3 CCR 716-1.15 - RULES AND REGULATIONS FOR PRESCRIPTIVE AUTHORITY FOR ADVANCED PRACTICE REGISTERED NURSES
A.
BASIS: The authority for the promulgation of these rules and
regulations by the State Board of Nursing ("Board") is set forth in sections
12-20-204(1),
12-255-107(1)(j),
and 12-255-112, C.R.S., of the
Colorado Revised Statutes (C.R.S.).
B.
PURPOSE: Section
12-255-112(4),
C.R.S. sets forth the legal requirements for an Advanced Practice Registered
Nurse (APRN) to obtain prescriptive authority in Colorado. First, the APRN must
obtain Provisional Prescriptive Authority. Generally, those requirements are:
1. Completion of the appropriate graduate
degree or post-graduate degree or certificate, as determined by the Board, in
the advanced practice Role and, if applicable, Population Focus;
2. Satisfactory completion of educational
requirements, as determined by the Board, in the use of controlled substances
and prescription drugs;
3. National
certification by a nationally recognized certifying body, as determined by the
Board, in the Role and, if applicable, Population Focus of the APRN, unless the
Board grants an exception; and
4.
Completion of at least three years of combined clinical work experience as a
professional nurse and/or as an APRN.
Upon receiving Provisional Prescriptive Authority, the APRN is legally authorized to prescribe medications and controlled substances schedules II-V to patients appropriate to the APRN's Role and, if applicable, Population Focus. Within three years of receiving Provisional Prescriptive Authority the APRN with Provisional Prescriptive Authority (hereinafter referred to as RXN-P) must:
5. Complete a 750 hour Mentorship with a
Physician or an Advanced Practice Registered Nurse with Full Prescriptive
Authority and experience in prescribing medications. The Physician or APRN
shall have education, training, experience and a practice that corresponds with
but need not be identical to the Role and, if applicable, Population Focus of
the RXN-P.
If the RXN-P does not complete these additional requirements within three years of receiving Provisional Prescriptive Authority such authority will expire for failure to comply with statutory requirements.
The purpose of these Rules is to further clarify each of the statutory requirements, with the exception of professional liability insurance, which can be found in Rule 1.14 of the Board's Rules and Regulations. These Rules apply only to prescribing authority and should not be construed to govern other relationships between APRNs and health care providers in other situations.
C.
DEFINITIONS
1. Accrediting
Agency: An organization that establishes and maintains standards for
professional nursing programs and recognizes those programs that meet these
standards and is recognized by US Department of Education (USDE) and/or the
Council for Higher Education Accreditation (CHEA), including the Commission on
Collegiate Nursing Education (CCNE), Accreditation Commission for Education in
Nursing (ACEN), Council on Accreditation of Nurse Anesthesia Educational
Programs (COA), and Accreditation Council for Midwifery Education.
2. Advanced Practice Registered Nurse (APRN):
A professional nurse who meets the requirements of section
12-255-111, C.R.S., who obtained
specialized education or training and is included on the Advanced Practice
Registry.
3. Advanced Practice
Registry (APR): The Board's record of those professional nurses who are granted
APRN status by the Board in accordance with section
12-255-111, C.R.S. and Rule 1.14
of the Board's Rules and Regulations.
4. Applicant: An APRN seeking Provisional
Prescriptive Authority in the same Role and, if applicable, Population Focus
for which the APRN was recognized on the APR.
5. Board: The State Board of
Nursing.
6. Certifying Body: A
non-governmental agency approved by the Board that validates by examination,
based on pre-determined standards, an individual nurse's qualifications and
knowledge for practice in a defined APRN Role and, if applicable, Population
Focus.
7. Clinical Work Experience:
Any relevant experience accumulated as a professional nurse or an advanced
practice registered nurse, including paid or unpaid work experience, volunteer
work, or student work. The gratuitous care of friends or members of the family
is not included in Clinical Work Experience.
8. DEA: Drug Enforcement
Administration.
9. Disciplinary
Sanction: Any current restriction, limitation, encumbrance or condition on the
Physician Mentor's medical license or on the RXN Mentor's nursing license,
including confidential participation in peer health assistance or an
alternative to discipline program authorized by the Mentor's licensing
board.
10. Full Prescriptive
Authority: The authority granted to the RXN to prescribe medications upon
completion of the requirements set forth in Section (F)(2) of Rule
1.15.
11. Mentor: Physician Mentor:
A person who holds a license to practice medicine in Colorado or a physician
who is otherwise exempted from licensure pursuant to section
12-240-107(3)(i),
C.R.S. The physician's license must be in good standing without Disciplinary
Sanction as defined in Section (C)(9) of Rule 1.15. The Physician Mentor must
be actively practicing medicine in the State of Colorado and shall have
education, training, experience and a practice that corresponds with but need
not be identical to the Role and, if applicable, Population Focus of the RXN-P.
The Physician Mentor must also have an unrestricted DEA registration.
12. Mentor: RXN Mentor: A professional nurse
who has met the qualifications for an APRN, is included on Colorado's APR, has
Full Prescriptive Authority in Colorado, and has experience prescribing
medications with full prescriptive authority preceding the beginning of the
Mentorship. The RXN Mentor's nursing license must be without Disciplinary
Sanction as defined in Section (C)(9) of Rule 1.15. The RXN Mentor shall have
an active practice in Colorado and shall have education, training, experience
and a practice that corresponds with, but need not be identical to, the Role
and, if applicable, Population Focus of the RXN-P. The RXN Mentor must have an
unrestricted DEA registration.
13.
Mentorship: A formal, Mutually Structured relationship between the RXN-P as
defined in Section (C)(23) of Rule 1.15, and the Physician Mentor or RXN Mentor
to further the RXN-P's knowledge, skill, and experience in
prescribing.
14. Mentorship
Agreement: A mutually structured agreement documented in writing and signed by
the RXN-P and the Mentor(s) which outlines a process and frequency for ongoing
interaction and discussion of prescriptive practice throughout the Mentorship
between the Mentor(s) and the RXN-P to assure safe prescribing
practice.
15. Mutually Structured:
Developed, implemented, and agreed upon by the RXN-P and the
Mentor(s).
16. Pathophysiology: A
minimum of three semester hours or four quarter hours completed either as part
of a degree program or in addition to a degree program at the graduate or
post-graduate level in an accredited nursing program for which graduate credit
has been awarded with an emphasis appropriate to the Role and, if applicable,
Population Focus of the APRN, including but not limited to pathophysiologic
processes of all body systems.
17.
Pharmacology: A minimum of three semester credit hours or four quarter hours
completed either as part of a degree program or in addition to a degree program
at the graduate or post-graduate level in an accredited nursing program for
which graduate credit has been awarded with an emphasis appropriate to, but
need not be identical to the Role and, if applicable, Population Focus of the
APRN, including but not limited to the study of pharmacotherapeutics and
pharmacokinetics of broad categories of pharmacological agents.
18. Physical Assessment: A minimum of three
semester hours or four quarter hours completed either as part of a degree
program or in addition to a degree program at the graduate or post-graduate
level in an accredited nursing program for which graduate credit has been
awarded with an emphasis appropriate to the Role and, if applicable, Population
Focus of the APRN including, but not limited to comprehensive history taking;
physical and psychological assessment; pathophysiologic and psychopathologic
status of the patient; and development of a clinical diagnosis and management
plan.
19. Population Focus: A broad
area of study encompassing the common problems of a specific group of patients
and the likely co-morbidities, interventions and responses to those problems
including, but not limited to, the following areas of practice:
family/individual across the life span, adult/gerontology, pediatrics,
neonates, women's healthcare/gender-related, and psychiatry and mental health.
A Population Focus is not defined as a specialty, specific disease, health
problem or intervention.
20.
Provisional Prescriptive Authority: The authority granted to the Applicant to
prescribe medications within the Role and, if applicable, Population Focus of
the APRN pursuant to Section (F)(1) and Section (J)(2) of Rule 1.15.
21. Role: The advanced practice area for
which the Applicant has been prepared including nurse practitioner (NP),
certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA),
and/or clinical nurse specialist (CNS).
22. RXN: An APRN who is listed on the APR and
who has been granted Full Prescriptive Authority by the Board.
23. RXN Provisional (RXN-P): An APRN who is
listed on the APR and who has been granted Provisional Prescriptive Authority
by the Board.
24. Synchronous
Communication: Real-time communication; existing or happening at the same time;
occurring at the same moment of time; simultaneous. Synchronous Communication
will be conducted in a secure manner to safeguard protected information.
Synchronous Communication may include the use of electronic communication tools
such as audio, web or video conferencing. Synchronous Communication does not
include email communications.
25.
Unencumbered: No current restriction to practice in the state of
Colorado.
D.
EDUCATIONAL REQUIREMENTS FOR PRESCRIPTIVE AUTHORITY
1. An Applicant for prescriptive authority
must have successfully completed an appropriate graduate degree or
post-graduate degree or certification as determined by the Board in the Role
and, if applicable, Population Focus for which the Applicant seeks prescriptive
authority. Such coursework shall include a minimum of three graduate semester
hours or four quarter hours, or the equivalent thereof, as determined by the
Board, in each of the following: Pathophysiology, Pharmacology and Physical
Assessment. The coursework in Pharmacology shall include education on
prescribing drugs and controlled substances.
2. The transcript shall verify date of course
completion, grade and credits awarded. Applicants may provide copies of course
descriptions or course syllabi when the required coursework in Physical
Assessment, Pathophysiology, and Pharmacology is integrated into broad
categories of advanced practice courses or when course titles do not accurately
reflect course content.
3. Letters
of verification from the education program may be accepted as documentation for
the educational requirements of Physical Assessment, Pathophysiology, and
Pharmacology. Applicants may petition the Board on a case-by-case basis for a
waiver. The decision to grant or deny such waiver shall be at the sole
discretion of the Board.
E.
NATIONAL CERTIFICATION
REQUIREMENT
1. Pursuant to section
12-255-112(4)(a)(III),
C.R.S., an APRN applying for prescriptive authority must obtain and maintain
national certification from a recognized Certifying Body.
2. Certification requirements for Nurse
Practitioner (NP) or Clinical Nurse Specialist (CNS): A Nurse Practitioner (NP)
or Clinical Nurse Specialist (CNS) must pass the national certification
examination as administered by a Certifying Body in the Role and Population
Focus for which the APRN is applying for prescriptive authority. Documentation
required shall be verification of current certification or recertification from
the Certifying Body, as approved by the Board.
3. Certification requirements for Certified
Registered Nurse Anesthetist (CRNA): Certified Registered Nurse Anesthetist
(CRNA) must pass the national certification examination as administered by the
Council on Certification of Nurse Anesthetists. Documentation required shall be
verification of current certification or recertification from the Council on
Certification of Nurse Anesthetists or the Council on Recertification of Nurse
Anesthetists, as approved by the Board.
4. Certification Requirements for Certified
Nurse-Midwife (CNM): A Certified Nurse-Midwife must meet the standards for
education and certification established by the American Midwifery Certification
Board (AMCB). Documentation required shall be verification of status as a
current holder of an AMCB certificate.
5. If the Applicant cannot meet the
requirements for national certification, the Applicant may petition the Board
for an exception. Exceptions will be reviewed on a case-by-case basis. The
decision to grant or deny such exception shall be at the sole discretion of the
Board.
F.
REQUIREMENTS FOR PRESCRIPTIVE AUTHORITY
1. Requirements for Provisional Prescriptive
Authority.
a. Must apply in a manner approved
by the Board;
b. Pay application
fee;
c. Submit proof of an
appropriate degree and satisfactory completion of education requirements as
described in Section (D) of Rule 1.15;
d. Submit verification of National
Certification as described in Section (E) of Rule 1.15, unless the Board grants
an exception under 12-255-112(4)(a)(III), C.R.S.;
e. An attestation of having professional
liability insurance pursuant to section
12-255-113, C.R.S., and Rule
1.14;
f. Submit verification of
inclusion on the Advanced Practice Registry pursuant to section
12-255-111, C.R.S.;
g. An attestation stating the Applicant has
completed at least three years of Clinical Work Experience, as defined in
Section (C)(7) of Rule 1.15;
h. An
attestation stating that the Applicant's Mentor(s) meets requirements in
Section (C)(11) or (C)(12) of Rule 1.15; and
i. Has an active professional nurse and APRN
license that is in good standing and without disciplinary sanctions or
significant adverse prescribing as determined by the Board.
2. Requirements for Original Full
Prescriptive Authority.
a. Submit an
application in a manner approved by the Board which includes:
(1) An attestation of successful completion
of 750 hours of experience in a Mentorship.
b. The application for Full Prescriptive
Authority must be submitted within three years of being granted Provisional
Prescriptive Authority or if applying under Section (J)(4) of Rule 1.15 within
one year of being granted Provisional Prescriptive Authority.
3. Any application not completed
within one year of the date of receipt of the application expires and will be
purged.
J.
REQUIREMENTS FOR AN ADVANCED PRACTICE REGISTERED NURSE WITH PRESCRIPTIVE
AUTHORITY IN ANOTHER STATE TO OBTAIN FULL PRESCRIPTIVE AUTHORITY IN COLORADO
G.
MENTORSHIP
REQUIREMENTS
1. To obtain Full
Prescriptive Authority, the RXN-P must complete 750 hours of experience in a
Mentorship. The Mentorship shall be conducted with either a Physician Mentor or
RXN Mentor [hereinafter referred to as Mentor(s)] as defined in Sections
(C)(11) and (C)(12) of Rule 1.15, respectively. The Mentor(s) shall have
education, training, experience, and a practice that corresponds with the Role
and Population Focus of the RXN-P. The Mentorship must be completed within the
Role and Population Focus for which the RXN-P is applying for prescriptive
authority. The Mentorship must be completed within three years after
Provisional Prescriptive Authority is granted.
a. To obtain Full Prescriptive Authority, the
RXN-P must submit to the Board verification of 750 hours of mentored experience
on prescribing of drugs, devices, and other treatments based on clinical
considerations, patient needs, and reasonable expectations of effectiveness for
the individual patient and specific to the RXN-P's role. All experiences of
prescribing of drugs, devices, and other treatments must correspond with the
RXN-P's Role and Population Focus. As part of the verification, the Mentor(s)
shall attest that the RXN-P has completed their mentorship in prescribing in
multiple pharmacological categories that are typically utilized in the Role and
Population Focus for which the RXN-P seeks Full Prescriptive Authority.
b. Licensure occurs at the level
of Role and Population Focus. APRNs may specialize but cannot be licensed
solely within a specialty area. Experience gained while practicing within a
particular specialty or specialties correspond and provide evidence of
experience satisfactory to the Board of prescribing for patients under the
RXN-P's Role and Population Focus, regardless of specialty or
specialties.
c. Prior to beginning
a mentorship for the purpose of obtaining full prescriptive authority, the
RXN-P shall submit to the Board, in a form and manner approved by the Board,
documentation sufficient to allow the Board to determine whether the proposed
mentorship is sufficiently structured to assure the RXN-P, upon successful
completion of the mentorship, will have gained sufficient experience to meet
the requirements for Full Prescriptive Authority within their Role and
Population Focus. The documentation submitted to the Board for consideration
pursuant to this subsection shall, at minimum, clearly describe the Role and
Population Focus of the mentorship and how the RXN-P's practice in the
mentorship will prepare the RXN-P for prescribing to patients within the stated
Role and Population Focus.
2. The Mentorship Agreement shall contain the
following elements:
a. Is documented in
writing and signed by the RXN-P and the Mentor(s).
b. Outlines the prescribing practice within
the population focus requested within the mentorship of the RXN-P.
3. The Mentorship Agreement shall
be retained for a period of three years by the RXN and the Mentor(s) following
completion of the Mentorship and shall be available to the Board upon
request.
4. The RXN-P and the
Mentor(s) shall provide documentation of the successful completion of the
Mentorship as requested by the RXN-P to complete an application to obtain Full
Prescriptive Authority. The Mentor(s) shall not, without good cause, withhold
his/her signature or otherwise fail to attest to the completion of the
Mentorship.
5. If a circumstance
such as retirement, illness, relocation or other event precludes any Mentor
from continuing in the Mentorship, the RXN-P shall secure a replacement Mentor
and enter into a new, Mutually Structured Mentorship. Any hours accrued during
the period of time in which the RXN-P does not have a Mentor will not be
credited toward completion of the 750 hour Mentorship.
6. The Mentor(s) shall not require payment or
employment as a condition of entering into the mentor relationship. The
Mentorship relationship should not be financially burdensome to either party.
In recognition of the Mentor(s) time and expertise, reasonable expenses may be
paid. Compensation by the RXN-P to the Mentor(s) should be agreed upon as part
of the Mutually Structured Mentorship, shall comply with standards of fair
market value, and shall not be onerous or otherwise present a barrier to
completion of the Mentorship.
H.
[Repealed eff.
10/28/2020]
I.
OTHER
REQUIREMENTS
1. The RXN-P or RXN must
hold a valid DEA registration to prescribe controlled substances, Schedule II
through V, and must adhere to all DEA requirements.
2. Pursuant to section
12-255-112(7)(c)(II),
C.R.S., nothing in Rule 1.15 shall be construed to require a registered nurse
to obtain prescriptive authority to deliver anesthesia care.
3. Pursuant to section
12-255-112(9),
C.R.S., nothing in Rule 1.15 shall be construed to permit dispensing or
distribution, as defined in section
12-280-103(14) and
(15), C.R.S., by the RXN, except for
receiving and distributing a therapeutic regimen of prepackaged drugs prepared
by a licensed pharmacist or drug manufacturer registered with the FDA and
appropriately labeled, free samples supplied by a drug manufacturer, and
distributing drugs for administration and use by other individuals as
authorized by law.
J.
REQUIREMENTS FOR AN ADVANCED PRACTICE REGISTERED NURSE WITH PRESCRIPTIVE
AUTHORITY IN ANOTHER STATE TO OBTAIN FULL PRESCRIPTIVE AUTHORITY IN
COLORADO
1. Applicants must submit an
application in a manner approved by the Board.
2. Applicants must be actively listed on the
Advanced Practice Registry in the Role and, where applicable, the Population
Focus, or equivalent as determined by the Board, for which the Applicant seeks
Prescriptive Authority.
3.
Applicants must have Active Prescriptive Authority in another state or U.S.
jurisdiction in the Role and, where applicable, the Population Focus, or
equivalent as determined by the Board, for which the Applicant seeks
Prescriptive Authority.
a. Prescriptive
Authority credentials issued by the United States Military are deemed to be
substantially equivalent to prescriptive authority in another state or
jurisdiction.
4.
Requirements to apply for Full Prescriptive Authority for applicants with
prescriptive authority and at least 750 hours of documented experience
prescribing medications in another state, U.S. jurisdiction, or U.S military:
a. Verification of prescriptive authority and
750 hours of documented experience prescribing medications, in another state,
jurisdiction, or the U.S. military, in a manner approved by the Board. The
acceptance of the documented hours of experience prescribing medications is at
the sole discretion of the Board; and
b. An attestation stating the Applicant has
completed at least three (3) years of Clinical Work Experience, as defined in
Section (C)(7) of Rule 1.15
5. Requirements to apply for Full
Prescriptive Authority for applicants with prescriptive authority and less than
750 hours of documented experience prescribing medications in another state,
jurisdiction, or the U.S. military:
a. Active
Provisional Prescriptive Authority granted pursuant to Section (F)(1) of Rule
1.15.
b. Completion of the
additional hours, up to at least 750 hours, of experience prescribing
medications within a Mentorship as set forth in Section (G) of Rule
1.15.
c. Submission of an
application for Full Prescriptive Authority within three years of obtaining
Provisional Prescriptive Authority, providing evidence of the following:
(1) Verification of prescriptive authority
and hours of documented experience prescribing medications, in another state,
in a manner approved by the Board. The acceptance of the documented hours of
experience prescribing medication is at the sole discretion of the Board;
and
(2) Additional mentored
prescribing hours, up to at least 750 hours, completed within a Mentorship in
Colorado.
d. Upon
petition by the applicant, and with due consideration of the need to protect
the public, the Board may accept a substantially equivalent method of
establishing the requirements set forth in this Section (J)(5) of Rule 1.15. It
is anticipated that such alternative will rarely be used. The decision to
accept such substantially equivalent method of establishing the requirements is
at the sole discretion of the Board.
K.
REINSTATEMENT OF PRESCRIPTIVE
AUTHORITY
1. To apply for
reinstatement of prescriptive authority the APRN must possess an active,
Colorado or multi-state compact professional nurse license that is in good
standing and without Disciplinary Sanction as defined in Section (C)(9) of Rule
1.15, and have reinstated the Role and, if applicable, Population Focus on the
APR for which the APRN wishes to reinstate Full Prescriptive Authority.
2. An APRN applying to reinstate
Full Prescriptive Authority must complete the reinstatement application for
Full Prescriptive Authority and meet the requirements as set forth in Section
(F)(1) of Rule 1.15.
a. If an APRN fails to
meet the requirements as set forth in section
12-255-112, C.R.S., and the
Provisional Prescriptive Authority expires by operation of law, the APRN must
complete a new application for Provisional Prescriptive Authority and meet the
current requirements as set forth in Sections (D), (E), and (F) of Rule 1.15.
3. An APRN whose
Provisional or Full Prescriptive Authority is withdrawn as the result of a
disciplinary action under section
12-255-119, C.R.S., as set forth
in Section (M)(2)(a) of Rule 1.15, shall not be eligible to apply for
Prescriptive Authority for two years after the date of the withdrawal of such
Prescriptive Authority. After the end of the two year waiting period an APRN
must complete a new application and meet all requirements as set forth in Rule
1.15.
4. Every advanced practice
registered nurse with prescriptive authority applying for reinstatement, except
those who qualify for an exemption, must fulfill the substance use prevention
training requirements set forth in Section (C) of Rule 1.23.
L.
RENEWAL OF PRESCRIPTIVE
AUTHORITY
1. Renewal of Provisional or
Full Prescriptive Authority is required at the time of the RXN's professional
nurse license renewal in Colorado. Multi-state compact licensed professional
nurses granted Provisional or Full Prescriptive Authority by the Board shall be
required to renew the Provisional or Full Prescriptive Authority every two
years and shall be issued a specific expiration date for the Prescriptive
Authority.
2. Every advanced
practice registered nurse with prescriptive authority applying for renewal,
except those who qualify for an exemption, must fulfill the substance use
prevention training requirements set forth in Section (C) of Rule
1.23.
M.
WITHDRAWAL
OF PROVISIONAL OR FULL PRESCRIPTIVE AUTHORITY
1. The RXN may request that the Provisional
or Full Prescriptive Authority be voluntarily withdrawn.
2. The Board may withdraw Provisional or Full
Prescriptive Authority if the APRN no longer meets the requirements for
Provisional or Full Prescriptive Authority or the APRN is subject to discipline
under section
12-255-120, C.R.S., in accordance
with the procedures set forth in section
12-255-119, C.R.S.
a. The APRN whose Provisional or Full
Prescriptive Authority has been withdrawn as a result of disciplinary action
under section
12-255-119, C.R.S., shall not be
eligible to apply for Prescriptive Authority for two years after the date of
the Board's withdrawal of such Prescriptive Authority. For the purpose of this
Section (M)(2)(a), withdrawal of Provisional or Full Prescriptive Authority
shall include surrender or revocation of same.
3. If Provisional or Full Prescriptive
Authority has been withdrawn, and the APRN wishes to apply for Provisional or
Full Prescriptive Authority, the APRN must file a new application and meet all
requirements as set forth in Rule 1.15 at the time of application.
N.
DISCIPLINE OF ADVANCED
PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY
1. RXN and RXN-P disciplinary proceedings
shall be the same as set forth in section
12-255-119, C.R.S., and the
grounds for discipline are as set forth in section
12-255-120, C.R.S.
Approved: January 27, 2010
Effective: July 1, 2010
Revised: July 25, 2012
Effective: September 14, 2012
Revised: September 18, 2015
Effective: November 14, 2015
Revised: July 26, 2017
Effective: September 14, 2017
Revised: October 27, 2021
Effective: December 30, 2021
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
A. BASIS: The authority for the promulgation of these rules and regulations by the State Board of Nursing ("Board ") is set forth in sections 12-20-204(1), 12-255-107(1)(j), and 12-255-112, C.R.S., of the Colorado Revised Statutes (C.R.S.).
B. PURPOSE: Section 12-255-112(4), C.R.S. sets forth the legal requirements for an Advanced Practice Registered Nurse (APRN) to obtain prescriptive authority in Colorado. First, the APRN must obtain Provisional Prescriptive Authority. Generally, those requirements are:
1. Completion of the appropriate graduate degree or post-graduate degree or certificate, as determined by the Board , in the advanced practice Role and, if applicable, Population Focus;
2. Satisfactory completion of educational requirements, as determined by the Board , in the use of controlled substances and prescription drugs;
3. National certification by a nationally recognized certifying body, as determined by the Board , in the Role and, if applicable, Population Focus of the APRN, unless the Board grants an exception; and
4. Completion of at least three years of combined clinical work experience as a professional nurse and/or as an APRN.
Upon receiving Provisional Prescriptive Authority, the APRN is legally authorized to prescribe medications and controlled substances schedules II-V to patients appropriate to the APRN's Role and, if applicable, Population Focus. Within three years of receiving Provisional Prescriptive Authority the APRN with Provisional Prescriptive Authority (hereinafter referred to as RXN-P) must:
5. Complete a 750 hour Mentorship with a Physician or an Advanced Practice Registered Nurse with Full Prescriptive Authority and experience in prescribing medications. The Physician or APRN shall have education, training, experience and a practice that corresponds with but need not be identical to the Role and, if applicable, Population Focus of the RXN-P.
If the RXN-P does not complete these additional requirements within three years of receiving Provisional Prescriptive Authority such authority will expire for failure to comply with statutory requirements.
The purpose of these Rules is to further clarify each of the statutory requirements, with the exception of professional liability insurance, which can be found in Rule 1.14 of
C. DEFINITIONS
1. Accrediting Agency: An organization that establishes and maintains standards for professional nursing programs and recognizes those programs that meet these standards and is recognized by US Department of Education (USDE) and/or the Council for Higher Education Accreditation (CHEA), including the Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), Council on Accreditation of Nurse Anesthesia Educational Programs (COA), and Accreditation Council for Midwifery Education.
2. Advanced Practice Registered Nurse (APRN): A professional nurse who meets the requirements of section 12-255-111, C.R.S., who obtained specialized education or training and is included on the Advanced Practice Registry.
3. Advanced Practice Registry (APR): The Board 's record of those professional nurses who are granted APRN status by the Board in accordance with section 12-255-111, C.R.S. and Rule 1.14 of the Board 's Rules and Regulations.
4. Applicant: An APRN seeking Provisional Prescriptive Authority in the same Role and, if applicable, Population Focus for which the APRN was recognized on the APR.
5. Board : The State Board of Nursing.
6. Certifying Body: A non-governmental agency approved by the Board that validates by examination, based on pre-determined standards, an individual nurse's qualifications and knowledge for practice in a defined APRN Role and, if applicable, Population Focus.
7. Clinical Work Experience: Any relevant experience accumulated as a professional nurse or an advanced practice registered nurse, including paid or unpaid work experience, volunteer work, or student work. The gratuitous care of friends or members of the family is not included in Clinical Work Experience.
8. DEA: Drug Enforcement Administration.
9. Disciplinary Sanction: Any current restriction, limitation, encumbrance or condition on the Physician Mentor's medical license or on the RXN Mentor's nursing license, including confidential participation in peer health assistance or an alternative to discipline program authorized by the Mentor's licensing board .
10. Full Prescriptive Authority: The authority granted to the RXN to prescribe medications upon completion of the requirements set forth in Section (F)(2) of Rule 1.15.
11. Mentor: Physician Mentor: A person who holds a license to practice medicine in Colorado or a physician who is otherwise exempted from licensure pursuant to section 12-240-107(3)(i), C.R.S. The physician's license must be in good standing without Disciplinary Sanction as defined in Section (C)(9) of Rule 1.15. The Physician Mentor must be actively practicing medicine in the State of Colorado and shall have education, training, experience and a practice that corresponds with but need not be identical to the Role and, if applicable, Population Focus of the RXN-P. The Physician Mentor must also have an unrestricted DEA registration.
12. Mentor: RXN Mentor: A professional nurse who has met the qualifications for an APRN, is included on Colorado's APR, has Full Prescriptive Authority in Colorado, and has experience prescribing medications with full prescriptive authority preceding the beginning of the Mentorship. The RXN Mentor's nursing license must be without Disciplinary Sanction as defined in Section (C)(9) of Rule 1.15. The RXN Mentor shall have an active practice in Colorado and shall have education, training, experience and a practice that corresponds with, but need not be identical to, the Role and, if applicable, Population Focus of the RXN-P. The RXN Mentor must have an unrestricted DEA registration.
13. Mentorship: A formal, Mutually Structured relationship between the RXN-P as defined in Section (C)(23) of Rule 1.15, and the Physician Mentor or RXN Mentor to further the RXN-P's knowledge, skill, and experience in prescribing.
14. Mentorship Agreement: A mutually structured agreement documented in writing and signed by the RXN-P and the Mentor(s) which outlines a process and frequency for ongoing interaction and discussion of prescriptive practice throughout the Mentorship between the Mentor(s) and the RXN-P to assure safe prescribing practice.
15. Mutually Structured: Developed, implemented, and agreed upon by the RXN-P and the Mentor(s).
16. Pathophysiology: A minimum of three semester hours or four quarter hours completed either as part of a degree program or in addition to a degree program at the graduate or post-graduate level in an accredited nursing program for which graduate credit has been awarded with an emphasis appropriate to the Role and, if applicable, Population Focus of the APRN, including but not limited to pathophysiologic processes of all body systems.
17. Pharmacology: A minimum of three semester credit hours or four quarter hours completed either as part of a degree program or in addition to a degree program at the graduate or post-graduate level in an accredited nursing program for which graduate credit has been awarded with an emphasis appropriate to, but need not be identical to the Role and, if applicable, Population Focus of the APRN, including but not limited to the study of pharmacotherapeutics and pharmacokinetics of broad categories of pharmacological agents.
18. Physical Assessment: A minimum of three semester hours or four quarter hours completed either as part of a degree program or in addition to a degree program at the graduate or post-graduate level in an accredited nursing program for which graduate credit has been awarded with an emphasis appropriate to the Role and, if applicable, Population Focus of the APRN including, but not limited to comprehensive history taking; physical and psychological assessment; pathophysiologic and psychopathologic status of the patient; and development of a clinical diagnosis and management plan.
19. Population Focus: A broad area of study encompassing the common problems of a specific group of patients and the likely co-morbidities, interventions and responses to those problems including, but not limited to, the following areas of practice: family/individual across the life span, adult/gerontology, pediatrics, neonates, women's healthcare/gender-related, and psychiatry and mental health. A Population Focus is not defined as a specialty, specific disease, health problem or intervention.
20. Provisional Prescriptive Authority: The authority granted to the Applicant to prescribe medications within the Role and, if applicable, Population Focus of the APRN pursuant to Section (F)(1) and Section (J)(2) of Rule 1.15.
21. Role: The advanced practice area for which the Applicant has been prepared including nurse practitioner (NP), certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), and/or clinical nurse specialist (CNS).
22. RXN: An APRN who is listed on the APR and who has been granted Full Prescriptive Authority by the Board .
23. RXN Provisional (RXN-P): An APRN who is listed on the APR and who has been granted Provisional Prescriptive Authority by the Board .
24. Synchronous Communication: Real-time communication; existing or happening at the same time; occurring at the same moment of time; simultaneous. Synchronous Communication will be conducted in a secure manner to safeguard protected information. Synchronous Communication may include the use of electronic communication tools such as audio, web or video conferencing. Synchronous Communication does not include email communications.
25. Unencumbered: No current restriction to practice in the state of Colorado.
D. EDUCATIONAL REQUIREMENTS FOR PRESCRIPTIVE AUTHORITY
1. An Applicant for prescriptive authority must have successfully completed an appropriate graduate degree or post-graduate degree or certification as determined by the Board in the Role and, if applicable, Population Focus for which the Applicant seeks prescriptive authority. Such coursework shall include a minimum of three graduate semester hours or four quarter hours, or the equivalent thereof, as determined by the Board , in each of the following: Pathophysiology, Pharmacology and Physical Assessment. The coursework in Pharmacology shall include education on prescribing drugs and controlled substances.
2. The transcript shall verify date of course completion, grade and credits awarded. Applicants may provide copies of course descriptions or course syllabi when the required coursework in Physical Assessment, Pathophysiology, and Pharmacology is integrated into broad categories of advanced practice courses or when course titles do not accurately reflect course content.
3. Letters of verification from the education program may be accepted as documentation for the educational requirements of Physical Assessment, Pathophysiology, and Pharmacology. Applicants may petition the Board on a case-by-case basis for a waiver. The decision to grant or deny such waiver shall be at the sole discretion of the Board .
E. NATIONAL CERTIFICATION REQUIREMENT
1. Pursuant to section 12-255-112(4)(a)(III), C.R.S., an APRN applying for prescriptive authority must obtain and maintain national certification from a recognized Certifying Body.
2. Certification requirements for Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS): A Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS) must pass the national certification examination as administered by a Certifying Body in the Role and Population Focus for which the APRN is applying for prescriptive authority. Documentation required shall be verification of current certification or recertification from the Certifying Body, as approved by the Board .
3. Certification requirements for Certified Registered Nurse Anesthetist (CRNA): Certified Registered Nurse Anesthetist (CRNA) must pass the national certification examination as administered by the Council on Certification of Nurse Anesthetists. Documentation required shall be verification of current certification or recertification from the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists, as approved by the Board .
4. Certification Requirements for Certified Nurse-Midwife (CNM): A Certified Nurse-Midwife must meet the standards for education and certification established by the American Midwifery Certification Board (AMCB). Documentation required shall be verification of status as a current holder of an AMCB certificate.
5. If the Applicant cannot meet the requirements for national certification, the Applicant may petition the Board for an exception. Exceptions will be reviewed on a case-by-case basis. The decision to grant or deny such exception shall be at the sole discretion of the Board .
F. REQUIREMENTS FOR PRESCRIPTIVE AUTHORITY
1. Requirements for Provisional Prescriptive Authority.
a. Must apply in a manner approved by the Board ;
b. Pay application fee;
c. Submit proof of an appropriate degree and satisfactory completion of education requirements as described in Section (D) of Rule 1.15;
d. Submit verification of National Certification as described in Section (E) of Rule 1.15, unless the Board grants an exception;
e. An attestation of having professional liability insurance pursuant to section 12-255-113, C.R.S., and Rule 1.14;
f. Submit verification of inclusion on the Advanced Practice Registry pursuant to section 12-255-111, C.R.S.;
g. An attestation stating the Applicant has completed at least three years of Clinical Work Experience, as defined in Section (C)(8) of Rule 1.15;
h. An attestation stating that the Applicant's Mentor(s) meets requirements in Section (C)(11) or (C)(12) of Rule 1.15; and
i. Has an active professional nurse and APRN license that is in good standing and without disciplinary sanctions or significant adverse prescribing as determined by the Board .
2. Requirements for Original Full Prescriptive Authority.
a. Submit an application in a manner approved by the Board which includes:
(1) An attestation of successful completion of 750 hours of experience in a Mentorship.
b. The application for Full Prescriptive Authority must be submitted within three years of being granted Provisional Prescriptive Authority or if applying under Section (J)(2) of Rule 1.15 within one year of being granted Provisional Prescriptive Authority.
(1) If the RXN-P cannot meet the requirements in Section (F)(2)(a) of Rule 1.15, the RXN-P may petition the Board for an exception to demonstrate competence. Exceptions will be reviewed on a case-by-case basis. The decision to grant or deny such exception will be at the sole discretion of the Board .
3. Any application not completed within one year of the date of receipt of the application expires and will be purged.
G. MENTORSHIP REQUIREMENTS
1. To obtain Full Prescriptive Authority, the RXN-P must complete 750 hours of experience in a Mentorship. The Mentorship shall be conducted with either a Physician Mentor or RXN Mentor [hereinafter referred to as Mentor(s)] as defined in Sections (C)(11) and (C)(12) of Rule 1.15, respectively. The Mentor(s) shall have education, training, experience, and a practice that corresponds with the Role and Population Focus of the RXN-P. The Mentorship must be completed within the Role and Population Focus for which the RXN-P is applying for prescriptive authority. The Mentorship must be completed within three years after Provisional Prescriptive Authority is granted.
a. To obtain Full Prescriptive Authority, the RXN-P must submit to the Board verification of 750 hours of mentored experience on prescribing of drugs, devices, and other treatments based on clinical considerations, patient needs, and reasonable expectations of effectiveness for the individual patient and specific to the RXN-P's role. All experiences of prescribing of drugs, devices, and other treatments must correspond with the RXN-P's Role and Population Focus. As part of the verification, the Mentor(s) shall attest that the RXN-P has completed their mentorship in prescribing in multiple pharmacological categories that are typically utilized in the Role and Population Focus for which the RXN-P seeks Full Prescriptive Authority.
b. Licensure occurs at the level of Role and Population Focus. APRNs may specialize but cannot be licensed solely within a specialty area. Experience gained while practicing within a particular specialty or specialties correspond and provide evidence of experience satisfactory to the Board of prescribing for patients under the RXN-P's Role and Population Focus, regardless of specialty or specialties.
c. Prior to beginning a mentorship for the purpose of obtaining full prescriptive authority, the RXN-P shall submit to the Board , in a form and manner approved by the Board , documentation sufficient to allow the Board to determine whether the proposed mentorship is sufficiently structured to assure the RXN-P, upon successful completion of the mentorship, will have gained sufficient experience to meet the requirements for Full Prescriptive Authority within their Role and Population Focus. The documentation submitted to the Board for consideration pursuant to this subsection shall, at minimum, clearly describe the Role and Population Focus of the mentorship and how the RXN-P's practice in the mentorship will prepare the RXN-P for prescribing to patients within the stated Role and Population Focus.
2. The Mentorship Agreement shall contain the following elements:
a. Is documented in writing and signed by the RXN-P and the Mentor(s).
b. Outlines the prescribing practice within the population focus requested within the mentorship of the RXN-P.
3. The Mentorship Agreement shall be retained for a period of three years by the RXN and the Mentor(s) following completion of the Mentorship and shall be available to the Board upon request.
4. The RXN-P and the Mentor(s) shall provide documentation of the successful completion of the Mentorship as requested by the RXN-P to complete an application to obtain Full Prescriptive Authority. The Mentor(s) shall not, without good cause, withhold his/her signature or otherwise fail to attest to the completion of the Mentorship.
5. If a circumstance such as retirement, illness, relocation or other event precludes any Mentor from continuing in the Mentorship, the RXN-P shall secure a replacement Mentor and enter into a new, Mutually Structured Mentorship. Any hours accrued during the period of time in which the RXN-P does not have a Mentor will not be credited toward completion of the 750 hour Mentorship.
6. The Mentor(s) shall not require payment or employment as a condition of entering into the mentor relationship. The Mentorship relationship should not be financially burdensome to either party. In recognition of the Mentor(s) time and expertise, reasonable expenses may be paid. Compensation by the RXN-P to the Mentor(s) should be agreed upon as part of the Mutually Structured Mentorship, shall comply with standards of fair market value, and shall not be onerous or otherwise present a barrier to completion of the Mentorship.
H.[Repealed eff. 10/28/2020]
I. OTHER REQUIREMENTS
1. The RXN-P or RXN must hold a valid DEA registration to prescribe controlled substances, Schedule II through V, and must adhere to all DEA requirements.
2. Pursuant to section 12-255-112(7)(c)(II), C.R.S., nothing in Rule 1.15 shall be construed to require a registered nurse to obtain prescriptive authority to deliver anesthesia care.
3. Pursuant to section 12-255-112(9), C.R.S., nothing in Rule 1.15 shall be construed to permit dispensing or distribution, as defined in section 12-280-103(14) and (15), C.R.S., by the RXN, except for receiving and distributing a therapeutic regimen of prepackaged drugs prepared by a licensed pharmacist or drug manufacturer registered with the FDA and appropriately labeled, free samples supplied by a drug manufacturer, and distributing drugs for administration and use by other individuals as authorized by law.
J. REQUIREMENTS FOR AN ADVANCED PRACTICE REGISTERED NURSE WITH PRESCRIPTIVE AUTHORITY IN ANOTHER STATE TO OBTAIN FULL PRESCRIPTIVE AUTHORITY IN COLORADO
1. Applicants must submit an application in a manner approved by the Board .
2. Applicants must be actively listed on the Advanced Practice Registry in the Role and, where applicable, the Population Focus, or equivalent as determined by the Board , for which the Applicant seeks Prescriptive Authority.
3. Applicants must have Active Prescriptive Authority in another state or U.S. jurisdiction in the Role and, where applicable, the Population Focus, or equivalent as determined by the Board , for which the Applicant seeks Prescriptive Authority.
a. Prescriptive Authority credentials issued by the United States Military are deemed to be substantially equivalent to prescriptive authority in another state or jurisdiction.
4. Requirements to apply for Full Prescriptive Authority for applicants with prescriptive authority and at least 750 hours of documented experience prescribing medications in another state, U.S. jurisdiction, or U.S. military:
a. Verification of prescriptive authority and 750 hours of documented experience prescribing medications, in another state, jurisdiction, or the U.S. military, in a manner approved by the Board . The acceptance of the documented hours of experience prescribing medications is at the sole discretion of the Board ; and
5. Requirements to apply for Full Prescriptive Authority for applicants with prescriptive authority and less than 750 hours of documented experience prescribing medications in another state, jurisdiction, or the U.S. military:
a. Active Provisional Prescriptive Authority granted pursuant to Section (F)(1) of Rule 1.15.
b. Completion of the additional hours, up to at least 750 hours, of experience prescribing medications within a Mentorship as set forth in Section (G) of Rule 1.15.
c. Submission of an application for Full Prescriptive Authority within three years of obtaining Provisional Prescriptive Authority, providing evidence of the following:
(1) Verification of prescriptive authority and hours of documented experience prescribing medications, in another state, in a manner approved by the Board . The acceptance of the documented hours of experience prescribing medication is at the sole discretion of the Board ; and
(2) Additional mentored prescribing hours, up to at least 750 hours, completed within a Mentorship in Colorado.
d. Upon petition by the applicant, and with due consideration of the need to protect the public, the Board may accept a substantially equivalent method of establishing the requirements set forth in this Section (J)(5) of Rule 1.15. It is anticipated that such alternative will rarely be used. The decision to accept such substantially equivalent method of establishing the requirements is at the sole discretion of the Board .
K. REINSTATEMENT OF PRESCRIPTIVE AUTHORITY
1. To apply for reinstatement of prescriptive authority the APRN must possess an active, Colorado or multi-state compact professional nurse license that is in good standing and without Disciplinary Sanction as defined in Section (C)(9), and have reinstated the Role and, if applicable, Population Focus on the APR for which the APRN wishes to reinstate Full Prescriptive Authority.
2. An APRN applying to reinstate Full Prescriptive Authority must complete the reinstatement application for Full Prescriptive Authority and meet the requirements as set forth in Sections (D), (E), (F) and (H) of Rule 1.15.
a. If an APRN fails to meet the requirements as set forth in section 12-255-112, C.R.S., and the Provisional Prescriptive Authority expires by operation of law, the APRN must complete a new application for Provisional Prescriptive Authority and meet the current requirements as set forth in Sections (D), (E), and (F) of Rule 1.15.
3. An APRN whose Provisional or Full Prescriptive Authority is withdrawn as the result of a disciplinary action under section 12-255-119, C.R.S., as set forth in Section (M)(2)(a) of Rule 1.15, shall not be eligible to apply for Prescriptive Authority for two years after the date of the withdrawal of such Prescriptive Authority. After the end of the two year waiting period an APRN must complete a new application and meet all requirements as set forth in Rule 1.15.
4. Every advanced practice registered nurse with prescriptive authority applying for reinstatement, except those who qualify for an exemption, must fulfill the substance use prevention training requirements set forth in Section (C) of Rule 1.25.
L. RENEWAL OF PRESCRIPTIVE AUTHORITY
1. Renewal of Provisional or Full Prescriptive Authority is required at the time of the RXN's professional nurse license renewal in Colorado. Multi-state compact licensed professional nurses granted Provisional or Full Prescriptive Authority by the Board shall be required to renew the Provisional or Full Prescriptive Authority every two years and shall be issued a specific expiration date for the Prescriptive Authority.
2. Every advanced practice registered nurse with prescriptive authority applying for renewal, except those who qualify for an exemption, must fulfill the substance use prevention training requirements set forth in Section (C) of Rule 1.25.
M. WITHDRAWAL OF PROVISIONAL OR FULL PRESCRIPTIVE AUTHORITY
1. The RXN may request that the Provisional or Full Prescriptive Authority be voluntarily withdrawn.
2. The Board may withdraw Provisional or Full Prescriptive Authority if the APRN no longer meets the requirements for Provisional or Full Prescriptive Authority or the APRN is subject to discipline under section 12-255-120, C.R.S., in accordance with the procedures set forth in section 12-255-119, C.R.S.
a. The APRN whose Provisional or Full Prescriptive Authority has been withdrawn as a result of disciplinary action under section 12-255-119, C.R.S., shall not be eligible to apply for Prescriptive Authority for two years after the date of the Board 's withdrawal of such Prescriptive Authority. For the purpose of this Section (M)(2)(a), withdrawal of Provisional or Full Prescriptive Authority shall include surrender or revocation of same.
3. If Provisional or Full Prescriptive Authority has been withdrawn, and the APRN wishes to apply for Provisional or Full Prescriptive Authority, the APRN must file a new application and meet all requirements as set forth in Rule 1.15 at the time of application.
N. DISCIPLINE OF ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY
1. RXN and RXN-P disciplinary proceedings shall be the same as set forth in section 12-255-119, C.R.S., and the grounds for discipline are as set forth in section 12-255-120, C.R.S.
Approved: January 27, 2010
Effective: July 1, 2010
Revised: July 25, 2012
Effective: September 14, 2012
Revised: September 18, 2015
Effective: November 14, 2015
Revised: July 26, 2017
Effective: September 14, 2017
Revised: October 27, 2021
Effective: December 30, 2021