Ohio State Nursing Practice Certification and Licensure

Obtaining Certification and Licensure in Ohio

In Ohio, the process of obtaining Advance Practice Registered Nurse (APRN) licensure is defined by the state’s nurse practice act. To apply for APRN licensure, an individual must have an active Ohio Registered Nurse (RN) license. Additionally, applicants must hold a master’s or doctoral degree in a qualifying nursing specialty, enabling them to sit for a certification exam recognized by the Ohio Board of Nursing. For Certified Nurse Practitioners (CNP) in Ohio, the degree must also include proof of completing an Advanced Pharmacology course of at least 45 contact hours within the five years preceding the APRN licensure application.

Application Process for Certification

Applicants for APRN licensure in Ohio should utilize the eLicense Ohio Professional Licensure System for the application process. The applicant’s school must email an official transcript confirming the completion of a master’s or doctoral degree in a nursing specialty. This transcript should also demonstrate the required 45 contact hours in Advanced Pharmacology completed within the last five years. Additionally, applicants must submit proof of national certification directly from an approved National Certification Organization recognized by the Ohio Board of Nursing. For the Adult-Gerontology Primary Care Nurse Practitioner, Ohio acknowledges the American Association of Nurse Practitioners Certification Board (AANPCB) and the American Nurses Credentialing Center (ANCC) as approved national testing agencies. Applicants who complete programs outside of Ohio are also required to complete continuing education related to Ohio law and rules governing Schedule II prescribing. The application may be submitted conditionally before the completion of the APRN education program or the taking of a national examination. The Ohio Board of Nursing retains applications for one year from the date of receipt. There is a nonrefundable fee of $150.00 due at the time of application.

Scope of Practice and Collaborative Agreements

The scope of practice for Certified Nurse Practitioners (CNP) involves practicing in collaboration with one or more physicians or podiatrists, as required by Ohio law. This collaboration is formalized through a Standard Care Agreement (SCA) with the collaborating physician. CNPs are empowered to provide preventative and primary care services, address acute illnesses, evaluate and promote patient wellness within their specialty, and make decisions consistent with their education, certification, and Ohio Board of Nursing regulations. In addition to direct patient care, CNPs in Ohio are allowed to engage in research, education, and health policy advocacy. Despite the necessity of a collaborative agreement, CNPs can make independent care decisions and are accountable for their choices. They also possess prescriptive authority to prescribe medications, with the scope of practice varying slightly when collaborating with a podiatrist.

Restrictions and Limitations

While Certified Nurse Practitioners in Ohio are required to collaborate with a physician or podiatrist via a Standard Care Agreement, there are specific limitations to their practice. CNPs cannot prescribe Schedule II medications unless a physician has previously prescribed them, and even in such cases, the supply must not exceed 72 hours. For Schedule II controlled substances, CNPs may prescribe only up to 2,500 dosage units in any thirty-day period. CNPs may prescribe opioid analgesics for treating acute, subacute, and chronic pain. However, they are prohibited from prescribing any drug or device to perform or induce an abortion.

Prescriptive Authority and DEA Registration

In Ohio, Certified Nurse Practitioners (CNPs) have prescriptive authority in line with their scope of practice, national certification, Standard Care Agreement (SCA), standards of practice, and the prescriptive authority of their collaborating physician. CNPs must adhere to the Exclusionary Formulary defined in Ohio Revised Code and comply with current state and federal laws. All APRNs in Ohio with prescriptive authority must register with the Ohio Automated Rx Reporting System (OARRS) and review OARRS reports for controlled substances. A collaborating physician is limited to collaborating in prescribing with a maximum of five CNPs. CNPs can prescribe Schedule II controlled substances under specific circumstances, such as when a patient has a terminal illness.

Legislative and Advocacy Activities

The Ohio Association of Advanced Practice Nurses (OAAPN) is the primary organization in Ohio responsible for legislative advocacy related to nurse practitioners. OAAPN, founded in 1996, is the only full-service statewide organization for Advanced Practice Registered Nurses (APRNs) of all specialties in Ohio, representing approximately 12,800 members. OAAPN advocates for high-quality, cost-effective, and accessible healthcare for Ohio residents. They have been involved in various legislative efforts, including introducing bills like the Better Access, Better Care Act, which aimed to allow APRNs in Ohio to treat patients without the requirement of a Standard Care Agreement (SCA). While this bill did not pass, OAAPN continues to work on advancing legislation that supports APRNs in Ohio.

Discussion 1: Exploring Scholary Sources and the Walden Library

Barriers to Practice

Barriers to independent practice in Ohio revolve around the views of physicians and organizations like the Ohio State Medical Association (OSMA), which opposes certain legislative initiatives aimed at granting more autonomy to APRNs. OSMA argues that there is no shortage of physicians in Ohio and that nurse practitioners lack

References

Drug Enforcement Administration (DEA). (2021). Mid-Level practitioners authorization by state. U.S. Department of Justice. https://www.deadiversion.usdoj.gov/drugreg/practioners/mlp_by_state.pdf

Ohio Association of Advanced Practice Nurses (OAAPN). (2021). Our accomplishments and legislative efforts.  https://oaapn.org/2021/03/our-accomplishments-and-legislative-efforts/

Ohio Board of Nursing. (2021a). APRN licensure and practice in Ohio. https://nursing.ohio.gov/wp-content/uploads/2021/02/APRN-Licensure-and-Practice.pdf

Ohio Board of Nursing. (2021b). Advanced practice registered nurse application certified nurse practitioner.  https://nursing.ohio.gov/wp-content/uploads/2021/04/CNP-Sample-APP.pdf

Ohio State Medical Association (OSMA). (2020). Ohio legislative update. https://osma.org/aws/OSMA/pt/sd/news_article/302869/_PARENT/layout_details-news/false

Ohio Rev. Code. § 4723.43 (2020). https://codes.ohio.gov/ohio-revised-code/section-4723.43

Ohio Rev. Code. § 4723.481 (2011). https://codes.ohio.gov/ohio-revised-code/section-4723.481

Discussion: Certification and Licensure

Although there is a movement called the APRN Consensus Model to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.

Another important area to consider and plan for is prescriptive authority. Prescriptive authority is granted under state law by the appropriate board. The board granting prescriptive authority may be the medical board, state board of pharmacy, or nursing board for the appropriate state licensure being pursued. The authority to write for a controlled substance is granted at a federal level and is verified through the Drug Enforcement Administration (DEA) by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.

Finally, the legal landscape for NPs is constantly changing as the status of NPs as providers improves on a national level. Legislative changes may occur annually, bi-annually, or during an emergency legislative meeting at the state or federal level. These legislative sessions and any subsequent changes will significantly impact your scope of practice as a nurse practitioner.

For this Discussion, you examine professional issues for your state, including certification and licensure, scope of practice, independent practice, prescriptive authority, and legislative activities.

To prepare:

• Review practice agreements in your state.
• Identify whether your state requires physician collaboration or supervision for nurse practitioners and, if so, what those requirements are.
• Research the following:
  • How do you get certified and licensed in your state?
  • What is the application process for certification in your state?
  • What is the primary nurse licensure office resource website in your state?
  • How does your state define the scope of practice of a nurse practitioner?
  • What is included in your state’s practice agreement?
  • How do you get a Drug Enforcement Agency (DEA) license?
  • How does your state describe a nurse practitioner’s controlled-substance prescriptive authority and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
  • In what legislative and advocacy activities are your state nurse practitioner organization(s) involved?

By Day 3

Post a summary of your findings on your state based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on 2 different days in one or more of the ways listed below.

• Share an insight from having viewed your colleagues’ posts.
• Suggest additional actions or perspectives.
• Share insights after comparing state processes, roles, and limitations.
• Suggest a way to advocate for the profession.
• Share resources with those who are in your state.