CNS · Puerto Rico
Supervision Agreement for Clinical Nurse Specialists in Puerto Rico
Yes, a written supervising-physician agreement is required. Puerto Rico does not name a specific instrument.
Mapped to Ley 254-2015's 'Especialista Clínico' advanced-practice category (Art. 2(e)(2)(a)) — provides expert clinical nursing care but recommends treatments and orders diagnostics only 'en colaboración con los médicos' via pre-approved protocols. A separate, non-advanced-practice 'Enfermera/o Especialista' role (Art. 2(e)(3)) exists but is not this CNS mapping.
What the supervision must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
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
Ley 254-2015 Art. 2(e)(2)(a) authorizes the Especialista Clínico to recommend treatments and order non-pharmacological therapeutic measures and diagnostics under protocol, but — unlike the NP paragraph in the same article — does not enumerate medication-ordering authority. Treat CNS as lacking independent prescriptive authority absent further confirmation from the Junta Examinadora de Enfermería.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Corporación Profesional under Ley 164-2009, Cap. 238 — no PR statute found barring CNS ownership of a nursing-services professional corporation.
Legal sources for these rules (1)
What a supervising physician costs here
Typical monthly cost in Puerto Rico
$500 – $600
Estimate for one Clinical Nurse Specialist. Standard-tier state.
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.