Advanced Practice Registered Nurses
- Certified Nurse Midwife Practice and Prescriptive Authority
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Full independent practice and prescriptive authority.
Nurse midwives shall practice within a health care system and have clinical relationships with obstetrician-gynecologists that provide for consultation, collaborative management or referral, as indicated by the health status of the patient. Nurse midwifery care shall be consistent with the standards of care established by the American College of Nurse Midwives.
Nurse midwives may engage in prescriptive practice without guidelines or supervision. Code Mass. Reg. §244-4.06; Code Mass. Reg. §244-4.07
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- Nurse Practitioner Practice and Prescriptive Authority
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Full practice authority but transition to independent prescribing authority.
A NP will only practice in the clinical category(s) for which the CNP has attained and maintained certification. NPs with less than two years of experience need guidelines for prescriptive practice and will be supervised by a Qualified Healthcare Professional (physician or NP with independent practice authority). After this period, the NP may independently prescribe. Code Mass. Reg. §244-4.07
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- Nurse Practitioner Authority to Sign POLST Forms
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Although not codified, NPs are authorized to sign medical orders for life-sustaining treatment (MOLST) forms. Please see the Massachusetts MOLST website for more information.
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- Nurse Practitioner as a Primary Care Provider
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NPs are recognized in state policy as primary care providers. If a health care carrier requires the designation of a primary care provider, the carrier must provide its insured with an opportunity to select a participating provider nurse practitioner as a primary care provider or to change its primary care provider to a participating provider nurse practitioner at any time during their coverage period. Mass. Gen. Laws Ann. tit. 22 ch.176R §4
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- CRNA Practice and Prescriptive Authority
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Full independent practice authority; transition to prescribing period required.
Massachusetts opted out of the CRNA federal supervision requirement in 2024.
A CRNA may only practice in the clinical category or categories for which the CRNA has attained and maintained certification. CRNAs may attain additional competencies within a category consistent with the scope and standards of CRNA practice. It is the responsibility of each CRNA to maintain records of competency-based training and submit evidence to the nursing board upon request. 244 Code Mass. Regs. § 4.06
CRNAs are eligible to register for prescriptive authority. CRNAs shall have independent practice authority to issue written prescriptions and medication orders and order tests and therapeutics without the supervision if they have two years of supervised practice by a board-qualified health care professional following certification from a board-recognized certifying body. CRNAs who do not register for prescriptive authority must develop mutually agreed upon “protocols” with a “physician responsible for the care of the patient” to administer anesthesia. Mass. Gen. Laws ch. 112, § 80H and Code Mass. Reg. §244-4.06
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