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Kentucky Board of Nursing

Practice

Frequently Asked Questions

​​​​This page provides information on frequently asked questions (FAQ) the KBN receives related to nursing scope of practice.  You may review all the nursing scope of practice FAQs through the list below, search by key words, or select the license type or credential under "FAQs by Practice" located on the right side of this page.  Please note: additional FAQs are added routinely.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

​Can an APRN dispense medications?

“Dispensing" for a nurse is specifically defined in KRS 314.011(17) and KRS 315.010(9), as it relates to legend and scheduled drugs.

An APRN may only dispense labeled pharmaceutical legend medications if they are;
  1. ​​Samples; or ​
  2. If they are from a local, district, and independent health department.
Other than these specific exceptions, APRNs do not have the legal authority to dispense medications.

Can an APRN stock and store medications?

If a patient grants permission, the patient’s medication may be dispensed by a pharmacy to the provider’s office. When the APRN’s office accepts and acknowledges receipt of the medication, the office (and staff) become custodians of the medication for the patient. Accepting or storing the medication for a patient at the provider’s office is acceptable if the office follows state and federal guidelines for the storing of such medications. The medication may be directly administered to the patient by an RN, LPN, or delegated to an unlicensed assistive personnel (UAP), see Kentucky Administrative Regulations 201 KAR 20:400, according to the provider’s orders; or the patient may be provided the education necessary to self-administer a medication.


​What is Prescriptive Authority?​​

​Prescriptive authority is the ability to prescribe medications, including controlled substances. In Kentucky, APRN's must enter into a collaborative agreement with a physician for a period to prescribe medications. This agreement can be for controlled substances (CAPA-CS) or nonsheduled legend drugs (CAPA-NS).​​


Is a Certified Registered Nurse Anesthetist (CRNA) required to obtain a CAPA-CS to administer anesthesia?

No. The Certified Registered Nurse Anesthetist (CRNA) who is delivering anesthesia care is not required to obtain a CAPA-CS to administer the anesthesia. 

Please note: If a CRNA wishes to prescribe either non-controlled or controlled substances outside of administering anesthesia care they must obtain a CAPA-NS/CAPA-CS.


What is considered same or similar specialty for a collaborative agreement?​

This means that the populations served, or the diseases treated by the APRN are similar or have some type of minimal overlap to that of the collaborating physician's populations served or illnesses treated. For example, a Family Practice physician who treats children within the practice could enter into a CAPA agreement with a Pediatric Nurse Practitioner.


What steps do I need to take to obtain prescriptive authority for nonscheduled legend/noncontrolled drugs (CAPA-NS)?

  • ​​Enter into a collaborative agreement with a licensed Kentucky physician in a same or similar specialty.
  • The APRN must notify KBN through their nurse portal.​
    • You may access the nurse portal here.​​​
    • You may find instructions for obtaining prescriptive authority for the 1st time here​

What steps do I need to take to obtain controlled substance authority under a collaborative agreement (CAPA-CS)?

  • Enter into a collaborative agreement with a licensed Kentucky ​physician in a same or similar specialty.
  • The APRN must notify KBN through their nurse portal. 
    • ​​​You may access the nurse portal here.​
  • You may find instructions for obtaining prescriptive authority for the 1st time here.​
  • Obtain Kentucky DEA registration and upload a copy through the KBN nurse portal.
    • ​You can find more information about the DEA registration here.​
    • You can find more information about PDMP/KASPER master accounts here.
  • You may obtain your KASPER Master Account Verification Form through the Kentucky Online Gateway (KOG) account.​


Can an APRN prescribe refills for scheduled controlled substances? 

The APRN with prescriptive authority for controlled substances who holds a DEA registration number may prescribe scheduled II-V controlled substances. See, KRS 314.011(8).​ ​

Schedule II controlled substances classified under KRS 218A.060, except hydrocodone combination products as defined in KRS 218A.010, shall be limited to a seventy-two (72) hour supply without any refill. Prescriptions issued by advanced practice registered nurses for hydrocodone combination products as defined in KRS 218A.010 shall be limited to a thirty (30) day supply without any refill.

Schedule II psychostimulants may be written for a thirty (30) day supply only by an advanced practice registered nurse certified in psychiatric-mental health nursing who is providing services in a health facility as defined in KRS Chapter 216B or in a regional services program for mental health or individuals with an intellectual disability as defined in KRS Chapter 210.

​Schedule III classified under KRS 218A.080 shall be limited to a thirty (30) day supply without refills.

Schedules IV and V controlled substances classified under KRS 218A.100 and 218A.120 shall be limited to the original prescription and refills not to exceed a six (6) month supply.​

​

How does the collaborative agreement work if I am in my 1st year of licensure as an APRN? 

The APRN in their first year of licensure must:

  • ​​Be employed by a healthcare entity or provider.
    • ​If the provider is an APRN, the APRN must have been granted a CAPA-CS exemption.
  • Meet with the licensed Kentucky physician with whom they entered into a CAPA-CS agreement at least quarterly to review the APRN’s reverse KASPER report or that of the prescription drug monitoring program (PDMP) currently in use in Kentucky.
    • ​A record of the meeting date, summary of discussion, and any recommendations are required to be made in writing and a copy retained by both parties (physician and APRN) for a period of one year past the expiration of the CAPA-CS.
    • ​The meeting records could be audited by the KBN or the KBML.
    • The meeting may be held in person or through videoconferencing.​
  • During the succeeding three years these meetings are to be held bi-annually and meeting documentation is required.


​Does the APRN need a “Supervising Physician”? ​

​Unless the APRN will be prescribing medications, the APRN does not require physician supervision or collaboration for the independent practice of nurse practitioners (regardless of specialty). The APRN is a licensed, independent practitioner, who practices autonomously and in coordination with healthcare professionals and other individuals. NPs provide a wide range of health care services, including the diagnosis and management of acute, chronic, and complex health problems; health promotion; disease prevention; health education; and counseling to individuals, families, groups, and communities.

An institutional policy may require physician supervision. Please note: KBN has no jurisdiction over facility policies and procedures. 

If the APRN will be prescribing medications, they will be required to obtain prescriptive authority to prescribe legend drugs and/or obtain controlled substance authority to prescribe controlled substances. 

The APRN who has prescriptive authority may be required to have a “collaborative agreement for prescriptive authority” (CAPA) with a physician.

Is an Advanced Practice Registered Nurse (APRN) an independent practitioner in Kentucky?


Yes, an APRN who holds a current and active Kentucky APRN license may practice independently. However, an APRN who prescribes medications may need to be in a collaborative agreement with a physician​. Regardless, there is no statutory or regulatory requirement that an APRN be supervised by a physician.

For more information, see:

​Are there any circumstances in which a provisionally licensed APRN must work under supervision?

Yes, a new graduate APRN who has not yet taken their national certification exam may work under a provisional license for a period of 6 months under the mentorship of an APRN or physician using the title Advanced Practice Registered Nurse Applicant (APRNA). Please note that while the APRNA may function as an APRN during this time they are not permitted to prescribe medications.


For more information regarding the APRN provisional license, see:


​When are APRNs eligible to file for the CAPA-NS discontinuation or the CAPA-CS exemption so that I may prescribe non-scheduled legend drugs or controlled substances independently?

The APRN who has been prescribing for a period of four (4) years with a collaborative agreement may apply for independent prescriptive authority through the KBN nurse portal.

  • ​You may view 201 KAR 20:057 here​.

What is the process to discontinue a CAPA-NS?​

After four (4) years of prescribing non-scheduled legend drugs the APRN must notify the KBN if they wish to prescribe non-scheduled legend drugs without a CAPA-NS. ​

  • ​​Submit a request for discontinuation through the KBN nurse portal.​
  • You may find instructions on how to submit a request to discontinue the CAPA-NS through the KBN nurse portal here

What is the process to request an exemption for a CAPA-CS?

After four (4) years of prescribing controlled substances the APRN must notify the KBN if they wish to prescribe controlled substances without a CAPA-CS.

  • ​​Submit a request for exemption through the KBN nurse portal;
  • ​Ensure that the KBN has on file a copy of their current DEA registration, PDMP/KASPER master account, and CAPA-CS;
  • ​Pay the required fee;
  • ​Be determined to be in good standing; and
  • You may find instructions on how to submit a request for exemption of the CAPA-CS through the KBN portal here: APRN-Exemption from the CAPA-CS Requirement (After Four Years) Instructions

What if I am an APRN wishing to endorse from another state and have been prescribing for more than four (4) years?

​You may be exempt from the CAPA-CS requirement provided the following has been met:​

  • ​Have been prescribing controlled substances for more than four (4) years in a state that grants this authority to APRNs;
  • Have a DEA registration that reflects the issue date of at least four (4) years prior to endorsing; and​
  • Have a license in good standing.
    • ​If you do not meet the requirements as stated above, you are required to enter into a CAPA-CS, obtain a KY DEA, and have a PDMP/KASPER master account to prescribe controlled substances.​
    • You may find information on how to apply for endorsement here,
    • You may find instructions on how to submit a request for exemption of the CAPA-CS through the KBN portal here


​​Can an APRN open/own a practice such as a Med Spa/IV Hydration Clinic?

Yes, Kentucky nursing laws do not prohibit a nurse from owning or opening a practice. However, such a practice may need to be licensed by the Kentucky Board of Cosmetology. Licensees are encouraged to contact the Board of Cosmetology​ regarding these requirements.  

The Kentucky Board of Nursing does not have jurisdiction over healthcare agencies/facilities/practices. These entities are overseen by the Kentucky Cabinet for Health and Family Services (CHFS).

  • ​You may view AOS #35 Roles of Nurses in Cosmetic and Dermatological Procedures here​.
  • You may view the Joint Statement of the Kentucky Boards of Medical Licensure, Nursing, and Pharmacy Regarding Retail IV Therapy here.  

Can an APRN be the Medical Director of a Med Spa/IV Hydration?

Yes, if an APRN meets the requisite educational and experiential requirements they may function as the medical director. An APRN who functions as the medical director would be expected to be educationally prepared and clinically competent to perform Cosmetic and Dermatological Procedures. All nurses are held responsible and accountable for making decisions that are based upon the individual's educational preparation and current clinical competence. See, KRS 314.021(2)​​

  • You may view KRS 314.021 here
  • You may also wish to review AOS #35 Roles of Nurses in Cosmetic and Dermatological Procedures here
  • You may also wish to review the Joint Statement of the Kentucky Boards of Medical Licensure, Nursing, and Pharmacy Regarding Retail IV Therapy here​


Can the APRN mix multiple supplements for administration in an IV Hydration Clinic?

Yes, however no more than three (3) medications may be added to a bag of IV fluids. Adding more than three (3) medications is considered compounding and is outside the scope of practice of the nurse. 

IV Hydration clinics, mobile or freestanding are not regulated in Kentucky. IV fluid administration, regardless of whether medications may or may not be added, is considered a treatment.

As outlined in KRS 314.021(2), nurses are held responsible and accountable for their decisions regarding the receipt and implementation of patient care orders based on the individual's educational preparation and clinical competence in nursing. The nurse’s practice should be consistent with the Kentucky Nursing Laws, established standards of practice, and be evidence-based.


Can the APRN provide “standing orders” or “protocols” for cosmetic and dermatologic treatments?

Yes, nurses can administer the prescribed treatment, supervised by an APRN, and may use established standing orders or protocols that have been established by an APRN. “Supervision” means the APRN is physically on the premises where the patient is being cared for or readily available by telephone. ​

“The terms “protocol,” and “standing or routine orders,” are not defined in the Kentucky Nursing Laws (KRS Chapter 314) and are often used differently in various health care settings. Such orders may apply to all patients in each situation or be specific pre-printed orders of a given qualified provider. The determination as to when and how “protocols and standing/routine orders” may be implemented by nurses is a matter for internal deliberation by the health care facility.

  • ​You may view Advisory Opinion Statement (AOS) #14: Roles of Nurses in the Implementation of Patient Care Orders: Use of Protocols, Standing Orders, and Routine Orders here
  • You may also wish to review AOS #35 Roles of Nurses in Cosmetic and Dermatological Procedures here​


Can a PMHNP perform cosmetic and dermatologic procedures?

As outlined in KRS 314.011(8) "Advanced practice registered nursing" means the performance of additional acts by registered nurses who have gained advanced clinical knowledge and skills through an accredited education program that prepares the registered nurse for one (1) of the four (4) APRN roles; Certified Nurse Practitioner (CNP), Clinical Nurse Specialist (CNS), Certified Nurse Midwife (CNM) and Certified Registered Nurse Anesthetist (CRNA), and who is certified in at least one (1) population focus. Per 201 KAR 20:057 Section 2. Population foci recognized by the Board include the following: Family Practice, Women’s Health, Pediatric (Primary and Acute), Adult-Gerontology (Primary and Acute), Neonatal, and Psychiatric Mental Health. ​

The APRN who wishes to provide Aesthetic Services may do so provided the professional scope of practice indicates that such could be within their role and populations focus. Based upon a review of definitions, scope and standards, a table developed and included in AOS #35 Roles of Nurses in Cosmetic and Dermatological Procedures indicates both the roles and population foci that would allow the advanced registered nurse practitioner to undertake the necessary training to become a competent and skilled aesthetic/cosmetic provider. It was determined that it is not within the scope of practice for a Psychiatric Mental Health APRN to provide cosmetic/aesthetic services. 

  • ​You may view KRS 314.011 here;
  • ​You may view 201 KAR 20:057 here:
  • ​You may view AOS #35 Roles of Nurses in Cosmetic and Dermatological Procedures here


​How can an APRN obtain the Authorization to Provide Certification to obtain Medicinal Cannabis?

Under Kentucky law, advanced practice registered nurses (APRNs) who have been authorized by the Kentucky Board of Nursing to be medical cannabis practitioners can issue written certifications verifying the patient has a qualifying condition for medicinal cannabis treatment.

The certifications are not “prescriptions.” A certification verifies that the patient has a qualifying condition that makes the patient eligible to use cannabis for medicinal purposes. The patient must use the certification to obtain a registry identification card from the Cabinet of Health and Family Services.


What are the eligibility requirements for an authorized medical cannabis practitioner?

The APRN who wishes to become an authorized medical cannabis practitioner must:​


How often does an APRN renew their medical cannabis authorization?

The authorization to provide medical cannabis certifications must be renewed annually during the licensure renewal period November 1 – October 31st of each year.

  • ​​You may view 201 KAR 20:067 Professional Standards for Medicinal Cannabis here​​


What are the Continuing Education (CE) Requirements for medicinal cannabis authorization?

  • ​For initial authorization: 6 hours of CE on specific topics related to medicinal cannabis listed below​;
  • For annual renewal: 3 hours of CE on specific topics related to medical cannabis which include:​
    • ​​Diagnosing qualifying medical conditions;
    • Treating qualifying medical conditions with medicinal cannabis;​
    • The pharmacological characteristics of medicinal cannabis and possible drug interactions; and​
    • Indications of cannabis use disorder.
  • You may view 201 KAR 20:067 Professional Standards for Medicinal Cannabis here.​


Can the first visit prior to providing the certification to obtain medicinal cannabis be telehealth? 

No, the initial visit consists of establishing a bona fide practitioner-patient relationship during an in-person exam.​

  • ​You may view 201 KAR 20:067 Professional Standards for Medicinal Cannabis here

Additional Resources:


​Can an APRN prescribe Hormone Replacement Therapy with Testosterone Containing Pellets?

Hormone pellets are compounded implantable pellets for the slow release of hormones that lasts four to six months, as such APRNs are unable to prescribe hormone pellets containing testosterone as it is a schedule III-controlled substance, and prescribing of schedule III substances is limited to a 30-day supply without refills as outlined in KRS 314.011(8)(b). ​​

  • ​​You may view See KRS 314.011 here​


Can an APRN perform subcutaneous administration/insertion of hormone replacement therapy with pellet implants?

Yes, it is within the scope of advanced practice registered nursing practice for the APRN who is educationally prepared and clinically competent.

Any testosterone supply provided in quantities or duration that are greater than 30 days requires an APRN to obtain a physician's order pursuant to KRS 314.011(8)(b) for the administration of the hormone replacement therapy pellet implants and the performance of the procedure.

  • ​​You may view See KRS 314.011 here​


​​Is it within the Scope of Practice for the PMHNP to Prescribe Weight Loss Medications such as Semaglutide?​

Although there is research that links psychiatric disorders and obesity, there is no clear psychological or psychiatric cause for obesity. Most of the research concludes that the biology of obesity is multifactorial and may include genetic and endocrine defects. The PMHNP has a role in working with the obese individual especially as it relates to those psychiatric conditions that contribute to the development of obesity. While a PMHNP could certainly order lab work to determine whether there is an underlying endocrine disorder that is responsible for or contributing to an individual’s weight gain; such would need to be referred to a primary care provider or an endocrinologist for management depending on the disorder. In addition, there are multiple co-morbidities that are also associated with being overweight/obese; type 2 diabetes and hypertension being the most often occurring. Both would require management by a primary care provider.

Semaglutide injections have been FDA approved for the chronic weight management in adults with obesity and at least one related condition such as type 2 diabetes or high cholesterol. The focus of an article published by the FDA seems to center around the term chronic weight management. As such, weight loss management, including the prescribing of such medication would fall under the purview of the primary care practitioner and not the PMHNP.

Please note: the FDA has received adverse event reports after patients used compounded Semaglutide. Use caution in prescribing of a compounded drug if an approved drug is not available to treat a patient. Healthcare professionals should understand that the FDA does not review compounded versions of these drugs for safety, effectiveness, or quality. Providers should be aware that some products sold as ‘Semaglutide’ may not contain the same active ingredient as FDA-approved Semaglutide products and may be the salt formulations. Products containing these salts, such as Semaglutide sodium and Semaglutide acetate, have not been shown to be safe and effective.

You may view the FDA article "​FDA’s Concerns with Unapproved GLP-1 Drugs Used for Weight Loss"​​ here.


​​Can an APRN prescribe Buprenorphine?

Yes, provided you are an APRN with controlled substance prescriptive authority (CAPA-CS or have independent prescribing authority through the CAPA-CS exemption).

  • You may find the administrative regulation 201 KAR 20:065 regarding Buprenorphine-MonoProduct or Buprenorphine-Combined-with-Naloxone here​.​​


​​Can an APRN perform Acupuncture?​

APRNs may be authorized to perform additional acts due to training and experience, such as prescribing treatment, devices, and order diagnostic tests pursuant to KRS 314. 011(8).  ​

It is the opinion of the Board that the performance of acupuncture is within the scope of practice for the APRN who is currently educationally prepared and clinically competent in the performance of the procedure. Further, the APRN should maintain documentation of having completed a nationally recognized course of study in acupuncture. The performance of acupuncture should be in accordance with documented facility policy and procedures and credentialing processes, as well as current evidence-based practice. ​

  • ​You may view AOS #45 Roles of Nurses in the Performance of Complementary Procedures here.
  • You may also wish to view additional information related to the Kentucky Board of Medical Licensure who license acupuncturists here.​


​Can an APRN Prescribe Across State Lines?

Care is considered to occur where the patient is located. If the patient is in Kentucky, then the APRN must be licensed in Kentucky to lawfully treat. If the patient is in another state, then the APRN will need to obtain licensure in the state where the patient is located.

However, if the patient was seen in Kentucky and the prescription is being sent across state lines according to a literature review, for nurse practitioners, state scope of practice law may take one of three approaches to handling prescriptions written by NPs licensed in another state:

  1. ​​Prescriptions written by out-of-state NPs are subject to the same rules as those written by NPs licensed in the state.
  2. ​Prescriptions written by out-of-state NPs are subject to the rules within the state in which the NP is licensed.
  3. The filling of prescriptions written by nurse practitioners licensed out of state is prohibited.

State and federal laws govern the filling of prescriptions by pharmacies which affect the APRN’s ability to prescribe. These laws specify when and how prescribing across state lines can occur. For example, the prescribing of controlled substances must occur within the boundaries of an established patient-provider relationship. The same holds true when it comes to prescribing across state lines. To fill a prescription written by a provider in another state, in states where it is allowable, the pharmacist may only do so 'in good faith' that a provider-patient relationship exists.

Overall, APRNs prescribing across state lines is allowable within the patient’s state’s prescribing guidelines. Prescribing should always occur within the scope of practice for the state within which the NP is licensed, and often within the scope of practice in the state where the prescription is filled. Before prescribing out of state, the nurse practitioner should have a thorough understanding of the prescribing law in their home state, and the state(s) where they plan to prescribe.

  • ​You may view KRS 314.155 here​.​
  • You may view KRS 218A.010 here.
  • You may view Advisory Opinion Statement #42 Telehealth and Nursing here.


​Can the APRN Provide Telehealth Services for a Patient in Another State?

​201 KAR 20:520 identifies that nursing care occurs where the patient is located. Therefore, the APRN must hold an APRN license in the State where the patient is located and managed. There is no APRN nurse licensure compact. So, if the APRN wishes to provide telehealth services to a patient outside of Kentucky they would need to contact that state’s Board of Nursing to obtain licensure in that state.
  • ​​You may view 201 KAR 20:520 here.
  • You may view Advisory Opinion Statement #42 Telehealth and Nursing here.​


Can Telehealth be used when prescribing controlled substances?

Yes, as outlined in KRS 314.155(3), “‘telehealth’ means the use of interactive audio, video, or other electronic media to deliver health care. It includes the use of electronic media for diagnosis, consultation, treatment, transfer of health or medical data, and continuing education.” The term does not include audio-only telephone calls, email messages, or facsimile transactions.

One of the most important elements in patient care is the medical relationship that exists between the nurse and the patient. The relationship is termed the “practitioner-patient relationship” and is defined in KRS 218A.010 (41) used in relation to prescribing controlled substances . . . and means “a . . . relationship that exists between a patient and a practitioner or the practitioner's designee, after the practitioner or his or her designee has conducted at least one (1) good faith prior examination;”

  • You may view KRS 314.155 here.​
  • You may view KRS 218A.010 here.
  • You may view Advisory Opinion Statement #42 Telehealth and Nursing here.​​



​If the APRN is the Sole Provider for Care of a Patient, what Constitutes Patient Abandonment?

Patient abandonment occurs when a healthcare provider improperly terminates the healthcare provider/patient relationship.​

Patient Abandonment occurs if: ​

  • ​​A healthcare provider/patient relationship has been established; and
  • A patient who requires medical attention is refused continued treatment without giving the proper notice and adequate time to find another provider.

Healthcare providers may have a valid reason to discontinue a relationship with a patient. However, they should either refer a patient to another provider or take appropriate steps to ensure that the patient has an adequate amount of time to gain access to care.

Abandonment does not occur when:​

  • Healthcare providers do not have the necessary training or knowledge to continue treatment
  • Healthcare providers do not have the supplies or resources to continue treatment​
  • A conflict of interest arises
  • Patients violate the policies of the provider or behave inappropriately, such as verbally abusing the healthcare provider​
  • Patients repeatedly miss or cancel appointments​
  • Patients do not comply with care recommendations


​​What is Patient Abandonment?​

While the terms “abandonment” and “patient abandonment” are not used in the Kentucky Nursing Laws (Kentucky Revised Statutes Chapter 314), the Board has the authority to take disciplinary action in specific cases based on its interpretation of what constitutes professional misconduct.

In Kentucky, a nurse whose behaviors are inconsistent with the safe practice of nursing may be charged with being in violation of KRS 314.091(1)(d) “…negligently or willfully acting in a manner inconsistent with the practice of nursing….” All complaints received by the Board alleging patient abandonment are evaluated on a case-by-case basis. The Kentucky Board of Nursing (KBN) has investigated and disciplined nurses for issues surrounding the concept of abandonment as it relates to the nurse’s duty to a patient.​

The position of KBN applies to the licensed practical nurse (LPN), registered nurse (RN), and advanced registered nurse practitioner (APRN).

While it is difficult to specifically state when abandonment occurs, abandonment does not occur when a nurse who cannot practice with reasonable skill and safety leaves an assignment after fulfilling the two obligations stated above. There are employment issues that do not rise to the level of patient abandonment, and thus, are not within the jurisdiction of the Board to address. Examples of employer issues include an employee “no call, no show” situation, an employee refusal to work “mandatory overtime” beyond the regularly scheduled number of hours, and employer resignation policies.

As a guide to nurses and employers, the Board advises that, in general, a nurse who has accepted responsibility for a patient assignment may leave the patient assignment only after: ​

  1. ​Communicating the need to do so with the nurse’s supervisor; and ​
  2. Exhausting all reasonable and prudent efforts to place the care of the patients in another nurse’s care.

Nurses have a professional and ethical obligation to provide for patient safety, avoid patient abandonment, and to withdraw only when assured that, nursing care is available to the patient (American Nurses Association - ANA, 2015).​


​​Can an APRN sign a Death Certificate?

Yes, in accordance with KRS 213.076, a death certificate may be signed by an advanced practice registered nurse (APRN).

  • ​You may view KRS 213.076 here.
  • You may view Advisory Opinion Statement #36 Resuscitation Orders, Pronouncement of Death, and Death Certificates here.​


​What is the Scope of Practice for the APRN?

APRNs are licensed, independent practitioners, NPs practice autonomously and in coordination with health care professionals and other individuals. APRN scope of practice is not setting specific.
​
An APRN may work in almost any setting provided that the needs of the patients for whom they are providing care falls within their professional scope of practice; consistent with the APRN Consensus Model, that describes the four (4) roles and the recognized population foci. ​

Scope of practice can evolve and change through experience, clinical competency, evidence-based practice, research, technology, legislation, and changes in the healthcare system. When seeking to acquire new skills or activities an APRN may wish to consider whether the new skill is:
  • ​​​​Consistent with the professional scope and standards of practice in which the APRN has received national certification and licensure (role and population focus). 
  • Consistent with state and federal laws.​
Further, the APRN will be expected to be able to provide documentation for how the APRN become educationally prepared and clinically competent to perform a newly acquired skill. One method for demonstrating educational preparation and clinical competence is through obtaining relevant certifications within a specialty area. Another method would be to create a portfolio of trainings, workshops, and continuing education that demonstrates the acquisition of additional knowledge and clinical competency in the specialty area.​

  • ​​You may find Kentucky Nursing laws related to APRN Practice on the KBN website here.​


​How can I Determine if a Particular Task is within My Scope of Practice?

In the practice of nursing, professional issues and practice questions arise that require the nurse to apply education, experience, and professional judgment and to be legally responsible and accountable for the outcome(s). The role of a Board of Nursing is to establish minimum standards for education, licensure, and practice, and to provide information to practicing nurses, to ultimately promote public protection. Scope of practice is the range of roles, functions, responsibilities, and activities that a nurse is educated, competent, and authorized to perform. Scope of practice can evolve and change through experience, clinical competency, evidence-based practice, research, technology, legislation, and changes in the healthcare system.

When the performance of a specific act is not definitively addressed in the Kentucky Nursing Laws or an advisory opinion of the Board, the nurse must exercise professional judgment in determining whether the performance of the act is within the scope of practice for which the individual nurse is licensed. The KBN has developed a decision-making model that provides guidelines to nurses in determining whether a selected act is within an individual nurse’s scope of practice. ​

For more information regarding scope of practice determination guidelines see:​


​Can an RN own a Medspa?

Statutes and regulations do not prohibit a nurse from owning a practice. However, RNs can only administer medication and treatment as prescribed by a qualified healthcare provider*. An RN may use standing orders or protocols that have been established by a qualified healthcare provider.

For more information regarding Medspas see:

Does a client need to be seen by a healthcare provider prior to aesthetic treatments?

Prior to determining and ordering a course of treatment, the qualified healthcare provider* must establish a practitioner-patient relationship, See, KRS 218A.010 (41), and assess the patient by conducting a good-faith prior examination, See, KRS 218A.010 (18). A Registered Nurse (RN) may conduct ongoing assessments related to the qualified healthcare provider’s course of treatment, using a standardized nursing assessment tool as noted within protocols or standing orders that have been created by the facility/agency/office providing aesthetic services. Standing orders/protocols can only be approved by a qualified healthcare provider.*

For more information regarding Medspas see:

  • ​​AOS #35 ​Roles of Nurses in Cosmetic and Dermatological Procedures
  • ​AOS #14​ Roles of Nurses in the Implementation of Patient Care Orders​
  • AOS #41​ RN/LPN/APRN Scope or Practice Determination Guidelines

​What dermatology and cosmetic Procedures can an RN perform?

Provided below are some important takeaways from AOS #35 Roles of Nurses in Cosmetic and Dermatological Procedures. It is recommended to review the AOS in its entirety if practicing in this setting.

  • Aesthetic, cosmetic, and dermatological procedures may be performed by a nurse as a part of a medically prescribed plan of care for treatment of various dermatological conditions.​
    • ​​If the procedure is not a part of the medically prescribed plan of care, it may require licensure by another regulatory Board.
  • ​The RN may follow standing orders/protocol after the qualified healthcare provider* has established a treatment plan.
  • ​RNs can implement interventions, administer medications, and treatments as prescribed and supervised by a qualified healthcare provider*.
  • It is not within the scope of practice for an RN to independently practice, order products, prescribe treatments, or perform medical aesthetic procedures such as Botox© or Dermal fillers.

The nurse should use the AOS # 41 RN/LPN/APRN Scope or Practice Determination Guidelines to determine if a specific activity is within the nurse's legal and individual scope of practice.

For more information regarding Aesthetics:

  • ​​AOS #35 ​Roles of Nurses in Cosmetic and Dermatological Procedures
  • ​AOS #14​ Roles of Nurses in the Implementation of Patient Care Orders​
  • AOS #41​ RN/LPN/APRN Scope or Practice Determination Guidelines

Can an RN administer Botox® or inject medications for sclerotherapy or dermal fillers?

The nursing laws and rules allow a competent and appropriately trained registered nurse to administer neuromodulators (such as Botox®, Dysport®, or Xeomin®). These procedures require a prescription by a qualified healthcare provider*.

For more information regarding Aesthetics:​
  • ​​AOS #35 ​Roles of Nurses in Cosmetic and Dermatological Procedures
  • ​AOS #14​ Roles of Nurses in the Implementation of Patient Care Orders​
  • AOS #41​ RN/LPN/APRN Scope or Practice Determination Guidelines


​

What is the RN’s role in an IV Hydration Clinic?

IV Hydration clinics, mobile or freestanding are not regulated in Kentucky. IV fluid administration is considered a treatment and requires and order, regardless of whether medications may or may not be added. Nurses are held responsible and accountable for their decisions regarding the receipt and implementation of patient care orders based upon the individuals' educational preparation and clinical competence in nursing. The nurse’s practice should be consistent with the Kentucky Nursing Laws, established standards of practice, and be evidence-based. See, KRS 314.011. 

The performance of a documented initial assessment and development of a treatment plan by a qualified healthcare provider* is a prerequisite for the implantation of any treatment or therapy. After the patient has been assessed by a qualified healthcare provider*, and the orders are specific to the patient noting whether it is a one-time-only administration or is a series with a specific time frame for the administration of such fluids, a nurse may administer the IV medication. It is not within the scope of practice for the nurse to independently practice, assess, diagnose, order products, or prescribe treatments. Following the performance of a documented initial assessment and the development of a treatment plan by a qualified healthcare provider*, treatment or therapies may be performed. The nurse may apply standing orders and protocols that have been prescribed. ​

No more than three (3) medications may be added to a bag of IV fluids. Adding more than three (3) medications is considered compounding and is outside the scope of practice of the nurse.

For more information related to IV Hydration Clinics see:

  • 201 KAR 2:076 Compounding 
  • RN IV Hydration Clinics ​- KBN 
  • Joint Statement of the Kentucky Boards of Medical Licensure, Nursing, and Pharmacy Regarding Retail IV Therapy 
  • AOS #14 Roles of Nurses in the Implementation of Patient Care Orders: Use of Protocols, Standing Orders, and Routine Orders 
  • AOS #41 RN/LPN/APRN Scope of Practice Determination Guidelines


Does a client need to be seen by a healthcare provider prior to IV Hydration treatments?

Prior to determining and ordering a course of treatment, the qualified healthcare provider* must establish a practitioner-patient relationship, See, KRS 218A.010 (41), and assess the patient by conducting a good-faith prior examination, See, KRS 218A.010 (18). A Registered Nurse (RN) may conduct ongoing assessments related to the qualified healthcare provider’s course of treatment, using a standardized nursing assessment tool as noted within protocols or standing orders that have been created by the facility/agency/office providing aesthetic services.. Standing orders/protocols can only be approved by a qualified healthcare provider.*​

For more information related to IV Hydration Clinics see:​


​Are there any medications that the RN is not allowed to administer? ​

The nursing laws and rules do not prohibit a competent and appropriately trained registered nurse from administering any medication – legend or controlled substance (Schedule II-IV) or over-the-counter medications. The RN may administer medications by any route. The RN must be competent and follow the standards for medication administration.

Please note: While it is within the scope of practice for an RN to administer medications for procedural sedation and analgesia, it is not within the RNs scope of practice to administer medications for the purpose of anesthesia.

For more information regarding medication administration:

  • ​AOS #16 Roles of Nurses in the Administration of Medication via Various Routes 
  • AOS #17 Roles of Nurses in the Administration of "PRN" Medication and Placebos 
  • AOS #32​ The Role of Nurses in Procedural Sedation, Analgesia, and Airway Management in Various Settings

Can the RN be delegated to enter medication prescriptions into an electronic health system or call in an order to a pharmacy?

Receiving telephone and verbal prescription orders, transcribing, and transmitting prescription orders are activities often performed by nurses and appropriately included by many organizations in the responsibilities of the registered nurse. The RN has the skill and knowledge to receive a prescription order and transcribe it accurately for other nurses to implement or transmit the order to a pharmacist to dispense. The laws and rules do not prohibit the RN from calling in medication orders except for those restrictions in the Controlled Substances Act. The RN may enter medication prescriptions into an electronic health system under the direction of a qualified healthcare provider*. These directions may come through standing orders or verbal orders.

For more information regarding medication prescriptions:


Can the RN renew a prescription?

It is not within the scope of practice for the RN to independently renew an existing medication without a new prescription from a qualified healthcare provider*. ​

For more information regarding medication prescriptions:

  • AOS #14​ Role of Nurses in the Implementation of Patient Care Orders


Can the registered nurse compound medications?

No, adding more than three (3) sterile products is considered compounding and is outside the scope of practice of the registered nurse.

For more information regarding compounding see:​


Is it within the scope of practice for an RN to insert Testosterone Pellets?

No, it is not within the RNs scope of practice to administer sub-q testosterone pellets.

For more information regarding women’s health see:

  • ​AOS #10 Roles of Nurses in Women's Health Across the Lifespan



​What task can be delegated by the RN?

When considering if a task should be delegated the nurse must consider the following:​

  • Right task: The activity falls within the delegatee’s job description or is included as part of the established written policies and procedures for the nursing practice setting….
  • Right circumstance: The health condition of the patient must be stable. If the patient’s condition changes, the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation. 
  • Right person: The licensed nurse along with the employer and the delegatee is responsible for ensuring that the delegatee possesses the appropriate skills and knowledge to perform the activity. 
  • Right directions and communication: Each delegation situation should be specific to the patient, the licensed nurse and the delegatee. The licensed nurse is expected to communicate specific instructions for the delegated activity to the delegatee; the delegatee, as part of the two-way communication, should ask any clarifying questions…. The delegatee must understand the terms of the delegation and must agree to accept the delegated activity. The licensed nurse should ensure that the delegatee understands that she or he cannot make any decisions or modifications in carrying out the activity without first consulting the licensed nurse.
  • Right supervision and evaluation: The licensed nurse is responsible for monitoring the delegated activity, following up with the delegatee at the completion of the activity, and evaluating patient outcomes. The delegatee is responsible for communicating patient information to the licensed nurse during the delegated situation.
For more information regarding delegation of nursing tasks see:
  • ​201 KAR 20:400​ Delegation of nursing tasks is the law to guide the nurse in the delegation of nursing task
  • AOS #15 Roles of Nurses in the Supervision and Delegation of Nursing Acts to Unlicensed Personnel


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Is a school nurse from another state required to have a Kentucky nursing license to accompany students to Kentucky for a field trip?

  • ​​For Nurses Outside of Kentucky Without a Multistate/Compact License If the school nurse has a single state license, and the state is not a member of the Nurse Licensure Compact, and the nurse is in the state on a non-routine basis not to exceed seven (7) days; the nurse may practice while in the state.
  • A nurse with a multistate license from another NLC state has the privilege to practice in KY.​
  • A nurse travelling to Kentucky would be expected to understand Kentucky laws related to nursing practice in the state.

For more information related to school nursing see:


Is it okay for the School Nurse to monitor a student’s continuous glucose monitoring (CGM) on a personal device?

School nurses who provide nursing care for monitoring and maintaining continuous glucose monitoring (CGM) for students during the school day or during school activities should do so only if they are educationally prepared and clinically competent to perform such tasks. The school nurse should never use a personal device for CGM, data collection, or communication between themselves, students, guardians, or healthcare providers due to the risk of confidential student data being compromised. 

Further, schools should develop internal policies and procedures related to:

  1. The storage of CGM monitoring devices on school property; and
  2. Appropriate training guidelines for all staff responsible for using or storing CGM devices.

For more information related to school nursing see:

​What is the RN’s responsibility specific to patient abandonment? 

The KBN, as outlined in KRS 314.021(2), holds nurses individually responsible and accountable for rendering safe, effective nursing care to patients and for judgments exercised and actions taken while providing care.​

The nurse must fulfill a patient care assignment or transfer responsibility to another qualified person once the assignment has been accepted. ​

As a guide to nurses and employers, the Board advises that, in general, a nurse who has accepted responsibility for a patient assignment may leave the patient assignment only after: ​

  1. ​Communicating the need to do so with the nurse’s supervisor; and
  2. Exhausting all reasonable and prudent efforts to place the care of the patients in another nurse’s care.​

For more information related to patient abandonment see:


What if my employer requires me to work overtime or take an assignment that I believe unsafe due to staffing ratios? Does this fall under patient abandonment?

There are employment issues that do not rise to the level of patient abandonment, and thus, are not within the jurisdiction of the Board to address. Examples of employer issues include an employee “no call, no show” situation, an employee refusal to work “mandatory overtime” beyond the regularly scheduled number of hours, and employer resignation policies. Please note: The KBN has no jurisdiction over facility-based policies regarding hours worked or overtime hours.​


Does the Kentucky Board of Nursing Require a Specific Nurse to Patient Ratio?

No, the Kentucky Board of Nursing does not establish a ratio for the given number of patients for which a nurse may be assigned. Pursuant to the KRS Chapter 216B, the Cabinet for Health and Family Services promulgate administrative regulations requiring that health care facilities employ enough qualified personnel to meet the needs of the patients [902 KAR 20:016; 048; 051]. A patient/nurse ratio should be minimally based upon the qualifications of each nursing staff member, nursing care needs of the patient, and the patient's prescribed medical and nursing care requirements set forth in a plan of care. When patients do not receive necessary care because of understaffing, then the specific facts of the given situations should be documented and reported to the nurse's chain of command as well to the Cabinet for Health and Family Services, Office of the Inspector General, Division of Health Care Facilities and Services, (502-564-7963), and to the Joint Commission on Accreditation of Healthcare Organizations.

For more information see:

​What does Telehealth consist of? ​

Telehealth includes the use of interactive audio, video, or other electronic media to deliver health care. It includes the use of electronic media for diagnosis, consultation, treatment, transfer of health or medical data, and continuing education. The term does not include audio-only telephone calls, email messages, or facsimile transactions​.

For more information regarding Telehealth see:


​What is the RN’s role when utilizing telehealth services?

Nurses must be licensed to practice in each state in which the patients they provide care to reside. Currently, licensing in 42 states may be accomplished by holding a Nursing Compact License. Telehealth may be practiced by nurses as defined by their licensed scope of practice in KRS 314.011​. Each nurse must practice within his/her licensed scope of practice. Telehealth/telenursing may include all elements of the nursing process. Nurses utilizing telehealth to provide patient care must follow all requirements listed in KRS 314.155​ and 201 KAR 20:520 and, as relevant 907 KAR 3:170.


​Can an RN sign a death certificate?

In Kentucky, 314.181 Determination of death by registered nurses -- Notification. A registered nurse who is employed by a health facility as defined in KRS 216B.015 may determine whether a patient is dead in accordance with the requirements of KRS 446.400. The nurse shall notify the patient's attending physician or other appropriate practitioner of the death in accordance with the facility's policy. The registered nurse is authorized to sign the provisional report of death as furnished by the state registrar of vital statistics.​

For more information regarding Death Certificates, see:


​Is it within the scope of practice for an RN to perform Ultrasound/Ultrasonography?

A nurse who is educationally prepared and clinically competent to perform ultrasound/ultrasonography may perform the act within the legal scope of registered nursing practice. The formulation of a medical diagnosis is not within the scope of registered nursing practice.

​For more information regarding women’s health see:

Is it within the scope of practice for an RN to insert Testosterone Pellets?

No, it is not within the RNs scope of practice to administer sub-q testosterone pellets.​

​For more information regarding women’s health see:


Can an LPN perform medical aesthetics procedures?

Yes. according to the Advisory Opinion Statement AOS #35 Role of Nurses in Cosmetic and Dermatological Procedures the LPN who is educationally prepared and clinically competent to perform cosmetic and dermatological procedures (except sclerotherapy) under the direct supervision of a qualified healthcare provider*. The LPN who performs these acts should meet the criteria described in AOS #35. It is recommended to review the AOS in its entirety if practicing in this setting.

  • ​Aesthetic, cosmetic, and dermatological procedures may be performed by a nurse as a part of a medically prescribed plan of care for treatment of various dermatological conditions.
    • If the procedure is not a part of the medically prescribed plan of care, it may require licensure by another regulatory Board.

The nurse should use the AOS # 41 RN/LPN/APRN Scope or Practice Determination Guidelines to determine if a specific activity is within the nurse's legal and individual scope of practice.

For more information regarding aesthetics see:


Can an LPN administer Botox® or inject medications for dermal fillers?

The nursing laws allow a competent and appropriately trained licensed practical nurse to administer neuromodulators (such as Botox®, Dysport®, or Xeomin®) under the direction of a qualified healthcare provider or under the direction and supervision of a registered nurse. These procedures require a prescription from a qualified healthcare provider. The LPN should use the AOS #41 RN/LPN/APRN Scope of Practice Guidelines to determine if these activities are within the nurse's legal and individual scope of practice. AOS # 35 Role of Nurses in Cosmetic and Dermatological Procedures provides additional guidance for the LPN related to aesthetic procedures. ​

For more information regarding aesthetics see:



Can an LPN provide infusion therapy? 

Yes, according to 201 KAR 20:490 it is within the scope of practice for an LPN to provide infusion therapy within their scope and training if they are delegated to do so by a RN or qualified healthcare provider.* Please review 201 KAR 20:490 for additional information on the LPN’s role in infusion therapy including Section 5 which provides a list of functions an LPN cannot perform.

​



Can the LPN administer antineoplastic drugs? ​

According to 201 KAR 20:490 (5)(12) an LPN shall not perform the following infusion therapy functions: Administration of immunoglobulins, antineoplastic agents, or investigational drugs.

For more information regarding LPN infusion therapy see: 


Can an LPN provide line and site care on a Peripherally Inserted Central Catheter (PICC)? 

Yes, according to the Advisory Opinion Statement AOS # 20 Roles of Nurses in Cardiovascular Nursing Practice, the LPN can manage the care of and administer medications via central lines as stated in 201 KAR 20:490 ​The peripheral insertion of a central or midline intravenous catheter is not within the scope of licensed practical nursing practice.

For more information regarding LPN practice see:

​​​​

​Can an LPN delegate nursing tasks to Unlicensed Assistive Personnel (UAP)?

Yes, according to Advisory Opinion Statement (AOS #15) Roles of Nurses in the Supervision and Delegation of Nursing Acts to Unlicensed Personnel, the LPN practices under the direction of a registered nurse, advanced practice registered nurse, physician, physician assistant, or dentist, and may supervise and delegate nursing tasks to unlicensed persons in accordance with 201 KAR 20:400​ Delegation of nursing tasks as outlined in Section 1, except in a school setting.

For more information regarding delegation see: ​

​Can an LPN pronounce death?

No, in Kentucky, KRS 314.181​ states that a registered nurse (RN) who is employed by a health facility as defined in KRS 216B.015 may determine whether a patient is dead in accordance with the requirements of KRS 446.400.

For more information regarding LPN practice see:


Can an LPN practice independently?

No, the Nurse Practice Act defines standards related to the scope of practice for licensed practical nurses in KRS 314.011(10), specifically an LPN shall engage in practical nursing only under the supervision of a registered nurse, or qualified healthcare provider.* 

For more information regarding practice see:

What settings may an LPN practice in?

​An LPN may work in any setting where nursing care is provided. Scope of practice remains the same regardless of setting. Examples of settings include (but not limited to): Hospitals, nursing homes, assisted living facilities, adult family homes, schools, camps, clinics, public health clinics, homes, hospice, community health centers, homeless shelters, insurance companies and other businesses. 

For more information regarding practice see:

Can an LPN perform the initial triage of a patient?

No, while some LPNs may be involved in triage activities, particularly in specific settings or under the supervision of an RN, the primary responsibility for initial patient assessment and triage typically falls to the RN.

For more information regarding LPN practice see:


Can an LPN do the initial assessment of a patient admitted to a long-term care facility?

No, in a nursing home setting, while LPNs can collect data and perform focused assessments, the initial comprehensive assessment, including interpretation of data and development of the care plan, is the responsibility of an RN.

For more information regarding LPN practice see:​

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