NAC630.490. Collaboration with advanced practice registered nurse.

     1. Except as otherwise provided in this section, a physician may collaborate with an advanced practice registered nurse if the physician:

     (a) Holds an active license in good standing to practice medicine;

     (b) Actually practices medicine in this State; and

     (c) Has not been specifically prohibited by the Board from acting as a collaborating physician.

     2. No physician may collaborate with an advanced practice registered nurse whose scope of practice or medical competence is other than the scope of practice or medical competence of the physician.

     3. Before collaborating with an advanced practice registered nurse, a physician, on a form prescribed by the Board, shall notify the Board of the name and location of the practice of the advanced practice registered nurse and the portion of the practice of the advanced practice registered nurse that the physician will collaborate on with the advanced practice registered nurse. The notice must contain the signatures of the advanced practice registered nurse and the collaborating physician.

     4. In addition to any other requirements, if the State Board of Nursing pursuant to NRS 632.325 has disciplined an advanced practice registered nurse, a physician shall not collaborate with that advanced practice registered nurse unless the physician has been specifically approved by the Board to act as the collaborating physician of that advanced practice registered nurse.

     5. A collaborating physician shall immediately notify the Board of the termination of collaboration between the collaborating physician and an advanced practice registered nurse. For any portion of the practice of the advanced practice registered nurse that the collaborating physician terminating collaboration with the advanced practice registered nurse collaborated, no physician shall collaborate with the advanced practice registered nurse until the physician submits notice to the Board pursuant to subsection 3.

     6. The collaborating physician or his or her substitute shall be available at all times that the advanced practice registered nurse is providing medical services to consult with the advanced practice registered nurse. Those consultations may be indirect, including, without limitation, by telephone.

     7. The collaborating physician shall, at least once a month, spend part of a day at any location where the advanced practice registered nurse provides medical services to act as consultant to the advanced practice registered nurse and to monitor the quality of care provided by an advanced practice registered nurse.

     8. The collaborating physician shall develop and carry out a program to ensure the quality of care provided by an advanced practice registered nurse. The program must include, without limitation:

     (a) An assessment of the medical competency of the advanced practice registered nurse;

     (b) A review and initialing of selected charts;

     (c) An assessment of a representative sample of referrals or consultations made by the advanced practice registered nurse with another health professional as required by the condition of the patient;

     (d) Direct observation of the ability of the advanced practice registered nurse to take a medical history from and perform an examination of patients representative of those cared for by the advanced practice registered nurse; and

     (e) Maintenance of accurate records and documentation of the program for each advanced practice registered nurse with whom the physician collaborated.

     9. The collaborating physician shall ensure that the advanced practice registered nurse:

     (a) Does not use presigned prescriptions; and

     (b) Practices in strict compliance with the regulations of the State Board of Pharmacy regarding prescriptions, controlled substances, dangerous drugs and devices.

     10. The medical director of a practice that is specific to a site, including, without limitation, a facility for skilled nursing or a hospital, may act as a collaborating physician to an advanced practice registered nurse who works at the practice. A medical director acting as a collaborating physician may allow the advanced practice registered nurse to evaluate and care for patients under the direction of an attending physician who is not the collaborating physician of the advanced practice registered nurse.

     11. A collaborating physician shall ensure that the medical services that an advanced practice registered nurse performs while collaborating with the physician are:

     (a) Commensurate with the education, training, experience and level of competence of the advanced practice registered nurse; and

     (b) Within the scope of practice of the:

          (1) Advanced practice registered nurse;

          (2) Certification of the advanced practice registered nurse; and

          (3) Collaborating physician.

     12. If the collaborating physician is unable to act as the collaborating physician for an advanced practice registered nurse, he or she shall designate a qualified substitute physician to act as a temporary collaborating physician. The scope of practice or medical competence of the temporary collaborating physician must be the same as the scope of practice or medical competence of the original collaborating physician.

     13. The collaborating physician is responsible for all the medical services performed by the advanced practice registered nurse.

     (Added to NAC by Bd. of Medical Exam’rs, eff. 6-23-86; A by R149-97, 3-30-98; R145-03, 12-16-2003)