 0, n.d., from https://www.aanp.org/advocacy/state/state-practice-environment.

Texas Board of Nursing. (2020). Texas Board of Nursing. Retrieved December 1, 2021, from https://www.bon.texas.gov/newaprn.asp.

When the MA  nursing board states that the NP has to complete 2 years of supervised practice after certification, is it with another PMHNP or a psychiatrist? Also, how much experience does the supervisor of the NP have to have to supervise? In Colorado, due to the shortage the NP has to complete 750 hrs of supervision according to Colo. Rev. Stat. § 12-255-112 (https://casetext.com/statute/colorado-revised-statutes/titlesection-12-255-112). Is the time being supervised a calendar year or 1260 hours which is working 40hrs/weekly such as a full time job. When I was researching this response, I found that in the Colorado the supervisor of the NP is not allowed to be paid for the supervision (https://dpo.colorado.gov/Nursing). Is that true in MA? Do you have to pay a fee for your supervisor to supervise you and if so what is it?

References:

Casetext.com. (2021). https://casetext.com/statute/colorado-revised-statutes/titlesection-12-255-112.

Colorado Board of Nursing. (2021). https://dpo.colorado.gov/Nursing.

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