314.042 License to practice as an advanced practice registered nurse -- Application
3,984 words·~18 min read·
/ky/314-042A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
-- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under
CAPA-NS and CAPA-CS -- Exemption from CAPA-NS and CAPA-CS
requirement -- CAPA-CS Committee -- Administrative regulations.
(1)An applicant for licensure to practice as an advanced practice registered nurse shall
file with the board a written application for licensure and submit evidence, verified
by oath, that the applicant:
(a)Has completed an education program that prepares the registered nurse for
one
(1)of four
(4)APRN roles that has been accredited by a national nursing
accrediting body recognized by the United States Department of Education;
(b)Is certified by a nationally established organization or agency recognized by
the board to certify registered nurses for advanced practice registered nursing;
(c)Is able to understandably speak and write the English language and to read the
English language with comprehension; and
(d)Has passed the jurisprudence examination approved by the board as provided
in subsection
(5)of this section.
(2)Upon request, an applicant who meets the requirements of subsection (1)(a), (c),
and
(d)of this section, but has not yet taken the national certification exam, may be
issued a provisional license that shall expire no later than six
(6)months from the
date of issuance.
(3)An individual who holds a provisional license shall have the right to use the title
"advanced practice registered nurse applicant" and the abbreviation "APRNA." An
APRNA may function as an APRN, except for prescribing medications and shall
only practice under a mentorship with an advanced practice registered nurse or a
physician.
(a)An APRNA shall take and pass the national certification exam recognized by
the board to the certify registered nurses for advanced practice registered
nursing within the six
(6)month term of the provisional license to become a
fully licensed APRN.
(b)If the APRNA fails to take and pass the national certification exam on the first
attempt, the APRNA shall be given one
(1)more opportunity to take and pass
the exam.
(c)If the APRNA does not pass the national certification exam on the second
attempt, the provisional license shall immediately be terminated.
(5)The jurisprudence examination shall be prescribed by the board and be conducted
on the licensing requirements under this chapter and administrative regulations
applicable to advance practice registered nursing promulgated in accordance with
KRS Chapter 13A.
(6)The board may issue a license to practice advanced practice registered nursing to an
applicant who holds a current active registered nurse license issued by the board or
holds the privilege to practice as a registered nurse in this state and meets the
qualifications of subsection
(1)of this section. An advanced practice registered
nurse shall be:
(a)Designated by the board as a certified registered nurse anesthetist, certified
nurse midwife, certified nurse practitioner, or clinical nurse specialist; and
(b)Certified in at least one
(1)population focus.
(7)The applicant for licensure or renewal thereof to practice as an advanced practice
registered nurse shall pay a fee to the board as set forth in regulation by the board.
(8)An advanced practice registered nurse shall maintain a current active registered
nurse license issued by the board or hold the privilege to practice as a registered
nurse in this state and maintain current certification by the appropriate national
organization or agency recognized by the board.
(9)Any person who holds a license to practice as an advanced practice registered nurse
in this state shall have the right to use the title "advanced practice registered nurse"
and the abbreviation "APRN." No other person shall assume the title or use the
abbreviation or any other words, letters, signs, or figures to indicate that the person
using the same is an advanced practice registered nurse. No person shall practice as
an advanced practice registered nurse unless licensed under this section.
(10)Any person heretofore licensed as an advanced practice registered nurse under the
provisions of this chapter who has allowed the license to lapse may be reinstated on
payment of the current fee and by meeting the provisions of this chapter and
regulations promulgated by the board pursuant to the provisions of KRS Chapter
13A.
(11)The board may authorize a person to practice as an advanced practice registered
nurse temporarily and pursuant to applicable regulations promulgated by the board
pursuant to the provisions of KRS Chapter 13A if the person is awaiting licensure
by endorsement.
(a)Except as authorized by subsection
(13)of this section, before an advanced
practice registered nurse engages in the prescribing or dispensing of
nonscheduled legend drugs as authorized by KRS 314.011(8), the advanced
practice registered nurse shall enter into a written "Collaborative Agreement
for the Advanced Practice Registered Nurse's Prescriptive Authority for
Nonscheduled Legend Drugs" (CAPA-NS) with a physician licensed in
Kentucky that defines the scope of the prescriptive authority for nonscheduled
legend drugs.
(b)The advanced practice registered nurse shall notify the Kentucky Board of
Nursing of the existence of the CAPA-NS and the name of the collaborating
physician and shall, upon request, furnish to the board or its staff a copy of the
completed CAPA-NS. The Kentucky Board of Nursing shall notify the
Kentucky Board of Medical Licensure that a CAPA-NS exists and furnish the
collaborating physician's name.
(c)The CAPA-NS shall be in writing and signed by both the advanced practice
registered nurse and the collaborating physician. A copy of the completed
collaborative agreement shall be available at each site where the advanced
practice registered nurse is providing patient care.
(d)The CAPA-NS shall describe the arrangement for collaboration and
communication between the advanced practice registered nurse and the
collaborating physician regarding the prescribing of nonscheduled legend
drugs by the advanced practice registered nurse.
(e)The advanced practice registered nurse who is prescribing nonscheduled
legend drugs and the collaborating physician shall be qualified in the same or
a similar specialty.
(f)The CAPA-NS is not intended to be a substitute for the exercise of
professional judgment by the advanced practice registered nurse or by the
collaborating physician.
(g)The CAPA-NS shall be reviewed and signed by both the advanced practice
registered nurse and the collaborating physician and may be rescinded by
either party upon written notice to the other party and the Kentucky Board of
Nursing.
(a)Before an advanced practice registered nurse may discontinue or be exempt
from a CAPA-NS required under subsection
(12)of this section, the advanced
practice registered nurse shall have completed four
(4)years of prescribing as
a certified nurse practitioner, clinical nurse specialist, certified nurse midwife,
or as a certified registered nurse anesthetist. For nurse practitioners and
clinical nurse specialists, the four
(4)years of prescribing shall be in a
population focus as defined in KRS 314.011.
(b)After four
(4)years of prescribing with a CAPA-NS in collaboration with a
physician:
1. An advanced practice registered nurse whose license is in good standing
at that time with the Kentucky Board of Nursing and who will be
prescribing nonscheduled legend drugs without a CAPA-NS shall notify
that board that the four
(4)year requirement has been met and that he or
she will be prescribing nonscheduled legend drugs without a CAPA-NS;
2. The advanced practice registered nurse will no longer be required to
maintain a CAPA-NS and shall not be compelled to maintain a CAPA-
NS as a condition to prescribe after the four
(4)years have expired, but
an advanced practice registered nurse may choose to maintain a CAPA-
NS indefinitely after the four
(4)years have expired; and
3. If the advanced practice registered nurse's license is not in good
standing, the CAPA-NS requirement shall not be removed until the
license is restored to good standing.
(c)An advanced practice registered nurse wishing to practice in Kentucky
through licensure by endorsement is exempt from the CAPA-NS requirement
if the advanced practice registered nurse:
1. Has met the prescribing requirements in a state that grants independent
prescribing to advanced practice registered nurses; and
2. Has been prescribing for at least four
(4)years.
(d)An advanced practice registered nurse wishing to practice in Kentucky
through licensure by endorsement who had a collaborative prescribing
agreement with a physician in another state for at least four
(4)years is
exempt from the CAPA-NS requirement.
(a)There is hereby established the "Collaborative Agreement for the Advanced
Practice Registered Nurse's Prescriptive Authority for Controlled Substances"
(CAPA-CS) Committee. The committee shall be composed of four
members selected as follows:
1. Two
(2)members shall be advanced practice registered nurses who
currently prescribe or have prescribed scheduled drugs, each appointed
by the Kentucky Board of Nursing from a list of names submitted for
each position by the Kentucky Association of Nurse Practitioners and
Nurse-Midwives; and
2. Two
(2)members shall be physicians who have currently or had
previously a signed CAPA-CS with an advanced practice registered
nurse who prescribes scheduled drugs, each appointed by the Kentucky
Board of Medical Licensure from a list of names submitted for each
position by the Kentucky Medical Association.
(b)Within sixty
(60)days of June 29, 2023, the committee shall develop a
standardized CAPA-CS form to be used in accordance with the provisions of
subsection
(15)of this section. The standardized CAPA-CS form shall be used
by all advanced practice registered nurses and all physicians in Kentucky who
enter into a CAPA-CS.
(c)The committee may be reconvened at the request of the Kentucky Board of
Nursing or the Kentucky Board of Medical Licensure if it becomes necessary
to update the standardized CAPA-CS form.
(d)The Kentucky Board of Nursing and the Kentucky Board of Medical
Licensure shall each be responsible for and have exclusive authority over their
respective members appointed to the committee.
(e)The committee shall be attached to the Kentucky Board of Nursing for
administrative purposes. The Kentucky Board of Nursing shall be responsible
for the expenses of its members. The Kentucky Board of Medical Licensure
shall be responsible for the expenses of its members.
(f)The Kentucky Board of Nursing shall promulgate an administrative regulation
pursuant to KRS Chapter 13A within ninety
(90)days of June 29, 2023, to
establish and implement the standardized CAPA-CS form developed by the
committee.
(a)Except as provided in subsections
(17)and
(18)of this section, before an
advanced practice registered nurse engages in the prescribing of Schedules II
through V controlled substances as authorized by KRS 314.011(8), the
advanced practice registered nurse shall enter into a written "Collaborative
Agreement for the Advanced Practice Registered Nurse's Prescriptive
Authority for Controlled Substances" (CAPA-CS) on a standardized CAPA-
CS form with a physician licensed in Kentucky that defines the scope of the
prescriptive authority for controlled substances.
(b)The advanced practice registered nurse shall notify the Kentucky Board of
Nursing of the existence of the CAPA-CS and the name of the collaborating
physician and shall, upon request, furnish to the board or its staff a copy of the
completed standardized CAPA-CS form. The Kentucky Board of Nursing
shall notify the Kentucky Board of Medical Licensure that a CAPA-CS exists
and furnish an executed copy of the Kentucky Board of Nursing notification
of a CAPA-CS completed by the advanced practice registered nurse to the
Kentucky Board of Medical Licensure.
(c)The CAPA-CS shall be in writing and signed by both the advanced practice
registered nurse and the collaborating physician. A copy of the completed
standardized CAPA-CS form shall be available at each site where the
advanced practice registered nurse is providing patient care.
(d)The CAPA-CS shall describe the arrangement for collaboration and
communication between the advanced practice registered nurse and the
collaborating physician regarding the prescribing of controlled substances by
the advanced practice registered nurse.
(e)The advanced practice registered nurse who is prescribing controlled
substances and the collaborating physician shall be qualified in the same or a
similar specialty.
(f)The CAPA-CS is not intended to be a substitute for the appropriate exercise
of professional judgment by the advanced practice registered nurse or by the
collaborating physician.
(g)The relevant statutes and regulations pertaining to the prescribing authority of
advanced practice registered nurses for controlled substances shall be
reviewed by the advanced practice registered nurse and the collaborating
physician at the outset of the CAPA-CS.
(h)Prior to prescribing controlled substances, the advanced practice registered
nurse shall obtain a Controlled Substance Registration Certificate through the
United States Drug Enforcement Administration.
(i)The CAPA-CS shall be reviewed and signed by both the advanced practice
registered nurse and the collaborating physician and may be rescinded by
either party upon thirty
(30)days written notice to the other party. The
advanced practice registered nurse shall notify the Kentucky Board of Nursing
that the CAPA-CS has been rescinded. The Kentucky Board of Nursing shall
notify the Kentucky Board of Medical Licensure that the CAPA-CS has been
rescinded and shall furnish an executed copy of the Kentucky Board of
Nursing rescission of a CAPA-CS completed by the advanced practice
registered nurse or by the collaborating physician to the Kentucky Board of
Medical Licensure.
(j)The CAPA-CS shall state any limits on controlled substances which may be
prescribed by the advanced practice registered nurse, as agreed to by the
advanced practice registered nurse and the collaborating physician. The limits
so imposed may be more stringent than either the schedule limits on
controlled substances established in KRS 314.011(8) or the limits imposed in
regulations promulgated by the Kentucky Board of Nursing thereunder. The
CAPA-CS shall also include any requirements, as agreed to by both the
advanced practice registered nurse and the collaborating physician, for
communication between the advanced practice registered nurse and the
collaborating physician.
(k)Within thirty
(30)days of obtaining a Controlled Substance Registration
Certificate from the United States Drug Enforcement Administration, and
prior to prescribing controlled substances, the advanced practice registered
nurse shall register with the electronic system for monitoring controlled
substances established by KRS 218A.202 and shall provide a copy of the
registration certificate to the board.
(l)After June 29, 2023, for advanced practice registered nurses who have not had
a CAPA-CS:
1. An advanced practice registered nurse wishing to have a CAPA-CS in
his or her first year of licensure must be employed by a health care
entity or provider. If the employing provider is an advanced practice
registered nurse, he or she must have completed four
(4)years of
prescribing with a CAPA-CS and no longer be required to maintain a
CAPA-CS;
2. In the first year of the CAPA-CS, the advanced practice registered nurse
and the physician shall meet at least quarterly, either in person or via
video conferencing, to review the advanced practice registered nurse's
reverse KASPER report or that of the prescription drug monitoring
program
(PDMP)currently in use in Kentucky pursuant to KRS
218A.202. The advanced practice registered nurse and the collaborating
physician may meet via telephonic communication when an in-person
meeting or videoconferencing session is not logistically or
technologically feasible. The review of specific prescriptions identified
in the reverse KASPER report or that of the PDMP currently in use in
Kentucky pursuant to KRS 218A.202 by the advanced practice
registered nurse and the collaborating physician may include
information from the patient's medical record that relates to the
condition or conditions being treated with controlled substances by the
advanced practice registered nurse to facilitate meaningful discussion. A
record of the meeting date, summary of discussions, and any
recommendations made shall be made in writing and a copy retained by
both parties to the agreement for a period of one
(1)year past the
expiration of the CAPA-CS. The meeting records shall be subject to
audit by the Kentucky Board of Nursing for the advanced practice
registered nurse and by the Kentucky Board of Medical Licensure for
the physician. The sole purpose of the audit shall be to document that
the collaboration meetings have taken place as required by this section
and that other provisions of this section have been met; and
3. In the ensuing three
(3)years of the CAPA-CS, the advanced practice
registered nurse and the physician shall meet at least biannually in
person or via video conferencing to review the advanced practice
registered nurse's reverse KASPER report or that of the PDMP currently
in use in Kentucky pursuant to KRS 218A.202. The advanced practice
registered nurse and the collaborating physician may meet via
telephonic communication when an in-person meeting or
videoconferencing session is not logistically or technologically feasible.
The review of specific prescriptions identified in the reverse KASPER
report or that of the PDMP currently in use in Kentucky pursuant to
KRS 218A.202 by the advanced practice registered nurse and the
collaborating physician may include information from the patient's
medical record that relates to the condition or conditions being treated
with controlled substances by the advanced practice registered nurse to
facilitate meaningful discussion. A record of the meeting date, summary
of discussions, and any recommendations made shall be noted in writing
and a copy retained by both parties to the agreement for a period of one
(1)year past the expiration of the CAPA-CS. The meeting records shall
be subject to audit by the Kentucky Board of Nursing for the advanced
practice registered nurse and by the Kentucky Board of Medical
Licensure for the physician. The sole purpose of the audit shall be to
document that the collaboration meetings have taken place as required
by this section and that other provisions of this section have been met.
(16)Nothing in this chapter shall be construed as requiring an advanced practice
registered nurse designated by the board as a certified registered nurse anesthetist to
enter into a collaborative agreement with a physician, pursuant to this chapter or
any other provision of law, in order to deliver anesthesia care.
(a)Except as provided in subsection
(18)of this section, an advanced practice
registered nurse who wishes to continue to prescribe controlled substances
may be exempt from a CAPA-CS required under subsection
(15)of this
section if the advanced practice registered nurse has:
1. Completed four
(4)years of prescribing authority for controlled
substances with a CAPA-CS;
2. Maintained a United States Drug Enforcement Administration
registration; and
3. Maintained a master account with KASPER or the PDMP currently in
use in Kentucky pursuant to KRS 218A.202.
(b)On or after June 29, 2023:
1. An advanced practice registered nurse who has had four
(4)years of
prescribing authority with a CAPA-CS and who wishes to prescribe
controlled substances without a CAPA-CS shall submit, via the APRN
update portal, a request for review from the Kentucky Board of Nursing
that the advanced practice registered nurse's license is in good standing;
2. An advanced practice registered nurse who has fewer than four
(4)years
of prescribing authority with a CAPA-CS and who wishes to prescribe
controlled substances without a CAPA-CS shall complete the required
number of years under the then-current CAPA-CS to reach four
years and shall submit, via the APRN update portal, a request for review
from the Kentucky Board of Nursing that the advanced practice
registered nurse's license is in good standing. However, if the then-
current CAPA-CS expires or is rescinded prior to the end of the four
year term, a new CAPA-CS shall be required and subject to the
provisions of this section;
3. The advanced practice registered nurse shall not prescribe controlled
substances without a CAPA-CS until the board has completed its review
and has notified the advanced practice registered nurse in writing that
the advanced practice registered nurse is exempt from the CAPA-CS
requirement; and
4. The review request shall include the payment of a fee set by the board
through the promulgation of an administrative regulation.
(c)Upon receipt of a request pursuant to this subsection, the Kentucky Board of
Nursing shall perform a review to determine whether the license of the
advanced practice registered nurse is in good standing based upon an
evaluation of the criteria specified in this subsection and in the administrative
regulation promulgated by the board pursuant to this subsection, including but
not limited to verification:
1. That a current United States Drug Enforcement Administration
registration certificate for the advanced practice registered nurse is on
file with the board;
2. That a current CAPA-CS notification for the advanced practice
registered nurse is on file with the board;
3. That the advanced practice registered nurse has an active master account
with the electronic system for monitoring controlled substances pursuant
to KRS 218A.202;
4. Through a criminal background check of the absence of any unreported
misdemeanor or felony convictions in Kentucky; and
5. Through a check of the coordinated licensure information system
specified in KRS 314.475 of the absence of any unreported disciplinary
actions in another state.
(d)Based on the findings of these actions, the Kentucky Board of Nursing shall
determine if the advanced practice registered nurse's license is in good
standing for the purpose of removing the requirement for the advanced
practice registered nurse to have a CAPA-CS in order to prescribe controlled
substances.
(e)If the advanced practice registered nurse's license is found to be in good
standing, the advanced practice registered nurse shall be notified by the board
in writing that a CAPA-CS is no longer required. The advanced practice
registered nurse shall not be required to maintain a CAPA-CS as a condition
to prescribe controlled substances unless the board later imposes such a
requirement as part of an action instituted under KRS 314.091(1). An
advanced practice registered nurse may choose to maintain a CAPA-CS
indefinitely after the determination of good standing has been made. An
advanced practice registered nurse who chooses to prescribe without a CAPA-
CS shall be held to the same standard of care as all other providers with
prescriptive authority.
(f)If the advanced practice registered nurse's license is found not to be in good
standing, the CAPA-CS requirement shall not be removed until the license is
restored to good standing, as directed by the board.
(g)The Kentucky Board of Nursing shall conduct random audits of the
prescribing practices of advanced practice registered nurses, including those
who are no longer required to have a CAPA-CS in order to prescribe, through
a review of data obtained from the KASPER report or that of the PDMP
currently in use in Kentucky pursuant to KRS 218A.202 and shall take
disciplinary action under KRS 314.091(1) if a violation has occurred.
(a)An advanced practice registered nurse wishing to practice in Kentucky
through licensure by endorsement is exempt from the CAPA-CS requirement
if the advanced practice registered nurse:
1. Has met the prescribing requirements for controlled substances in a state
that grants such prescribing authority to advanced practice registered
nurses;
2. Has had authority to prescribe controlled substances for at least four
years; and
3. Has a license in good standing as described in subsection
(17)of this
section and in the administrative regulation promulgated by the board
pursuant to subsection
(17)of this section.
(b)An advanced practice registered nurse wishing to practice in Kentucky
through licensure by endorsement who has had the authority to prescribe
controlled substances for less than four
(4)years and wishes to continue to
prescribe controlled substances shall enter into a CAPA-CS with a physician
licensed in Kentucky and comply with the provisions of this section until the
cumulative four
(4)year requirement is met, after which the advanced practice
registered nurse who wishes to prescribe controlled substances without a
CAPA-CS shall follow the process identified in subsection
(17)of this section
and in the administrative regulation promulgated by the board pursuant to
subsection
(17)of this section.
(19)An advanced practice registered nurse shall not prescribe controlled substances
without a CAPA-CS until the board has completed its review and has notified the
advanced practice registered nurse in writing that the advanced practice registered
nurse is exempt from the CAPA-CS requirement.