Code of Massachusetts Regulations
244 CMR - BOARD OF REGISTRATION IN NURSING
Title 244 CMR 4.00 - Advanced Practice Registered Nursing
Section 4.06 - Responsibility, Accountability and Scope of Practice for Advanced Practice Registered Nurses

(a) A CRNA will only practice in the clinical category(s) for which the CRNA has attained and maintained certification. A CRNA may attain additional competencies within their category(s) consistent with the scope and standards of CRNA practice. It is the responsibility of each CRNA to maintain records of competency-based training and submit evidence to the Board upon request.

(b) The scope of CRNA practice is reflective of standards for the provision of healthcare services in diverse settings for for individuals across the lifespan, whose health status may range from healthy through all recognized levels of acuity, including persons with immediate, severe, or life-threatening illness or injury, including anesthesia care and anesthesia-related care, acute and chronic pain management, palliative care, emergency care, critical care, resuscitative and sedation services. In order to issue prescriptions, the CRNA must register with the Department of Public Health's Drug Control Program pursuant to M.G.L. c. 94C, and 105 CMR 700.00: Implementation of M.G.L. c. 94C, as well as with the U.S. Drug Enforcement Agency (DEA), if applicable.

(c) A CRNA who does not register for prescriptive authority administers anesthesia pursuant to the signed order of a registered prescriber. Such CRNA may select anesthetic agents based upon protocols that are mutually developed with a registered prescriber responsible for the perioperative care of a patient, as appropriate for the practice setting.

(d) Pursuant to M.G.L. c. 112, § 80H, the administration of anesthesia by a CRNA directly to a patient does not require a prescription.

(a) A CNM will only practice in the clinical category(s) for which the CNM has attained and maintained certification. A CNM may attain additional competencies within their category(s) consistent with the scope and standards of CNM practice. It is the responsibility of each CNM to maintain records of competency-based training and submit evidence to the Board upon request.

(b) The scope of CNM practice is reflective of the standards established by a Board recognized national organization for midwifery practice for the provision of primary health care services in diverse settings to individuals throughout the lifespan, including gynecologic care, abortion for pregnancy less than 24 weeks, family planning services, preconception care, prenatal and postpartum care, childbirth, care of the newborn and treatment of the partner of their clients for sexually transmitted disease, transgender care, sexual health and reproductive health for which the CNM has been educationally prepared and for which competency has been established and maintained. A CNM practices within a healthcare system and develops clinical relationships with obstetrician-gynecologists.

(a) A CNP will only practice in the clinical category(s) for which the CNP has attained and maintained certification. A CNP may attain additional competencies within their category(s) consistent with the scope and standards of CNP practice. It is the responsibility of each CNP to maintain records of competency-based training and submit evidence to the Board upon request.

(b) The scope of CNP practice is reflective of standards for the provision of health care services in diverse settings to individuals throughout the lifespan, including health promotion, disease prevention, health education, abortion for pregnancy less than 24 weeks, counseling and making referrals to other members of the health care team, as well as the diagnosis and management of acute and chronic illness and disease.

(c) Pursuant to M.G.L. c. 112, § 80I, when a law or rule requires a signature, certification, stamp, verification, affidavit or endorsement by a physician, when relating to physical or mental health, that requirement may be fulfilled by a CNP, provided that the signature, certification, stamp, verification, affidavit, or endorsement is consistent with established scope of practice standards and does not expand the scope of practice of the CNP.

(d) Pursuant to St. 2012, c. 369 and M.G.L. c. 112, § 80I, CNPs with independent practice authority, and CNPs under supervised practice pursuant to mutually agreed upon guidelines between the CNP and Qualified Healthcare Professional, as defined in 244 CMR 4.07, supervising the CNP's prescriptive practice, are authorized to issue written certifications of marijuana for medical use.

(a) A PNMHCS will only practice in the clinical category(s) for which the PNMHCS has attained and maintained certification. A PNMHCS may attain additional competencies within their category(s) consistent with the scope and standards of PNMHCS practice. It is the responsibility of each PNMHCS to maintain records of competency-based training and submit evidence to the Board upon request.

(b) The scope of PNMHCS practice is reflective of standards for the provision of psychiatric health care services in diverse settings to individuals throughout the lifespan, including health promotion, disease prevention, health education, counseling and making referrals to other members of the health care team, as well as the diagnosis and management of acute and chronic psychiatric illness and psychiatric disease.

(a) A CNS will only practice in the clinical category(s) for which the CNS has attained and maintained certification. A CNS may attain additional competencies within their category(s) consistent with the scope and standards of CNS practice. It is the responsibility of each CNS to maintain records of competency-based training and submit evidence to the Board upon request.

(b) The scope of CNS practice is reflective of standards for the integration of an advanced level of direct and indirect nursing care beyond the scope of RN practice. In addition to the provision of assistance to other nurses and health professionals in establishing and meeting health goals of individuals and groups, a CNS may provide health care services in diverse settings to individuals throughout the lifespan, including health promotion, disease prevention, health education, counseling and making referrals to other members of the health care team, as well as the diagnosis and management of illness and disease.