Professional Documents
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Purpose
This document authorizes the acute care nurse practitioner (ACNP) to perform medical acts in
accordance with the Mississippi Nursing Practice Law, §73-15-20. This document delegates
certain medical acts, as required by Mississippi law, and sets forth guidelines for collaboration
between the delegating physician, Dr. ______________, a Mississippi licensed physician whose
practice or prescriptive authority is not limited as a result of voluntary surrender or
legal/regulatory order. and Kelly Johnson, MSN, RN, ACNP.
This agreement is not intended to limit the health care services the ACNP provides under their
scopes of practice, based on the advanced practice role and specialty authorized by the
Mississippi Board of Nurse Examiners.
Scope of Practice
The role of the ACNP is to provide advanced nursing care across the continuum of health care
services to meet the specialized physiologic and psychologic needs of patients with complex
acute, critical, and chronic health conditions. This care is continuous and comprehensive. The
population in acute care practice includes acutely, and critically ill patients experiencing episodic
illness, exacerbation of chronic illness, or terminal illness.
The ACNP practices with a focus on the adult population, those age 15 and older and not
pregnant, in any setting in which privileges exist (inpatient and outpatient), and in which patient
care requirements include management/stabilization of chronic and acute illness, complex
monitoring and therapies, high-intensity nursing intervention, or continuous nursing vigilance
within the range of high-acuity care.
Diagnoses seen by the ACNP include, but are not limited to: hypertension, hyperlipidemia,
coronary artery disease, congestive heart failure, atrial fibrillation, ventricular
arhthmias/dysrythmias, diabetes mellitus, chronic obstructive pulmonary disease, pneumonia,
influenza, acute respiratory distress syndrome, sepsis, abscess, sinusitis, rhinitis, phyrangitis,
pancreatitis, gastroesphogeal reflux disease, and lumbago.
In addition to functions/procedures within the scope of RN practice, services in the ACNP’s scope
of practice include, but are not limited to:
Teaching-Coaching Function
• Eliciting from the patient the characteristics of his/her learning style from which
to plan and implement the teaching.
• Communicating health advice, instruction and counseling appropriately using
evidence-based rationale.
Professional Role
• Functioning in a variety of role dimensions: health care provider, coordinator,
consultant, educator, coach, advocate, administrator, researcher, and leader.
• Advocating for the patient to ensure health needs are met.
• Advocating for access to quality, cost-effective health care.
Cultural/Spiritual Competence
• Showing respect for the inherent dignity of every human being, whatever their
age, gender, religion, socioeconomic class, sexual orientation, and ethnicity.
• Recognizing cultural issues and interacting with patients from other cultures in
culturally sensitive ways.
Kelly Johnson
Restorative care is the focus of the ACNP, and short-term goals include patient stabilization,
minimization of complications, and promotion of physical and psychological well-being. The
long-term goal is to restore maximal health potential while evaluating risk factors in achieving
this outcome.
The nurse practitioner shall practice according to standards and guidelines of the American
Nurses Credentialing Center (ANCC) and in a collaborative/consultative relationship with a
licensed physician whose practice is compatible with that of the nurse practitioner. The nurse
practitioner must be able to communicate reliably with a collaborating/consulting physician at all
times while practicing.
Some medications that will be routinely prescribed include, but are not limited to:
antihypertensives (lisinopril, carvedilol, amlodipine), antilipids (atorvastatin, fenofibrate),
antiarrhythmics (diltiazem, amiodarone), antibiotics (levofloxacin, clarithromycin), proton pump
inhibitors (esomeprazole, pantoprazole), narcotics (morphine, oxycodone), vasopressors
(neosyneprine, norepinephrine ), diuretics (furosemide, hydrochlorothiazide), antidiabetics
(regular insulin, metformin), inotropics (dobutamine, digoxin), and bronchodilators (albuterol).
Nurse practitioners may not write prescriptions for, dispense or order the use of or administration
of any schedule of controlled substances except as follows:
• Pursuant to a physician's order, the nurse practitioner may call-in a prescription for any
schedule of controlled substances or administer any schedule of controlled substances,
but only after the physician has made an independent determination as to the need for
the controlled substance and this is documented in the patient records.
• Pursuant to these regulations of the State of Mississippi, and once registered with the
U.S. Drug Enforcement Administration in compliance with Title 21 CFR Part 1301 Food
and Drugs; the authorized nurse practitioner may prescribe Schedules II-V.
• The ACNP registered to prescribe controlled substances may order, possess, prescribe,
administer, distribute or conduct research with those substances to the extent authorized
by their registration and in conformity with the other provisions of these regulations and
in conformity with provisions of the Mississippi Uniform Controlled Substances Law,
Miss. Code Ann. §41-29-101 et seq.
Kelly Johnson
Collaboration/Consultation
Each collaborative/consultative relationship shall include and implement a formal quality
assurance/quality improvement program which shall be maintained on site and shall be
available for inspection by representatives of the Mississippi Board of Nursing and
Mississippi State Board of Medical Licensure. The quality assurance/quality
improvement program criteria shall consist of:
Education/Training
• Current license as a RN in Mississippi
• Registered with the U.S. Drug Enforcement Administration
• Masters of Science in Nursing, ACNP
• Graduate of accredited Nurse Practitioner Program
University of South Alabama, College of Nursing
Mobile, Alabama
Graduation Date: December 2009
• 680 clinical hours have been completed in acute care settings
• Eligibility to practice as an ACNP in the state of Mississippi.
• Certified ACLS & BLS provider 04/2009-04/2011
• Current DEA number from the United States Drug Enforcement Administration
Prior to certification:
Kelly Johnson
Changes in status:
• The advanced practice registered nurse shall notify the board immediately
regarding changes in the collaborative/consultative relationship with a licensed
physician or dentist. If changes leave the advanced practice registered nurse
without a board approved collaborative/consultative relationship with a physician
or dentist, the advanced practice nurse may not practice as an advanced practice
registered nurse.
Setting
The nurse practitioners will practice under these protocols at the following sites.
Kelly Johnson
We, the undersigned, agree to the terms of this Collaborative Practice Agreement as set forth in
this document.
_____________________________ Delegating Physician
Reviewed on __________________
Reviewed on __________________
Reviewed on __________________
Reviewed on __________________