Use of Nurse Practitioners in the Emergency Department During A Public Health Emergency

The Louisiana State Board of Nursing (LSBN) regulates Advanced Practice Registered Nurses (APRN) in Louisiana, which includes nurse practitioners (NP). Under Louisiana law, a nurse practitioner must be educated in a specified area of care and certified in accordance with the requirements of a nationally recognized accrediting agency. The Louisiana State Board of Nursing requires formal education and certification as an Acute Care NP for NPs to treat patients in the Emergency Department who present with critical, traumatic, and/or unstable conditions commonly associated with acute care. The LSBN has not waived this requirement during the statewide public health emergency.

An NP who is not certified as an Acute Care NP may still evaluate and manage patients in the Emergency Department with less acute and critical problems within the scope of practice of the NP. The hospital must appropriately credential the NP to work in the Emergency Department based on the NP’s training, education, experience, certification, and scope of practice and provide credentials to the NP that are consistent with NP’s training, education, experience, certification, and scope of practice, including limiting credentials based on the NP’s scope and authorized practice. The credentials must accurately reflect the role and population focus within which the NP is licensed and certified. An NP practicing in the Emergency Department should not be permitted to practice outside the NP’s scope and authorized practice during the public health emergency.

On March 31, 2020, the Governor issued Proclamation Number 38 JBE 2020 that suspends certain statutes and rules for licensure and practice of APRNs in the state. These provisions apply retroactively from March 11, 2020, and are effective until April 30, 2020, or as extended by any subsequent Proclamation or terminated sooner.

According to Proclamation Number 38 JBE 2020, the collaborative practice agreement requirements of the LSBN and Louisiana State Board of Medical Examiners for APRNs (including NPs) are suspended during the public health emergency. The suspension of the collaborative practice requirements does not mean an NP can treat patients without the supervision of a physician. During the public health emergency, NPs should only treat patients in the Emergency Department under the direct supervision of a licensed physician.

According to Proclamation Number 38 JBE 2020, the requirement that an out-of-state APRN (including NP) obtain a license to practice APRN nursing in Louisiana is temporarily suspended provided such person has an active, unencumbered, unrestricted license to practice APRN from any US state, territory or district, which has been confirmed through NURSYS System. An individual APRN who holds an active, unencumbered, unrestricted license to practice APRN from any US state, territory or district, which has been confirmed through NURSYS System, and who has unrestricted hospital credentials and privileges in any U.S. state, territory, or district, may practice nursing at a hospital that is licensed by the Louisiana Department of Health upon the following terms and conditions being met:

1. The licensed Louisiana hospital shall verify all the APRN’s credentials and privileges;
2. The licensed Louisiana hospital shall keep a list of all APRN nurses coming to practice at the hospital and shall provide this list to the Louisiana State Board of Nursing within 10 days of each APRN starting practice at the licensed Louisiana hospital; and
3. The licensed Louisiana hospital shall also provide written notice to the Louisiana State Board of Nursing as of the date that the APRN stopped practicing nursing in Louisiana at that hospital; such written notification shall be made within 10 days of the APRN’s cessation of the practice of nursing at that Louisiana hospital.

According to Proclamation Number 38 JBE 2020, no fingerprinting or criminal background checks shall be required for any healthcare worker covered by the proclamation provided the healthcare works holds a full, unlimited, and unrestricted license to practice in another state, territory, or district.