It is the intent of these rules to maximize the collaborative
practice of certified nurse practitioners and supervising physicians in a
manner consistent with quality health care delivery.
(1) A supervising physician, certified nurse
practitioner or a substitute supervising physician must possess a current,
unencumbered license to practice in the state of Tennessee.
(2) Supervision does not require the
continuous and constant presence of the supervising physician; however, the
supervising physician must be available for consultation at all times or shall
make arrangements for a substitute physician to be available.
(3) A supervising physician and/or substitute
supervising physician shall have experience and/or expertise in the same area
of medicine as the certified nurse practitioner.
(4) Nurse Practitioners who hold a temporary
certificate of fitness shall be supervised pursuant to T.C.A. §
63-7-123 and Board of Nursing rule
1000-4-.04. Such supervision requires the physical presence of either the
supervising physician or certified nurse practitioner.
Protocols are required and:
(a) Shall be jointly developed and approved
by the supervising physician and nurse practitioner;
(b) Shall outline and cover the applicable
standard of care;
(c) Shall be
reviewed and updated biennially;
(d) Shall be maintained at the practice
(e) Shall account for all
protocol drugs by appropriate formulary;
(f) Shall be specific to the population
(g) Shall be dated and
(h) Copies of protocols
and formularies shall be maintained at the practice site and shall be made
available upon request for inspection by the respective boards.
(6) The supervising physician
shall be responsible for ensuring compliance with the applicable standard of
care under (5). Additionally, the supervising physician shall develop clinical
guidelines in collaboration with the certified nurse practitioner to include a
method for documenting consultation and referral.
Once every ten (10) business days the
supervising physician shall make a personal review of the historical, physical
and therapeutic data and shall so certify by signature on any patient within
thirty (30) days:
(a) When medically
(b) When requested by
(c) When prescriptions
written by the certified nurse practitioner fall outside the
(d) When prescriptions
are written by a nurse practitioner who possesses a temporary certificate of
(e) when a controlled
drug has been prescribed.
(8) In any event, a supervising physician
shall personally review at least twenty percent (20%) of charts monitored or
written by the certified nurse practitioner every thirty (30) days.
(9) The supervising physician shall be
required to visit any remote site at least once every thirty (30)
(10) Any prescription written
and signed or drug issued by a nurse practitioner under the supervision and
control of a supervising physician shall be deemed to be that of the nurse
(11) The supervising
physician shall make provision for preprinted prescription pads bearing the
name, address and telephone number of the supervising physician and that of the
nurse practitioner. The nurse practitioner shall sign his or her own name on
each prescription so written. Where the preprinted prescription pad contains
the names of more than one (1) physician, the nurse practitioner shall indicate
on the prescription which of those physicians is the nurse practitioner's
primary supervising physician by placing a checkmark beside or a circle around
the name of that physician.
Eligible certified nurse practitioners shall use numbers assigned to them by
the DEA when prescribing controlled substances.