Nurse Practitioner Scope of Practice: Florida

Who wouldn't want to live in the Sunshine State?  Complete with palm trees, beaches and a relatively low cost of living, Florida has a lot to offer residents.  But, nurse practitioners practicing in Florida face a different reality.  Despite Florida's sunny disposition, unfavorable laws towards nurse practitioner practice have NPs flocking inland. 

State laws regulating nurse practitioners in Florida are among the strictest in the nation.  With half of physicians in Florida reaching retirement age over the next five to ten years and just three percent of medical students in the state choosing to enter primary care, NPs are scrambling to increase their scope of practice.  They want to be influential as millions become insured under the Affordable Care Act but are meeting resistance.  What laws currently restrict nurse practitioners in Florida?

Florida's Nurse Practitioner Supervision Laws

Florida law requires that nurse practitioners are supervised by physicians.  This arrangement must be outlined in writing.  A physician may not oversee nurse practitioners at more than four offices in addition to his or her primary practice location.  While the supervising physician does not need to be available to the NP in person he/she must be available by phone for consultation.  

State law also requires that patients be notified when the physician will and will not be present in the clinic.  These hours must be conspicuously posted in each office staffed by nurse practitioners and supervised by a physician so patients are aware when the MD will be on site.  There is no minimum amount of time the physician must be present in the clinic, they must simply alert patients if the supervising MD is off site. 

Rules for specialty clinics are even stricter in Florida.  Physicians in specialty practice may supervise nurse practitioners at only one location in addition to their primary practice and these clinics must be no more than 75 miles apart. 

Florida's Nurse Practitioner Prescribing Laws

Florida is one of just two states that does not allow nurse practitioners to prescribe controlled substances even with physician supervision.  Legislators in Florida recognize that some practices may attempt to circumvent this law. So, they also created laws that prevent nurse practitioners from using prescription forms pre-signed by a physician and from using a physician's DEA number on a prescription. 

Other Scope of Practice Laws in Florida

NPs practicing in Florida may sign for handicap parking permits but they may not sign death certificates. 

Compared to other states, Florida's nurse practitioner scope of practice is stricter than most.  How have Florida's tight regulations affected your practice as an NP?

Comments

As an NP in Washington State considering a move to Florida to be closer to family, this article gives me second thoughts.

Pama

That example given of an NP is exactly why Florida has not changed its way. If a regime works for a person for many years, then there is no reason to change it because of statistcs on misuse of drugs. The NP and physician need to assess closely those who are drug addicts and those that truly are in severe chronic pain.

NP Student

Agree with the response back to Penny. Overuse of narcotics are dangerous and are not to be used long term. Its time to explore other options for pain medication. As for the question that was actually asked. I am graduating in June and I am constantly weighing my options for an NP position in different states. Tampa is an area I am particularly interested in because sports medicine is very popular and renowned. Its different in each state and in some it seems so restricted that the NP position doesn't seem that different than an RN. Is there anyone who feels that they have a great position in FL as an NP?

NP Student

Seems to me Florida is moving backwards , there are 24 states with full prescriptive authority , nationally we should all work together to get rid of any restrictions for prescribing. The amount of licensing and degrees needed to become a nurse practitioner gives us right to complain when we don't get the respect and recognition we deserve . There is power in numbers - join your state association and call your congressman - get involved , that's the only way to make change !

family nurse pr...

Penny: Your tirade about worthless NPs and PAs makes it sound just like you are just a drug seeker looking for a fix. We have a massive over prescription addiction in the US. These medicines are not supposed to be used long term. That is the problem. MDs, PAs, NPs all hear these same stories; SEVERAL TIMES A DAY.

NPs, PAs, and M...

I became a nurse practitioner in December of 2012. I finally was able to open my own practice in a small town outside of Tampa. I am so frustrated with the rules and regulations regarding scheduled medications for pain management. I have medical director that I pay a lot of money each month just to call for a pain medication for a patient, maybe once or twice per month. This is ludicrous...the practice is young, and barely making any money, and when we do make some money, we have to pay it out. Patients will not return to the clinic if they know that their pain cannot be manage. And the fact of the matter is, many doctors are hooked on pain medication more than nurse practitioners. They prescribe for each other...this I know as a fact. I am capable enough to manage patients with the need of a pain medication, without abusing it myself. Florida is twenty years behind the times.

Gertrude Walks

My spinal pain management dr has moved out of state (from Florida), and a new dr has taken over the practice. December was this new drs first month here, but I didn't get to see him, only his NP, who was VERY rude, who refused to mark one of my Rx's to be printed out for the dr to sign, that I've been using for years now since breaking my back, blowing out every disk in both my neck and lumbar, extra long rods in lumbar because section of vertebrae were also disjointed, & spinal fusion in lumbar and in neck, along with small plate in neck at 2 worst injury locations. Also a lot of nerve damage, bone spurs, arthritis all through spine, hips, & other locations. I have severe muscle spasms on a regular basis & after trying every one on the market, even recently this past year, Soma is still what works for me. But this NP REFUSED to mark it on the computer to be printed, even though I've been using it with great success after almost 20 years & never experienced ANY problems with it. She didn't even consult with the dr about this even after me explaining it all to her. I've never used illegal drugs, never so much as had a parking ticket EVER! And I am almost 59 years old, yet she treated me like I'm a criminal and drug addict. She even admitted them not having my full file on my spinal injuries, surgeries, MRI's & x-rays, yet took it upon herself to change a combination of medications that have worked great after all of these years. So that being said, I have no use for or faith in NP's or PA's. With the numer of spinal injuries I have & the severity of them, including nerve damage, I need a DOCTOR! NOT a nurse of any kind! Some of my injuries are still life threatening, as some disks are still touching and others pushing into my spinal cord a little. The one disk in my neck my neurosurgeon did surgery on was causing about 50% stenosis and causing extreme pain in right shoulder & arm because of the smashed nerve root there that he was surprised it even "plumped" back up as it did & all of that pain was gone instantly post-op. But this NP, doesn't know any of this and was not even interested in hearing any of it. I hope that not all NP's are like this one. I wouldn't trust her with my dog!

Penny

As an ARNP in Florida involved in a practice where we see patients at their homes or in an ALF, may I sign patient charts where an RN
at my direction has seen patients and I have not? Or does my supervising physician need to sign the charts?

James

Instead of complaining do something about it and contact your representative.

David

I was considering moving to Florida, but after I saw the limited scope of practice--I changed my mind--I'll stay in Arizona.

Amy Simmons

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