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Learn more about prescriptive authority requirements and practice guidelines

Prescriptive authority is the ability for a CNP, CRNA, CNM, or PCNS to issue written or oral prescriptions or medication orders.

What are prescriptive guidelines?

Guidelines are required, written instructions and procedures describing the methods that a certified nurse practitioner (CNP),certified registered nurse anesthetist (CRNA), or psychiatric clinical nurse specialist (PCNS) with prescriptive authority is to follow when managing medications. The guidelines specify the instances in which referral to or consultation with a physician is required for appropriate medication management. When appropriate, guidelines also address procedures for the ordering of tests and therapeutics. 

Guideline development is an opportunity for an advanced practice registered nurse (APRN) to collaborate with a physician regarding the parameters of their prescriptive practice. The Board provides an audit tool for compliance with the regulations at 244 CMR 4.00 to help your guideline development.

  • Certified nurse-midwives (CNM) are not required to have guidelines
  • Clinical nurse specialists (CNS) are not authorized by statute to register for prescriptive practice.

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Education requirements for prescribers

To apply for prescriptive authority from MA Controlled Substance Registration (MCSR) and to renew your APRN authorization every two years, all prescribers must complete education relative to:

  • Effective pain management
  • The risks of abuse and addiction associated with opioid medication
  • Identification of patients at risk for substance use disorders
  • Counseling patients about the side effects, addictive nature and proper storage and disposal of prescription medications
  • Appropriate prescription quantities for prescription medications that have an increased risk of abuse
  • Opioid antagonists, overdose prevention treatments and instances in which a patient may be advised on both the use of and ways to access opioid antagonists and overdose prevention treatments.

These requirements are in accordance to Massachusetts state law M.G.L. c. 94C s.18(e). Please note that M.G.L. c. 94C s.18(e) does not specify a minimum number of contact hours to comply with this education requirement.

Nurse prescribers may choose any program that meets the required content and is consistent with the Board’s continuing education requirements, such as the free course work at SCOPE of Pain or National Institute on Drug Abuse (NIDA).

Prescriptive guidelines for practicing in more than one setting

When you register with the Department of Public Health Drug Control Program (DCP) for prescriptive practice as a CNP, CRNA, or PCNS, you are required to provide the name and credentials of your supervising physician with whom you establish and sign prescriptive guidelines. If you are employed in additional settings in which your supervising physician is not, you may be required to amend your Massachusetts Controlled Substances Registration (MCSR) to reflect the establishment of additional guidelines with another physician. Please refer to the DCP requirements in 105 CMR 700.00 and 105 CMR 721.

Contact the DCP at (617) 973-0800 or for more information regarding MCSR requirements.

Requirement to register for and use the Prescription Monitoring Program (PMP)

The PMP uses a computer-based, Electronic Data Transfer (EDT) system to collect prescription data from Massachusetts community hospitals, outpatient and clinic pharmacies, and out-of-state mail order pharmacies that deliver to patients in Massachusetts. PMP is a tool that supports safe prescribing and dispensing and assists in addressing prescription drug misuse and abuse.

You must register for and use Massachusetts Prescription Awareness Tool (MassPAT) online.