Certification and Licensure Plan
In this discussion, I plan to discuss how to obtain and maintain an advanced practice registered nurse license in the state of Georgia. I will also answer several questions about the scope of practice and the state practice agreement in Georgia. I will discuss how to obtain a DEA license, how the state of Georgia describes a nurse practitioner’s controlled-substance prescriptive authority, and what drug schedules nurse practitioners are authorized to prescribe in Georgia.
Certification and Licensure in the state of Georgia
Advanced practice registered nurses have many specialty areas of practice including nurse practitioners (NP), certified registered nurse anesthetists (CRNA), and psychiatric mental health nurse practitioners (PMHNP) to name a few. In Georgia advanced nursing practice means practice by a registered professional nurse who meets the educational, practice, certification requirements, or a combination of such requirements, as specified by the Board, and is authorized to perform advanced nursing functions and certain medical acts which include, but are not limited to, ordering drugs, treatments, and diagnostic studies (GA. Comp. R & Regs. 410-11-.01, n.d., 2 (b).
Becoming certified and licensed as an advanced practice registered nurse in the state of Georgia requires
• Evidence of current licensure as a registered nurse in the state of Georgia.
• A completed board application with the required fee.
• An official transcript to verify graduation with a master’s degree or higher in nursing in the nurse practitioner specialty or post-master’s certification in an advanced practice registered nurse practitioner’s specialty and evidence of advanced pharmacology, advanced physical assessments, and advanced pathophysiology as part of the curriculum.
• Verification of current national certification from a Board-recognized certifying organization (GA. Comp. R & Regs. 410-11-.03, n.d., 3(a-d).
There must be documentation in the past four years preceding the date of application of one of the following:
• 500 hours of practice as an advanced practice registered nurse.
• Graduation from a nursing education program or graduate level post-master’s certification program in an advanced practice specialty.
• Completion of a Georgia Board-approved practice registered nurse reentry or refresher program (GA. Comp. R & Regs. 410-11-.03, n.d., 4 (a-c).
State application Process for APNP and Website
The application process for becoming an APNP in the state of Georgia involves completing the application and including a check or money order for the application fee and processing fee of $85.00. All the board rules discussed previously from chapters 410-11-.03(3) and (4) including the national certifying body must be completed and sent to the Georgia Board of Nursing at [email protected] along with official transcripts from the graduate education program that is within four years of the date of application (Georgia Board of Nursing, 2022, p. 1). Official transcripts can be submitted with the application but must be sealed by the envelope from the school or can be sent electronically to [email protected] by the school or by using a transcript exchange service and the transcript must show proof of a master’s level degree or higher, proof of advanced pharmacology, pathophysiology, physical assessment, and APRN specialization (Georgia Board of Nursing, 2022, p. 1). Georgia law requires proof of United States citizenship via driver’s license or passport or another document. (Georgia Board of Nursing, 2022, p. 1). The Georgia Board of Nursing website is https://sos.ga.gov/.
Scope of practice and Standard of Practice agreement
According to rules 410-11-.03 (2a) scope and standards of practice for the nurse practitioner, nurse practitioner provides advanced practice nursing care and medical services specific to the nurse practitioner’s specialty to individuals, families, and groups, emphasizing health promotion and disease prevention as well as the diagnosis and management of acute and chronic diseases and collaborates as necessary with a variety of individuals to diagnose and manage clients’ health care problems (GA. Comp. R & Regs. 410-10-.03, n.d., 4(a).
The clinical nurse specialist psychiatric/mental health (CNS/PMH) provides services from mental health promotion to mental illness and rehabilitation, provides psychotherapy, clinical supervision, consultation, and liaison services, and must practice within the standards of the American Nurses Association’s statement of psychiatric-Mental Health Clinical Nursing Practice and Standards of Psychiatric-Mental Health Nursing Practice (GA. Comp. R. & Regs 410-11-.05, n.d., 2 (a).
The state of Georgia standard of practice agreement requires a written agreement, nurse protocol, that specifies delegated medical acts by the physician in the same specialty field and provides consultation with the delegating physician that must the mutually agreed upon, signed and dated by the nurse practitioner and physician (GA. Comp. R.& Regs. 410-10-.13, n.d., 2 (c).
The nurse protocol written agreement must also provide:
Performance specific to each medical act authorized by the written nurse protocol including, if included as a medical act, ordering, and administering controlled substances, ordering, and dispensing dangerous drugs, medical treatments, and diagnostic studies with specific parameters under which medical acts delegated by the physician may be performed.
Must be available upon request with provisions for periodic review of patients’ records by delegating physician.
It must be reviewed, revised, or updated annually.
Must include provision for immediate consultation with the delegating physician or a physician designated in the absence of the delegating physician (GA. Comp. R.& Regs. 410-10-.13, n.d., 2 (d), 3 (a-g).
How to get a DEA License
The federal government, Drug Enforcement Administration (DEA), monitors prescribing of controlled substances. A nurse practitioner must register with the DEA and obtain a DEA number before being able to prescribe controlled substances and must use the DEA number on prescriptions for scheduled drugs. (Buppert, 2021, p. 211). New APRN applicants must complete form 224 on the US department of justice website for a midlevel practitioner. The APRN must possess all required state authority to handle controlled substances for their state, including collaborative agreement and prescriptive authority to handle controlled substances before applying with the DEA. Once all requirements have been met the application can be filed with the fee of $888 for 3 years (US Department of Justice [DOJ] & Drug Enforcement Administration [DEA], 2022).
Prescriptive Monitoring Program
The Georgia Prescriptive Drug Monitoring Program (PDMP) is an electronic database used to monitor prescribing and dispensing of controlled substances to help eliminate overprescribing of controlled substances.
The Georgia General Assembly passed House Bill 249 effective July 1, 2017, which requires all dispensers to enter prescription information for Schedule II, III, IV, and V controlled substances within 24 hours (Georgia Department of Public Health [DPH], 2021). All prescribers with an active Ga. professional license and DEA number are required to register in the Ga PDMP and are required to check the PDMP before initial prescribing of opiate or cocaine derivatives in schedule II drugs and benzodiazepines and every 90 days if the patient continues the prescription.
Nurse Practitioners’ Controlled Substance Prescriptive Authority in Georgia
According to O.C.G.A. § 43-34-25, an advanced practice registered nurse (APRN), who is in good standing and has been recognized by the Georgia Board of Nursing as having met the requirements to engage in advanced nursing practice, is permitted to issue a prescription drug order or orders for any dangerous drugs, except for drugs intended to cause an abortion to occur pharmacologically, or for any Schedule III, IV, or V controlled substance without the co-signature of a delegating physician under the following conditions:
• The APRN must have delegated authority to issue prescriptions for dangerous drugs and controlled substances by a physician licensed by the Georgia Composite Medical Board in a nurse protocol agreement and that agreement has been filed with the Georgia Composite Medical Board.
• If the prescription is for controlled substances, the APRN has a DEA number.
• If the prescription is a hard copy of an electronic visual image prescription drug order given directly to the patient the hard copy must be printed on security paper with the wording that indicates the signature was electronically generated (Ga. Comp. R. & Regs. R. 480-22-.12 2 (a-d). The APRN has no prescriptive authority to prescribe schedule I or II controlled substance (GA. Comp. R. & Regs. 410-11-.14 2(e) 1).
Conclusion
It is essential to be familiar with the certification and licensure requirements in your state before becoming an APRN. This role carries much responsibility, and we must be educated about the laws, and regulations to ensure that we follow them so that we can provide the best care to our patients and avoid causing harm to ourselves or our patients. This discussion has been extremely enlightening for me to study and understand the regulations for the state of Georgia where I live and plan to practice. I was aware of some of the regulations regarding physician delegation and supervision. However, until I read the rules and regulations on prescriptive authority and scope and standard of practice, I had no idea how regulated and restricted the state of Georgia is regarding APRNs.
References
Buppert, C. (2021). Nurse practitioners business practice and legal guide (7th ed.). Jones and Bartlett Learning.
GA. Comp. R & Regs., Purpose definitions, title, and authority for advanced nursing practice §410-11-.01. https://rules.sos.ga.gov/gac/410-11
GA. Comp. R. & Regs, Rules for clinical nurse specialist psychiatric/mental health §410-11-.05. https://rules.sos.ga.gov/gac/410-11
GA. Comp. R & Regs., Rules for nurse practitioners §410-11-.03. https://rules.sos.ga.gov/gac/410-11
GA. Comp. R.& Regs., Regulation of protocol use by advanced practice registered nurses as authorized by O.C.G.A. Section 43-34-26.1 §410-11-13. https://rules.sos.ga.gov/gac/410-11
Georgia Board of Nursing. (2022). Georgia board of nursing – Initial authorization as an advanced practice registered nurse. Georgia board of nursing. Retrieved August 30, 2022, from https://sos.ga.gov/how-to-guide/how-guide-aprn-np#Initial%20Authority%20Licensure%20Checklist
Georgia Department of Public Health. (2021, September 2). Prescription drug monitoring program. Retrieved August 30, 2022, from https://dph.georgia.gov/pdmp
US Department of Justice & Drug Enforcement Administration. (2022, May 11). Registration. Diversion Control Division. Retrieved August 30, 2022, from https://www.deadiversion.usdoj.gov/drugreg/index.html
