Board of Nursing

Collaborative Practice Arrangement Checklist

COLLABORATIVE PRACTICE ARRANGEMENT CHECKLIST

CP Rule: 20 CSR 2200-4.200 (Nursing) or 20 CSR 2150-5.100 (Healing Arts)

Written Collaborative Practice Arrangement (CPA) Between Physician And Registered Professional Nurse (RN) Who Is Not An Advanced Practice Nurse

NOTE:

-CPA refers to written agreements, written jointly agreed-upon protocols, or written standing orders for the delivery of health care services [See 334.104, RSMo].

-Collaborative Practice Rule does not apply if RN is not in a CPA with a physician.

-RN does not require a CPA with a physician nor require physician oversight to perform nursing acts that the RN has the specialized education, judgement, and skill to perform [See 335.016(9), RSMo].

-Collaborating physician and collaborating RN may want to use pertinent, reputable texts/literature to draft defensible, practice-related operational definitions for phrases/terms not defined in Rule.

-Exceptions to Rule:

    1. Collaborative Practice Rule does not extend to CPAs of RNs who are:
    2. hospital employees

      providing inpatient care

      within hospitals as defined pursuant to chapter 197, RSMo [See 334.104.3, RSMo].

    3. In the case of collaborating physicians and collaborating RNs practicing in association with public health clinics that provide specific (see list in rule) population-based health services, geographic areas, methods of treatment, and review of services occur as identified by the collaborating physicians and collaborating RNs in the CPA [(5)(A)].

Geographic Areas

Methods of Treatment

With such a CPA in place, the collaborating RN may:

-provide health care services for acute self-limited or well defined problems [(3)(J)];

-provide health care services for conditions other than acute self-limited or well defined problems [(3)(J)];

-provide care to well patients or to those with narrowly circumscribed conditions in public health clinics or community health settings that provide specific (see list in rule) population-based health services [(4)(E)];

-provide specific (see list in rule) population-based health services in association with public health clinics [(5)(A)]; and

-provide health care services for acutely or chronically ill or injured persons after diagnosis and initiation of treatment by the collaborating physician or an advanced practice nurse in CPA with physician (e.g., provide continuing or ongoing care) [(2)(B), (2)(C), (3)(J), & (4)(C)]

-entity exceptions to above include: Title X family planning providers or publicly funded clinics in community health settings that dispense medications free of charge [(3)(I)10.]

Review of Services

-exception to this once every two (2) week review by collaborating physician are settings in which collaborating RNís health care is provided to well patients or to those with narrowly circumscribed conditions in public health clinics or community health settings that provide specific (see list in rule) population-based health services; review of these services occurs as needed and identified in written CPA [(4)(E)]

Collaborating physician and collaborating RN determine and document in written CPA an appropriate process of review and management of abnormal test results [(4)(D)]