Nurse Practitioner Scope of Practice: Tennessee | ThriveAP

This morning, I’m excited to feature the scope of practice for NP’s in my beloved state of residence, Tennessee.  Not only does this great state feature a Dolly Parton-based theme park, the home of Elvis Presley and boast a spirit of volunteerism, Tennessee has pretty favorable laws toward NP’s.  Recent rankings show Tennessee is overall the 3rd freest state in our nation.  Fortunately, this attitude of freedom and independence extends to state laws governing nurse practitioners.

Let’s take a look at the rules and regulations governing nurse practitioners in the Volunteer State.

Tennessee’s Nurse Practitioner Supervision Laws

While Tennessee does require NP’s to be supervised by a physician, these rules are lax compared to many other states.  TN State Law defines a supervising physician as “a licensed and actively practicing physician who has been identified as accepting the responsibility for supervising certified nurse practitioners”.  Within this supervision agreement, Tennessee law outlines a few specific requirements:

1. The supervising physician must be available for consultation with the NP at all times. This does not mean the physician need to be physically present or practicing in the same location as the nurse practitioner.  If the physician cannot be available for any reason, they must make arrangements for a substitute physician to be available.
2. The supervising physician must have experience or expertise in the same area of medicine as the nurse practitioner.
3. A written practice protocol must be in place outlining an acceptable standard of patient care.  The physician and NP are responsible for reviewing and updating this protocol biennially.  Copies must be maintained at each practice site.
4. Once every ten business days, the supervising physician must review the nurse practitioner’s charts if medically indicated, requested by the patient or when a controlled medication has been prescribed.
5. The supervising physician is responsible for reviewing at least 20% of the NP’s charts every 30 days.
6. The supervising physician’s name and contact information must be listed on any prescriptions written by the nurse practitioner.  The physician’s signature is not required.

Overall, nurse practitioners are required to be loosely supervised by physicians in Tennessee.  The physician must comply with mandatory site visits and chart reviews as well as be available to the nurse practitioner at all times but not necessarily in person.

Tennessee’s Nurse Practitioner Prescribing Laws

In Tennessee, nurse practitioners are allowed to prescribe medications with physician supervision.  The physician’s name and contact information along with the nurse practitioner’s name and contact information (address and phone number) must be present on the prescription.  Before prescribing medication, as in all states, NP’s in TN must apply for and receive a license to prescribe from the DEA.

Nurse practitioners in Tennessee are allowed to prescribe controlled substances.  TN Law acknowledges that prescribing medications for and treating chronic pain is tricky and many patients abuse the system.  It encourages nurse practitioners to use judgement when prescribing pain medications while ensuring that individuals with pain are adequately treated.  Should a nurse practitioner choose not to treat a patient’s pain, they must make an appropriate referral to another provider for further evaluation and treatment.

TN State Law specifically prohibits NP’s from prescribing or issuing drugs whose sole purpose it to perform an abortion.

Other Scope of Practice Laws in Tennessee

Under TN State Law, nurse practitioners are not allowed to sign death certificates.  They are, however officially recognized as primary care providers and are allowed to sign handicap parking permits.

Are you a nurse practitioner in Tennessee?  Let us know about your experience!  Do you feel that the laws are favorable towards NP’s or do they present problems in your daily practice?

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