Alabama Administrative Code Chapter 610-X-9 — Advanced Practice Nursing

610 Alabama Board of Nursing

Ala. Admin. Code r. 610-X-9-.01 Qualifications For Approval To Practice As A Certified Registered Nurse Anesthetist

(1) The applicant for approval to practice as a certified registered nurse anesthetist shall have:

(a) An active registered nurse license issued by Alabama or a multistate registered nurse license issued by a party state, as defined in Chapter 4 of these rules. Initial applicants shall have an active registered nurse license, unless authorized by the Board.

(b) Met all requirements for completion of or graduation from an organized program of study and clinical experience beyond the basic educational preparation as a registered nurse that prepares nurse anesthetists and is accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs/Schools or its predecessor, the American Association of Nurse Anesthetists and recognized by the Board of Nursing.

(c) Earned at least a master’s degree, or post-master’s certificate in advanced practice nursing from an accredited graduate program in nurse anesthesia recognized by the Board.

(d) Current certification as a registered nurse anesthetist by the National Board of Certification and Recertification for Nurse Anesthetists, or other certifying body approved by the Board of Nursing.

(2) The applicant for approval as a certified registered nurse anesthetist who graduated from an accredited school of nurse anesthesia prior to December 31, 2003, is exempt from the master’s degree requirement.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-84.
• Filed September 29, 1982. Repealed and New Rule: Filed August 25, 2003; effective September 29, 2003. Amended: Filed May 14, 2007; effective June 18, 2007. Amended: Filed May 20, 2019; effective July 4, 2019. Amended: Filed July 26, 2019; effective September 9, 2019; operative January 1, 2020.

Ala. Admin. Code r. 610-X-9-.02 Application For Approval To Practice As A Certified Registered Nurse Anesthetist

The applicant for approval to practice as a certified registered nurse anesthetist shall submit to the Board:

(1) A completed application and the required fee(s).

(2) An official transcript of education for advanced practice nursing as a nurse anesthetist that indicates the date of completion of the program and the date degree or certificate was conferred if the dates are not the same.

(3) Official evidence of current certification by the National Board of Certification and Recertification for Nurse Anesthetists, or other certifying body approved by the Board of Nursing, as a registered nurse anesthetist.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-84.
• Filed September 29, 1982. Repealed and New Rule: Filed August 25, 2003; effective September 29, 2003. Amended: Filed May 20, 2019; effective July 4, 2019.

Ala. Admin. Code r. 610-X-9-.03 Authorization For Practice As A Certified Registered Nurse Anesthetist

(1) The Board of Nursing may grant approval for advanced practice nursing as certified registered nurse anesthetists to applicants who meet the requirements of Chapter 610-X-9-.01 and .02.

(2) Only those registered nurses whose credentials have current approval from the Board may hold themselves out to be certified registered nurse anesthetists, use the designation “CRNA” or use titles to imply that they are nurse anesthetists.

(3) The advanced practice approval shall expire on the expiration date of the RN license or on the expiration date of the licensee’s national certification as a certified registered nurse anesthetist, whichever occurs first.

(4) Certified registered nurse anesthetists shall renew approval to practice at the time of registered nurse license renewal. Approval for practice may be continued each biennium at the time of renewal of the registered nurse license upon verification of meeting the requirements of Rule 610-X-9-.01 and paying the advanced practice renewal fee(s).

(5) Approval for practice may be continued at the time of renewal upon verification of meeting the requirements of Rule 610-X-9-.01, paying the advanced practice renewal fee(s), and six contact hours of pharmacology content specific to practice in the approved area. Graduate pharmacology academic credit earned during the nurse anesthetist educational program prior to initial approval as a CRNA does not qualify as pharmacology continuing education for renewal of approval as a CRNA.

(6) Alabama-1icensed certified registered nurse anesthetists shall earn, as part of the required twenty-four (24) Board-approved or Board-recognized continuing education contact hours for license renewal, six contact hours of pharmacology.

(7) Failure to meet renewal requirements shall result in lapse of the advanced practice approval.

(8) A nurse who fails to attain certification from the Council on Certification of Nurse Anesthetists, or maintain recertification from the Council on Recertification of Nurse Anesthetists shall:

(a) Immediately notify the Board of Nursing.

(b) Not practice as or use the title of certified registered nurse anesthetist until approved by the Board of Nursing.

(9) A certified registered nurse anesthetist may, after the successful completion of an organized program of study and supervised clinical practice, carry out functions beyond the nurse anesthetist educational preparation provided the functions are approved by the Board of Nursing as being within the legal scope of practice for a certified registered nurse anesthetist and performed pursuant to a standardized procedure implemented in compliance with Section 610-X-6-.12.

(10) Practicing as a certified registered nurse anesthetist subsequent to expiration of advanced practice approval shall result in disciplinary action pursuant to Chapter 610-X-8.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-84.
• Filed September 29, 1982. Amended: Filed March 26, 1998; effective April 30, 1998. Repealed and New Rule: Filed August 25, 2003; effective September 29, 2003. Amended: Filed May 14, 2007; effective June 18, 2007. Amended: Filed April 22, 2016; effective June 6, 2016. Amended: Filed May 20, 2019; effective July 4, 2019. Amended: Filed July 26, 2019; effective September 9, 2019; operative January 1, 2020. Amended: Published June 30, 2021; effective August 14, 2021.

Ala. Admin. Code r. 610-X-9-.04 Standards Of Practice For A Certified Registered Nurse Anesthetist

The certified registered nurse anesthetist shall practice in accordance with the standards, scope of practice, and guidelines developed by the American Association of Nurse Anesthetists, congruent with Alabama law.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2(1).
• Filed September 29, 1982. Amended: Filed May 18, 2018; effective July 2, 2018. Amended: Published November 26, 2025; effective January 10, 2026.

Ala. Admin. Code r. 610-X-9-.05 Provisional Approval To Practice As A Graduate Registered Nurse Anesthetist

(1) An Alabama-1icensed registered nurse who meets the requirements of rule 610-X-9-.01 and .02, and who has applied for initial certification may request Provisional Approval for practice as a graduate nurse anesthetist by submitting:

(a) Official evidence of authorization to test from the National Board of Certification and Recertification for Nurse Anesthetists, or other certifying body approved by the Board of Nursing, for the initial certification examination.

(b) The name and address of the employer who will ensure the supervision of the provisional nurse anesthetist by a certified registered nurse anesthetist or a licensed physician.

(2) The nurse anesthetist with provisional approval may use the designation “Graduate Registered Nurse Anesthetist.” Provisional approval to practice is limited to a maximum of one year and shall expire immediately upon:

(a) Notification of passing the certification examination.

(b) Notification of failing the certification examination.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-84.
• Filed September 29, 1982. Repealed and New Rule: Filed August 25, 2003; effective September 29, 2003. Amended: Filed May 14, 2007; effective June 18, 2007. Amended: Filed May 20, 2019; effective July 4, 2019. Amended: Published November 30, 2020; effective January 14, 2021.

Ala. Admin. Code r. 610-X-9-.06 Notice Requirements

(1) Certified registered nurse anesthetists, as defined by statute and regulation, shall submit to the board, immediately upon receipt:

(a) Evidence of current national certification by the National Board of Certification and Recertification for Nurse Anesthetists, or other certifying body approved by the Board of Nursing, or recertification from the National Board of Certification and Recertification for Nurse Anesthetists, or other certifying body approved by the Board of Nursing.

1. Upon successful completion of the initial certification examination.

2. At the time of renewal of advanced practice approval.

3. Upon recertification by the Council.

(2) Failure to provide evidence of current national certification prior to the expiration of existing certification on file with the Board shall result in lapse of approval to practice as a certified registered nurse anesthetist and may result in disciplinary action pursuant to Chapter 610-X-8.

(3) The Board’s notice to the advanced practice nurse for approval to practice may be:

(a) A letter or notice granting provisional approval.

(b) A letter or other document granting full approval.

(4) Failure to submit evidence to the Board of meeting the requirements of Chapter 610-X-9, as applicable, shall result in lapse of the advanced practice approval.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2(1).
• Filed June 1, 1989; effective July 6, 1989. Amended: Filed June 18, 1996; effective July 23, 1996. Repealed: Filed March 20, 2003; effective April 24, 2003. New Rule: Filed May 14, 2007; effective June 18, 2007. Amended: Filed April 22, 2016; effective June 6, 2016. Amended: Filed May 20, 2019; effective July 4, 2019.

Ala. Admin. Code r. 610-X-9-.07 Reinstatement Of Lapsed Approval For Practice As A Certified Registered Nurse Anesthetist

(1) Lapsed approval as a certified registered nurse anesthetist may be reinstated upon submission of a completed application and compliance with the following:

(a) An active Alabama registered nurse license or a multistate registered nurse license issued by a party state, as defined in Chapter 4 of these rules.

(b) Payment of current renewal and reinstatement fees, as well as outstanding fees and fines, if applicable.

(c) Official evidence of current national certification as a certified registered nurse anesthetist by a national certifying agency recognized by the Board.

(d) Documented evidence of completion of six contact hours of pharmacology continuing education earned within the 24 months immediately preceding application.

(2) In the case of an Alabama-1icensed advanced practice nurse, if the reinstatement of a lapsed approval for advanced practice occurs during the renewal period for registered nurses, the expiration of the advanced practice approval shall be the expiration date of the RN license or the expiration date of the licensee’s national certification as a certified registered nurse anesthetist, whichever occurs first.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-84.
• New Rule: Filed September 27, 2018; effective November 11, 2018. Amended: Filed July 26, 2019; effective September 9, 2019; operative January 1, 2020.
• Editor's note: New Rule .07 was inserted and the original.07 was renumbered .08 per certification filed September 27, 2018; effective November 11, 2018.

Ala. Admin. Code r. 610-X-9-.08 Qualifications For Approval To Practice As A Clinical Nurse Specialist

(1) An applicant for approval to practice as a clinical nurse specialist shall have:

(a) An active Alabama registered nurse license or a multistate registered nurse license issued by a party state, as defined in Chapter 4 of these rules. Initial applicants shall have an active registered nurse license unless authorized by the Board.

(b) A master’s or higher degree, or post-master’s certificate, in nursing from an accredited educational institution in a curriculum designed to prepare clinical nurse specialists.

(c) Certification by a national certifying agency recognized by the Board in the clinical specialty consistent with educational preparation and appropriate to the area of practice.

(2) The registered nurse seeking approval as a clinical nurse specialist in a specialty for which no national certification examination is available may petition the Board for a declaratory ruling pursuant to Rule 610-X-1-.09.

History

• Author: Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-84.
• New Rule: Filed June 20, 1996; effective July 25, 1996. Repealed and New Rule: Filed August 25, 2003; effective September 29, 2003. Amended: Filed May 14, 2007; effective June 18, 2007. Amended: Filed July 26, 2019; effective September 9, 2019; operative January 1, 2020.
• Editor's note: Original rule .07 was renumbered .08 per certification filed September 27, 2018; effective November 11, 2018.

Ala. Admin. Code r. 610-X-9-.09 Application For Approval To Practice As A Clinical Nurse Specialist

The applicant for approval to practice as a clinical nurse specialist shall submit to the Board:

(1) A completed application and the required fee(s).

(2) An official transcript from an accredited educational institution, showing the attainment of a master’s or higher degree, or post-graduate certificate, in a curriculum designed to prepare clinical nurse specialists.

(3) Official evidence of current national certification as a clinical nurse specialist by a national certifying agency recognized by the Board.

History

• Author: Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-84.
• Filed September 29, 1982. Repealed: Filed June 20, 1996; effective July 25, 1996. New Rule: Filed June 20, 1996; effective July 25, 1996. Repealed and New Rule: Filed August 25, 2003; effective September 29, 2003.
• Editor's note: Original rule .08 was renumbered .09 per certification filed September 27, 2018; effective November 11, 2018.

Ala. Admin. Code r. 610-X-9-.10 Authorization For Practice As A Clinical Nurse Specialist

(1) The Board of Nursing may grant approval for advanced practice nursing as a clinical nurse specialist to applicants who meet the requirements of Chapter 610-X-9-.08 and .09.

(2) Only those registered nurses whose credentials have been approved by the Board may hold themselves out to be clinical nurse specialists, use the designation “CNS” or use titles to imply that they are clinical nurse specialists.

(3) The advanced practice approval shall expire on the same date as the registered nurse license or on the expiration date of the licensee’s national certification, whichever occurs first.

(4) Clinical nurse specialists shall renew approval for practice at the time of registered nurse license renewal. Approval for practice may be continued at the time of renewal upon verification of meeting the requirements of Rule 610-X-9-.01, paying the advanced practice renewal fee(s), and six contact hours of pharmacology content specific to practice in the approved area. Graduate pharmacology academic credit earned during the clinical nurse specialist educational program prior to initial approval as a CNS does not qualify as pharmacology continuing education for renewal of approval as a CNS.

(5) Failure to meet the renewal requirements shall result in lapse of advanced practice approval.

(6) A nurse who fails to attain or maintain certification in the appropriate area of practice shall:

(a) Immediately notify the Board.

(b) Not practice as or use the title of clinical nurse specialist until approved by the Board.

(7) A clinical nurse specialist may, after the successful completion of an organized program of study and supervised clinical practice, carry out functions beyond the clinical nurse specialist educational preparation provided the functions are approved by the Board of Nursing as being within the legal scope of practice for a clinical nurse specialist and performed pursuant to a standardized procedure implemented in compliance with Section 610-X-6-.12.

(8) Practicing as a clinical nurse specialist subsequent to expiration of advanced practice approval shall result in disciplinary action pursuant to Chapter 610-X-8.

History

• Author: Board of Nursing
• Authority: Code of Ala. 1975, §34-21-84.
• Filed September 29, 1982. Amended: Filed June 6, 1986; effective July 11, 1986. Repealed: Filed June 20, 1996; effective July 25, 1996. New Rule: Filed June 20, 1996; effective July 25, 1996. Repealed and New Rule: Filed August 25, 2003; effective September 29, 2003. Amended: Filed May 14, 2007; effective June 18, 2007. Amended: Filed April 22, 2016; effective June 6, 2016. Amended: Filed July 26, 2019; effective September 9, 2019; operative January 1, 2020. Amended: Published November 29, 2019; effective January 13, 2020. Amended: Published June 30, 2021; effective August 14, 2021.
• Editor's note: Original rule .09 was renumbered .10 per certification filed September 27, 2018; effective November 11, 2018.

Ala. Admin. Code r. 610-X-9-.11 Standards Of Practice For Clinical Nurse Specialists

(1) The clinical nurse specialist shall practice in accordance with the standards, scope of practice, and guidelines identified by the appropriate specialty certifying body as recognized by the Board of Nursing and as congruent with Alabama law.

(2) The CNS may perform advanced nursing skills under Board approved written nursing protocols, independent nursing contracts, and standardized procedures consistent with Article 5 of the Nurse Practice Act.

History

• Author: Board of Nursing
• Authority: Code of Ala. 1975, §34-21-84.
• Filed September 29, 1982. Amended: Filed June 6, 1986; effective July 11, 1986. Repealed: Filed June 20, 1996; effective July 25, 1996. New Rule: Filed June 20, 1996; effective July 25, 1996. Repealed and New Rule: Filed August 25, 2003; effective September 29, 2003. Amended: Filed May 18, 2018; effective July 2, 2018. Amended: Filed July 20, 2018; effective September 3, 2018.
• Editor's note: Original rule .10 was renumbered .11 per certification filed September 27, 2018; effective November 11, 2018.

Ala. Admin. Code r. 610-X-9-.12 Notice Requirements

(1) Clinical nurse specialists as defined by statute and regulation shall submit to the Board, immediately upon receipt:

(a) Evidence of current national certification by national certifying agency recognized by the Board in the clinical specialty consistent with educational preparation and appropriate to the area of practice.

(i) Upon successful completion of the initial certification examination.

(ii) At the time of renewal of advanced practice approval.

(iii) Upon recertification by the national certifying agency.

(2) Failure to provide evidence of current national certification prior to the expiration date of the existing certification on file with the Board shall result in lapse of approval to practice as a Clinical Nurse Specialist and may result in disciplinary action pursuant to Chapter 610-X-8.

History

• Author: Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-85, 34-21-90.
• Filed September 29, 1982. Repealed: Filed June 20, 1996; effective July 25, 1996. New Rule: Filed June 20, 1996; effective July 25, 1996. Amended: Filed March 26, 1998; effective April 30, 1998. Repealed: Filed August 25, 2003; effective September 29, 2003. New Rule: Filed May 14, 2007; effective June 18, 2007.
• Editor's note: Original rule .11 was renumbered .12 per certification filed September 27, 2018; effective November 11, 2018.

Ala. Admin. Code r. 610-X-9-.13 Reinstatement Of Lapsed Approval For Practice As A Clinical Nurse Specialist

(1) Lapsed approval as a clinical nurse specialist may be reinstated upon submission of a completed application and compliance with the following:

(a) An active Alabama registered nurse license or multistate registered nurse license issued by a party state, as defined in Chapter 4 of these rules.

(b) Payment of current renewal and reinstatement fees, as well as outstanding fees and fines, if applicable.

(c) Official evidence of current national certification as a clinical nurse specialist by a national certifying agency recognized by the Board.

(d) Documented evidence of completion of six contact hours of pharmacology continuing education earned within the 24 months immediately preceding application.

(2) In the case of an Alabama-1icensed advanced practice nurse, if the reinstatement of a lapsed approval for advanced practice occurs during the renewal period for registered nurses, the expiration of the advanced practice approval shall be the expiration date of the RN license or the expiration date of the licensee’s national certification as a clinical nurse specialist, whichever occurs first.

History

• Author: Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-2, Act 89-243.
• New Rule: Filed December 28, 2009; effective February 1, 2010. Amended: Filed September 27, 2018; effective November 11, 2018. Amended: Filed July 26, 2019; effective September 9, 2019; operative January 1, 2020.
• Editor's note: Original rule .12 was renumbered .13 per certification filed September 27, 2018; effective November 11, 2018.

Ala. Admin. Code r. 610-X-9-.14 Qualifications For Approval To Practice As A Certified Registered Nurse Practitioner

(1) The applicant for approval to practice as a certified registered nurse practitioner shall have:

(a) An active Alabama registered nurse license, or a multistate registered nurse license issued by a party state, as defined in Chapter 4 of these rules, unless authorized by the Board.

(b) Met all requirements for completion of or graduation from an organized program of study and clinical experience beyond the basic educational preparation as a registered nurse that prepares nurse practitioners and is recognized by the Board of Nursing and the appropriate specialty-certifying agency.

(c) At least a master’s or higher degree in advanced practice nursing from an accredited program recognized by the Board.

(d) Current certification as a certified registered nurse practitioner granted by a national certifying agency recognized by the Board of Nursing in the clinical specialty consistent with educational preparation and appropriate to the area of practice

(2) The applicant for initial approval as a certified registered nurse practitioner who meets one of the following criteria is exempt from the requirement for a master’s degree in nursing:

1. Graduation prior to 1996 from a Board-recognized post- baccalaureate program preparing nurse practitioners.

2. Graduation prior to 1984 from a non-baccalaureate program preparing nurse practitioners.

(2) The Board of Nursing may grant a waiver of the master’s degree requirement at its discretion.

(3) Have obtained continuing education prescribed by the Board of Nursing regarding the rules and statutes governing collaborative practice in Alabama, not more than forty-eight (48) months prior to or within twelve (12) months of commencement of the collaborative practice.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-84.
• New Rule: Published November 26, 2025; effective January 10, 2026. Amended: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-9-.15 Application For Approval To Practice As A Certified Registered Nurse Practitioner

(1) The applicant for approval to practice as a certified registered nurse practitioner shall submit to the Board:

(a) The required fee(s) and a completed application including the standard protocol to be followed by the certified registered nurse practitioner and each collaborating physician, unless application is made for an exemption from a collaborative practice agreement as provided for in Rule 610- X-5-.07.

(b) An official transcript of education for advanced practice nursing as a nurse practitioner that indicates the date of completion of the program and the date degree or certificate was conferred if the dates are not the same.

(c) Official evidence of current certification as a nurse practitioner by the respective specialty-certifying agency appropriate to the applicant’s educational preparation, proposed clinical area of practice, and proposed collaborating physician’s area of practice.

(2) The Board of Nursing may decline to consider an applicant who is under investigation for a potential violation of Code of Ala. 1975, Section 34-21-25 and Alabama Board of Nursing Administrative Code Chapter 610-X-8.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-84.
• New Rule: Published November 26, 2025; effective January 10, 2026. Amended: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-9-.16 Authorization For Practice As A Certified Registered Nurse Practitioner

(1) The Board of Nursing may grant a certificate of qualification for advanced practice nursing as a certified registered nurse practitioner to applicants who meet the requirements of 610-X-9-14.

(2) Use of the designation “CRNP” or of any titles that imply that they are certified registered nurse practitioners shall be restricted to those registered nurses who have been issued certificates of qualification by the Board of Nursing and either:

(a) Have current approval for collaborative practice in the state of Alabama;

(b) Are employed by the United States government and working in federal facilities; or

(c) Hold teaching positions in nurse practitioner education programs recognized by the Alabama Board of Nursing. Prior to approval as a CRNP, the registered nurse may use only the designation or title granted by the national certifying agency.

(d) Are employed by the Alabama Board of Nursing.

(3) When for any reason the collaborative practice agreement with the physician designated in the application for approval is terminated, then approval of such certified registered nurse practitioner and collaborating physician designated in the application is automatically withdrawn.

(a) The certified registered nurse practitioner and the physician shall each inform their respective board in writing of the effective date of the termination of the collaborative practice agreement and the reasons for such termination. Failure to notify the respective board of termination may be considered a violation of these rules and regulations.

(b) The certified registered nurse practitioner shall notify the Board of Nursing using the designated on-1ine form for terminating a collaboration.

(c) A certified registered nurse practitioner in a collaborative practice which is voluntarily terminated by either party is responsible for notifying the Board of Nursing of the date on which the collaborative practice agreement terminates. Notification to the Board of Nursing by the Alabama Board of Medical Examiners that a physician has voluntarily terminated

(d) a collaborative practice agreement will meet the notification requirement and will result in termination of the certified registered nurse practitioner’s approval to practice under the collaborative practice agreement.

(4) The advanced practice approval shall expire prior to the RN license if the nurse practitioner’s national certification expires during the license period.

(5) Approval for advanced practice may be continued at the time of renewal, upon verification of:

(a) Meeting the requirements of Rule 610-X-9-.14.

(b) Continued collaboration with the approved physician(s) or eligibility for continued exemption from collaboration.

(c) Payment of the advanced practice renewal fee.

(d) Six contact hours of pharmacology content specific to prescriptive practice in the approved area for collaborative practice. Graduate pharmacology academic credit earned during the nurse practitioner educational program prior to initial approval as a CRNP does not qualify as pharmacology continuing education for renewal of approval as a CRNP.

(e) Documented evidence of completion of continuing education prescribed by the Board of Nursing regarding the rules and statutes governing collaborative practice in Alabama, not more than forty-eight (48) months prior to or within twelve (12) months of commencement of the collaborative practice.

(6) Failure to meet the requirements for renewal shall result in lapse of the advanced practice approval.

(7) A nurse who fails to attain or maintain national certification as a nurse practitioner from a national certifying agency shall:

(a) Immediately notify the Board of Nursing.

(b) Not practice as or use the title of certified registered nurse practitioner until approved by the Board of Nursing.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-85, 34-21-90.
• New Rule: Published November 26, 2025; effective January 10, 2026. Amended: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-9-.17 Temporary Approval To Practice As A Certified Registered Nurse Practitioner

(1) The applicant for approval to practice as a certified registered nurse practitioner may be granted temporary approval for practice under the following stipulations until such time as the application is approved or denied by the Board of Nursing and the Board of Medical Examiners.

(a) The applicant shall meet the requirements of Rules 610-X-9-.14 and 610-X-9-.15.

(b) The collaborating physician shall meet the qualifications established in Rule 610-X-8-.04.

(c) Temporary approval is limited to the standard protocol and formulary approved by the Joint Committee of the Alabama Board of Nursing and the Alabama Board of Medical Examiners and does not include the authority to:

1. Perform additional skills as provided in Rule 610- X-5-.11.

2. Prescribe drugs that are listed in the standard formulary with “Restrictions.”

(2) Provisional Approval: An Alabama-1icense registered nurse who meets the requirements of Rules 610-X-9-.14 and 610-X-9-.15. with the exception of national certification, and who has applied for initial certification may be granted temporary approval under paragraph (1)(c) of this rule with these additional stipulations.

(a) Practice under the on-site supervision of an approved certified registered nurse practitioner or a licensed physician.

(b) During the period of provisional approval, there shall be one hundred percent review of patient cases by the collaborating physician.

(c) The nurse practitioner with provisional approval may use the designation “Graduate Registered Nurse Practitioner.”

(d) Provisional approval to practice is limited to a maximum of six months and shall expire immediately upon:

1. Notification of approval by the Board of Nursing.
2. Notification of failing the certification exam.

(3) Interim Approval: If the relationship with the collaborating physician is terminated, a certified registered nurse practitioner approved to practice under the provisions of these rules may continue in a collaborative practice with an interim physician after application for approval until such time as the new application is approved or denied, provided the interim physician meets the qualifications established in Rule 610-X-8-.04.

(4) An applicant for approval to practice as a certified registered nurse practitioner may be granted temporary approval when either the collaborating physician or certified registered nurse practitioner applicant is under investigation by a state or federal authority. The temporary approval shall remain in force until the application has been approved, denied, or withdrawn. However, the Board of Nursing or Board of Medical Examiners may decline to approve the application until the investigation has been concluded. The Board of Medical Examiners may withdraw temporary approval in accordance with Rule 540-X-8-.13.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-84, 34-21-85.
• New Rule: Published November 26, 2025; effective January 10, 2026.

Ala. Admin. Code r. 610-X-9-.18 Standards Of Practice For A Certified Registered Nurse Practitioner

The certified registered nurse practitioner shall practice in accordance with national standards and functions identified by the appropriate specialty-certifying agency as recognized by the Board of Nursing and as congruent with Alabama law.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-81.
• New Rule: Published November 26, 2025; effective January 10, 2026.

Ala. Admin. Code r. 610-X-9-.19 Functions and Activities Of A Certified Registered Nurse Practitioner

(1) The certified registered nurse practitioner is responsible and accountable for the continuous and comprehensive management of a broad range of health services for which the certified registered nurse practitioner is educationally prepared and for which competency is maintained, with physician collaboration as described in these rules. These services include but are not restricted to the following:

(a) Evaluate current health status and risk factors of individuals based on comprehensive health history and comprehensive physical examinations and assessments.

(b) Formulate a working diagnosis, develop and implement a treatment plan, evaluate and modify therapeutic regimens to promote positive patient outcomes.

(c) Prescribe, administer and provide therapeutic measures, tests, procedures, and drugs.

(d) Counsel, teach and assist individuals and families to assume responsibility for self-care in prevention of illness, health maintenance, and health restoration.

(e) Consult with and refer to other health care providers as appropriate.

(2) A standard protocol approved by the Board of Nursing and State Board of Medical Examiners shall address permissible functions and activities specific to the advanced practice of the certified registered nurse practitioner.

(3) A certified registered nurse practitioner may, after the successful completion of an organized program of study and supervised clinical practice, carry out functions beyond the nurse practitioner educational preparation provided the functions are approved by the Board of Nursing as being within the legal scope of practice for a certified registered nurse practitioner. Such functions shall be submitted to the Joint Committee for consideration for inclusion on the standard protocol.

(4) Requests for additional functions to be added to the protocol may be submitted to the Joint Committee for consideration.

(5) A certified registered nurse practitioner may write admission orders for inpatients as directed by the physician and subsequent orders in accordance with established protocols and institutional policies.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-85, 34-21-87.
• New Rule: Published November 26, 2025; effective January 10, 2026.

Ala. Admin. Code r. 610-X-9-.20 Reinstatement Of Lapsed Approval For Practice As A Certified Registered Nurse Practitioner

(1) Lapsed approval as a certified registered nurse practitioner may be reinstated upon submission of a completed application and compliance with the following:

(a) An active Alabama registered nurse license, or a multistate registered nurse license issued by a party state, as defined in Chapter 4 of these rules.

(b) Payment of current renewal and reinstatement fees, as well as outstanding fees and fines, if applicable.

(c) Official evidence of current national certification as a certified registered nurse practitioner by a national certifying agency recognized by the Board.

(d) Documented evidence of completion of six contact hours of pharmacology content specific to prescriptive practice in the approved area for collaborative practice earned within the 24 months immediately preceding application.

(2) In the case of an Alabama-1icensed advanced practice nurse, if the reinstatement of a lapsed approval for advanced practice occurs during the renewal period for registered nurses, the expiration of the advanced practice approval shall be the expiration date of the RN license or the expiration date of the licensee’s national certification as a certified registered nurse practitioner, whichever occurs first.

(3) Have obtained continuing education prescribed by the Board of Nursing regarding the rules and statutes governing collaborative practice in Alabama, not more than forty-eight (48) months prior to or within twelve (12) months of commencement of the collaborative practice.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-84.
• New Rule: Published November 26, 2025; effective January 10, 2026.

Ala. Admin. Code r. 610-X-9-.21 Qualifications For Approval To Practice For a Certified Nurse Midwife

(1) The applicant for approval to practice as a certified nurse midwife shall have:

(a) An active Alabama registered nurse license, or a multistate registered nurse license issued by a party state, as defined in Chapter 4 of these rules, unless authorized by the Board.

(b) Met all requirements for completion of or graduation from an organized program of study and clinical experience beyond the basic educational preparation as a registered nurse, that prepares nurse midwives and is recognized by the Board of Nursing and the appropriate specialty certifying agency.

(c) At least a master’s or higher degree in advanced practice nursing from an accredited program recognized by the Board.

(d) The applicant for initial approval as a nurse midwife who meets one of the following criteria is exempt from the requirement for a master’s degree in nursing:

1. Graduation prior to 1996 from a Board recognized post-baccalaureate program preparing nurse midwives.

2. Graduation prior to 1984 from a non-baccalaureate program preparing nurse midwives.

3. The Board of Nursing may grant a waiver of the master’s degree requirement at its discretion.

(e) Current certification as a certified nurse midwife by the American Midwifery Certification Board.

(f) Obtained continuing education prescribed by the Board of Nursing regarding the rules and statutes governing collaborative practice in Alabama, not more than forty-eight (48) months prior to or within twelve (12) months of commencement of the collaborative practice.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-84.
• New Rule: Published November 26, 2025; effective January 10, 2026. Amended: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-9-.22 Application For Approval To Practice As A Certified Nurse Midwife

(1) The applicant for approval to practice as a certified nurse midwife shall submit to the Board:

(a) The required fee(s) and a completed application including the standard protocol to be followed by the certified nurse midwife and each collaborating physician, unless application is made for an exemption from a collaborative practice agreement as provided in Rule 610-X-5-.18.

(b) An official transcript of education for advanced practice nursing as a nurse midwife that indicates the date of completion of the program and the date the degree or certificate was conferred if the dates are not the same.

(c) Official evidence of current certification as a certified nurse midwife by the American College of Nurse Midwives Certification Council.

(2) The Board of Nursing may decline to consider an applicant who is under investigation for a potential violation of the Code Ala. 1975, Section 34-21-25 and the Alabama Board of Nursing Administrative Code, Chapter 610-X-8.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-85, 34-21-90.
• New Rule: Published November 26, 2025; effective January 10, 2026. Amended: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-9-.23 Authorization For Practice As A Certified Nurse Midwife

(1) The Board of Nursing may grant a certificate of qualification for advanced practice nursing as a nurse midwife to applicants who meet all requirements of 610-X-5-.14.

(2) Use of the designation “CNM” or of any titles that imply that they are certified nurse midwives shall be restricted to those registered nurses who have been issued certificates of qualification by the Board of Nursing and either:

(a) Have current approval for collaborative practice in the state of Alabama.

(b) Are employed by the United States government and working in federal facilities.

(c) Hold teaching positions in nurse midwife education programs recognized by the Alabama Board of Nursing. Prior to approval as a CNM, the registered nurse may use only the designation or title granted by the national certifying agency.

(d) Are employed by the Alabama Board of Nursing.

(3) When for any reason the collaborative practice agreement with the physician designated in the application for approval is terminated, then approval of such certified nurse midwife and collaborating physician designated in the application is automatically withdrawn.

(a) The certified nurse midwife and the physician shall each inform their respective board in writing of the effective date of the termination of the collaborative practice agreement and the reasons for such termination. Failure to notify the respective board of termination may be considered a violation of these rules and regulations.

(b) The certified nurse midwife shall notify the Board of Nursing using the designated on-1ine form for terminating a collaboration.

(c) A certified nurse midwife in a collaborative practice which is voluntarily terminated by either party is responsible for notifying the Board of Nursing of the date on which the collaborative practice agreement terminates. Notification to the Board of Nursing by the Alabama Board of Medical Examiners that a physician has voluntarily terminated a collaborative practice agreement will meet the notification requirement and will result in termination of the certified nurse midwife’s approval to practice under the collaborative practice agreement.

(4) The advanced practice approval shall expire prior to the RN license if the advanced practice national specialty certification expires during the license period.

(5) Approval for advance practice may be continued at the time of renewal, upon verification of:

(a) Meeting the requirements of Rule 610-X-5-.14.

(b) Continued collaboration with the approved physician(s) or eligibility for continued exemption from collaboration.

(c) Payment of the advanced practice nursing renewal fee.

(d) Six contact hours of pharmacology content specific to prescriptive practice in the approved area for collaborative practice. Graduate pharmacology academic credit earned during the nurse midwife educational program prior to initial approval as a CNM does not qualify as pharmacology continuing education for renewal of approval as a CNM.

(e) Documented evidence of completion of continuing education prescribed by the Board of Nursing regarding the rules and statutes governing collaborative practice in Alabama, not more than forty-eight (48) months prior to or within twelve (12) months of commencement of the collaborative practice.

(6) Failure to meet the requirements for renewal shall result in lapse of the advanced practice approval.

(7) A nurse who fails to attain or maintain national certification as a nurse midwife from the American College of Nurse Midwives Certification Council shall:

(a) Immediately notify the Board of Nursing.

(b) Not practice or use the title of certified nurse midwife until approved by the Board of Nursing.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-85, 34-21-90.
• New Rule: Published November 26, 2025; effective January 10, 2026. Amended: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-9-.24 Temporary Approval To Practice As A Certified Nurse Midwife

(1) The applicant for approval to practice as a certified nurse midwife may be granted temporary approval for practice under the following stipulations until such time as the application is approved or denied by the Board of Nursing and the Board of Medical Examiners.

(a) The applicant shall meet the requirements of Rules 610-X-9-.22 and 610-X-9-.23.

(b) The collaborating physician shall meet the qualifications established in Rule 610-X-8-.18.

(c) Temporary approval is limited to the standard protocol and formulary, including oxytocics, approved by the Joint Committee of the Alabama Board of Nursing and the Alabama State Board of Medical Examiners and does not include the authority to:

1. Perform additional skills as provided in Rule 610- X-9-.27.

2. Prescribe drugs other than oxytocics that are defined in the standard formulary with “Restrictions.”

(2) Provisional Approval: An Alabama-1icensed registered nurse who meets the requirements of Rules 610-X-9-.22 and 610-X-9-.23 with the exception of national certification, and who has applied for initial certification may be granted temporary approval under paragraph (1)(c) of this rule with these additional stipulations.

(a) Practice under the on-site supervision of an approved certified nurse midwife or a licensed physician.

(b) During a minimum of the first thirty days of practice or until satisfactory clinical skills are demonstrated, the collaborating physician or covering physician shall be in attendance at all deliveries by the nurse midwife. The nurse midwife shall contact the collaborating physician or the physician providing medical coverage.

(c) The nurse midwife with provisional approval may use the designation “Graduate Nurse Midwife.”

(d) Provisional approval to practice is limited to a maximum of six months and shall expire immediately upon:

1. Notification of approval by the Board of Nursing
2. Notification of failing the certification exam.

(3) Interim Approval: If the relationship with the collaborating physician is terminated, a certified nurse midwife approved to practice under the provisions of these rules may continue in a collaborative practice with an interim physician after application for approval until such time as the new application is approved or denied, provided all requirements and stipulations for temporary approval cited in paragraph (1) are met.

(4) An applicant for approval to practice as a certified nurse midwife may be granted temporary approval when either the collaborating physician or certified nurse midwife applicant is under investigation by a state or federal authority. The temporary approval shall remain in force until the application has been approved, denied, or withdrawn. However, the Board of Nursing or Board of Medical Examiners may decline to approve the application until the investigation has been concluded. The Board of Medical Examiners may withdraw temporary approval in accordance with Rule 540-X-8-.13.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-84, 34-21-85
• New Rule: Published November 26, 2025; effective January 10, 2026.

Ala. Admin. Code r. 610-X-9-.25 Standards Of Practice For A Certified Nurse Midwife

The certified nurse midwife shall practice in accordance with the standards and functions developed by the American College of Nurse Midwives as recognized by the Board of Nursing and as congruent with Alabama law.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-85, 34-21-87
• New Rule: Published November 26, 2025; effective January 10, 2026.

Ala. Admin. Code r. 610-X-9-.26 Functions and Activities of a Certified Nurse Midwife

(1) The certified nurse midwife is responsible and accountable for the continuous and comprehensive management of women’s health care focusing on pregnancy, childbirth, the post-partum period, care of the newborn, family planning and gynecological needs for which the certified nurse midwife is educationally prepared and for which competency is maintained, with physician collaboration as described in these rules. These services include but are not restricted to the following:

(a) Evaluate current health status and risk factors of individuals based on comprehensive health history and comprehensive physical examinations and assessments.

(b) Formulate a working diagnosis, develop and implement a treatment plan, evaluate and modify therapeutic regimens to promote positive patient outcomes.

(c) Prescribe, administer and provide therapeutic measures, tests, procedures, and drugs.

(d) Counsel, teach and assist individuals/families to assume responsibility for self-care in prevention of illness, health maintenance, and health restoration.

(e) Consult with and refer to other health care providers as appropriate.

(2) A standard protocol approved by the Board of Nursing and State Board of Medical Examiners shall address permissible functions and activities specific to the advance practice of the certified nurse midwife.

(3) A certified nurse midwife may, after the successful completion of an organized program of study and supervised clinical practice, carry out functions beyond the nurse midwifery educational preparation provided the functions are approved by the Board of Nursing as being within the legal scope of practice for a certified nurse midwife. Such functions will be submitted to the Joint Committee for consideration for inclusion on the standard protocol.

(4) Requests for additional functions to be added to the protocol may be submitted to the Joint Committee for consideration.

(5) A certified nurse midwife may write admission orders for inpatients and subsequent orders in accordance with established protocols and institutional policies.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §§34-21-85, 34-21-87.
• New Rule: Published November 26, 2025; effective January 10, 2026.

Ala. Admin. Code r. 610-X-9-.27 Reinstatement Of Lapsed Approval For Practice As A Certified Nurse Midwife

(1) Lapsed approval as a certified nurse midwife may be reinstated upon submission of a completed application and compliance with the following:

(a) An active Alabama registered nurse license, or a multistate registered nurse license issued by a party state, as defined in Chapter 4 of these rules.

(b) Payment of current renewal and reinstatement fees, as well as outstanding fees and fines, if applicable.

(c) Official evidence of current national certification as a certified nurse midwife by a national certifying agency recognized by the Board.

(d) Documented evidence of completion of six contact hours of pharmacology content specific to prescriptive practice in the approved area for collaborative practice earned within the 24 months immediately preceding application.

(2) In the case of an Alabama-1icensed advanced practice nurse, if the reinstatement of a lapsed approval for advanced practice occurs during the renewal period for registered nurses, the expiration of the advanced practice approval shall be the expiration date of the RN license or the expiration date of the licensee’s national certification as a certified nurse midwife, whichever occurs first.

(3) Have obtained continuing education prescribed by the Board of Nursing regarding the rules and statutes governing collaborative practice in Alabama, not more than forty-eight (48) months prior to or within twelve (12) months of commencement of the collaborative practice.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-84.
• New Rule: Published November 26, 2025; effective January 10, 2026.