Psychiatric Certified APRNs

The passage of HB 111 two weeks ago removed another barrier to care access for Ohioans. OAAPN was the spark for this legislative change which took six years to become a reality. This bill was signed by Governor Kasich on June 29 and will go into effect September 27, 2018. Note that HB 111 does have two provisions noted in paragraph five below that have been marked as an emergency which go into effect immediately after the governor signs the bill.

Essentially, psychiatric certified clinical nurse specialists (CNS) and psychiatric mental health nurse practitioners (PMHNP) will have the authority to compel mental health exams for an individual who demonstrates behavior that would pose harm to another or oneself. Many providers call this action, “Pink Slipping”. Before the passage of HB 111 only physicians, psychologists, police and public health officers could “pink slip” a person.

Compelling a mental health exam means a person who is “pink slipped” (having the appropriate form signed by the psychiatric CNS or PMHNP) will be taken (generally by the police) to a hospital (most commonly an emergency department) to determine if the demonstrated behaviors meet homicidal or suicidal ideations requiring further evaluation during a short-term admission up to 72 hours. During this time a psychiatric provider will either admit the person for inpatient care or discharge for outpatient follow up.

Many have asked why all Ohio APRNs were not provided this authorization. Organizations who support individual rights were strongly opposed to the initial legislation that included all APRNs because removing the freedom of an individual cannot be taken lightly. Through negotiation between no authority to “pink slip” or some APRN authority, the latter was decided. Because of Ohio’s behavioral health crisis, legislators recognized adding psychiatric certified APRNs “pink slipping” authority was a necessary step to further address one of Ohio’s public health issues.

Whenever a bill is moving in a legislative session, like amendments (health-care-related to a healthcare bill) may be added before votes are taken by a committee or a chamber. Adding many amendments to a bill is termed a “Christmas Tree” bill. HB 111 was a “Christmas Tree” bill. Here are additional changes to the Ohio Revised Code which affects the APRN community.

– PMHNP’s may now have a non-psychiatrist collaborating physician if the collaborating physician is in one of the following specialties: Internal Medicine, Pediatrics or Family medicine. HB 216 only allowed psychiatric certified CNSs to have this waiver.

– EMERGENCY PROVISION: An APRN (CNM, CNP and CRNA) is exempt from a master’s or doctoral degree in nursing requirement if all the following occurs:

  • The BON Issued a certificate of authority to practice as a CRNA, CNM or CNP before January 1, 2000
  • The applicant submitted documentation satisfactory to the BON that the applicant obtained certification in the applicant’s nursing specialty (CRNA, CNM or CNP) with a national certification body prior to March 20, 2013.
  • The applicant submitted documentation satisfactory to the BON that the applicant has maintained the certification.

– EMERGENCY PROVISION: An APRN applicant who desires to practice as a CNS is exempt from the certification requirement if both of the following are the case: 

  • The BON issued a certificate of authority to practice as a CNS before January 1, 2001.
  • The CNS submitted documentation satisfactory to the board that the applicant earned either of the following:
    º A master’s or doctoral degree with a major in a clinical area of nursing from an educational institution accredited by a national or regional accrediting organization;
    º A master’s or doctoral degree in nursing or a related field and was certified as a CNS by ANCC or another national certifying organization that was at that time approved by the BON.

– EMERGENCY PROVISION: For APRNs endorsing into Ohio for an APRN license:

  • May include evidence of all the following:
    º (1) Successfully completing the course of study in advanced pharmacology and related topics more than five years before the date the application is filed;
    º (2) Holding, for a continuous period of at least one year during the three years immediately preceding the date of application, valid authority in any jurisdiction to prescribe therapeutic devices and drugs, including at least some controlled substances;
    º (3) Exercising prescriptive authority for the minimum one-year period.

OAAPN is extremely grateful for the members who actively worked for the successful passage of this bill and to all APRNs who are members of OAAPN, who without their memberships, OAAPN would not be successful in supporting Ohio’s APRN Community.

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