Practice Agreement · RN
Registered Nurse Practice Agreement in Puerto Rico
Puerto Rico law does not require a Registered Nurse to hold a named agreement with a physician. Practices still use one to define the working relationship; here is what it covers and what the state does require.
General RN licensure ('Enfermero/a Generalista', Ley 254-2015 Art. 2(e)(3)) is not subject to physician supervision or a collaborative agreement — RNs 'podrán funcionar de manera independiente y tener práctica privada,' direct the nursing care delegated to associate/practical nurses, and work within physician orders/protocols rather than under an APRN-style agreement.
What a Registered Nurse practice agreement covers in Puerto Rico
Governed by the Puerto Rico Board of Nurse Examiners. Each numbered item is a statutory requirement the agreement must satisfy.
The Registered Nurse ("RN") shall practice under the orders, standing orders, or delegation of the Physician, consistent with Law 254-2015. Puerto Rico law does not require a collaborative agreement for this Registered Nurse's general scope of practice; the Physician shall instead be available to the Registered Nurse for consultation regarding clinical and patient care issues arising under any order or delegation.
- The agreement on file also carries 2 scope, 2 education, 2 registration clauses, generated in the document itself.
Statutes and rules cited
- Ley Núm. 247 de 3 de septiembre de 2004, según enmendada ("Ley de Farmacia de Puerto Rico")statute
Puerto Rico Pharmacy Act, published by the Puerto Rico Department of Health, providing for a Board-defined "Protocol" under which a pharmacist and a physician (or group of physicians) may agree that the pharmacist will manage a patient's pharmacotherapy on a collaborative basis.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the agreement has to carry, from the state's supervision rules.
Proximity
Not codified — left to the agreement
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · no controlled-substance authority
RNs do not have independent prescriptive authority in PR; they administer medications per physician orders/protocols.
Written agreement
Not required
Unconditional — general RN licensure is never subject to physician supervision or a collaborative agreement in PR, unlike the APRN/PA categories above.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Corporación Profesional under Ley 164-2009, Cap. 238 for nursing services; non-clinical businesses an RN might own fall outside this regime entirely.
Legal sources for these rules (1)
About Puerto Rico's rules
PR's 'Médico Asistente' (PA) credential is NOT the mainland PA profession — it is a bridge pathway mainly for internationally-trained physicians awaiting PR licensure (Ley 71-2017), capped at 2 per supervising physician with zero prescriptive authority. APRNs (NP/CNM/CRNA/CNS) need patient-level collaborative protocols with a physician for nearly all diagnostic/prescriptive functions (Ley 254-2015) despite AANP rating PR 'Reduced Practice.' No dedicated esthetician license currently exists.
Other clinicians in Puerto Rico: see the state overview.