Chapter 07. Practice of the Nurse Practitioner
Regulation .01 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“AANPNCB” means the American Academy of Nurse Practitioners National Certification Board.
(2)
“Advanced practice registered nurse (APRN)” means a registered nurse who is certified by the Board as:
(a)
A certified nurse midwife (CNM);
(b)
A certified registered nurse anesthetist (CRNA);
(c)
A certified nurse practitioner (CRNP); or
(d)
A clinical nurse specialist (CNS).
(3)
“Board” means the Board of Nursing.
(4)
“Certification” means permission to practice as a nurse practitioner granted by the Board to a registered nurse who has:
(a)
Met all the specified requirement of a national certifying body recognized by the Board; and
(b)
Complied with the requirements of this chapter.
(5)
“Collaborating” means a cooperative relationship with other health care providers.
(6)
“Facility” means a health care facility as defined under Health-General Article, §19-114(d), Annotated Code of Maryland.
(7)
“Mentor” means a certified nurse practitioner or physician, licensed in Maryland, who:
(a)
Has 3 or more years of clinical practice experience; and
(b)
Will be available for advice, consultation, and collaboration, as needed, for 18 months beginning on the date an application is received by the Board from an applicant who has never been certified in this or any other State.
(8)
“Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B.
(9)
“Nurse practitioner” means an advanced practice registered nurse who is certified by the Board to practice as a nurse practitioner in this State.
(10)
“Personally prepare and dispense” means that a nurse practitioner:
(a)
Is physically present on the premises where the prescription is filled; and
(b)
Performs a final check of the prescription before the prescription is provided to the patient.
(11)
“Physician” means an individual who has an unencumbered license to practice medicine, issued under Health Occupations Article, Title 14, Annotated Code of Maryland.
(12)
“Registered nurse (RN)” means an individual who:
(a)
Is licensed by the Board to practice registered nursing; or
(b)
Has a multistate licensure privilege to practice registered nursing.
(13)
“Starter dosage” means an amount of a drug sufficient to begin therapy:
(a)
Of a short duration of 72 hours or less; or
(b)
Before obtaining a larger quantity of the drug to complete therapy.
(14)
“Unencumbered license” means a license that is not:
(a)
Revoked;
(b)
Suspended; or
(c)
On probationary status.
Regulation .02 Certification.LinkCopy Citation
A.
An applicant for certification as a nurse practitioner shall obtain certification from the Board before commencing practice.
B.
An applicant for certification as a nurse practitioner shall:
(1)
Hold a current Maryland license in good standing to practice registered nursing or a multistate licensure privilege to practice registered nursing;
(2)
Have graduated from a Board-approved accredited graduate level program for nurse practitioners at the Masters’ level or higher that meets the requirements of Regulation .06 of this chapter;
(3)
Hold a current national certification:
(a)
For each area of specialization in which certification is sought; and
(b)
From the AANPNCB or other national certifying body recognized by the Board;
(4)
Submit to the Board a completed application for certification as a nurse practitioner for each area of specialization in which certification is sought;
(5)
Comply with all the requirements set forth in COMAR 10.27.01.04;
(6)
Demonstrate written and oral competency in the English language;
(7)
If the applicant has not been certified by the Board or any other Board of Nursing, identify a designated mentor for 18 months as defined in Regulation .01 of this chapter; and
(8)
Pay all fees.
C.
The Board shall:
(1)
Maintain an up-to-date list of all nurse practitioners certified in the State; and
(2)
Include on the nurse practitioner’s registered nursing license an indication that the licensee is certified as a nurse practitioner and designate the nurse practitioner’s area of specialization.
D.
The Board shall certify a nurse practitioner consistent with the nurse practitioner’s specialty, education, and national certification.
Regulation .03 Nurse Practitioner — Scope and Standards of Practice.LinkCopy Citation
A.
A nurse practitioner may independently perform the following functions:
(1)
A comprehensive physical assessment of patients;
(2)
In accordance with Family Law Article, §2-301, Annotated Code of Maryland, certify to the clerk of the court that a:
(a)
16 or 17 year old individual, who wants to get married without parental consent, has been examined and found to be pregnant or has given birth to a child; or
(b)
15 year old individual, who has parental consent to be married, has been examined and found to be pregnant or has given birth to a child;
(3)
In accordance with Transportation Article, §13-704, Annotated Code of Maryland, certify to the Department of Transportation that an individual needs special consideration for certain health reasons;
(4)
In accordance with Health-General Article, §4-208, Annotated Code of Maryland, complete the date of birth and medical information required on a birth certificate;
(5)
In accordance with Health-General Article, §4-212, Annotated Code of Maryland, complete a death certificate if:
(a)
The medical examiner does not take charge of the body; and
(b)
The deceased was under the care of the nurse practitioner;
(6)
Establish medical diagnosis for common short-term and chronic stable health problems;
(7)
In accordance with Health-General Article, §4-212, Annotated Code of Maryland, file a replacement death certificate;
(8)
In accordance with Health-General Article, §5-601, Annotated Code of Maryland, issue a do not resuscitate order on a Maryland Emergency Medical Services form.
(9)
Order, perform, and interpret laboratory and diagnostic tests;
(10)
Order and perform diagnostic, therapeutic, and corrective measures;
(11)
Prescribe drugs;
(12)
Provide emergency care;
(13)
Refer patients to appropriate licensed physicians or other health care providers as needed;
(14)
In accordance with COMAR 20.31.03.01, certify that the utility client has a serious illness or the need for life-support equipment; and
(15)
In accordance with Health-General Article, §5-602, Annotated Code of Maryland, witness an advance directive.
B.
A psychiatric nurse practitioner together with a physician is authorized to sign applications:
(1)
In accordance with Health-General Article, §10-615, Annotated Code of Maryland, to admit a minor to a facility for treatment of a mental disorder; and
(2)
In accordance with Health-General Article, §10-616, Annotated Code of Maryland, to admit an individual on an involuntary basis to a facility for treatment of a mental disorder.
C.
A nurse practitioner may practice only in the area of specialization in which certified.
D.
Nothing in this chapter limits or prohibits a registered nurse from performing those functions which constitute the practice of registered nursing as defined by law.
E.
A nurse practitioner has a right and obligation to refuse to perform any delegated act, oral or written, if in the nurse practitioner's judgment it is unsafe or an invalidly prescribed medical act.
F.
An individual certified under this chapter shall be subject to disciplinary sanctions set forth in Health Occupations Article, §8-316, Annotated Code of Maryland.
G.
A nurse practitioner shall maintain medical records in accordance with Health-General Article, Title 4, Subtitle 4, Annotated Code of Maryland.
Regulation .04 Renewal of Certification.LinkCopy Citation
A.
A certification as a nurse practitioner expires at the same time as the nurse practitioner's registered nursing license.
B.
Before a nurse practitioner’s certification expires, the nurse practitioner may renew the certification biennially if the nurse practitioner:
(1)
Is otherwise entitled to be certified;
(2)
Submits to the Board:
(a)
Documentation of every current national certification as a nurse practitioner from a national certifying body recognized by the Board that was the basis of the Board’s initial certification under Regulation .02B of this chapter; and
(b)
A completed renewal application on the form that the Board requires; and
(3)
Pays all fees.
C.
Certified nurse practitioner renewal applicants who are authorized to practice registered nursing in this State under a multistate licensure privilege shall be periodically required to submit to a criminal history records check in accordance with the schedule and requirements set forth in COMAR 10.27.01.13J—N.
D.
The certified nurse practitioner shall ensure that the Board has a record of each renewed national certification if any national certification expires before the registered nurse license renewal date.
E.
Certification as a nurse practitioner in an area of specialization shall be deemed to have lapsed if the Board does not have a record of the current active national certification in that area of specialization.
F.
Practicing on an expired national certification is prohibited and subject to discipline under Health Occupations Article, §8-316(a), Annotated Code of Maryland.
Regulation .05 Practice Before Maryland Certification.LinkCopy Citation
A.
A registered nurse who has completed a Board-approved educational program for nurse practitioners and who has applied to take a Board-approved national certifying examination may practice as a nurse practitioner graduate before certification in this State upon approval of the Board if the nurse has:
(1)
Submitted a completed application for certification as a nurse practitioner in this State in accordance with Regulation .02 of this chapter;
(2)
Completed a nurse practitioner education program approved by the Board;
(3)
Presented evidence of submission of an application to take a Board-approved national certification examination;
(4)
Provided the name of a certified nurse practitioner, who has an active unencumbered Maryland license to practice as a registered nurse or a multistate privilege to practice registered nursing, who will directly supervise the nurse practitioner graduate; and
(5)
Paid all fees.
B.
If a certified nurse practitioner is not available in the graduate’s practice setting, as required in §A(4) of this regulation, a physician may provide this direct supervision if the nurse practitioner graduate provides the Board with the name of a certified nurse practitioner, who has an active unencumbered Maryland license to practice registered nursing or a multistate licensure privilege to practice registered nursing, with whom the nurse practitioner graduate has regular consultation.
C.
A nurse practitioner graduate who fails the Board-required examination shall immediately cease practice as a nurse practitioner graduate.
D.
An application for Maryland certification shall remain on file for a period of 18 months. During this time, applicants who have failed a national certifying examination may retake the examination and, upon proof of passing, may become eligible for Maryland certification.
Regulation .06 Education.LinkCopy Citation
A.
An applicant certified by a national certifying body before October 1, 2010, who is certified by the Board and in good standing shall be deemed to meet the education requirements under this regulation.
B.
An applicant for certification shall be a graduate from a Board-approved nationally accredited education program for nurse practitioners in a school of nursing that:
(1)
Provides advanced practice instruction at the Masters’ level or higher in a clinical nursing program;
(2)
Is accredited by a nursing accrediting body recognized by the United States Department of Education, the Council for Higher Education Accreditation or any other national accrediting body recognized by the Board;
(3)
Follows established educational standards that build upon educational preparation and experience as a registered nurse;
(4)
Ensures completion of the advanced practice core, nurse practitioner core, and population specific core competencies;
(5)
Has a didactic and clinical curriculum that, at a minimum, includes advanced courses in:
(a)
Physiology and pathophysiology;
(b)
Physical and health assessment;
(c)
Pharmacology; and
(d)
Diagnosis and management of health problems and diseases commonly encountered within the respective nurse practitioner’s population focus;
(6)
Provides didactic courses and supervised clinical experiences of sufficient depth and breadth in the nurse practitioner role and the specific population focus of the program; and
(7)
Ensures that graduates of the program are eligible for national certification and Maryland certification.
C.
To be a Board-approved education program the program shall:
(1)
Be a nationally accredited education program; and
(2)
Ensure ongoing competence and maintenance of certification by:
(a)
Providing a mechanism for renewing certification;
(b)
Having a renewal of certification process that is acceptable to the Board; and
(c)
Developing a mutually agreeable procedure that ensures communication with the Board.
Regulation .07 Preparing and Dispensing.LinkCopy Citation
A.
A nurse practitioner may personally prepare and dispense any drug that a nurse practitioner is authorized to prescribe in the course of treating a patient at:
(1)
A medical facility or clinic that specializes in the treatment of medical cases reimbursable through workers' compensation insurance;
(2)
A medical facility or clinic that is operated on a nonprofit basis;
(3)
A health center that operates on a campus of an institution of higher education;
(4)
A public health facility, a medical facility under contract with a State or local health department, or a facility funded with public funds; or
(5)
A nonprofit hospital or a nonprofit hospital out-patient facility as authorized under the policies established by the hospital.
B.
A nurse practitioner who personally prepares and dispenses a drug in the course of treating a patient shall:
(1)
Comply with the labeling requirements of Health Occupations Article, §12-505, Annotated Code of Maryland;
(2)
Record the dispensing of the prescription drug on the patient's chart;
(3)
Allow the Division of Drug Control to enter and inspect the nurse practitioner's office at all reasonable hours;
(4)
Except for starter dosages or samples dispensed without charge, provide the patient with a written prescription; and
(5)
Stamp all Schedule III, IV, and V prescriptions with the letter “C” in red ink, not less than 1 inch high in the lower right hand corner.
C.
A nurse practitioner shall:
(1)
Maintain two separate files, one for Schedule II prescriptions and another file for all other prescriptions; and
(2)
Maintain all prescription files for 7 years.
D.
A nurse practitioner may personally prepare and dispense a starter dosage of any drug the nurse practitioner is authorized to prescribe. The nurse practitioner shall:
(1)
Label the starter dosage in compliance with the labeling requirements of Health Occupations Article, §12-505, Annotated Code of Maryland;
(2)
Provide the starter dose free of charge; and
(3)
Enter the starter dose dispensed in the patient's medical record.
Regulation .08 Unlawful Practices.LinkCopy Citation
Unless authorized to practice as a nurse practitioner under Health Occupations Article, Title 8, Annotated Code of Maryland, an individual may not:
A.
Represent to the public by title or by description of services, methods, procedures, or otherwise, that the individual is authorized to practice as a nurse practitioner in this State;
B.
Use as a title or describe the services the individual provides by use of the words “nurse practitioner” or “certified nurse practitioner”; or
C.
Use the abbreviation “NP”, “CRNP”, “CNP”, or any other words, letters, or symbols with the intent to represent that the individual practices as a nurse practitioner.
Chapter annotations
Authority: Family Law Article, §2-301; Health-General Article, §§4-208(a), 4-212, §4-403, 5-601(c)—(e), 5-608(c), 10-616, 10-628, 13-701, and 13-704; Health Occupations Article, §§8-205(a)(1), (2), (4), and (5), and 8-302; Transportation Article, §§13-616(a) and (b), Annotated Code of Maryland; Ch. 342, Acts of 2015; Ch. 468, Acts of 2015
History: Effective date: March 6, 1981 (8:5 Md. R. 473)
History: Regulation .01B amended effective August 29, 1994 (21:17 Md. R. 1439)
History: Regulation .02 amended effective June 7, 1993 (20:11 Md. R. 913)
History: Regulation .03A amended effective June 7, 1993 (20:11 Md. R. 913)
History: Regulation .04 amended effective June 7, 1993 (20:11 Md. R. 913)
History: Regulation .05 repealed and new Regulation .05 adopted effective June 7, 1993 (20:11 Md. R. 913)
History: Regulation .08 adopted effective August 29, 1994 (21:17 Md. R. 1439)
History: Chapter revised effective July 11, 2011 (38:14 Md. R. 790)
History: Chapter revised effective December 10, 2015 (42:24 Md. R. 1505)
History: Regulation .02A amended effective August 28, 2017 (44:17 Md. R. 835)
History: Chapter revised effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .03G adopted effective October 13, 2025 (52:20 Md. R. 1002)
History: Regulation .07C amended effective October 13, 2025 (52:20 Md. R. 1002)