Advanced Practice Registered Nurses

Developed: 07/87

Revised: 07/94, 06/07, 02/18

The American Nurses Association Code of Ethics for Nurses states that the nurse:
The nurse practice with compassion and respect for the inherent dignity, worth, and
unique attributes of every person.

The nurse’s primary commitment is to the patient, whether an individual, family, group,
community, or population.

The nurse promotes, advocates for, and protects the rights, health, and safety of the

The nurse has authority, accountability, and responsibility for nursing practice; makes
decisions; and takes action consistent with the obligation to promote health and to
provide optimal care.

The nurse owes the same duties to self as to others, including the responsibility to
promote health and safety, preserve wholeness of character and integrity, maintain
competence, and continue personal and professional growth.

The nurse, through individual and collective effort, establishes, maintains, and improves
the ethical environment of the work setting and conditions of employment that are
conducive to safe, quality health care.

The nurse, in all roles and settings, advances the profession through research and
scholarly inquiry, professional standards development, and the generation of both
nursing and health policy.

The nurse collaborates with other health professionals and the public to protect human
rights, promote health diplomacy, and reduce health disparities.

The profession of nursing, collectively through its professional organizations, must
articulate nursing values, maintain the integrity of the profession, and integrate
principles of social justice into nursing and health policy.

In accordance with the Code of Ethics for Nurses, the intent of this statement is to provide
guidelines and definitions for advanced practice registered nurses {APRNs}. The role of the
registered nurse changes with advancing technology and newly identified needs. The registered
nurse’s role must be consistent with the scope of practice defined in the Nurse Practice Act,
rules of the board of nursing, and the standards developed by the nursing profession.

Advanced practice registered nurses (APRN) function in diverse roles and settings. The APRN is
prepared to engage in independent and/or collaborative nursing practice that provides costeffective,
quality care to individuals, groups, or families.

The nursing care provided by advanced practice registered nurses requires advanced
knowledge of current scientific principles and competent clinical experience. Such action should
be goal directed and incorporate assessment, analysis, planning, implementation and

Registered nurses in advanced practice have a graduate degree (Masters or higher) with a
major in nursing as a nurse practitioner, clinical nurse specialist, nurse midwife, or the provision
of anesthesia. APRNs are certified in advanced clinical practice by a national or regional
accrediting organization approved by the Ohio Board of Nursing. APRNs conduct
comprehensive health assessments; demonstrate a high level of autonomy and expert skill in
the diagnosis and treatment of complex responses of individuals and groups to actual or
potential health problems. They formulate clinical decisions to manage acute and chronic illness
and promote health and wellness in the APRN’s specialty area of practice. Advanced practice
registered nurses integrate education, research, management and consultation into their
clinical roles. They function in collaborative relationships with nursing peers, physicians, and
other professionals who influence the health environment. A standard care agreement (SCA) is
required by the Ohio Board of Nursing (OBN) in collaboration with a physician, podiatrist, or

APRNs, as recognized providers of health care services, should receive reimbursement for their
services commensurate with like services provided by other licensed professionals.

There are four principle types of advanced practice registered nurses:
Certified Registered Nurse Anesthetists (CRNA)
Certified Nurse Midwives (CNM)
Clinical Nurse Specialist (CNS)
Certified Nurse Practitioner (CNP)

The scope of practice of the CRNA encompasses the professional functions, privileges, and
responsibilities associated with nurse anesthesia practice. CRNAs must practice with a
supervising dentist, physician, or podiatrist. There is no authorization to prescribe or personally
furnish medications.

Nurse midwife practice is the independent management of women’s health care, focusing
primarily on pregnancy, childbirth, the postpartum period, care of the newborn, and the family
planning and gynecological needs of women. CNMs practice in accord with the Standards for
the Practice of Nurse Midwifery, as defined by the American College of Nurse Midwives.
A CNS provides direct nursing care to individuals, families, and groups and manages complex
problems in accordance with standards established by the profession. CNSs have advanced
knowledge, skill, and competence in a specialized area of nursing.

A CNP has advanced education and the clinical skills necessary for the provision of preventative
and primary or acute health care in a defined area of practice.

All APRNs must be licensed in the state of Ohio as such in addition to their RN license. All APRNs
except for CRNAs must enter into a standard care agreement (SCA) with one or more
collaborating physicians or podiatrists prior to engaging in practice. CNPs, CNSs, and CNMs may
prescribe, including Schedule II drugs, in accordance with an exclusionary formulary and within
the parameters of the SCA.

An overview of the details needed for the SCA can be found in Chapter 4723-8 of the Ohio
Administrative Code. Among other issues, the SCA must include provisions for quality
assurance, parameters for prescribing, services offered, reimbursement concerns, and
resolution for disagreements concerning patient treatments. A SCA template can be obtained
from the Ohio Association of Advanced Practice Nurses for a fee.

Clinical Practice The activities of each advanced practice registered nurse are unique to that
APRN’s practice area. Advanced Practice Registered Nurses:

• Demonstrate a high level of autonomy and expert skill in the diagnosis and
treatment of complex responses of individuals, families, and communities to actual
or potential health problems;

• Conduct comprehensive health assessments;

• Work with patients and families to develop comprehensive and realistic plans of
care which maximize health;

• Use highly developed clinical and interpersonal communication skills, implement the
plan of care effectively, and encourage patients to assume responsibility for their
own health;

• Collaborate with other health care professionals and make referrals to meet
patients’ needs;

• Perform case management and coordination of care with other health care
providers to assure continuity of care;

• Participate in consultation, research, and education for the purposes of improving
the provision of health care and to advance the profession.

Ohio Revised Code 4723.41- 4723.50
Ohio Administrative Code 4723.8 – 4723.9
OBN Summary of Major Provisions of HB 216
OBN document: CNPs, CNSs, CNMs – Transition to Licensure
OBN document: CRNAs – Transition to Licensure
OBN document: OAC rule 4723-9-10
American College of Nurse Midwives: Scope of Practice