Important Update on APRNs Invoking Health Care Proxies

MCNP is thrilled to share that during their meeting on November 13, 2024, the Board of Registration in Nursing (BORN) approved an advisory ruling that will allow Certified Nurse Practitioners (CNPs) and Psychiatric Nurse Mental Health Clinical Specialists (PCNSs) who have the required knowledge and competencies to invoke the health care proxy (HCP) for patients under their care.  

As many of you know, the MCNP had introduced a capacity determination bill this legislative session, which would have granted this authority by amending the statute that has previously limited invoking the HCP to an "attending physician" only.

Although our bill did not advance, and we were planning to refile it next session, the BORN, under their regulatory powers over APRN practice, revisited the issue and determined that global signatory authority would apply to invoking health care proxies.

Under the new BORN advisory, "NPs who have the required knowledge and competencies are authorized to invoke health care proxies in compliance with MGL 112 § 80B, § 80I, and 244 CMR 4.06 (3)(c)."

Importantly, and has we have argued, this advisory does not expand APRN scope of practice, but rather corrects one of many inconsistencies between current APRN practice and outdated statutes. This action is aligned with the goals of Full Practice Authority and will help ensure that APRNs can practice to the full extent of their education and training without statutory obstacles.

We will be seeking guidance from the BORN regarding any details relative to specific knowledge and competency requirements and will provide an update once this has been clarified.

The MCNP extends our sincere thanks to the Massachusetts Board of Registration in Nursing for their bold leadership and for taking this important step that will benefit patients and their families.

For more details, please review the attached advisory.