A summary of Tennessee’s collaboration, agreement, filing, supervision, prescribing, and specialty rules for NPs and the physicians who collaborate with them.
Collaborating Physician Required? Yes
Physician Involvement: High
Agreement Name: Protocol (collaborative practice protocol)
On-Site Requirements: Physician must visit any remote site at least once every 30 days; up to 10 of the required annual visits may be by HIPAA-compliant video
Chart Review: At least 20% of the NP’s charts every 30 days; 100% of charts involving a controlled substance
Controlled Substances: Allowed with a certificate of fitness and a federal DEA registration; Schedule II/III/IV require prior physician consultation and approval on the patient’s first prescription
Reduced Supervision / Transition Requirements: None
Tennessee NP Collaboration Requirements Summary
Tennessee requires nurse practitioners to practice with a collaborating physician who oversees their prescribing and reviews their care. Tennessee is a collaborative-practice state: physician involvement is high, there is no independent-practice pathway, and the physician must review charts monthly and visit remote practice sites on a set schedule. The NP works under a written protocol jointly developed with the physician, and the physician must be available for consultation at all times.
Source: Tenn. Code Ann. § 63-7-123; Tenn. Comp. R. & Regs. 0880-06-.02
Type of Collaborative Relationship
Tennessee NPs practice under the supervision of a collaborating physician who stays actively involved — reviewing charts monthly, visiting remote sites, and remaining available for consultation at all times. There is no path to reduced supervision or independent practice in Tennessee; the collaborating relationship continues for as long as the NP prescribes. The physician does not have to be physically present continuously, but must be reachable at all times or arrange a substitute.
Source: Tenn. Comp. R. & Regs. 0880-06-.02(2)
What is an NP’s scope of practice in Tennessee?
A Tennessee NP with a certificate of fitness may perform medical diagnosis, develop a medical plan of care, prescribe or issue drugs, and prescribe other treatments — but does so under a collaborating physician and a jointly developed protocol, not independently.
Do NPs need a collaborating physician in Tennessee?
Yes. An NP who prescribes must have a supervising/collaborating physician who has control and responsibility for the NP’s prescriptive services.
Can NPs practice independently in Tennessee?
No. Tennessee has no independent-practice pathway; a prescribing NP must maintain a collaborating physician relationship, and there is no reduced-supervision transition after a period of experience.
How many NPs can a physician supervise in Tennessee?
There is no fixed limit. Tennessee sets no specific number; the physician determines how many NPs and PAs to supervise at the practice level, consistent with good medical practice and their ability to meet the chart-review and site-visit obligations.
Who can be a collaborating physician in Tennessee?
A physician who has experience or expertise in the same area of medicine as the NP. This also applies to any substitute supervising physician.
Are there proximity or in-person requirements in Tennessee?
Yes. The supervising physician must visit any remote site at least once every 30 days; up to 10 of those required annual visits may be conducted by HIPAA-compliant video rather than in person, with the rest occurring on site.
Collaboration Agreement Requirements
Tennessee’s written agreement is called a protocol, and it must be jointly developed and approved by the NP and the collaborating physician. The protocol must cover the applicable standard of care, include a formulary accounting for all protocol drugs, be specific to the population the NP sees, and be dated and signed. The physician must also develop clinical guidelines that include a method for documenting consultation and referral. Tennessee does not provide a state template, and a copy of the protocol must be kept at the practice site.
Source: Tenn. Comp. R. & Regs. 0880-06-.02(5),(6); Tenn. Code Ann. § 63-7-123(b)(4)
What must be included in an NP collaborative agreement in Tennessee?
The protocol must outline and cover the applicable standard of care, account for all protocol drugs by an appropriate formulary, be specific to the population seen, and be dated and signed. A method for documenting consultation and referral must also be established, though it is not required to be inside the agreement itself.
What is the collaborative agreement called in Tennessee?
It is called a protocol — Tennessee’s term for the written, jointly developed agreement between an NP and the collaborating physician. Tennessee does not publish a state-provided template.
Who has to sign the collaborative agreement in Tennessee?
Both the NP and the collaborating physician. The protocol must be jointly developed and approved by both, and it must be dated and signed.
How often must the agreement be reviewed or renewed in Tennessee?
At least every two years. The protocol must be reviewed and updated biennially.
Is a backup physician required in Tennessee?
No. Tennessee does not require a designated backup physician in the protocol, though the supervising physician must be available for consultation at all times or arrange for a substitute physician to be available.
Board Filing Requirements
Tennessee does not require the collaborative protocol itself to be filed with the board, but a prescribing NP must file a notice before prescribing. That notice contains the NP’s name, the collaborating physician’s name, and a copy of the formulary describing the categories of drugs the NP may prescribe. If the NP prescribes controlled substances, both the NP and the physician must also confirm their supervisory relationship in the Controlled Substance Monitoring Database. The NP must keep this information updated.
Source: Tenn. Code Ann. § 63-7-123(b)(1); Tenn. Comp. R. & Regs. 1000-04-.04(4),(5)
Do you have to file the collaborative agreement with the board in Tennessee?
No, the protocol itself is not filed. However, a prescribing NP must file a notice with the board containing the NP’s name, the collaborating physician’s name, and the prescribing formulary.
Can an NP start practicing as soon as they file in Tennessee?
No, not for prescribing. Tennessee regulations state the NP cannot prescribe prior to filing the required notice and formulary, and must file updates before prescribing under any changed information.
What are the termination and notice requirements in Tennessee?
For prescribing NPs, the NP must update the board within 30 days of a change to the collaborating-physician relationship. Tennessee does not set a separate leeway period for an unanticipated termination.
Collaboration Compliance
Tennessee’s ongoing obligations center on monthly chart review, periodic site visits, and constant physician availability. The supervising physician must personally review at least 20% of the NP’s charts every 30 days, and must be available for consultation at all times or arrange a substitute. Certain charts require a signed personal review at least once every 10 business days — including any chart where a controlled drug was prescribed, where care is medically indicated, where the patient requests it, or where a prescription falls outside the protocol.
Source: Tenn. Comp. R. & Regs. 0880-06-.02(2),(7),(8)
How many charts must a collaborating physician review in Tennessee?
At least 20% of the charts the NP monitors or writes, every 30 days. In addition, 100% of charts in which a controlled substance was prescribed must be personally reviewed and signed.
How often must an NP and collaborating physician meet in Tennessee?
Tennessee sets no fixed meeting cadence, but the physician must visit any remote site at least once every 30 days (up to 10 of the required annual visits may be by HIPAA-compliant video) and must be available for consultation at all times.
How long must collaboration records be kept in Tennessee?
Tennessee sets no specific recordkeeping duration for collaboration documentation. The protocol must be maintained at the practice site and made available to the boards on request.
Prescribing Rules
Tennessee NPs may prescribe and issue drugs once they hold an active certificate of fitness and have filed their notice and formulary; controlled-substance prescribing carries added conditions. To prescribe controlled substances, the NP must maintain a federal DEA registration at the practice location. Schedule II, III, and IV prescriptions require that the drug either be authorized on the formulary or be expressly approved after consultation with the collaborating physician before the patient’s initial prescription, and a Schedule II or III opioid on the formulary is limited to a non-refillable 30-day course unless the physician approves more after consultation.
Source: Tenn. Code Ann. § 63-7-123(b)(2); Tenn. Comp. R. & Regs. 1000-04-.04(1),(3)
Can an NP prescribe controlled substances in Tennessee?
Yes, with conditions. The NP must hold a certificate of fitness and a federal DEA registration, and the NP and physician must document their relationship in the Controlled Substance Monitoring Database.
Can an NP prescribe Schedule II drugs in Tennessee?
Yes, but with prior physician involvement. A Schedule II prescription must be authorized on the formulary or expressly approved after consultation with the collaborating physician before the patient’s initial prescription, and a Schedule II opioid on the formulary is capped at a non-refillable 30-day course unless the physician approves more after consultation.
What schedule drugs can an NP prescribe in Tennessee?
Legend (prescription) drugs on the NP’s formulary, plus controlled substances in Schedules II, III, and IV subject to the formulary or prior physician consultation and approval on the initial prescription. Opioid prescriptions in Schedules II and III carry an added 30-day limit unless the physician approves more.
Does an NP need a DEA license in Tennessee?
Yes, to prescribe controlled substances. An NP with a certificate of fitness must maintain a federal DEA registration at the practice location, available for inspection by the board.
Can an NP prescribe independently in Tennessee?
No. NPs prescribe under a collaborating physician and their formulary, and controlled-substance prescriptions in Schedules II–IV require the physician’s prior consultation and approval on the patient’s initial prescription.
Specialty & Telehealth Requirements
Tennessee sets no specialty-specific NP collaboration requirements and no telehealth-specific collaboration rules. Tennessee does make the collaborating physician expressly responsible for the NP’s prescribing practices, since the physician named in the required notice has control and responsibility for the NP’s prescriptive services. For remote practice, the physician’s site-visit obligation still applies, with up to 10 of the required annual visits allowed by HIPAA-compliant video.
Source: Tenn. Code Ann. § 63-7-123(b)(1)
Are there telehealth or telemedicine requirements for NPs in Tennessee?
No, Tennessee sets no telehealth-specific collaboration requirements.
Are there specialty-specific requirements for NPs in Tennessee?
No, Tennessee sets no specialty-specific NP requirements, aside from the general rule that the collaborating physician must have experience or expertise in the same area of medicine as the NP.
How do you verify a collaborating physician’s license in Tennessee?
Physician licenses can be verified through the Tennessee Board of Medical Examiners’ public license-verification records. Confirm the physician holds an active Tennessee medical license and practices in the same area of medicine as the NP.
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