Alabama Moves to Let NPs, PAs Sign K-12 Athletic Physicals — What It Means for Nurses

The Alabama House of Representatives recently took a significant step toward expanding who can sign off on K-12 athletic physicals — including certified registered nurse practitioners (CRNPs), certified nurse midwives (CNMs) and physician assistants (PAs). The bill, HB 276, passed the House unanimously and now heads to the Senate for consideration.

What the Alabama Bill Would Do

House Bill 276 would allow certified registered nurse practitioners (CRNPs), certified nurse midwives, and physician assistants to endorse K–12 athletic physicals so they are accepted as valid, not just "prepped" for a physician to cosign later. The measure passed the Alabama House 99–0 and was sent to the Senate, where it was referred to the Senate Committee on Healthcare on February 10, 2026.

Rep. Ed Oliver, the bill’s sponsor, said that under current practice "these same people perform the K-12 physical, but the student would go sit in the doctor’s office until he got around to signing it." HB 276 also says athletic associations, clubs, or leagues may not reject a K–12 physical signed by a CRNP, nurse midwife, or PA.

What Lawmakers Say About Risk and Liability

Debate on the House floor was brief, but one lawmaker did raise the concerns many nurses will have: workload, scope, and liability. House Minority Leader Anthony Daniels said he had received an email from an orthopedic surgeon and asked Oliver to "explain what the scope of work would be expanded for nurses" and "from a risk standpoint, I just want to make sure I’m clear on who has the liability."

In response, Oliver said the bill would not increase nurses’ workload and argued that liability would stay essentially the same as long as these clinicians continue practicing in collaboration with a physician. "They’re no more a liability than there is now. These people who are all signing these physicals, nurses, nurse practitioners, PAs are all in collaboration with a physician."

For nurses on the ground, that reassurance may feel incomplete. Even if the legal framework and collaborating-physician requirement do not change, having your signature as the final sign‑off on a pre-participation exam is a meaningful shift in perceived responsibility, documentation habits, and potentially how parents or schools see your role.

How Alabama Compares with Other States

Alabama is currently considered a reduced-practice authority state for nurse practitioners, meaning NPs have more restrictions on independent practice and prescribing than in full-practice states. In many full-practice states, nurse practitioners already sign routine forms—including school and camp physicals—without physician supervision, because they can evaluate, diagnose, and manage treatments independently.

• Full-practice authority examples: States like Colorado, New Mexico, and Washington allow NPs to practice and prescribe independently after meeting state requirements, and sports physical forms are often treated like any other primary care visit.
• Reduced-practice states like Alabama: NPs typically must maintain a collaborative or supervisory agreement with a physician for at least some elements of practice or prescribing.
• Restricted-practice states like California: NPs have even more restrictions.

In other words, while HB 276 feels groundbreaking within Alabama’s more restrictive framework, it actually brings one very specific task—signing K–12 athletic physicals—closer to what NPs in many full-practice states have been doing for years. The bill does not convert Alabama to full practice authority, nor does it remove its collaboration requirements; it carves out a practical exception so that the clinician who actually performs the physical can also be the one whose signature counts.

Why This Matters for Nurses

For nurses and advanced practice providers in Alabama, HB 276 is about more than just a signature line.

• Recognition of work already being done: Oliver openly acknowledged that CRNPs and nurse midwives are already the ones actually conducting these student physicals. Allowing their signatures to stand on their own validates the clinical work they perform instead of treating them as invisible labor while a physician “rubber stamps” the visit.
• Access and timeliness for students and families: When a team’s start date is looming, waiting on a physician to sign off a completed exam can delay student participation, especially in rural or underserved areas where physician availability is limited. Letting NPs, midwives, and PAs sign directly has the potential to speed up clearance and reduce extra visits, time off work, and transportation barriers for families.
• Professional accountability and documentation: A name on the dotted line comes with expectations. If the bill becomes law, NPs and PAs who sign sports physicals will want to review their exam templates, screening questions, and documentation habits to ensure they align with best practices for detecting cardiac, orthopedic, or other conditions that could put young athletes at risk.
• Advocacy momentum in a reduced-practice state: Alabama’s classification as a reduced-practice state highlights how constrained NP roles can be compared with full-practice states. A bill like HB 276 may become an example for future legislation that gradually aligns legal authority with what nurses are already trained and routinely trusted to do in schools, clinics, and rural health settings.

The Alabama State Nurses Association has been tracking HB 276 in its legislative updates, signaling that organized nursing is watching and engaging on this issue. For nurses across the state, this is a moment to connect with your professional association, understand your own employer’s policies, and think about how expanded sign‑off authority fits into your practice.

 

What Happens Next

For school nurses and advanced practice nurses in Alabama, HB 276 could expand professional utility and help families get timely access to care. 

The changes also signal a broader shift in how states consider advanced practice roles in preventive and school-based health — especially when those roles already include performing the underlying clinical exam. 

If you practice or care for student athletes, this bill is one to watch as it advances through the legislature.

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