Full Practice Authority
The Massachusetts Board of Registration in Nursing (Board) announced the implementation of revised regulations governing the practice of the Advanced Practice Registered Nurse (APRN) effective August 1, 2014. The amended regulations (244 CMR 4.00) reflect recent changes to state law, and make the regulation of APRN practice more consistent with the national APRN Consensus Model and the Institute of Medicine’s Future of Nursing Report.
In particular, the new rules specify that a Certified Nurse-Midwife (CNM) does not require a supervising physician or written guidelines for prescriptive practice in order to provide care according to St. 2012, c. 24,. While the new regulations do not require hospitals, institutions or payors to grant full scope practice to midwives, they lay the groundwork to update bylaws and policies that do away with burdensome and unproven requirements (for OB/GYNs as well as CNMs).
Highlights of the New Regulations:
Section 4.02 defines the clinical relationship between a CNM and an obstetrician-gynecologist, which includes consultation, collaborative management and referral, specifies that "neither a supervising physician nor written guidelines for prescriptive practice are required". The Prescriptive Practice of the rule, section 4.07 (2), reiterates that a CNM does not require guidelines for prescriptive practice.
Section 4.06, defines the CNM scope of practice as follows: “The scope of CNM practice is reflective of the standards established by the American College of Nurse Midwives (ACNM) for the provision of primary health care services to women throughout the lifespan including gynecologic care, family planning services, preconception care, prenatal and postpartum care, childbirth, care of the newborn and treatment of the partner of their clients for sexually transmitted disease and reproductive health. The CNM is responsible and accountable for engaging in the practice of midwifery, including interpretation of laboratory and diagnostic data, only within the CNM's scope of practice and in accordance with ACNM standards. A CNM practices within a healthcare system and develops clinical relationships with obstetrician-gynecologists to provide care in diverse settings, including, but not limited to, home, hospital, birth center, and a variety of ambulatory care settings including private offices, community and public health clinics.”
Sample bylaws, supporting documents and other helpful information can be found at Credentialing and Medical Staff Privileging.
The members only section of our website is dedicated to facilitating communication among practices, sharing resources and strategies with each other, as well as sharing our successes as motivation for more forward progress. This section of our website can be found under “Updating Institutional Bylaws."