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South Carolina
S-OUTHCAROLINA Nurse-midwives in South Carolina practice under the Nurse Practice Act with its rules, regulations, and Statements of Determinants (hereafter called the determinants). The determinants, which have been approved jointly by the Board of Nursing and the Board of Medical Examiners, include the following definition: A Certified Nurse-Midwife [certification by the American College of Nurse-Midwives] is a registered nurse who has extended the limits of her practice into the area of management of care of mothers and babies throughout the maternity cycle so long as progress meets criteria accepted as normal. Nurse-Midwifery also includes interconceptional care for family planning, immediate care of the newborn at delivery, and well-child supervision.
in South Carolina must be licensed as a registered nurse in the state, be graduated from an ACNM-approved or recognized basic education program, and be certified by the ACNM “signifying successful passage” of the certification examination. A new graduate who has taken the examination but who has not yet received results may practice. If a candidate fails the examination he or she may not practice nurse-midwifery pending the results of reexamination. The scope of nurse-midwifery practice is set out in the determinants in the form of a list of functions of a CNM in clinical practice. A CNM may take patient histories and perform physical examinations and “participate” in a patient education and family planning program. He or she also may evaluate and manage patient care antepartally, intrapartally, postpartally, admit patients in labor, administer medications selected from standing orders, deliver babies, use pudendal anesthesia, perform an episiotomy and repair, A nurse-midwife
Revised January 1987
and give immediate care to the newborn; these acts are “additional acts” as defined in the Nurse Practice Act. “Additional Acts” are those that require special education and training and are recognized jointly by medicine and nursing as proper for the nurse to perform. A CNM, who is a nurse practitioner for purposes of the regulations, is required to have “physician support” and operate within “approved written protocols.” The protocols are specific statements that are to be developed collaboratively by the physician or medical staff and the nurse; they are meant to “define the procedures that are being delegated as ‘additional acts.’ ” An advisory opinion issued by the State Board of Nursing on July 27, 1982, addressed the question of whether nurse practitioners in South Carolina legally can prescribe drugs (write and sign prescriptions) designated by the protocol. It concluded that the answer is “yes” if specific written protocols are developed in a joint practice “which reflect appropriate delegation and supervision by the physician and appropriate parameters for the prescribing activities of the nurse practitioner.” Furthermore, a report in August 1982, by the Ad Hoc Committee on Certified Nurse-Midwives, appointed jointly by the Boards of Medicine and Nursing, recommended that the nurse-midwife should order drugs in her own name from preestablished written protocols. The legal validity of this regulatory scheme has been questioned in an opinion issued on January 4, 1983, by an outgoing Attorney General. That opinion questioned the legal validity of the determinants and stated that the act of prescribing medications is the practice of medicine and cannot be delegated. The
Journal of Nurse-Midwifery 0 Vol. 32, No. 4, July/August 1987
new Attorney General has held the opinion “in abeyance” in order to study the matter, but a new opinion has not been issued. In early October 1983, the Nursing and Medical Boards issued a “proposed agreement regarding nurse practitioners and their supervising physicians related to physician delegated functions.” The proposal for the first time requires review and approval of all written protocols by a joint committee of the Boards of Nursing and Medicine. Among other functions, the review and approval process is to “confirm” that the “scope of all extended activities is defined and submitted” and that the “nurse practitioner and the supervising physicians are well ‘matched as demonstrated by previously submitted curriculum vitae and resume with emphasis on approved training and experience.” The proposal also states that nurses in extended roles may write prescriptions but only a physician may sign the order. A physician may not pre-sign a blank prescription because a statute makes this a criminal offense. In the Spring of 1987, the state legislature will be rescheduling and revising according to recommendations of the Nursing and Medical Boards, all Professional Practice Acts in compliance with South Carolina’s “Sunset Revision” laws. This will be an opportunity to re-address the issue of nurse practitioners and nurse-midwives establishing the legal practice of prescribing drugs in accordance with written protocol. Lay-midwives are regulated by the Department of Health and Environmental Control and must be registered. Lay-midwifery is defined as “services provided by a person, who is not a medical professional otherwise licensed by an agency of the state, which are provided for the
241
purpose of giving primary assistance in the birth process either free for trade or for money.” This regulation does not apply in emergencies, nor does it preclude licensed health professionals from being registered under it. A nine-member lay-midwifery board advises the Department “regarding standards of practice and education of lay-midwifery and to monitor outcomes.” Two members of the board must be CNMs. CNMs in South Carolina are reimbursed by Medicaid care services only.
for maternity
Are CNMs practicing in the jurisdiction: Yes Authorizing law: Nurse Practice Act Regulated by: Board of Nursing, with input from Board of Medical Examiners Form of legal authorization to practice: RN license
242
Frequency of renewal of legal authorization: Annually CNM named in statute: No CNM named in regulations: Yes ACNM certification recognized: Yes RN license required: Yes Written evidence of collaboration agreement required: Uncertain Prescriptive authority: Uncertain Can CNMs sign birth certificates: Yes Third-party reimbursement mandated: No Medicaid reimbursement status: Regulations in place Can graduate nurse-midwives practice before ACNM certification: Yes CEUs required for CNM: No CEUs required for RN: No
ADDRESS OF REGULATORY AGENCY
State Board of Nursing for South Carolina
1777 St. Julian Place, Suite iO2 ’ Columbia, SC 29204 ADDRESS
OF MEDICAID OFFICE
South Carolina Department of Social Services PO Box 1520 Columbia, SC 29202 ESSENTIAL LEGAL CITATIONS
Practice statute: South Carolina Code Annotated, Section 43-33-10 et seq. Practice regulations: South Carolina Code Annotated, Volume 26, Chapter 91 Other midwifery regulations: South Carolina Code Annotated, Volume 25, Regulation 61-24 Medical practice act: South Carolina Code Annotated, Section 40-47-10 et seq. Birth certificates: South Carolina Code Annotated, Volume 25, Regulation 61-19, Section 8
Journal of Nurse-Midwifery
??Vol.
32, No. 4, July/August 1987
in South Carolina must be licensed as a registered nurse in the state, be graduated from an ACNM-approved or recognized basic education program, and be certified by the ACNM “signifying successful passage” of the certification examination. A new graduate who has taken the examination but who has not yet received results may practice. If a candidate fails the examination he or she may not practice nurse-midwifery pending the results of reexamination. The scope of nurse-midwifery practice is set out in the determinants in the form of a list of functions of a CNM in clinical practice. A CNM may take patient histories and perform physical examinations and “participate” in a patient education and family planning program. He or she also may evaluate and manage patient care antepartally, intrapartally, postpartally, admit patients in labor, administer medications selected from standing orders, deliver babies, use pudendal anesthesia, perform an episiotomy and repair, A nurse-midwife
Revised January 1987
and give immediate care to the newborn; these acts are “additional acts” as defined in the Nurse Practice Act. “Additional Acts” are those that require special education and training and are recognized jointly by medicine and nursing as proper for the nurse to perform. A CNM, who is a nurse practitioner for purposes of the regulations, is required to have “physician support” and operate within “approved written protocols.” The protocols are specific statements that are to be developed collaboratively by the physician or medical staff and the nurse; they are meant to “define the procedures that are being delegated as ‘additional acts.’ ” An advisory opinion issued by the State Board of Nursing on July 27, 1982, addressed the question of whether nurse practitioners in South Carolina legally can prescribe drugs (write and sign prescriptions) designated by the protocol. It concluded that the answer is “yes” if specific written protocols are developed in a joint practice “which reflect appropriate delegation and supervision by the physician and appropriate parameters for the prescribing activities of the nurse practitioner.” Furthermore, a report in August 1982, by the Ad Hoc Committee on Certified Nurse-Midwives, appointed jointly by the Boards of Medicine and Nursing, recommended that the nurse-midwife should order drugs in her own name from preestablished written protocols. The legal validity of this regulatory scheme has been questioned in an opinion issued on January 4, 1983, by an outgoing Attorney General. That opinion questioned the legal validity of the determinants and stated that the act of prescribing medications is the practice of medicine and cannot be delegated. The
Journal of Nurse-Midwifery 0 Vol. 32, No. 4, July/August 1987
new Attorney General has held the opinion “in abeyance” in order to study the matter, but a new opinion has not been issued. In early October 1983, the Nursing and Medical Boards issued a “proposed agreement regarding nurse practitioners and their supervising physicians related to physician delegated functions.” The proposal for the first time requires review and approval of all written protocols by a joint committee of the Boards of Nursing and Medicine. Among other functions, the review and approval process is to “confirm” that the “scope of all extended activities is defined and submitted” and that the “nurse practitioner and the supervising physicians are well ‘matched as demonstrated by previously submitted curriculum vitae and resume with emphasis on approved training and experience.” The proposal also states that nurses in extended roles may write prescriptions but only a physician may sign the order. A physician may not pre-sign a blank prescription because a statute makes this a criminal offense. In the Spring of 1987, the state legislature will be rescheduling and revising according to recommendations of the Nursing and Medical Boards, all Professional Practice Acts in compliance with South Carolina’s “Sunset Revision” laws. This will be an opportunity to re-address the issue of nurse practitioners and nurse-midwives establishing the legal practice of prescribing drugs in accordance with written protocol. Lay-midwives are regulated by the Department of Health and Environmental Control and must be registered. Lay-midwifery is defined as “services provided by a person, who is not a medical professional otherwise licensed by an agency of the state, which are provided for the
241
purpose of giving primary assistance in the birth process either free for trade or for money.” This regulation does not apply in emergencies, nor does it preclude licensed health professionals from being registered under it. A nine-member lay-midwifery board advises the Department “regarding standards of practice and education of lay-midwifery and to monitor outcomes.” Two members of the board must be CNMs. CNMs in South Carolina are reimbursed by Medicaid care services only.
for maternity
Are CNMs practicing in the jurisdiction: Yes Authorizing law: Nurse Practice Act Regulated by: Board of Nursing, with input from Board of Medical Examiners Form of legal authorization to practice: RN license
242
Frequency of renewal of legal authorization: Annually CNM named in statute: No CNM named in regulations: Yes ACNM certification recognized: Yes RN license required: Yes Written evidence of collaboration agreement required: Uncertain Prescriptive authority: Uncertain Can CNMs sign birth certificates: Yes Third-party reimbursement mandated: No Medicaid reimbursement status: Regulations in place Can graduate nurse-midwives practice before ACNM certification: Yes CEUs required for CNM: No CEUs required for RN: No
ADDRESS OF REGULATORY AGENCY
State Board of Nursing for South Carolina
1777 St. Julian Place, Suite iO2 ’ Columbia, SC 29204 ADDRESS
OF MEDICAID OFFICE
South Carolina Department of Social Services PO Box 1520 Columbia, SC 29202 ESSENTIAL LEGAL CITATIONS
Practice statute: South Carolina Code Annotated, Section 43-33-10 et seq. Practice regulations: South Carolina Code Annotated, Volume 26, Chapter 91 Other midwifery regulations: South Carolina Code Annotated, Volume 25, Regulation 61-24 Medical practice act: South Carolina Code Annotated, Section 40-47-10 et seq. Birth certificates: South Carolina Code Annotated, Volume 25, Regulation 61-19, Section 8
Journal of Nurse-Midwifery
??Vol.
32, No. 4, July/August 1987