Please note that requirements for commencement of a collaborative practice have changed. We now require a disclosure of all collaborative/supervisory agreements in all states and an agreement signed by each covering physician.
- How to Apply for Approval of a Collaborative Practice Agreement
- Qualifications for Approval - CRNP/CNM
- Qualifications for Physicians
- Changes to Hours Worked/Voluntary Termination
- The Board of Medical Examiners and the Board of Nursing jointly approve applications for collaborative practice between physicians and Certified Registered Nurse Practitioners (CRNPs) and Certified Nurse-Midwives (CNMs).
- Collaborative agreements initiate when the physician submits a Notice of Commencement form and fee to the Board.
- The CRNP/CNM then applies to the Alabama Board of Nursing for approval of an initial or modified collaborative agreement.
- The collaborative agreement specifies the duties to be performed, work hours, quality assurance plans, and other details.
- Duties and skills not included in the core skills list are requested separately.
- Temporary approval to practice as a CRNP is issued solely by the Board of Nursing upon the CRNP's completion of the requirements for collaborative practice. This temporary approval only becomes effective upon submission and approval of the qualified physician's Commencement of Collaborative Practice form and $200 registration fee to the Board of Medical Examiners.
- Collaborative agreements are not renewed annually, but notification of termination is required within 14 days. Physicians can terminate collaborative practices through the Licensee Portal.
- Active Alabama registered nurse license or multi state registered nurse license issued by a party state.
- Has met all requirements for completion of/graduation from an organized program of study and clinical experience beyond the basic educational preparation as a registered nurse recognized by the Nursing Board.
- At least a master’s or higher degree in advanced practice nursing from an accredited program recognized by the Nursing Board.
- Current certification as a certified registered nurse practitioner or certified nurse midwife.
- Current, unrestricted license to practice medicine in Alabama.
- Practiced medicine for at least one year if certified by or eligible for specialty board certification, or practiced medicine for at least three years.
- Paid all collaborative practice fees due to the Medical Board and completion of a Commencement of Collaborative Practice form.
To make changes in the hours worked of a CRNP/CNM, please contact the Collaborative Practices Department.
A physician in a collaborative practice that is voluntarily terminated by either party is responsible for notifying the Medical Board of the date upon which the agreement terminates.
Notification to the Medical Board or the Nursing Board that a CRNP/CNM has voluntarily terminated an agreement will meet the notification requirement and will result in termination of the physician’s approval to practice under the agreement.
Initial collaborative agreement application forms are available through the Board of Nursing.
- Commencement Form
- Covering Physician Agreement
- 45-day transitional allowance request
- Skills Protocol (Critical Care and Orthopedic)
Critical Care Specialty Skills
- Critical skills request to train
- Critical care skill requirements for initial certification
- Critical care advanced protocol initial requirements attestation
- Critical care advanced protocol ATS designation criteria attestation
- Advanced protocol training record
- CVL advanced request to train
- Chest tube request to train
- Thoracentesis request to train
Orthopedic Specialty Skills
Otolaryngology Specialty Skills
Outside Protocol Skill Requests
- Request for additional skills outside of protocol
- Botulinum toxin for hyperhidrosis protocol
- Botulinum toxin for hyperhidrosis protocol request to train
The fee for a physician commencing a collaborative practice is $200.
There is no renewal of collaborative practice agreements. The parties are expected to notify their respective licensing boards when an agreement is terminated.
How many nurse practitioners may a physician supervise?
The determination is not made on the number of people. The Board limits a physician to supervise a total of 160 "full-time equivalent" (FTE) hours per week of mid-level practitioners. Mid-level practitioners include CRNPs, CNMs and PAs. The county and state health departments are exempt from this rule. Please contact our office if you have further questions about this issue.
How much time is a physician required to spend with a nurse practitioner?
The Collaborating Physician shall have no additional requirement for documentation of on-site collaboration when working in the same facility with the CRNP.
For the CRNP with less than two years (4000 hours) of clinical experience since initial certification or in the collaborating physician’s practice specialty, the physician must be present for not less than ten percent (10%) of the CRNP’s scheduled hours in an approved practice site.
For the CRNP with two years (4000 hours) of clinical experience, the physician must meet no less than quarterly and must visit remote sites no less than twice annually.
Can nurse practitioners prescribe medicines?
The legend and controlled drugs a nurse practitioner is authorized to prescribe are specified in the collaboration agreements and formularies. To prescribe controlled substances, nurse practitioners must apply and be approved for a Qualified Alabama Controlled Substances Certificate (QACSC). To prescribe Schedule II controlled substances, a nurse practitioner must also apply and be approved for a Limited Purpose Schedule II Permit (LPSP). See the Board's QACSC and LPSP web pages for more information. Currently, nurse practitioners may only prescribe certain medications for the treatment of obesity. See Board Rules, Chapter 540-X-17 for more information regarding prescribing for obesity/weight loss.
Can a physician with a restricted license collaborate with a nurse practitioner?
No, a collaborating physician's Alabama medical license must be current and unrestricted.
What is a remote site?
An approved site for a collaborative agreement without a collaborating or covering physician on-site. The collaborating physician’s principal practice site, acute care hospitals, skilled nursing facilities, licensed, special-care assisted living facilities, and licensed assisted living facilities are not remote practice sites for the purpose of these rules.
What is Quality Assurance?
A plan for quality assurance management with defined quality outcome measures for evaluation of the clinical practice of the physician assistant and include review of a meaningful sample of medical records plus all adverse outcomes. The term “medical records” includes, but is not limited to, electronic medical records. Documentation of quality assurance review shall be readily retrievable, identify records that were selected for review, include a summary of findings conclusions, and if indicated, recommendations for change.
May a collaborating or covering physician supervise a PA, CRNP, or CNM practicing in a hospital where the physician does not have privileges?
No, a PA, CRNP, or CNM may only practice in a hospital where the practitioner and his or her supervising or collaborating physician both have privileges.
Can a PA, CRNP, or CNM refer patients to physical therapists?
Yes, they may refer to physical therapists for treatment based on a protocol prescribed by the licensed physician under whom the PA, CRNP, or CNM is practicing.