Ohio § 4723.431

§ 4723.431.

(A)(1) An advanced practice registered nurse who is designated as a clinical nurse specialist,

certified nurse-midwife, or certified nurse practitioner may practice only in accordance

with a standard care arrangement entered into with each physician or podiatrist with

whom the nurse collaborates.  A copy of the standard care arrangement shall be retained on file by the nurse's

employer.  Prior approval of the standard care arrangement by the board of nursing is not required,

but the board may periodically review it for compliance with this section. A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner

may enter into a standard care arrangement with one or more collaborating physicians

or podiatrists.  If a collaborating physician or podiatrist enters into standard care arrangements

with more than five nurses, the physician or podiatrist shall not collaborate at the

same time with more than five nurses in the prescribing component of their practices. Not later than thirty days after first engaging in the practice of nursing as a clinical

nurse specialist, certified nurse-midwife, or certified nurse practitioner, the nurse

shall submit to the board the name and business address of each collaborating physician

or podiatrist.  Thereafter, the nurse shall notify the board of any additions or deletions to the

nurse's collaborating physicians or podiatrists.  Except as provided in division (D) of this section, the notice must be provided

not later than thirty days after the change takes effect. (2) All of the following conditions apply with respect to the practice of a collaborating

physician or podiatrist with whom a clinical nurse specialist, certified nurse-midwife,

or certified nurse practitioner may enter into a standard care arrangement: (a) The physician or podiatrist must be authorized to practice in this state. (b) Except as provided in division (A)(2)(c) of this section, the physician or podiatrist

must be practicing in a specialty that is the same as or similar to the nurse's nursing

specialty. (c) If the nurse is a clinical nurse specialist who is certified as a psychiatric-mental

health CNS or the equivalent of such title by the American nurses credentialing center

or a certified nurse practitioner who is certified as a psychiatric-mental health

NP or the equivalent of such title by the American nurses credentialing center or

American academy of nurse practitioners certification board, the nurse may enter into

a standard care arrangement with a physician but not a podiatrist and the collaborating

physician must be practicing in one of the following specialties: (i) Psychiatry; (ii) Pediatrics; (iii) Primary care or family practice. (B) A standard care arrangement shall be in writing and shall contain all of the following: (1) Criteria for referral of a patient by the clinical nurse specialist, certified nurse-midwife,

or certified nurse practitioner to a collaborating physician or podiatrist or another

physician or podiatrist; (2) A process for the clinical nurse specialist, certified nurse-midwife, or certified

nurse practitioner to obtain a consultation with a collaborating physician or podiatrist

or another physician or podiatrist; (3) A plan for coverage in instances of emergency or planned absences of either the clinical

nurse specialist, certified nurse-midwife, or certified nurse practitioner or a collaborating

physician or podiatrist that provides the means whereby a physician or podiatrist

is available for emergency care; (4) The process for resolution of disagreements regarding matters of patient management

between the clinical nurse specialist, certified nurse-midwife, or certified nurse

practitioner and a collaborating physician or podiatrist; (5) An agreement that the collaborating physician shall complete and sign the medical

certificate of death pursuant to section 3705.16 of the Revised Code ; (6) Any other criteria required by rule of the board adopted pursuant to section 4723.07 or 4723.50 of the Revised Code . (C) A standard care arrangement entered into pursuant to this section may permit a clinical

nurse specialist, certified nurse-midwife, or certified nurse practitioner to do any

of the following: (1) Supervise services provided by a home health agency as defined in section 3740.01 of the Revised Code ; (2) Admit a patient to a hospital in accordance with section 3727.06 of the Revised Code ; (3) Sign any document relating to the admission, treatment, or discharge of an inpatient

receiving psychiatric or other behavioral health care services, but only if the conditions

of section 4723.436 of the Revised Code have been met. (D)(1) Except as provided in division (D)(2) of this section, if a physician or podiatrist

terminates the collaboration between the physician or podiatrist and a certified nurse-midwife,

certified nurse practitioner, or clinical nurse specialist before their standard care

arrangement expires, all of the following apply: (a) The physician or podiatrist must give the nurse written or electronic notice of the

termination. (b) Once the nurse receives the termination notice, the nurse must notify the board of

nursing of the termination as soon as practicable by submitting to the board a copy

of the physician's or podiatrist's termination notice. (c) Notwithstanding the requirement of section 4723.43 of the Revised Code that the nurse practice in collaboration with a physician or podiatrist, the nurse

may continue to practice under the existing standard care arrangement without a collaborating

physician or podiatrist for not more than one hundred twenty days after submitting

to the board a copy of the termination notice. (2) In the event that the collaboration between a physician or podiatrist and a certified

nurse-midwife, certified nurse practitioner, or clinical nurse specialist terminates

because of the physician's or podiatrist's death, the nurse must notify the board

of the death as soon as practicable.  The nurse may continue to practice under the existing standard care arrangement

without a collaborating physician or podiatrist for not more than one hundred twenty

days after notifying the board of the physician's or podiatrist's death. (E)(1) Nothing in this section prohibits a hospital from hiring a clinical nurse specialist,

certified nurse-midwife, or certified nurse practitioner as an employee and negotiating

standard care arrangements on behalf of the employee as necessary to meet the requirements

of this section.  A standard care arrangement between the hospital's employee and the employee's collaborating

physician is subject to approval by the medical staff and governing body of the hospital

prior to implementation of the arrangement at the hospital. (2) Nothing in this section prohibits a standard care arrangement from specifying actions

that a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner

is authorized to take, or is prohibited from taking, as part of the nurse's practice

in collaboration with a physician or podiatrist.  In specifying such actions, the standard care arrangement shall not authorize the

nurse to take any action that is otherwise prohibited by the Revised Code or rule

of the board.