History of Advance Practice Nursing in Tennessee

  1960s

The shortage of physicians provided the opportunity to bring about changes in well-child care in ambulatory settings.

1965

First nurse practitioner education program in the U.S. at the University of Colorado in response to the shortage.

1969

Tennessee Medical Association-Tennessee Nurses Association-Tennessee Hospital Association Joint Practice Statement endorsed the expanding role of RNs (not specific to nurse practitioners) in coronary care units.

1970

Vanderbilt University began the first master's program to prepare nurse practitioners in Tennessee under the leadership of Dr. Beverly Bowns.  Dr Bowns recognized the role nurses had long played in public health and saw nurse practitioners as a natural evolution of that role.  She then moved to the University of Tennessee Health Science Center in 1972 to implement the master’s NP education model in a state university.

  1970s

Nurse practitioners were safely writing prescriptions as a delegated medical act in urban and rural areas and in many different settings.

1971

Nurse practitioners were so well recognized as providers of medical services that President Nixon announced a national commitment to their training.  He predicted that NPs would expand the supply of medical care and reduce its cost by performing medical tasks that traditionally had been restricted to MDs.

HEW recommended that states enact amendments to their medical practice acts to codify the authority of physicians to delegate medical tasks to health personnel working under their supervision.

1973

Tennessee Medical Association amended the medical practice act to include a section to authorize delegation of medical acts performed under medical supervision to a “physician’s trained assistant.”  “Physician’s trained assistant” was not defined.

1974

Board of Nursing promulgated rule 32 stating that RNs (not specific to nurse practitioners) may expand their role, but those who manage the medical aspects of a patient's care must have written medical protocols jointly developed by the nurse and the sponsoring physician.

1976

Tennessee Nurses Association-Tennessee Medical Association Joint Practice Statement stated that jointly developed written protocols should outline delegated medical tasks and drug management to be used in patient care.

1979

The Tennessee Board of Pharmacy tried unsuccessfully to promulgate rules to authorize filling prescriptions written by nurse practitioners, but the attorney general refused to approve the proposed rules stating there was no statutory authority to support them. The Board of Pharmacy issued a memo to all pharmacists warning that pharmacists who filled prescriptions after August 1, 1979 written by anyone other than a doctor, dentist or veterinarian would be violating state and federal laws.

A group of plaintiffs, including the Scotts Hill Clinic in Decatur County and the Primary Care Association, obtained a temporary restraining order to keep the Board of Pharmacy from enforcing their warning, and nurse practitioners continued to write prescriptions.

Speaker of the House Ned McWherter asked Rep. Paul Starnes, Chair of House Health Committee, to solve this problem. Rep. Starnes took a Special Committee including legislators, physicians and lobbyists across the state to look at primary care sites where nurse practitioners were writing prescriptions.

1980

Bill passed the Senate to authorize nurse practitioners to write prescriptions.

Bill passed the House to authorize nurse practitioners to write prescriptions but limited the authorization to certain sites approved by the Primary Care Advisory Board. The Senate concurred in the House amendment, and the bill became law. The legislation required that copies of NP/MD jointly developed Protocols and Formularies be submitted to Primary Care Advisory Board for site approval.

1994

Bill passed to delete the site approval process and allow NPs with a certificate of fitness to write prescriptions in any setting under medical supervision.

1995

Bill passed granting the Board of Nursing authority to jointly adopt the Board of Medical Examiners’ supervising MD rules. This legislation became necessary to halt approval by the Board of Medical Examiners of proposed rules for supervising MDs, which would have severely restricted NP practice.  

1996

Bill passed to delete requirement to mail copies of Protocols and Formularies to Primary Care Board. Protocols were to be maintained at practice site. Copies of Formularies, by category, were to be mailed to the Primary Care Board.

1997

Bill passed to authorize prescription of controlled drugs, Schedules II, III, IV, and V, pending joint adoption of rules for supervising MDs by the Board of Medical Examiners and the Board of Nursing. Formularies were to be mailed to the Tennessee Board of Nursing rather than the Primary Care Board.

1998

The Board of Medical Examiners and Board of Nursing jointly approved rules for supervising MDs related only to prescribing Schedules II-V controlled drugs by NPs.

Bill passed to sunset the Primary Care Advisory Board.

1999

Board of Nursing Rules and Board of Medical Examiners Rules were promulgated, and NPs were issued DEA numbers to prescribe, dispense, administer and procure Schedules II-V controlled drugs.

2002

Bill passed to protect the title “Advanced Practice Nurse” (APN) and grant the privilege (“may” apply) to apply for a certificate to practice as an APN. Sections of the original bill were lost that would have deleted the requirement for MD supervision for prescriptive authority.

2003

Bill passed to change “may” apply to “shall” apply for a certificate to practice, making it a requirement for all APNs to hold a certificate in order to practice.

Bill passed to "deem" the prescription to be that of the nurse practitioner rather than the physician and to require only the signature of the nurse practitioner. The language in the bill to replace “supervision” with “medical consultation and referral” related to prescriptive authority was lost.