I am currently trying to work on this template. This is a test post to see how it is working so far. Forgive the aggravation while I work on it. Thanks!

Below is an example of an ARNP Protocol that must be signed between you and your collaborating physician and filed with the Boards of Nursing and Medicine. I hope this helps you in your practice endeavors! Information retrieved from the Florida Board of Nursing.

ARNP Protocol - (format example)

(Should be no more than 2 to 5 pages)

1. Requiring Authority:

1. Nurse Practice Act, Florida Statutes, Chapter 464
2. Florida Administrative Code, Rules Chapter 64B9-4 Administrative Policies Pertaining to Advanced Registered Nurse Practitioners

II. Parties to Protocol:

(Should only list one ARNP & one Doctor here)

1.

Nancy R. Nurse, ARNP, RN 9999999

123 Main Street

Somewhere, FL 99999
2.

Ian M. Doctor, MD, MX 999999, DEA 999999

Practice Name

456 Center Street

Somewhere, FL 99999

III. Nature of Practice:

This collaborative agreement is to establish and maintain a practice model in which the nurse practitioner will provide health care services under the general supervision of Dr. Ian M. Doctor. This practice shall encompass family practice and shall focus on health screening and supervision, wellness and health education and counseling, and the treatment of common health problems. (Use appropriate description for your specialty and activities) Practice Location(s):

IV. Description of the duties and management areas for which the ARNP is responsible:

A. Duties of the ARNP:

The ARNP may interview clients, obtain and record health histories, perform physical and development assessments, order appropriate diagnostic tests, diagnose health problems, manage the health care of those clients for which she has been educated, provide health teaching and counseling, initiate referrals, and maintain health records. (Specific guidelines for patient care decision making may be referenced here. I.e., ARNP developed practice guidelines, professionally developed guidelines, text books, etc. Do not send these references to the Board of Nursing with protocol agreement.)

B. The conditions for which the ARNP may initiate treatment include, but are not limited to:

Otitis media and externa

Conjunctivitis

Upper respiratory tract infections

Sinusitis

C. Treatments that may be initiated by the ARNP, depending on the patient condition and judgment of the ARNP:

1. Suture of simple and complex lacerations not requiring ligament or tendon repair.
2. Incision and drainage of abscesses.
3. Removal of ingrown toenail.

D. Drug therapies that the ARNP may prescribe, initiate, monitor, alter, or order:

(ARNPs CANNOT PRESCRIBE CONTROLLED SUBSTANCES)

Any prescription medication which is not listed as a controlled substance and which is within the scope of training and knowledge base of the nurse practitioner.

-or –

Antibiotics

Antihypertensives

Etc.

V. Duties of the Physician:

The physician shall provide general supervision for routine health care and management of common health problems, and provide consultation and/or accept referrals for complex health problems. The physician shall be available by telephone or by other communication device when not physically available on the premises. If the physician is not available, his associate, John R. Doctor, MD, MX 999999 (or other description of designated doctor(s) or groups), will serve as backup for consultation, collaboration and/or referral purposes.

VI. Specific Conditions and Requirements for Direct Evaluation

With respect to specific conditions and procedures that require direct evaluation, collaboration, and/or consultation by the physician, the following will serve as a reference guide:

Clinical Guidelines in Family Practice, X Edition, by Constance R. Uphold, ARNP, PhD, and Mary Virginia Graham, ARNP, PhD (or other reference text or practitioner created reference guide)

OR

The physician will be consulted for the following conditions:

3rd degree lacerations

Severe hypertension determined by ____

Etc. (list appropriate conditions)

VII. All parties to this agreement share equally in the responsibility for reviewing treatment protocols as needed and no less than annually.

____________________________/ _______ License # RN9999999

Nancy R. Nurse, ARNP Date



____________________________/ ________ License #ME 999999

Ian M. Doctor, MD Date DEA # 999999

PLEASE NOTE:

Practicing ARNPs must file a protocol at the time of renewal or when there are changes with the Board of Nursing. Alterations or amendments should be signed by all parties and filed with the Board within 30 days.

The protocol and any amendments or changes are to mailed to the ARNP Department, Board of Nursing, 4052 Bald Cypress Way, Bin #C02, Tallahassee, FL 32399-3252. If there are no changes to the protocol, only a dated signature page is needed with a statement that there have been no amendments or changes since the last submission. A copy for each review period should be kept by each party for a period of four years. The supervising physician is responsible for submitting a notice to the Board of Medicine that they have entered into a supervisory relationship with an ARNP.

Once again, the legislative powers in Florida have chosen to drag behind the rest of the United States by not giving nurse practitioners prescriptive authority for controls.

Senate Bill 972 and companion House Bill 515 would have given NPs in rural areas the ability to write for controls such as sleep aids, anxiety medications, and various pain medications (Schedule II-V) under a collaborative agreement with their collaborating MD. Nurse Practitioners have been writing prescriptions since 1987. Florida is now one of the LAST TWO states that have continued to have a total block against NPs regarding these controlled medications.

One reason that Nurse Practitioners need the ability to write these medications is that many NPs practice independently in offices in which their collaborating MDs are not working. In the office that I currently work, I am the only provider for right now. They are recruiting a doctor but if I need to write a pain medication for an injury or abscessed tooth, for example, I have to contact my collaborating MD by calling him to pull him out of a room or leave him an email which slows down the processes at both offices. It also delays the care that my patients need at the time. In our office, we send chronic pain patients to pain management so we don't write a lot of controls anyway. It really frustrates me that I cannot write for a sleep aid for insomnia or testosterone for male menopause. 

It is also limiting my practice due to having my front office personnel screening any new patients by explaining that I can do everything that a MD can do (diagnose, treat, refer to specialists, and educate etc.) but cannot write for certain meds. My office is one of the few Tricare Prime, and Signa providers in my area and am having to turn them away causing them to drive additional mileage. This is causing a hardship due to gas prices and causing delays in care. All due to being in one of the last two states dragging their feet. 

How can we fix this? If you are a NP, become more vocal in your practice and have your patients who are being inconvenienced write letters to their State legislature and complain LOUDLY. Become a member of your local NP group and become active in local venues. Speak with physicians in your area and find out about their concerns and show them current studies showing how well nurse practitioners take care of their patients. 

It's time for Florida to get on the ball with patient care!