Can Florida Psychiatric Nurse Practitioners Register their Autonomous Practice for Primary Care Services?

Recently, the Board of Nursing voted to approve the following revised language for adoption by rule as the definition of “primary care practice”:

“Includes physical and mental health promotion, assessment, evaluation, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses, inclusive of behavioral and mental health conditions”.

This definition would be read in conjunction with Section 464.0123(3), Florida Statutes.

The Board also voted to accept the recommendation, also for adoption by rule, from the Council on APRN Autonomous Practice for “standards of practice” as:

“Advanced practice registered nurses who are registered pursuant to Section 464.0123, F.S., shall engage in autonomous practice only in a manner that meets the General Standard of Practice. The General Standard of Practice shall be that standard of practice, care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similarly situated health care providers.”

 They don’t mention psychiatric nurse practitioners by name but the revised definition’s inclusion of words like “Mental health promotion, assessment, evaluation” and “treatment of….behavioral and mental health conditions” implies that this is inclusive of the services that a psychiatric NP would provide in a primary care setting.

We are awaiting further comment form the Board of Nursing with additional direction for the scope of services that psychiatric nurse practitioners can provide under this revised definition. I would argue that if the Board of Nursing approves your autonomous practice registration based on your description of providing psychiatric services that the BON is in turn permitting your to engage in autonomous practice for the provision of psychiatric nursing services in a primary care setting.

UPDATE (October 17, 2022): During an October 2022 Board Hearing, the Board of Nursing considered whether it is within the scope of practice for an autonomous practice APRN who is a psychiatric and mental health nurse practitioner to provide psychiatric and mental health treatment, including psychotherapy, to patients with psychiatric and mental health conditions. They also discussed whether it is within the scope of practice for an autonomous practice APRN to prescribe controlled substances under Section 893.03(2), F.S. for greater than a seven-day supply, for treatment for psychiatric and mental health conditions. Also, whether a supervising physician is needed to provide treatment, including psychotherapy, for psychiatric or mental health conditions. (Susan Patricia Lynch, APRN, R.N. – File#1711/304094 was the involved party)

The Florida Board of Nursing, after thoughtful deliberation and consideration of the law, answered “No”. The practice of an APRN, certified as a PMHNP, is not considered to be solely within the definition of primary care and as such, the PMHNP must still maintain a collaborative agreement. 

The BON asked for a continuance regarding the seven day supply of controlled substance class II medications to treat psychiatric mental health issues as the BON attorney wanted to research this subject further. This had not been considered formally by the BON since the passage of HB 607 authorizing a pathway for autonomous practice.

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