Nurse Practitioner Scope of Practice: Alabama

With the fourth highest rate of obesity in our nation and over 25 percent of its residents smokers, you would think Alabama needs nurse practitioners more than ever to help combat chronic disease.  However, notorious for laws limiting the NP scope of practice, Alabama is missing out on the advantages nurse practitioners have to offer.  How do laws in Alabama regulate NPs?

Alabama's Nurse Practitioner Supervision Laws

NPs practicing in Alabama are required to have a written collaborative practice agreement with a physician.  One physician may collaborate with no more than three full-time nurse practitioners, or 120 NP collaboration hours per week.  Interestingly, collaborative agreements for nurse practitioners working in health departments are exempt from the one physician to three NPs rule.  Collaborating physicians must also have at least one year of experience practicing medicine.

Alabama State Law requires that a collaborating physician be readily available to the NP for consultation either in person or by phone.  The collaborating physician must be present on site with the nurse practitioner at least ten percent of the time and review at least ten percent of the NP's charts.  

Alabama's Nurse Practitioner Prescribing Laws 

Nurse practitioners practicing in Alabama have limited authority to prescribe.  They are allowed to do so only with physician collaboration.  The name, practice site address and phone number of the collaborating physician must be present on each prescription written by the NP.  Nurse practitioners are not allowed to prescribe for themselves, immediate family members or individuals who are not patients of their practice.  

Recently, nurse practitioners were granted increased ability to prescribe certain substances under Alabama State Law.  NPs are now allowed to prescribe schedule III, IV and V medications but are still not allowed to prescribe schedule II drugs including narcotic pain medications.  

Other Scope of Practice Laws in Alabama

Strict laws regulating nurse practitioners in Alabama extend beyond supervision and prescribing.  For example, NPs in Alabama can perform but not sign sports physicals.   They cannot sign death certificates or sign handicap parking permits.  NPs practicing in Alabama are also not formally recognized as primary care providers.

Nurse practitioners in Alabama have some significant hurdles to overcome.  Hopefully legislators will continue to loosen regulations surrounding NPs allowing them to practice to their full ability.

 

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Comments

I am concerned that NPs are undereducated for the duties the physician may put on them. When I last saw a NP I reviewed his findings with the MD. The NP was woefully wrong on 3 of the 4 major points described in my care.
I see NPs in the ER where I work that can not interpret the exams and procedures they are allowed to order. Very disturbing..

karl

Alabama is probably a great place to live. Low crime, great climate, reasonable property costs. I look forward to moving there. I also plan to work locums in any other state rather than be hobbled by draconian hillbilly laws that limit my scope of practice. When I see ads in Alabama for "physician extenders" it emphatically reinforces my resolve.

Michael Steward

In response, I can understand concern, Alan, for not getting your medication in a timely manner. I do not understand how the NP is responsible for that issue, however. It seems the Doc did not inform his patients he was leaving; the 3 day notice is a minimum in most practices, and that's 3 business days. I recommend a week to my patients, no need to cut it close... what if the provider were on vacation. Also, the fact that the NP wants to see you before a new prescription is written is definitely appropriate, and any new MD taking over that practice, would require a visit in most cases, to bill you as a "new patient" to them. Had you not waited until you had 3 days left AND zero refills, perhaps you would not have been in this difficult situation. The only thing I would have done differently is authorized enough of a partial prescription until the first visit was available... like 4 more pills. It seems that people are quick to place blame and name call rather than take some responsibility, even if partial for their own role in their healthcare. A "good" PCP does just that, and doesn't enable bad habits further. I agree nothing is perfect, and their are always exceptions; however, I hope you can see their are 2 sides to your predicament. Furthermore, the law (in this case in AL) would even then be bent by a partial Rx due to strict regulations on Alabama laws to prescribing to someone you have never actually seen. Its not that NPs are always so difficult, its that our hands our tied very much so in 31 states left in this country that restrict our authority. However, if you move to Nebraska or one of the other 18 states that give full practice authority and Rxing, then maybe they would have been working M-F (as it would be their own practice, rather than an employee of someone at the mercy of that owners set schedule) and could have given you that Rx without a visit immediately, or with a phone consultation at least. So you see, its the ones that know much more about John Deere tractors (or maybe not even that) making the rules for those that know VERY much about patient care. It is a bureaucracy, make NO mistake!
I hope this helps with some inside perspective. I appreciate yours as well.

Jamie

I am on here because my primary care doc retired in December and told nobody. I had a pacer installed Monday and called Friday for a metformin refill. I had enough for three days when I called. It was ignored and when I called today I was told of the doc's retirement and that an NP was "running the practice" on his own now. NO doctor is available at the practice to collaborate. The NP didn't want to prescribe a refill for me because they haven't seen me. I asked to come in so I would get the med today. The NP "works from home" on Mondays. The first available appt. is THURSDAY. My wife is a retired RN and I understand that nothing in medicine is absolutely perfect but it appears to me that an unsupervised NP is a dangerous problem for patients. If you want increased freedom as most NPs deserve something needs to be done to rein in the ones who wouldn't know patient care from changing an oil filter on a John Deere tractor.

Alan Yates

Hi Jennifer, 

I have heard Georgia is similar to Alabama as well.  I will put together a formal post regarding Georgia's NP scope of practice laws this week. 

Erin Tolbert

Just out of curiosity, do you know how Georgia stacks up as far as supervision, prescribing and practicing laws go? I have heard it is not much better than Alabama.

Jennifer