After the fall 2016 publication of the Ohio Board of Nursing (“OBON”) un-authored Momentum article on the regulation of specialty practice for APRNs working in acute care practice sites, many hospital systems abruptly and prematurely changed their policies, limiting or eliminating non-ACNPs from these locations. The BON article scared hospital administrators by mentioning the risk of “significant criminal penalties” if a family nurse practitioner practiced in an acute care setting.

Unfortunately, there did not appear to be robust, inclusive stakeholder input prior to the article’s publication and meetings which were scheduled to discuss the issues were cancelled. The article’s publication resulted in a backlash of criticism directed to the OBON from many Ohio APRNs and hospital systems, including the Ohio Hospital Association. The OBON subsequently requested an Ohio Attorney General (AG) opinion regarding its legal authority to regulate specialty practice under current APRN practice law and rule.

On July 19, 2017, the Ohio Attorney General issued his opinion on the matter of nurse practitioners without acute care certification working in acute care environments. In summary, while the AG reiterated the OBON’s role in regulating APRN practice, it did find that if the OBON wishes to mandate that only ACNPs may provide acute care services, then the OBON needs to engage in the rulemaking process and adopt a rule to apply a uniform mandate. 

Direct from the AG opinion:

“… If the Board of Nursing intends to generally and uniformly apply and enforce a requirement that a certified nurse practitioner shall be nationally certified in acute care in order to provide services for acute illnesses, the board should adopt a rule that expressly states that qualification standard. In promulgating such a rule under R.C. Chapter 119, the board may receive comments from interested parties and consider whether a grace period or an exception to the requirement of national certification in acute care based upon particular post-graduate clinical experience or advanced certification is appropriate…”

Our Conclusions based on the AG opinion

  1. Pursuant to R.C. 4723.43(C), at this time, an advanced practice registered nurse designated as a certified nurse practitioner may provide services for acute illnesses, so long as the services are consistent with the nurse’s formal education, clinical experience, and national certification. The services must be provided in accordance with formal rules adoptedby the Board of Nursing.
  2. There are currently no restrictions to a CNP, not certified as an ACNP, to engage in acute care practice. Such restrictions may be investigated and imposed in the future.

The AG proposed that for the OBON to move in the direction of restricting acute care practice to solely ACNPs, then, if still desired, a rule would need to be enacted before enforcement could be placed in effect. It is unknown what the OBON will do, given the AG opinion issued.