New york nurse practitioner full practice agreement

The 4 types of New York nursing professions are:

• Licensed Practical Nurses (LPNs)
• Registered Professional Nurses (RNs)
• Nurse Practitioners (NPs). New York certifies NPs in the following specialty practice areas: Acute Care; Adult Health; College Health; Community Health; Family Health; Gerontology; Neonatology; Obstetrics; Oncology; Pediatrics, Perinatology; Psychiatry; School Health; Women’s Health; Holistic Care; and Palliative care.
• Clinical Nurse Specialists (CNSs). New York certifies CNSs in the following specialty practice areas: Adult Health; Pediatrics; Psychiatric/Mental Health; and Oncology.

*In New York, midwifery is not considered a nursing profession. Midwifery is a separately licensed profession.

* Nurse Aides and Home Health Aides are certified by the Department of Health.

2. The scopes of practice for the registered professional nurse, licensed practical nurse, clinical nurse specialist and nurse practitioner professions are defined in New York Law. Does that mean that I can do everything that falls within the legal scope of the practice of my nursing profession?

A nurse may provide nursing services allowed by New York Law only if the nurse is personally competent to provide the services. You are not legally allowed to provide nursing services that you are not personally competent to perform, even if New York Law generally allows a nurse to provide the service. As a licensed professional, it is your responsibility to provide care competently, and as authorized by New York Law. If you do not, you could be charged with unprofessional conduct.

3. Can an unlicensed person, such as a medical technologist, use the title "nurse" or be referred to as "the nurse" in New York?

No. New York Law restricts the use of the title “nurse” to persons who are licensed by the New York State Education Department as an RN, LPN, CNS or NP. Graduates of certain RN or LPN education programs may also use the title of “graduate nurse” or graduate practical nurse” if they have applied to the New York State Education Department (SED) for a New York RN or LPN license and a limited permit.

4. Do I have to be registered and licensed as a nurse with the SED to practice as a nurse in New York?

Yes. You must be licensed and registered by SED as an LPN to practice as an LPN. You must be licensed and registered by SED as a RN to practice as an RN. To practice as a nurse practitioner, you must be licensed and registered by SED as a RN and certified and registered by SED as a nurse practitioner. To practice as a clinical nurse specialist, you must be licensed and registered by SED as a RN and certified and registered by SED as a clinical nurse specialist.

Yes. You are legally required to wear an identification badge indicating your first and last name and your professional title while you are practicing at a hospital, clinic, medical practice or other establishment offering health services to the public.

6. Can a business venture that is not licensed to provide medical or nursing care hire a registered professional nurse, licensed practical nurse, clinical nurse specialist or nurse practitioner to provide nursing services?

No. If a business ventures is not specifically authorized by New York Law to provide medical or nursing care (i.e., salons or nutritional supplement stores) it is not legally allowed to hire licensed nurses to provide professional nursing services in New York.

7. Can a licensed practical nurse (LPN), registered professional nurse (RN) or clinical nurse specialist (CNS) perform services that constitute the practice of medicine (i.e., spinal taps) if delegated by a physician?

No. LPNs, RNs and CNSs are not legally allowed to practice medicine.

8. What options are available to a nurse if a co-worker is suspected of diverting controlled substances or appears to be impaired while providing care to patients?

Several options are available. The nurse could share their concerns with a supervisor or report their observations to the New York State Department of Health’s Bureau of Controlled Substances at 866-811-7957. If the co-worker is a nurse, the co-worker should be encouraged to contact; (1) the New York State Nurses Association's Statewide Peer Assistance for Nurses (SPAN) program by phone 518-782-9400 ext. 304, or electronically through their website at https://www.nysna.org/nursing-practice/statewide-peer-assistance-nurses; or, (2) the New York State Education Department's Professional Assistance Program (PAP) at 518-485-9353.

9. If an insurance company or managed care organization refuses to pay for a nursing service, does it mean that it is not within my legal scope of practice to perform the service?

Insurance companies, managed care organizations and other health care payors do not define the legal scope of practice of nurses. However, they may determine which nursing services they will pay for and how much they will pay. The State Board for Nursing does not have the authority to resolve fee disputes between nurses and managed care organizations, insurance companies or other payors.

10. If I am unsure about whether something falls within my legal scope of practice, how can I find out?

Please review the practice information on this website. If you cannot find the information that you seek, you may contact the Nursing Board Office by EMAIL at: nursebd@nysed.gov, or by telephone at 518-474-3817 ext. 120. You may also send a letter with your question to: New York State Education Department, 89 Washington Avenue-Education Building, State Board for Nursing, Second Floor, West Wing, Albany, New York, 12234.

Nurse Practitioner

Answer: In New York State, a nurse practitioner is a registered professional nurse who has completed advanced nursing education (usually a master's or doctorate degree) in a nurse practitioner specialty area and is certified by the New York State Education Department ("SED") as a "Nurse Practitioner" or "NP". SED certifies nurse practitioners to practice in the following specialty practice areas: Acute Care; Adult Health; Community Health; College Health; Family Health; Gerontology; Holistic Care; Neonatology; Obstetrics; Oncology; Palliative Care; Pediatrics; Perinatology; Psychiatry; School Health; and Women's Health. Nurse Practitioners manage the medical and nursing care of their patients. A nurse practitioner diagnoses illnesses and physical conditions and performs therapeutic and corrective measures within a specialty area of practice in which the nurse practitioner is certified by SED. In addition, nurse practitioners may issue non-patient specific orders and protocols to authorize and RN to administer certain: (1) immunizations; (2) emergency anaphylaxis treatment; (3) TB, HCV, HIV, COVID-19, Influenza, pregnancy and other lab tests; (4) opioid related overdose treatment; (5) medical screenings of persons at increased risk of having gonorrhea, syphilis or chlamydia, (6) medical services to newborn patients in hospitals, and, (7) emergency services for life threatening medical conditions. Certain medical services, including certain immunizations, and emergency treatments. Nurse practitioners also issue non-patient specific orders and protocols to authorize a licensed pharmacist to administer certain immunizations and dispense certain medications and medical devices.

There are many New York Laws and regulations that impact the practice of RNs. To view some of these laws and regulations, click on “Laws, Rules & Regulations” in the left navigation menu.

2. Please describe the "specialty practice areas" in which the SED issues nurse practitioner certifications.

SED issues nurse practitioner certificates in the following specialty practice areas:

Nurse Practitioner (Acute Care): diagnoses, treats, and manages the care of acutely ill patients in a variety of hospital and ambulatory care settings.

Nurse Practitioner (Adult Health): diagnoses, treats, and manages the care of adults (young adults from about age 18 to the very elderly). Adult nurse practitioners may provide primary care or acute care; they may address acute or chronic health problems or provide preventive or supportive care.

Nurse Practitioner (College Health): addresses the physical and mental health needs of adolescent and adult populations in college settings.

Nurse Practitioner (Community Health): provides primary care services in community settings and engages in population-based health planning for communities.

Nurse Practitioner (Family Health): diagnoses, treats and manages the care of families and individuals across the life span. Family nurse practitioners usually provide primary care but they may also provide acute care, address acute or chronic health problems, and provide preventive and supportive care. Family Nurse Practitioners practice in a variety of settings, including schools, homes, workplaces, hospitals, clinics and primary care health practices.

Nurse Practitioner (Gerontology): diagnoses, treats and manages the care of older adults. This includes primary care and acute care, adressing acute or chronic health problems and providing preventive or supportive care.

Nurse Practitioner (Holistic Care): provides care that encompasses the body, emotion, mind and spirit, focusing on personal development and self-healing.

Nurse Practitioner (Neonatology): diagnoses, treats and manages the care of newborns and infants up to 1 year of age and provides support services to new parents.

Nurse Practitioner (Obstetrics and Gynecology): provides obstetrical and gynecological care to adults and adolescents. Obstetrics and Gynecology nurse practitioners may provide primary care or acute care; they may address acute or chronic health problems and provide preventive or supportive care. Some Obstetrics and Gynecology nurse practitioners sub-specialize in fields such as Labor & Delivery.

Nurse Practitioner (Oncology): diagnoses and treats and manages oncology related care for patients with cancer, and counsels, educates and provides support to their families.

Nurse Practitioner (Palliative Care): provides care to improve the quality of life of individuals with chronic, debilitating and life limiting illnesses and their families. Palliative care nurse practitioners typically treat pain and other distressing symptoms as well as address other physical, psychosocial and spiritual needs of patients and families.

Nurse Practitioner (Pediatrics): diagnoses, treats, and manages the care of infants, children, adolescents and young adults (up to about age 21). Pediatric nurse practitioners provide primary care and acute care; they address acute or chronic health problems and provide preventive and supportive care.

Nurse Practitioner (Perinatology): promotes quality care across the spectrum of birth experiences, ranging from a physiologic approach to birth that minimizes unnecessary intervention to coordinating treatment plans for conditions typically associated with high-risk pregnancies. They also work with new parents to provide guidance on breast feeding and parenting.

Nurse Practitioner (Psychiatry): diagnoses and treats psychiatric disorders and manages other acute and chronic mental health problems of adults and children. They may provide primary mental health care services or acute mental health services (i.e., triage, crisis intervention services).

Nurse Practitioner (School Health): addresses the health care needs of students in school settings. School health nurse practitioners may develop care plans to be implemented in school settings, train school staff to help students with health issues, and provide counseling and health education to students and their families.

Nurse Practitioner (Women’s Health): diagnoses, treats and manages the care of women and female adolescents, with a focus on primary care and gynecological care. They diagnose and treat sexually transmitted diseases in adults and adolescents, regardless of sex or gender identity.

3. Can a nurse practitioner medically diagnose or prescribe medical treatments for patients outside of the specialty area of practice in which they are certified by SED?

Answer: No. A nurse practitioner may only diagnose and prescribe medical treatments within the specialty area of practice for which they are certified by SED.

4. Does New York State Education Law require physicians to supervise nurse practitioners (NPs) or co-sign their charts or records?

Answer: No. New York State Education Law holds nurse practitioners independently responsible for the care of their patients and does not require a physician to supervise the nurse practitioner or co-sign any of the nurse practitioner’s records or charts.

Answer: New York State Education Law requires all nurse practitioners to practice in accordance with written practice protocols and a written practice agreement with a collaborating physician, unless or until the nurse practitioner has completed more than 3600 hours of qualifying nurse practitioner experience. This experience must consist of practicing as a licensed or certified NP as follows:

1. in accordance with the laws of New York or another state, or
2. while employed by the United States veteran's administration, the United States armed forces or the Unites States public health service.

Nurse practitioners with more than 3,600 hours of qualifying practice experience are authorized to practice independently. This allows experienced nurse practitioners to provide the full scope of services they are educated and clinically trained to provide.

7. Is there a limitation on the medications that a nurse practitioner (NP) may prescribe under a DEA number?

Answer: New York State Education Law authorizes each NP to prescribe controlled substances (from Schedules II through V) for patients only within the specialty area of practice for which the NP is certified by SED. Federal and New York laws permit some NPs to prescribing Suboxone for treating drug dependence.

6. Can a nurse practitioner (NP) who has a written practice agreement with a collaborating physician continue to work while the collaborating physician is not available for prolonged periods or after the collaborating physician dies?

Answer: During an extended absence, the collaborating physician can designate a resource person to be available to the NP, as needed, during the physician's absence. For prolonged absences, it is preferred if the resource person is identified in the written practice agreement. However, if the collaborating physician dies, the written practice agreement signed by the nurse practitioner and physician is no longer valid. To continue practicing, a nurse practitioner with 3,600 or fewer hours of qualifying nurse practitioner practice must enter into a written practice agreement with another collaborating physician.

RN & LPN

New York's Nurse Practice Act allows LPNs to provide nursing services under the direction of a registered professional nurse (RN), clinical nurse specialist, physician, nurse practitioner, licensed midwife, physician assistant, specialist assistant, dentist, or podiatrist ("directing practitioner"). An LPN typically provides the following services under the direction of an RN or other directing practitioner (assuming that the LPN is appropriately trained and competent to provide the service or services):

• Administers most types of medications, immunizations and some blood products.
• Provides bedside nursing care in hospitals and residential health care facilities.
• Observes, measures, records, and reports data relating to a patient’s health status.
• Performs clinical procedures, such as urinary catheterizations, tracheal suctioning, sterile dressing changes, and starting a peripheral IV.
• Supervises unlicensed care staff, such as certified nurse aides (CNAs) in nursing homes.
• Identifies patient goals for consideration by the RN for possible inclusion in a patient’s care plan.

An LPN is not legally allowed to determine nursing diagnoses, develop or change nursing care plans, perform triage, or perform any service that the LPN is not personally competent to perform. There are many services not listed here that LPNs may or may not be allowed to perform. There are many New York laws and regulations that impact the practice of LPNs. To view some of these laws and regulations, click on "Laws, Rules & Regulations" in the left navigation menu.

New York's Nurse Practice Act allows RNs to diagnose and treat human responses to actual or potential health problems through such services as case finding, health teaching, health counseling and providing care supportive to or restorative of life and well-being. RNs perform nursing assessments, determine nursing diagnoses, and plan, implement and evaluate nursing care. A nursing regimen must be consistent with any existing medical regimen.

New York's Nurse Practice Act also allows RNs to execute medical regimens prescribed by a physician, dentist, nurse practitioner, physician assistant, specialist assistant, midwife or podiatrist for a specific patient. In addition, RNs execute non-patient specific orders and protocols issued by a physician or nurse practitioner for administering certain: (1) immunizations; (2) emergency anaphylaxis treatment; (3) TB, HCV, HIV, COVID-19, Influenza, pregnancy and other lab tests; (4) opioid related overdose treatment; (5) medical screenings of persons at increased risk of having gonorrhea, syphilis or chlamydia, (6) medical services to newborn patients in hospitals, and, (7) emergency services for three life threatening medical conditions.

RNs may practice independently, in collaboration with other health care practitioners, or under the supervision of a physician, nurse practitioner, midwife, dentist, podiatrist, clinical nurse specialist or another RN. An RN typically provides the following types of services (assuming that the RN is appropriately trained and competent to provide the service or services):

• Performs physical exams and patient assessments to identify and address health problems and unmet patient care needs.
• Develops comprehensive nursing care plans and performs nursing interventions (i.e., bereavement counseling, ostomy care).
• Performs medical treatments (i.e., medication administration, wound care) as prescribed or by a physician, dentist, nurse practitioner, physician assistant, specialist assistant, midwife or podiatrist.
• Provides health teaching and emotional support to help patients and their families adjust to or manage serious or chronic illnesses or injuries.
• Supervises care delivered by other health care personnel, such as licensed practical nurses and home health aides.
• Works with physicians, and other health care practitioners to ensure that patients receive appropriate, timely, well-coordinated care.
• Conducts health screenings to detect and address signs of early disease or risk factors for disease and then provide health teaching or make referrals, as appropriate.

An RN is not legally allowed to determine medical diagnoses, prescribe medical treatments, or perform any nursing services that the RN is not competent to perform. There are many New York laws and regulations that impact the practice of RNs. To view some of these laws and regulations, click on "Laws, Rules & Regulations" in the left navigation menu.