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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
SENATE BILL 459 By: Stanley
AS INTRODUCED
An Act relating to the practice of nursing; amending
59 O.S. 2021, Section 353.1, as amended by Section 6,
Chapter 288, O.S.L. 2022 (59 O.S. Supp. 2022, Section
353.1), which relates to definitions used in the
Oklahoma Pharmacy Act ; modifying definitions;
amending 59 O.S. 2021, Section 353.1a, which relates
to prescriptive authority of Adv anced Practice
Registered Nurses; modifying prescriptive authority
of Certified Nurse-Midwives; amending 59 O.S. 2021,
Section 567.3a, which relates to definitions used in
the Oklahoma Nursing Practice Act; modifying
definitions; amending 59 O.S. 2021, Section 567.4a,
which relates to prescriptive authority; eliminating
supervision requirement for Certified Nurse-Midwife;
providing for independent practice; directing the
Oklahoma Board of Nursing to promulgate certai n
rules; amending 59 O.S. 2021, Section 567.5a, which
relates to Advanced Practice Register ed Nurse
license; providing for independent prescri ptive
authority by endorsement for Certified Nurse-Midwife;
amending 63 O.S. 2021, Section 2-312, as amended by
Section 2, Chapter 184, O.S.L. 2022 (63 O.S. Supp.
2022, Section 2-312), which relates to controlled
dangerous substances; eliminating supervision
requirement for Certified Nurse-Midwife; and
providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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SECTION 1. AMENDATORY 59 O.S. 2021, S ection 353.1, as
amended by Section 6, Chap ter 288, O.S.L. 2022 (59 O.S. Supp. 2022,
Section 353.1), is amended to read as follows:
Section 353.1. For the purposes of the Ok lahoma Pharmacy Act:
1. “Accredited program” means those seminars, classes,
meetings, work projects, and oth er educational courses approved by
the Board State Board of Pharmacy for purposes of continuing
professional education;
2. “Act” means the Oklahoma Pharmacy Act;
3. “Administer” means the direct application of a drug, whether
by injection, inhalation, ingestion or any other m eans, to the body
of a patient;
4. “Assistant pharmacist” means any person presently license d
as an assistant pharmacist in the State of Oklahoma by the Board
pursuant to Section 353.10 of this title and fo r the purposes of the
Oklahoma Pharmacy Act shal l be considered the same as a pharmacist,
except where otherwise specified;
5. “Board” or “State Board” means the State Board of Pharmacy;
6. “Certify” or “certification of a prescription ” means the
review of a filled prescription by a licensed pharmac ist or a
licensed practitioner with dispensing authori ty to confirm that the
medication, labeling and packaging of the filled prescription are
accurate and meet all requirements prescribed by state and federal
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law. For the purposes of this paragraph, “licensed practitioner”
shall not include optometrists wit h dispensing authority;
7. “Chemical” means any medicinal substance, whether simple or
compound or obtained through the process of the science and art of
chemistry, whether of organic or inorganic ori gin;
8. “Compounding” means the combining, admixing, m ixing,
diluting, pooling, reconstituting o r otherwise altering of a drug or
bulk drug substance to create a drug. Compounding includes the
preparation of drugs or devices in anticipation of prescript ion drug
orders based on routine, regularly observed pre scribing patterns;
9. “Continuing professional education” means professional,
pharmaceutical education in the general areas of the socioeconomic
and legal aspects of health care; the properties and actions of
drugs and dosage forms; and the etiology, char acteristics and
therapeutics of the diseas ed state;
10. “Dangerous drug”, “legend drug”, “prescription drug” or “Rx
Only” means a drug:
a. for human use subject to 21 U.S.C. 353(b)(1), or
b. is labeled “Prescription Only”, or labeled with the
following statement: “Caution: Federal law restricts
this drug except for use by or on the order of a
licensed veterinarian.”;
11. “Director” means the Executive Dir ector of the State Board
of Pharmacy unless context clearly indicates otherwise;
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12. “Dispense” or “dispensing” means the interpretation,
evaluation, and implementation of a prescription drug order
including the preparation and delivery of a drug or devic e to a
patient or a patient ’s agent in a suitable container appropria tely
labeled for subsequent ad ministration to, or use by, a patient .
Dispense includes sell, distribute, leave with, give away, dispose
of, deliver or supply;
13. “Dispenser” means a retail pharmacy, hospital pharmacy, a
group of chain pharmacies under c ommon ownership and control th at do
not act as a wholesale distributor, o r any other person authorized
by law to dispense or adm inister prescription drugs, and the
affiliated warehouses o r distributions of such entities und er common
ownership and control t hat do not act as a wholesale distributor.
For the purposes of this para graph, “dispenser” does not mean a
person who dispenses only products to be used in animals in
accordance with 21 U.S.C. 360b(a)(5);
14. “Distribute” or “distribution” means the sale, purchase,
trade, delivery, handling, storage, or receipt of a product, and
does not include the dispensing of a product pursua nt to a
prescription executed in accordance with 21 U.S.C. 353(b)(1) or the
dispensing of a product approved under 21 U.S.C. 360 b(b); provided,
taking actual physical possession of a product or title s hall not be
required;
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15. “Doctor of Pharmacy” means a person licensed by the Board
to engage in the practice of pharmacy. The terms “pharmacist”,
“D.Ph.”, and “Doctor of Pharmacy” shall be interchangeable and s hall
have the same meaning wherever they a ppear in the Oklahoma Statutes
and the rules promulgated by the Board;
16. “Drug outlet” means all manufacturers, repackagers,
outsourcing faciliti es, wholesale distributors, third -party
logistics providers, pharm acies, and all other facilities which are
engaged in dispensing, delivery, distribution or storage of
dangerous drugs;
17. “Drugs” means all medicinal subst ances and preparations
recognized by the United States Pharmacopoeia and National
Formulary, or any revision thereof, and all substances an d
preparations intended for external and/or internal use i n the cure,
diagnosis, mitigation, treatment or prevention of disease in humans
or animals and all substances and preparations, other than food,
intended to affect the structure or any function of t he body of a
human or animals;
18. “Drug sample” means a unit of a prescription drug packaged
under the authority an d responsibility of the manufac turer that is
not intended to be sold and is intended to promote the sale of the
drug;
19. “Durable medical equipment” has the same meaning as
provided by Section 2 of this act;
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20. “Filled prescription” means a packaged prescription
medication to which a label has been affixed which contain s such
information as is requi red by the Oklahoma Pharmacy Act;
21. “Hospital” means any institution licensed as a hospital by
this state for the care and treatment of patients, or a pharmacy
operated by the Oklahoma Department of Veterans Affairs;
22. “Licensed practitioner” means:
a. an allopathic physician,
b. an osteopathic physician,
c. a podiatric physician,
d. a dentist,
e. a veterinarian or,
f. an optometrist, or
g. a Certified Nurse-Midwife,
licensed to practice and authorized to prescribe dangerous drugs
within the scope of practice of such p ractitioner;
23. “Manufacturer” or “virtual manufacturer” means with respect
to a product:
a. a person that holds an application appr oved under 21
U.S.C. 355 or a license issued under 42 U.S.C. 262 for
such product, or if such product is not the subject of
an approved application or license, the person who
manufactured the product,
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b. a co-licensed partner of the person described in
subparagraph a that obtains the product directly from
a person described in this subpa ragraph or
subparagraph a of this paragraph,
c. an affiliate of a person described in subpara graph a
or b who receives the product directly from a person
described in this subpar agraph or in subparagraph a or
b of this paragraph, or
d. a person who contracts with another to manufacture a
product;
24. “Manufacturing” means the production, preparation,
propagation, compounding, conversion or processing of a device or a
drug, either directly or indirectly by extraction from substances of
natural origin or independently by means of chemic al or biological
synthesis and includes any packaging or repackaging of the
substances or labeling or relabeling of its container, and the
promotion and marketing of such drug s or devices. The term
“manufacturing” also includes the preparation and promoti on of
commercially available produc ts from bulk compounds for resale by
licensed pharmacies, licensed practitioners or other persons;
25. “Medical gas” means those gases including those in liquid
state upon which the manufacturer or distributor has placed one of
several cautions, such as “Rx Only”, in compliance with federal l aw;
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26. “Medical gas order” means an order for medical gas issued
by a licensed prescriber;
27. “Medical gas distributor ” means a person licensed to
distribute, transfer, wholesale, deliver or sell medical gases on
drug orders to suppliers or oth er entities licensed to use,
administer or distribute medical gas and may also inclu de a patient
or ultimate user;
28. “Medical gas supplier” means a person who dispe nses medical
gases on drug orders only to a patient or ultimate user;
29. “Medicine” means any drug or combination of drugs which has
the property of curing, preventing, tr eating, diagnosing or
mitigating diseases, or which is used for that purpose;
30. “Nonprescription drugs ” means medicines or drug s which are
sold without a prescription and which are prepackaged for use by the
consumer and labeled in accordance with the r equirements of the
statutes and regulati ons of this state and the federal gov ernment.
Such items shall also include medical and d ental supplies and
bottled or nonbulk chemicals which are sold or offered for sale to
the general public if such articles or p reparations meet the
requirements of the Federal Food, Drug and Cosmetic Act, 21
U.S.C.A., Section 321 et seq.;
31. “Outsourcing facility” including “virtual outsourcing
facility” means a facility at one geographic location or address
that:
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a. is engaged in the compounding of sterile dru gs,
b. has elected to register as an outsourcing facility,
and
c. complies with all requirem ents of 21 U.S.C. 353b;
32. “Package” means the smallest individual saleable un it of
product for distribution by a manufact urer or repackager that is
intended by the manufacturer for ultimate s ale to the dispenser of
such product. For the purposes of this paragraph, “individual
saleable unit” means the smallest container of a produc t introduced
into commerce by the manufactur er or repackager that is intended by
the manufacturer or repackager fo r individual sale to a dispenser;
33. “Person” means an individual, partnershi p, limited
liability company, corporation or association, unles s the context
otherwise requires;
34. “Pharmacist-in-charge” or “PIC” means the pharmacist
licensed in this state responsible for th e management control of a
pharmacy and all other aspects of the practice of pharmacy in a
licensed pharmacy as defined by S ection 353.18 of this title;
35. “Pharmacy” means a place regularly licensed by the Board of
Pharmacy in which prescriptions, drugs, medicines, chemicals and
poisons are compounded or dispe nsed or such place where pharmacists
practice the profession of ph armacy, or a pharmacy operated b y the
Oklahoma Department of Veterans Affairs;
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36. “Pharmacy technician”, “technician”, “Rx tech”, or “tech”
means a person issued a Technician permit by the State Board of
Pharmacy to assist the pharmacist and perform nonj udgmental,
technical, manipulative, non-discretionary functions in the
prescription department under the immediate and direct supervi sion
of a pharmacist;
37. “Poison” means any substance which when introduced into the
body, either directly or by absorpti on, produces violent, morbid or
fatal changes, or which destroys living tissue with which such
substance comes into contact;
38. “Practice of pharmacy” means:
a. the interpretation and evaluation of prescription
orders,
b. the compounding, dispensing, adm inistering and
labeling of drugs and devices, except labeling by a
manufacturer, repackager or distributor of
nonprescription drugs a nd commercially packaged legend
drugs and devices,
c. the participation in drug selection and drug
utilization reviews,
d. the proper and safe storage of drugs and de vices and
the maintenance of proper r ecords thereof,
e. the responsibility for advising by counseling and
providing information, where professionally necessary
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or where regulated, of therapeutic values, content,
hazards and use of drugs and devices,
f. the offering or performing of those ac ts, services,
operations or transactions necessary in t he conduct,
operation, management and control of a pharmacy, or
g. the provision of those acts or services that are
necessary to provide pharmaceutical care;
39. “Preparation” means an article which may or may not contain
sterile products compounded in a licensed pharmacy pursuant to the
order of a licensed prescriber;
40. “Prescriber” means a person licensed in this state w ho is
authorized to prescribe dangerous drugs withi n the scope of practice
of the person’s profession;
41. “Prescription” means and includes any order for drug or
medical supplies written or signed, or transmitted by word of mouth,
telephone or other mean s of communication:
a. by a licensed prescriber,
b. under the supervision of an Oklahoma licensed
practitioner, an Oklahoma licensed advanced practice
registered nurse or an Oklahoma licensed a supervising
physician, by a physician assistant, Certified Nurse
Practitioner, or Clinical Nurse Spec ialist licensed in
this state, or
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c. by a Certified Nurse-Midwife licensed in this state,
or
d. by an Oklahoma licensed wholesaler or distributo r as
authorized in Section 353.29.1 of this title;
42. “Product” means a prescription drug in a finished dosage
form for administration to a patient w ithout substantial further
manufacturing, such as ca psules, tablets, and lyophilized products
before reconstitution. “Product” does not include blo od components
intended for transfusion, radioactive drugs or biologics and med ical
gas;
43. “Repackager”, including “virtual repackager”, means a
person who owns or operates an establishment that repac ks and
relabels a product or package for further sale or distribution
without further transaction;
44. “Sterile drug” means a drug that is intended for parenteral
administration, an ophthalmic or oral inhalation drug in aqueous
format, or a drug that is required to be sterile under state and
federal law;
45. “Supervising physician ” means an individual holding a
current license to practice as a physician from the State Board of
Medical Licensure and Supervision, pursuant to the provisions of the
Oklahoma Allopathic Medical and Surgical Licensure and Supervision
Act, or the State Board of Osteopathic Examiners, pursuant to t he
provisions of the Oklahoma Osteopathic Medicine Act, who supervises
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an advanced practice registered nurse a Certified Nurse Practitioner
or Clinical Nurse Specialist as defined in Section 567.3a of this
title, and who is not in training as an intern, resident, or fell ow.
To be eligible to supervise an advanced practice registered nurse,
such The supervising physician shall remain in compliance with the
rules promulgated by the State Board of Medical Li censure and
Supervision or the State Board of O steopathic Examiners;
46. “Supportive personnel ” means technicians and auxil iary
supportive persons who are regularly paid employees of a pharma cy
who work and perform tasks in the pharmacy as authorized by Section
353.18A of this title;
47. “Third-party logistics provider ” including “virtual third-
party logistics provider ” means an entity that provides or
coordinates warehousing, or other logi stics services of a product in
interstate commerce on beh alf of a manufacturer, wholesale
distributor, or dispenser of a product but does not take ownership
of the product, nor have res ponsibility to direct the sale or
disposition of the product. For the purposes of this paragraph,
“third-party logistics provid er” does not include shippers and the
United States Postal Service;
48. “Wholesale distributor” including “virtual wholesale
distributor” means a person other than a manufacturer, a
manufacturer’s co-licensed partner, a third-party logistics
provider, or repackager engaged in wh olesale distribution as defined
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by 21 U.S.C. 353(e)( 4) as amended by the Drug Supply Chain Security
Act;
49. “County jail” means a facility operated by a county for the
physical detention and c orrection of persons charged with, or
convicted of, criminal o ffenses or ordinance violations or persons
found guilty of civil or criminal contempt;
50. “State correctional facility ” means a facility or
institution that houses a p risoner population under the jurisdiction
of the Department of Corrections;
51. “Unit dose package” means a package that contains a single
dose drug with the name, strength, control number, and expiratio n
date of that drug on the label; and
52. “Unit of issue package” means a package that provides
multiple doses of the same drug, but each drug is individually
separated and includes the name , lot number, and expiration da te.
SECTION 2. AMENDATORY 59 O.S. 20 21, Section 353.1a, is
amended to read as f ollows:
Section 353.1a. A. Prescribing 1. Prescriptive authority
shall be allowed as provided by Section 2-312 of Title 63 of the
Oklahoma Statutes, under the medical direction of a supervising
physician, for an advanced practice nurse a licensed Advanced
Practice Registered Nurse recognized by the Oklahom a Board of
Nursing in one of the following categori es: advanced registered
nurse practitioners, clinical nurse speciali sts, or certified nurse -
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midwives as a Certified Nurse Practitioner or Clinical Nurse
Specialist.
2. Prescriptive authority shall be allowed as provided by
Section 2-312 of Title 63 of the Oklahoma Statutes, independent of
the medical direction of a supervising physician, fo r a licensed
Advanced Practice Registered Nurse recognized by the Oklahoma Board
of Nursing as a Certified Nurse-Midwife.
B. The advanced practice nurse Advanced Practice Registered
Nurse may write or sign, or transmit by word of mouth, telephone or
other means of communication an order for drugs or medical supplie s
that is intended to be filled, compounded, or dis pensed by a
pharmacist. The supervising physician, if applicable, and the
advanced practice nurse prescribing Advanced Practice Registere d
Nurse shall be identified at the time of origination of the
prescription and the name of the advanced practice nurse prescribing
Advanced Practice Registered Nurse shall be printed on the
prescription label.
B. C. Pharmacists may dispense prescriptions for non -controlled
prescription drugs authorized by an advanced practice nurse Advanced
Practice Registered Nurse or physician assistant, not located in
Oklahoma this state, provided that they are licensed in the state in
which they are actively prescribing.
C. D. 1. Pharmacists may only d ispense prescriptions for
controlled dangerous substances prescribed by an advanced practice
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nurse or physician assistant Advanced Practice Registered Nurse
licensed in the State of Oklahoma and supervised by an Oklahoma -
licensed practitioner this state who meets the criteria in paragraph
1 or 2 of subsection A of this section.
2. Pharmacists may only dis pense prescriptions for controlled
dangerous substances prescribed by a physician assistant license d in
this state and supervised by a supervising physician licensed in
this state.
SECTION 3. AMENDATORY 59 O.S. 2021, Section 567.3a, is
amended to read as follows:
Section 567.3a. As used in the Oklahoma Nursing Practice Act:
1. “Board” means the Oklahoma Board of Nursing;
2. “The practice of nursing ” means the performance of services
provided for purposes of nursing diagnosis and treatment of human
responses to actual or potential health problems consistent wit h
educational preparation. Knowledge and skill are the basis fo r
assessment, analysis, planning, intervention, and evaluation used in
the promotion and maintenance of healt h and nursing management of
illness, injury, infirmity, restoration or optimal func tion, or
death with dignity. Practice is based on understanding the human
condition across the human lifespan and understanding the
relationship of the individual within th e environment. This
practice includes execution of the medical regime including th e
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administration of medications and treatments prescribed by any
person authorized by state law to so prescribe;
3. “Registered nursing” means the practice of the full scop e of
nursing which includes, but is not limited to:
a. assessing the health status of individuals, families
and groups,
b. analyzing assessment dat a to determine nursing care
needs,
c. establishing goals to meet identified health care
needs,
d. planning a strategy of care,
e. establishing priorities of nursing intervention to
implement the strategy of care,
f. implementing the strategy of care,
g. delegating such tasks as may safely be performed by
others, consistent with educational preparation and
that do not conflict with the provisions of the
Oklahoma Nursing Practice Act,
h. providing safe and effective nursing care rendered
directly or indirectl y,
i. evaluating responses to interventions,
j. teaching the principles and practice of nursing,
k. managing and supervising the practice of nursing,
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l. collaborating with other health profess ionals in the
management of health care,
m. performing additiona l nursing functions in accordance
with knowledge and skills acquired beyond basic
nursing preparation, and
n. delegating those nursing tasks as defined in the rules
of the Board that may be pe rformed by an advanced
unlicensed assistive person;
4. “Licensed practical nursing” means the practice of nursing
under the supervision or direction of a registered nurse, licensed
physician or dentist. This directed scope of nursing practice
includes, but is not limited to:
a. contributing to the assessment of the h ealth status of
individuals and groups,
b. participating in the development and modification of
the plan of care,
c. implementing the appropriate aspects of the plan of
care,
d. delegating such tasks as may safely be performed by
others, consistent with ed ucational preparation and
that do not conflict with the Oklahoma Nursing
Practice Act,
e. providing safe and effective nursing care rendered
directly or indirectly,
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f. participating in the eva luation of responses to
interventions,
g. teaching basic nursing skills and related principles,
h. performing additional nursing procedures in accordance
with knowledge and skills acquired through education
beyond nursing preparation, and
i. delegating those nursing tasks as defined in the rules
of the Board that may b e performed by an advanced
unlicensed assistive per son;
5. “Advanced Practice Registered Nurse ” means a licensed
Registered Nurse:
a. who has completed an advanced practice registered
nursing education program in preparation for one of
four recognized advanced practice registered nurse
Advanced Practice Registered Nurse roles,
b. who has passed a national certif ication examination
recognized by the Board that measures the advanced
practice registered nurse Advanced Practice Registered
Nurse role and specialty competencies and who
maintains recertification in the role and specialty
through a national certification program,
c. who has acquired advanced clinical knowledge and
skills in preparation for providing both direct and
indirect care to patients; howeve r, the defining
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factor for all Advanced Practice Re gistered Nurses is
that a significant component of the edu cation and
practice focuses on direc t care of individuals,
d. whose practice builds on the competencies of
Registered Nurses by demonstrating a gre ater depth and
breadth of knowledge, a greater synt hesis of data, and
increased complexity of skills and inte rventions, and
e. who has obtained a license as an Advanced Practice
Registered Nurse in one of the following roles:
Certified Registered Nurse An esthetist, Certified
Nurse-Midwife, Clinical Nurse Specialist, or Certified
Nurse Practitioner.
Only those persons who hold a license to practice advanced
practice registered nursing in this s tate shall have the right to
use the title “Advanced Practice Re gistered Nurse” and to use the
abbreviation “APRN”. Only those persons who have obtained a license
in the following disciplines shall have the r ight to fulfill the
roles and use the applicabl e titles: Certified Registered Nurse
Anesthetist and the abbrev iation “CRNA”, Certified Nurse-Midwife and
the abbreviation “CNM”, Clinical Nurse Specialist and the
abbreviation “CNS”, and Certified Nurse Prac titioner and the
abbreviation “CNP”.
It shall be unlawful for any person to assume the role or use
the title Advanced Practice Registered Nurse or use the abbrevi ation
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“APRN” or use the respective specialty role titles a nd abbreviations
or to use any other titles or abbreviations that would reasonably
lead a person to believe the user is an Advanced Practice Regist ered
Nurse, unless permitted by the Oklahoma Nursin g Practice Act. Any
individual doing so shall be guilty o f a misdemeanor, which shall be
punishable, upon conviction, by imprisonment in the county jail for
not more than one (1) year or by a fine of not less than One Hundred
Dollars ($100.00) nor more th an One Thousand Dollars ($1,000.00), or
by both such imprisonment and fine for each offense;
6. “Certified Nurse Practitioner” is means an Advanced Practice
Registered Nurse who performs in an expanded ro le in the delivery of
health care:
a. consistent with advanced educational preparation as a
Certified Nurse Practitioner in an area of specialty,
b. functions within the Certified Nurse Practi tioner
scope of practice for the selected area of
specialization, and
c. is in accord with the standards for Certif ied Nurse
Practitioners as identified by the certifying bo dy and
approved by the Board.
A Certified Nurse Practitioner shall be eligible, in accordance
with the scope of practice of the Certified Nurse Pra ctitioner, to
obtain recognition as authorized by t he Board to prescribe, as
defined by the rules promulgated by the Board pursuant to this
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section and subject to the medical direction of a su pervising
physician. This authorization shall not include d ispensing drugs,
but shall not preclude, subject to federal regulations, the receipt
of, the signing for, or the dispensing of professional samples to
patients.
The Certified Nurse Practitioner accepts res ponsibility,
accountability, and obligation to prac tice in accordance with usual
and customary advanced practice registered nursing standards and
functions as defined by the scope of practice/role definition
statements for the Certified Nurse Practitioner;
7. a. “Clinical Nurse Specialist ” is means an Advanced
Practice Registered Nurse who holds:
(1) a master’s degree or higher in nursing with
clinical specializati on preparation to function
in an expanded role,
(2) specialty certification from a national
certifying organization recognized by the Board,
(3) an Advanced Practice Registered Nurse license
from the Board, and
(4) any nurse holding a specialty certificati on as a
Clinical Nurse Specialist valid on January 1,
1994, granted by a national certifying
organization recognized by the Board, shall be
deemed to be a Clinical Nurse Specialist under
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the provisions of the Oklahoma Nursing Practice
Act.
b. In the expanded role, the Clinical Nurse Specialist
performs at an advanced practice level which shall
include, but not be limited to:
(1) practicing as an expert clinician in the
provision of direct nursing care to a selected
population of patients or clients in any s etting,
including private practice,
(2) managing the care of patients or clients with
complex nursing problems,
(3) enhancing patient or client c are by integrating
the competencies of clinical practice, education,
consultation, and research, and
(4) referring patients or clients to other services.
c. A Clinical Nurse Specialist in accordance with t he
scope of practice of such Clinical Nurse Special ist
shall be eligible to obtain recognition as authorized
by the Board to prescribe, as defined by the rules
promulgated by the Board pursuant to this section, and
subject to the medical direction of a sup ervising
physician. This authorization shall not i nclude
dispensing drugs, but shall not preclude, subject to
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federal regulations, the receipt of, the signing fo r,
or the dispensing of professional samples to patients.
d. The Clinical Nurse Specialist acc epts responsibility,
accountability, and obligation to practice in
accordance with usual and customary advanced practice
nursing standards and functions as define d by the
scope of practice/role definition statements for the
Clinical Nurse Specialist;
8. “Nurse-Midwife” is means a nurse who has received an
Advanced Practice Registered Nurse license from the Oklahoma Board
of Nursing who possesses evidence of certif ication according to the
requirements of the American College of Nurse-Midwives.
A Certified Nurse-Midwife in accordance with the scope of
practice of such Certified Nurse -Midwife shall be eligible to obtain
recognition as authorized by the Board to prescr ibe, as defined by
the rules promulgated by the Board pursuant to this section and
subject to the medical direction of a supervising physician Section
567.4a of this title and as provided by Section 2-312 of Title 63 of
the Oklahoma Statutes . This authorization shall not include the
dispensing of drugs, but shall not preclude, subject to federal
regulations, the receipt of, the sig ning for, or the dispensing of
professional samples to patients.
The Certified Nurse-Midwife accepts responsibility ,
accountability, and obligation to practice in ac cordance with usual
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and customary advanced practice registered nursing standards and
functions as defined by the scope of practice/role definition
statements for the Certified Nurse-Midwife;
9. “Nurse-midwifery practice” means providing management of
care of normal newborns and women, antepartally, intrapartally,
postpartally and gynecologicall y, occurring within a health care
system which provides for medi cal consultation, medical management
or referral, and is in accord with the standards for nurse-midwifery
practice as defined by the American College of Nurse -Midwives;
10. a. “Certified Registered Nurse Anesthetist ” is an
Advanced Practice Registered Nurs e who:
(1) is certified by the National Board of
Certification and Recertification for Nurse
Anesthetists as a Certified Registered Nurse
Anesthetist within one (1) year following
completion of an approved certified registered
nurse anesthetist Certified Registered Nurse
Anesthetist education program, and continues to
maintain such recertification by the National
Board of Certification and Recertification for
Nurse Anesthetists, and
(2) administers anesthesia in collaboration with a
medical doctor, an osteo pathic physician, a
podiatric physician or a dentis t licensed in this
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state and under conditions in w hich timely onsite
consultation by such doctor, osteopath, podiatric
physician or dentist i s available.
b. A Certified Registered Nurse Anesthetist, in
collaboration with a medical doctor, osteopathic
physician, podiatric physician or dentist licensed in
this state, and under conditions in which timely, on -
site consultation by such medical docto r, osteopathic
physician, podiatric physician or dentist is
available, shall be authorized, pursuant to rules
adopted by the Oklahoma Board of Nursing, to order,
select, obtain and administer legend drugs, Schedules
II through, III, IV, and V controlled substances,
devices, and medical gases only when engaged in the
preanesthetic preparation and evaluation; anesthesia
induction, maintenance and emergence; and
postanesthesia care. A Certified Registered Nurse
Anesthetist may order, select, obtain and adminis ter
drugs only during the perioperative or periobstetrical
period.
c. A Certified Registered Nurse Anesthetist who applies
for authorization to order, select, obtain and
administer drugs shall:
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(1) be currently recognized as a Certified Registered
Nurse Anesthetist in this state,
(2) provide evidence of completion, wit hin the two-
year period immediately preceding the d ate of
application, of a minimum of fifteen (15) u nits
of continuing education in advanced pharmacology
related to the administration of anes thesia as
recognized by the National Board of Certification
and Recertification for Nurse Anesthetists, and
(3) complete and submit a notarized application, on a
form prescribed by the Board, accompanied by the
application fee established pursuant to this
section.
d. The authority to order, select, obtain and administe r
drugs shall be terminated if a Certified Register ed
Nurse Anesthetist has:
(1) ordered, selected, o btained or administered drugs
outside of the Certified Registered Nurse
Anesthetist scope of practice or ordered,
selected, obtained or administered drugs for
other than therapeutic purposes, or
(2) violated any provision of state laws or rules or
federal laws or regulations pertaining to the
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practice of nursing or the authority to order,
select, obtain and administer drugs.
e. The Oklahoma Board of Nursing shall notify the Board
of Pharmacy after terminatio n of or a change in the
authority to order, select , obtain and administer
drugs for a Certified Registered Nurse Anesthetist.
f. The Board shall provide by rule for biennial
application renewal and reautho rization of authority
to order, select, obtain and administer drugs for
Certified Registered Nurse Anesthetists. At the time
of application renewal, a Certified Registered Nurse
Anesthetist shall submit documentation of a minimum of
eight (8) units of con tinuing education, completed
during the previous tw o (2) years, in advanced
pharmacology relating to the administration of
anesthesia, as recognized by the Council on
Recertification of Nurse Anesthetists or the Council
on Certification of Nurse Anesthetis ts.
g. This paragraph shall not prohibit the admini stration
of local or topical anesthetics as now pe rmitted by
law. Provided further, nothing in this paragraph
shall limit the authority of t he Board of Dentistry to
establish the qualifications for dentis ts who direct
the administration of anesthesia.
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h. As used in this paragraph, “collaboration” means an
agreement between a medical doctor, osteopathic
physician, podiatric physician or dentist performing
the procedure or directly involved with the procedur e
and the Certified Registered Nurse Anesthetist wo rking
jointly toward a common goal providing servi ces for
the same patient. This collaboration involves the
joint formulation, discussion an d agreement of the
anesthesia plan by both parties, and the coll aborating
medical doctor, osteopathic physician, po diatric
physician or dentist performing the proced ure or
directly involved with the procedure and that. The
collaborating physician shall re main available for
timely onsite consultation during the deliver y of
anesthesia for diagnosis, consultation, and tr eatment
of medical conditions;
11. “Supervising physician” means an individual holding a
current license to practice as a physi cian from the State Board of
Medical Licensure and Supervision or the State Board of Osteopathic
Examiners, who supervises a Certified Nur se Practitioner, or a
Clinical Nurse Specialist, or a Certified Nurse-Midwife, and who is
not in training as an intern, resident, or fellow. To be eligible
to supervise such Advanced Practice Registered Nurse, such The
supervising physician shall remain i n compliance with the rules
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promulgated by the State Board of Medical Licensure and Supervision
or the State Board of Osteopathic Examiners;
12. “Supervision of an Advanced Practice Registered Nurse with
prescriptive authority ” means overseeing and accept ing
responsibility for the ordering and transmission by a Certified
Nurse Practitioner, or a Clinical Nurse Specialist, or a Certified
Nurse-Midwife of written, telephonic, electronic or oral
prescriptions for drugs and oth er medical supplies, subject to a
defined formulary; and
13. “Advanced Unlicensed Assistant” means any person who has
successfully completed a certified training program approved by the
Board that trains the Advanced Unlicensed Assistant to perform
specified technical skills identified b y the Board in acute care
settings under the direction and supervision of the Registered Nurse
or Licensed Practical Nurse.
SECTION 4. AMENDATORY 59 O.S. 20 21, Section 567.4a, is
amended to read as follows:
Section 567.4a. A. The Oklahoma Board of Nursing may grant
prescriptive authority through the Advanc ed Practice Registered
Nurse license to Certified Nurse Practitioners, Certified Nurse-
Midwives, and Clinical Nurse Specialists who meet the requirements
for prescriptive authority identified by law, including but not
limited to Section 2-312 of Title 63 of the Oklahoma Statutes, and
in the rules of the Board.
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B. Beginning on the effective da te of this act, a Certified
Nurse-Midwife shall not be required to prac tice under the medical
direction of a supervising physician to be eligible for prescriptive
authority recognition by the Board.
C. The rules regarding prescriptiv e authority recognition
promulgated by the Oklahoma Board of Nursing pursuant to paragraphs
6 through 9, 11 and 12 of Section 567.3a of this title sha ll:
1. Define For a Certified Nurse Practitioner or Clinical Nurse
Specialist, define the procedure for documenting supervision by a
supervising physician licensed in Oklahoma to pract ice by the State
Board of Medical Licensure and Supervision or the Stat e Board of
Osteopathic Examiners . Such procedure shall include a written
statement that defines appropriate referral, consultation, and
collaboration between the Advanced Practice Registered Nurse,
recognized to prescribe as defined in paragraphs 6 through 9, 11 and
12 of Section 567.3a of th is title, and the supervising physician .
The written statement shall include a method of assuri ng
availability of the supervising physician through direct contact,
telecommunications or other appropriate electronic means for
consultation, assistance with medical emergencies, or patient
referral. The writte n statement shall be part of the initial
application and the renewal application submitted to the Board for
recognition for prescriptive authority for the Advanced Practice
Registered Nurse. Changes to the written statement shall be filed
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with the Board within thirty (30) days of the change and shall be
effective on filing;
2. Define minimal requirements for initia l application for
prescriptive authority which shall include, but not be limited to,
evidence of completion of a minimum of forty -five (45) contact hours
or three (3) academic credit hours of education in
pharmacotherapeutics, clinical application, and use of
pharmacological agents in the prevention of illness, and in the
restoration and maintenance of health in a program beyond basic
registered nurse preparation, approved by the Board. Such contact
hours or academic credits shall be obtained within a time period of
three (3) years immediately preceding the date of application for
prescriptive authority;
3. Define minimal requirements for applic ation for renewal of
prescriptive authority which shall include, but not be limit ed to,
documentation of a minimu m of:
a. fifteen (15) contact hours or one (1) academic credit
hour of education in pharmacotherapeutics, clinical
application, and use of phar macological agents in the
prevention of illness, and in the restoration and
maintenance of health in a program be yond basic
registered nurse preparation, and
b. two (2) hours of education in pain management or two
(2) hours of education in opioid use or ad diction,
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unless the Advanced Practice Registered Nurse has
demonstrated to the sa tisfaction of the Board that the
Advanced Practice Registered Nurse does not currently
hold a valid federal Drug Enforcement Administration
registration number,
approved by the Board, within the two-year period immediately
preceding the effective date of a pplication for renewal of
prescriptive authority;
4. Require that beginning July 1, 2002, an Advanced Practice
Registered Nurse shall demonstrate demonstrates successful
completion of a master’s degree or higher in a clinical nurse
specialty one of the four Advanced Practice Registered Nurse roles
in order to be eligible for initial application for prescriptive
authority under the provisions of the Oklahoma Nursing Practice Ac t;
5. Define the method for communicating authority to prescribe
or termination of same, and the formulary to th e Board of Pharmacy,
all pharmacies, and all registered pharmacists;
6. Define terminology used in such rules;
7. Define the parameters for t he prescribing practices of the
Advanced Practice Registered Nurse;
8. Define the methods for termination of pre scriptive authority
for the Advanced Practice Registered Nurse; and
9. a. Establish a Formulary Advisory Council that shall
develop and submit to the Board recommendations for an
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exclusionary formulary that shall list drugs or
categories of drugs that shal l not be prescribed by
Advanced Practice Registered Nurse recognized to
prescribe by the Oklahoma Board of Nursing. The
Formulary Advisory Cou ncil shall also develop and
submit to the Board recommendations for practice -
specific prescriptive standards for each category of
Advanced Practice Registered Nurse recognized to
prescribe by the Oklahoma Board of Nursing pursuant to
the provisions of the Oklahoma Nursing Practice Act.
The Board shall either accept or reject the
recommendations made by the Council. No amendments to
the recommended exclusionary formulary may be made by
the Board without the approval of the Formulary
Advisory Council.
b. The Formulary Advisory Council shall be composed of
twelve (12) members as follows :
(1) four members, to include a pediatrician, an
obstetrician-gynecological physician, a general
internist, and a family practice physician;
provided that three of such member s shall be
appointed by the Oklahoma State Medical
Association, and one shall be appointed by the
Oklahoma Osteopathic Association,
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(2) four members who are registered pharmacists,
appointed by the Oklahoma Pharmaceutical
Association, and
(3) four members, one of whom shall be a Certified
Nurse Practitioner, one of whom shall be a
Clinical Nurse Specialist, one of wh om shall be a
Certified Nurse-Midwife, and one of whom shall be
a current member of the Oklahoma Board of
Nursing, all of whom shall be appoint ed by the
Oklahoma Board of Nursing.
c. All professional members of the Formular y Advisory
Council shall be in ac tive clinical practice, at least
fifty percent (50%) of the time, within their defined
area of specialty. The members of the Formulary
Advisory Council shall serve at the pleasure of the
appointing authority for a term of three (3) years.
The terms of the members shall be staggered. M embers
of the Council may serve beyond the expiration of
their term of office until a successor is appointed by
the original appointing authority. A vacancy on the
Council shall be filled fo r the balance of the
unexpired term by the original appointing au thority.
d. Members of the Council shall elect a chair and a vice -
chair from among the membership of the Counci l. For
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the transaction of business, at least seven members,
with a minimum of two members present from each of t he
identified categories of phys icians, pharmacists and
advanced practice registered nurses Advanced Practice
Registered Nurses, shall constitute a quorum. The
Council shall recommend and the Board shall approve
and implement an initial exclusionary formu lary on or
before January 1, 199 7. The Council and the Board
shall annually review the approved exclusionary
formulary and shall make any nece ssary revisions
utilizing the same procedures used to develop the
initial exclusionary formulary.
SECTION 5. AMENDATORY 59 O.S. 2021, Section 567.5a, is
amended to read as follows:
Section 567.5a. A. All applicants for a license to practice as
an Advanced Practice Registered Nurse shall be subject to Section
567.8 of this title.
B. An applicant for an initial license to practice as an
Advanced Practice Registered Nurse shall:
1. Submit a completed written application and appropriate fees
as established by the Board;
2. Submit a criminal history records check tha t complies with
Section 567.18 of this title;
3. Hold a current Registered Nurse license in this state;
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4. Have completed an advanced practice registered nursing
education program in one of the four advanced practice registered
nurse Advanced Practice Re gistered Nurse roles and a specialty area
recognized by the Board. Effective January 1, 2016, the applicant
shall have completed an accredited graduate level advanced practice
registered nursing education program in at least one of the
following population foci: family/individual across the lifespan,
adult-gerontology, neonatal, pediatrics, women’s health/gender-
related, or psychiatric/mental health;
5. Be currently certified in an ad vanced practice specialty
certification consistent with educational pre paration and by a
national certifying body recognized by t he Board; and
6. Provide any and all other evidence as required by the Board
in its rules.
C. The Board may issue a license b y endorsement to an Advanced
Practice Registered Nurse licensed under t he laws of another state
if the applicant meets the qualif ications for licensure in this
state. An applicant by endorsement shall:
1. Submit a completed written application and approp riate fees
as established by the Board;
2. Hold a current Registered N urse license in this state ;
3. Hold recognition as an Adv anced Practice Registered Nurse in
a state or territory;
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4. Have completed an advanced practice registered nursing
education program in one of the four roles and a specialty area
recognized by the Board. Effective January 1, 2016, the applicant
shall have completed an accredited graduate level advanced practice
registered nursing education program in at least one of the
following population foci: family/individual across the lifespan,
adult-gerontology, neonatal, pediatric s, women’s health/gender-
related, or psychiatric/mental health;
5. Be currently certified in an advanced practice specialty
certification consistent with educ ational preparation and by a
national certifying body recognized by the Board;
6. Meet continued competency requirements as set forth in Board
rules; and
7. Provide any and all other evidence as required by the Board
in its rules.
D. The Board may issue prescriptive authority recognition by
endorsement to an Advanced Pract ice Registered Nurse licen sed as an
APRN-CNP, APRN-CNS, or APRN-CNM under the laws of another state if
the applicant meets the requirements set forth in this section.
Prescriptive authority re cognition by endorsement shall be s ubject
to the provisions of Section 2 -312 of Title 63 of the Oklahoma
Statutes. An applicant for prescriptive authority recognition by
endorsement shall:
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1. Submit a completed written application and appropriate fees
as established by the Board;
2. Hold current Registered Nurse and Advanced Practice
Registered Nurse licenses (APRN-CNP, APRN-CNS, or APRN-CNM) in the
state;
3. Hold current licensure or recognition as an Advanced
Practice Registered Nurse in the same role and specialty with
prescribing privileges in another state or territory;
4. Submit documentation verifying successful c ompletion of a
graduate level advanced practice registered nursing education
program that included an academic course in pharmacotherapeutic
management, and didactic and clinical pr eparation for prescribing
incorporated throughout the program;
5. Submit If the Advanced Practice Registered Nurse is licensed
as a Certified Nurse Practitio ner or Clinical Nurse Spe cialist,
submit a written statement from an Oklahoma licensed a physician
licensed in this state supervising prescriptive authority as
required by the Board in its rules;
6. Meet continued competency requirements as set fo rth in Board
rules; and
7. Provide any and all other evidence as required by the Board
in its rules.
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E. An Advanced Practice Registered Nurse licen se issued under
this section shall be renewed concurrently with the registered nurse
license provided that qualifying criteria continue to be met.
F. The Board may reinstate a license as set forth in Board
rules.
SECTION 6. AMENDATORY 63 O.S. 2021, Section 2-312, as
amended by Section 2, Chapter 184, O.S.L. 2022 (63 O.S. Supp. 2022,
Section 2-312), is amended to read as follows:
Section 2-312. A. A physician, podiat rist, optometrist or a
dentist who has complied with the registration requ irements of the
Uniform Controlled Dangero us Substances Act, in good faith an d in
the course of such person ’s professional practice only, may
prescribe and administer controlled dang erous substances, or may
cause the same to be administered by medical or p aramedical
personnel acting under the dire ction and supervision of the
physician, podiatrist, optometrist or de ntist, and only may dispense
controlled dangerous substances pursuant t o the provisions of
Sections 355.1 and 355.2 of Title 59 of the Oklahoma Statutes.
B. A veterinarian who has compli ed with the registration
requirements of the Uniform Controlled Dangerous Substances Act, in
good faith and in the course of the profes sional practice of the
veterinarian only, and not for use by a human being, ma y prescribe,
administer, and dispense contr olled dangerous substances and may
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cause them to be administered by an assistant or orderly under the
direction and supervision of the veterinarian.
C. 1. An advanced practice nurse Advanced Practice Registered
Nurse who is recognized to prescribe by the Oklahoma Board of
Nursing as an advanced registered nurse pract itioner, clinical nurse
specialist or certified nurse-midwife a Certified Nurse Practitioner
or Clinical Nurse Specialist , who is subject to medical d irection by
a supervising physician, pursu ant to Section 567.3a of Title 59 of
the Oklahoma Statutes, and who has complied with the registration
requirements of the Uniform Cont rolled Dangerous Substances Act, in
good faith and in the course of professiona l practice only, may
prescribe and adminis ter Schedule III, IV, and V controlled
dangerous substances.
2. An Advanced Practice Registered Nurse who is recognized to
prescribe by the Oklahoma Board of Nursing as a Certified Nurse-
Midwife and who has complied with the registration requirements of
the Uniform Controlled Dangerous Substances Act, in good faith and
in the course of professional practice only, may prescribe and
administer Schedule III, IV , and V controlled dangerous substances.
D. An advanced practice nurse Advanced Practice Registered
Nurse who is recognized to order, select, obtain and administer
drugs by the Oklahoma Board of Nursing as a certified registered
nurse anesthetist Certified Registered Nurse Anesthetist pursuant to
Section 353.1b of Title 59 of the Oklahoma Statutes and who has
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complied with the registration requirements of the Uniform
Controlled Dangerous Substances Act, in good faith and in the course
of such practitioner ’s professional practice only, may order,
select, obtain and administer Schedules II through, III, IV, and V
controlled dangerous substances in a preanesthetic prepara tion or
evaluation; anesthesia induction, maintenance or emergence; or
postanesthesia care setting only. A certified registered nurse
anesthetist Certified Registered Nurse Anesthetist may order,
select, obtain and administer such drugs only during the
perioperative or periobstetrical period.
E. A physician assistant who is recognized to prescribe by the
State Board of Medical Licensure and Supervis ion under the medical
direction of a supervising physician, pursuant to Section 519.6 of
Title 59 of the Oklahoma Statutes, and who has complied with the
registration requirements of the Uniform Controlled Dangerous
Substances Act, in good fai th and in the course of profession al
practice only, may prescribe and administer Schedule II through V
Schedules II, III, IV, and V controlled dangerous substances.
SECTION 7. This act shall become effective November 1, 202 3.
59-1-226 DC 1/17/2023 11:10:01 AM