Last fall the Ohio Board of Nursing (OBON) published an article on Acute Care and Primary Care NP scope of practice in the OBON’s e-zine, Momentum. For the first time the OBON gave the opinion that an APRN’s national certification would determine where an APRN could practice and what type of patients they could see. Up until this time the OBON regulated the four APRN roles for licensure only.
The Momentum article gave the interpretation that only Acute Care NPs (ACNPs) could manage an unstable patient given their Master’s degree and national certification. So, if a Family Nurse Practitioner (FNP) was practicing in an emergency department, the FNP could not see any unstable patients and/or if a non-urgent patient became unstable, the FNP would need to turn over the patient’s management to an ACNP or physician. The OBON’s interpretation would stand regardless of the post-graduate education/training of the non-ACNP or the privileging status of the FNP. Unfortunately, the OBON based its opinion on the misinterpretation of the L.A.C.E. document and Ohio law, in addition to lending an ear to a very vocal academic on exclusive use of the ACNP in hospital settings.
Needless to say, this out-of-the-blue opinion caused an uproar among the APRN community and hospital systems. Some systems started to restrict what non-ACNPs could do in the emergency department and changed policies that only ACNPs could work in critical care units. The ramifications are vast and would negatively influence care access, patient safety and teamwork. Interestingly, no data on outcomes or safety when treated by an ACNP or non-ACNP in a hospital setting could be found.
Two organizations, OAAPN and the Ohio Hospital Association (OHA), requested meetings with the OBON starting in November. Each time contact was made the OBON could not meet due to budget preparation, readying the e-license system for HB 216 changes and a variety of other reasons. To OAAPN and OHA’s surprise, the OBON notified both organizations in March that the decision on whether the OBON had the regulatory authority to regulate APRN sub-specialty practice or not was sent to the Ohio Attorney General’s (AG) office for an opinion. An AG opinion is considered binding as it is based on existing Ohio law. The only way around this opinion would be to pass a new law.
Though frustration with the OBON was running high for not meeting with interested parties to mitigate this situation, both organizations (OAAPN and OHA) have been in contact with the AG staff. Legal arguments have been submitted on why this action by the OBON is not consistent with existing law. The AG opinion is not a short process and can take from 90-120 days. The earliest expected opinion release would be August 1. You can review the OBON’s request to the Attorney General HERE and OAAPN’s submission to the AG HERE.