Practice Issues for NPs and CNSs (cont)

• NPs and CNSs may not certify a terminal illness, but may act as the attending "physician" if the hospice patient selects the NP or CNS to act in this capacity.

• APNs may not order home health services from Medicare-certified agencies, but may oversee the plan of care for Medicare patients.

• Licensed home care agencies that are not Medicare-certified may accept orders from APNs.

• Medicaid's Primary Home Care Program allows APNs to establish the plan of care and order services.

• APNs may not order prosthetic or orthotic services.

• APNs specializing in family, adult or gerontological nursing may perform assessments and certify medical necessity for an emergency protective order for an adult or disabled individual.

• APNs may declare death (ascan and RN) but only a physician may sign a death certificate.

• APNs may sign University Interscholastic League forms verifying a student's fitness to participate in sports activities.

• APNs may sign Texas Works 1836 forms verifying that a client's abilit to work is limited due to disability or the need to care for a close family member.

• APNs may perform assessments and treat injured workers covered by Texas Workers' Compensation (TWC) Insurance, but only if their collaborating physician is a "treating doctor." APNs may sign (TWC) forms on behalf of the treating physician.

• APNs working in nursing and skilled nursing facilities have to meet CMS requirements in making patient visits.

• APNs should protect their rights in any employment or contract for services that they sign. The APN should be represented by an attorney that is familiar with APN practice issues and the APN should reasearch additional sources to determine elements that are important to include.

• APNs may delegate administration of immunizations to unlicensed personnel, but they may not delegate administration of prescription drugs to unlicensed persons.

• Non-physicians may not employ physicians except for certain health care organizations certified by the Texas Medical Board.

• Physicians may not jointly own a practice with APNs.

• In advertising their services to the public, APNs must avoid any reference to "medicine" or a "medical practice."

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