Mississippi Board of Nursing
MISSISSIPPI BOARD OF NURSING
ADVANCED PRACTICE REGISTERED NURSES
(APRNS): 2015 UPDATES
Lynn Langley, DNP, FNP-BC, ANP-BC, CPHQ
Executive Director
&
Phyllis Johnson, MSN, MS, FNP-BC
Director of Advanced Practice
Mississippi Nurse Practice Law
Mississippi Board of Nursing
 Legally charged to protect the public by regulating
the practice of Nursing.
 Mississippi Nurse Practice Act defines the practice
of nursing; (73-15-5)
Administrative Code
Mississippi Board of Nursing
Mississippi Administrative Code
Title 30: Professions and Occupations
Parts 2801 – 2900
 The authority of the Mississippi Board of Nursing
is to promulgate rules and regulations for the licensure of registered
nurses, advanced practice registered nurses, licensed practical nurses,
expanded role licensed nurses and certified hemodialysis technicians as
provided for in the laws of the Miss. Code Ann. Sections 73-15-17 (a),
&73-15-101.
Registered Nurses (RNs) and Advanced Practice
Registered Nurses (APRNs) in Mississippi
 Registered Nurses,
approximately: 45,000

APRNs account for
approximately: 3751
CRNAs – 750
 CNM – 56
 CNP – 2,945
 Special areas of
concern***

APRNs in Mississippi – Collaboration
State Law
• Each APRN must have one
collaborating physician who
will be available to…
– Review
protocols/agreement.
– Collaboration/
consultation at all times
APRN is practicing.
– Agrees to implement
Quality Assurance Plan
with APRN and make
quarterly face to face visits
with the APRN to review
for QA.
–
Recommend a secondary
collaborating physician.
Quality Assurance (QA)Review
 Sample size:
 10% of patients seen per
month or ….
 20 charts (which ever is
less)

Monthly review

Quarterly -sign by
collaborating physician
and APRN
MSBN QA Requirements
 If APRN consulted with
the collaborating
physician, this will
count as a review.
 Put this on your log.
 Keep records for seven
(7) years.
 QA log kept at primary
practice site.
Protocol/Agreement
 MBML wants signed
protocol on site. Be sure
physician reads protocol
 APRN must have an
agreement with a
collaborating physician
before practicing.
(Recommend a signed
copy.**)
 Important that physician
and APRNs reads and
understands
protocol/agreement.
MSBML - Collaboration

Rule 1.2 Definitions. For the purpose of Part 2630, Chapter 1 only, the following terms have the meanings
indicated:

A. “Physician” means any person licensed to practice medicine or osteopathic medicine in the state of
Mississippi who holds an unrestricted license or whose practice or prescriptive authority is not limited
as a result of voluntary surrender or legal/regulatory order.

B. “Free Standing Clinic” means a clinic or other facility wherein patients are treated by a nurse
practitioner, which is more than fifteen (15) miles away from the primary office of the
collaborative/consultative physician. Excluded from this definition are all licensed hospitals, state
health department facilities, federally qualified community health clinics and volunteer clinics.

C. “Primary Office” means the usual practice location of a physician and being the same location
reported by that physician to the Mississippi State Board of Medical Licensure and the United States
Drug Enforcement Administration.

D. “Collaborating/Consulting Physician” means a physician who, pursuant to a duly executed protocol
has agreed to collaborate/consult with a nurse practitioner.

E. “Nurse Practitioner” means any person licensed to practice nursing in the state of Mississippi and
certified by the Mississippi Board of Nursing to practice in an expanded role as a nurse practitioner.

F. “Advanced Practice Registered Nurse” includes all nurse practitioners, certified nurse midwives and
certified registered nurse anesthetists.

Source: Miss.
APRN & Collaborating Physicians
 An APRN must have a
collaboration physician
who has an unrestricted
license in Mississippi.
 Recommend backup
collaborating physician.
APRN Practice Site
 APRN must have a
practice site prior to
beginning practice.
 This is a problem!!!
Collaborating Physician and APRN
 Physician and APRN
must have a
comparable or “same
“like” practice.
Why Not….
 Joined at the “hip” does
NOT meet the intent of
either boards’
requirements for QA
activities.
What’s New?
MSBP – Prescription Monitoring Program
 The Mississippi Prescription Monitoring Program (MS
PMP) is managed by Mississippi Board of Pharmacy. The
Mississippi Prescription Monitoring Program, MS PMP,
is Mississippi solution for monitoring Schedule II-V
controlled substances dispensed in Mississippi.
 Mississippi State Statutes 73-21-127, 73-21-97 and 73-21-
103 set forth the legal requirements for reporting
Schedule II-V controlled substances dispensed in
Mississippi for use in the PMP system. Similarly, any
drug containing Ephedrine or Pseudoephedrine is to be
reported as a schedule III, and any drug containing
Tramadol or Butalbital is to be reported as a schedule IV.
Mississippi Board of Pharmacy- PMP
 Information about controlled substance dispensing
activities is reported regularly to the state of
Mississippi through the authorized data collection
vendor.
 Pharmacies and other dispensers (clinics, etc.) are
required by law to provide such reporting to the data
collection vendor in approved formats and
frequencies. This includes mail order pharmacies
that routinely mail orders into the state.
Mississippi PMP
 Mississippi began
collecting information in
April 2005.
 Reports available to law
enforcement in October
2005.
 State Law – Doctor
Shopping
 PMPi is the Interconnect
between states. Not all
states are on board.
 We currently share with
10 states – AR, TN, ND,
AZ, IL, KS, MN, NM, MI,
ID
MS PMP
 The primary beneficiaries of Mississippi PMP are
patients throughout Mississippi.
 Because of the Mississippi PMP, healthcare providers can
make better and more informed treatment decisions that
allow them to provide the most appropriate medical care
for their patients.
 All Mississippi citizens ultimately benefit through
improved medical care and reductions in the abuse and
diversion of controlled substance prescription drugs.
(Above information from Mississippi State Board of
Pharmacy)
 What is the
requirement for
enrolling in the
Mississippi
Prescription
Monitoring Program
(MS PMP) and how do
I get enrolled?
Enrolled in the Mississippi Prescription
Monitoring Program (PMP)
 All Physicians must have been
enrolled in MS PMP by
December 2013.

Regulated by MS BOML.

May delegate to assist with
PMP.
 CNPs, CNMs and CRNAs
(who work in a pain clinic
only), must have been
enrolled in the MS PMP by
December 2014.

Regulated by MS BON.

May delegate to a licensed
nurse to assist with PMP.
Controlled Substances
 Boards of Nursing have information about state’s
laws that determine if you are eligible to prescribe
controlled substances (CSs).
 In some states prescribing CSs may be limited to a
certain APRN role such as a nurse practitioner.
 In states where there is delegation of prescriptive
authority or that require collaboration or supervision
for APRN prescribing there may be special
requirements for eligibility.
Why are Regulator Boards Requiring
Enrollment in the PMP?
 Prescription drug abuse
has become the #1
healthcare problem in the
nation.
Red Flags
 Among the
prescription
medication frequently
seized by the
Mississippi Bureau of
Narcotics are
OxyContin,
Lorazepam,
hydrocodone and
Xanax
 *Holy Trinity
Why Change is Needed
 Drug overdose death rates
have been rising steadily
since 1992 with a 102%
increase from 1999 to 2010
alone.
 In 2010, 30,006 (78%) of
the 38,329 drug overdose
deaths in the United States
were unintentional, 5,298
(14%) of suicidal intent, and
2,963 (8%) were of
undetermined intent.
Controlled Substance
 In 2012, 90 percent of overdose
deaths in Mississippi were
caused by prescription drugs,
and most were accidental.
 Proper storage and disposal of
medications can prevent
injuries and deaths from drug
abuse and drug overdoses.
 Mississippi is ranked #30
nationally on drug overdose.
National Survey on Drug Use and
Health, roughly 2.8 million people
aged 12 or older had illegally used
the prescription drug OxyContin at
least once.
Mississippi has ordered opiods
6.1/10,000 with national average
7.1/10,000
Reason for Improvement
 Health care environments
are recognizing and
reshaping their services to
meet the needs of the
transition in the cultural
diversity and complexion of
communities across the
country.
 Shifting regulatory
landscape. Federal health
policymakers and private
foundations are making
changes based on the
Affordable Health Care Act.
Paradigm Shift
 Making the mistake that
you think you know
everything.
 Individual behavior
occur in context of a
particular environment.
 (Lee, 2006)
 Tip of the iceberg.
Culture – Woodstock to Now
Barriers
 Highest risk factors
associated with
prescription drug abuse
are ….

rurality and poverty.

Where do providers
work?
Rural and Poverty Areas
 Mississippi is 46,907
square miles, (82
counties) with 60% of
population living in
rural areas and 20%
of the population
living in poverty.
Educate --Educate
 Every eight minutes a
child is treated in the ER
for drug overdose (more
than fatal car accidents).
 Drugs are obtained from
individuals “medicine
cabinets”.
 Education must be
implemented for storage
of medication correctly.
DEA Practitioner’s Manual
 2006 Edition
 Joseph T. Rannazzisi
Deputy Assistant Administrator
Office of Diversion Control
 Mark W. Caverly
Chief, Liaison and Policy Section
 This manual has been prepared by the Drug
Enforcement Administration, Office of Diversion
Control, to assist practitioners (physicians,
dentists, veterinarians, and other registrants
authorized to prescribe, dispense, and administer
controlled substances) in their understanding of
the Federal Controlled Substances Act and its
implementing regulations as they pertain to the
practitioner’s profession.
National Investigation of Drug and
Diversion Association (NIDDA)
 Great example is
NIDDA organization.
 Nurses must be
involved in order to
make change.
Educational Classes
 APRN New Graduate
mandatory orientation
classes implemented in
October 2012.
 New APRNs were losing
their license to practice
based on deficient
controlled substance
prescribing practices.
Schedule II, Controlled Substances
 These drugs have a high potential for abuse that may lead
to severe psychological or physical dependence.
Examples include:
 Morphine, methadone (Dolophine®), meperidine
(Demerol®), fentanyl (Duragesic®)
 Oxycodone (Percocet®, Oxycontin®), hydromorphone
(Dilaudid®)
 Amphetamines (Dexedrine®, Adderall® ,(Ritalin®,
Concerta®)
 Cocaine, amobarbital and pentobarbital
 Effective October 6, 2014, Hydrocodone
(Examples Lortab, Norco, Vicodin, etc.) changed
to a Scheduled II.
Documentation: Controlled Substances
 Complete record of
examination including

Diagnosis
Reason for prescribing
 Controlled Substance
 Name
 Dose
 Strength
 Quantity
 Date
 Refills (Should limit to one,
however until
Administrative Code
changed has five)*
Documentation: Controlled Substances
 Good faith agreement or
contract.
 Patient treatment goals.
 Follow up.
Thank You for Your Kind Attention
 Questions??