SB129: Bill Text

LRB-2589/1

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1999 - 2000 LEGISLATURE

1999 Senate BILL 129

April 21, 1999 - Introduced by Senators Robson, Clausing, Cowles, Darling, Huelsman, Lazich, Moore, Panzer, Rosenzweig, Rude and Schultz, cosponsored by Representatives Johnsrud, Ainsworth, Albers, Bock, Brandemuehl, Carpenter, Cullen, Grothman, Gunderson, Hahn, Huber, Huebsch, Hutchison, Jensen, Klusman, Ladwig, La Fave, J. Lehman, Miller, Musser, Olsen, Petrowski, Pettis, Seratti, Stone, Townsend, Turner, Underheim, Walker and Wasserman. Referred to Committee on Human Services and Aging.

SB129,1,6 An Act to amend 441.01 (1), 441.06 (1), 441.06 (4), 441.07 (1) (b), 441.10 (3) (a), 441.10 (3) (c), 441.11 (1) to (3), 441.11 (4), 441.115 (1), 441.115 (2) (a), 441.115 (2) (b), 441.13 and 441.15 (3) (a); to repeal and recreate 441.11 (3) and 441.11 (4); and to create subchapter I (title) of chapter 441 [precedes 441.01] and subchapter II of chapter 441 [precedes 441.50] of the statutes; relating to: adopting the nurse licensure compact and granting rule-making authority.

Analysis by the Legislative Reference Bureau

Under current law, no person may practice professional nursing in this state unless he or she is licensed as a registered nurse by the board of nursing. Although a license is not required for practical nursing, no person without such a license issued by the board of nursing may hold himself or herself out as a licensed practiced nurse or indicate in any way that he or she is a licensed practical nurse. Exceptions to these prohibitions are provided for temporary practice. In addition, current law provides a mechanism for persons who are licensed in other states to be issued a license in this state without retaking the national licensing examination.

This bill adopts the interstate compact on nurse licensure, which was approved by the national council of state boards of nursing on December 15, 1997. Under the compact, a nurse who is licensed in a party state (a state that has adopted the compact) may practice nursing in any other party state without obtaining a license in the other state. The compact requires every nurse practicing in a party state to comply with the practice laws of that state and allows each party state to limit or revoke the multistate licensure privilege.

The compact also requires each party state to participate in the establishment of a coordinated data base of all licensed nurses. The system includes information on the licensure and disciplinary history of each nurse.

For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB129, s. 1 Section 1. Subchapter I (title) of chapter 441 [precedes 441.01] of the statutes is created to read:

SB129,2,3 chapter 441

SB129,2,5 subchapter i Regulation of nursing

SB129, s. 2 Section 2. 441.01 (1) of the statutes is amended to read:

SB129,2,7 441.01 (1) In this chapter subchapter, "board" means board of nursing.

SB129, s. 3 Section 3. 441.06 (1) of the statutes is amended to read:

SB129,3,2 441.06 (1) An applicant for licensure as a registered nurse who complies with the requirements of this chapter subchapter and satisfactorily passes an examination shall receive a license. The holder of such a license of another state or territory or province of Canada may be granted a license without examination if the holder's credentials of general and professional educational qualifications and other qualifications are comparable to those required in this state during the same period and if the board is satisfied from the holder's employment and professional record that the holder is currently competent to practice the profession. The board shall evaluate the credentials and determine the equivalency and competency in each case. The application for licensure without examination shall be accompanied by the fee prescribed in s. 440.05 (2).

SB129, s. 4 Section 4. 441.06 (4) of the statutes is amended to read:

SB129,3,11 441.06 (4) No person may practice or attempt to practice professional nursing, nor use the title, letters, or anything else to indicate that he or she is a registered or professional nurse unless he or she is licensed under this section. No person not so licensed may use in connection with his or her nursing employment or vocation any title or anything else to indicate that he or she is a trained, certified or graduate nurse. This subsection does not apply to any person who is licensed to practice nursing by a jurisdiction, other than this state, that has adopted the nurse licensure compact under s. 441.50.

SB129, s. 5 Section 5. 441.07 (1) (b) of the statutes is amended to read:

SB129,3,14 441.07 (1) (b) One or more violations of this chapter subchapter or any rule adopted by the board under the authority of this chapter subchapter.

SB129, s. 6 Section 6. 441.10 (3) (a) of the statutes is amended to read:

SB129,3,21 441.10 (3) (a) On complying with this chapter subchapter relating to applicants for licensure as licensed practical nurses, and passing an examination, the applicant shall receive a license as a licensed practical nurse. The holder of the license is a "licensed practical nurse" and may append the letters "L.P.N." to his or her name. The board may reprimand or may limit, suspend or revoke the license of a licensed practical nurse under s. 441.07.

SB129, s. 7 Section 7. 441.10 (3) (c) of the statutes is amended to read:

SB129,4,10 441.10 (3) (c) No license is required for practical nursing, but no person without a license may hold himself or herself out as a licensed practical nurse or licensed attendant, use the title or letters "Trained Practical Nurse" or "T.P.N.", "Licensed Practical Nurse" or "L.P.N.", "Licensed Attendant" or "L.A.", "Trained Attendant" or "T.A.", or otherwise seek to indicate that he or she is a licensed practical nurse or licensed attendant. No licensed practical nurse or licensed attendant may use the title, or otherwise seek to act as a registered, licensed, graduate or professional nurse. Anyone violating this subsection shall be subject to the penalties prescribed by s. 441.13. The board shall grant without examination a license as a licensed practical nurse to any person who was on July 1, 1949, a licensed attendant. This paragraph does not apply to any person who is licensed to practice practical nursing by a jurisdiction, other than this state, that has adopted the nurse licensure compact under s. 441.50.

SB129, s. 8 Section 8. 441.11 (1) to (3) of the statutes are amended to read:

SB129,4,14 441.11 (1) For compensation. Wherever the term "compensation" is used in this chapter subchapter it shall include indirect compensation as well as direct compensation and also the expectation thereof whether actually received or not.

SB129,4,19 (2) Nurse and nursing. Except as provided under s. 441.08, wherever the term "nurse" is used in this chapter subchapter without modification or amplification it shall mean only a registered nurse. Wherever the term "nursing" is used in this chapter subchapter without modification or amplification it shall mean the practice of professional nursing as specified in sub. (4).

SB129,5,8 (3) Practice of practical nursing. The practice of practical nursing under this chapter subchapter means the performance for compensation of any simple acts in the care of convalescent, subacutely or chronically ill, injured or infirm persons, or of any act or procedure in the care of the more acutely ill, injured or infirm under the specific direction of a nurse, physician, podiatrist licensed under ch. 448, dentist licensed under ch. 447 or optometrist licensed under ch. 449, or under an order of a person who is licensed to practice medicine, podiatry or dentistry in another state if that person prepared the order after examining the patient in that other state and directs that the order be carried out in this state. A simple act is one which that does not require any substantial nursing skill, knowledge or training, or the application of nursing principles based on biological, physical or social sciences, or the understanding of cause and effect in such acts and is one which that is of a nature of those approved by the board for the curriculum of schools for licensed practical nurses.

SB129, s. 9 Section 9. 441.11 (3) of the statutes, as affected by 1997 Wisconsin Act 62, is repealed and recreated to read:

SB129,5,24 441.11 (3) Practice of practical nursing. The practice of practical nursing under this subchapter means the performance for compensation of any simple acts in the care of convalescent, subacutely or chronically ill, injured or infirm persons, or of any act or procedure in the care of the more acutely ill, injured or infirm under the specific direction of a nurse, physician, podiatrist licensed under ch. 448, dentist licensed under ch. 447 or optometrist licensed under ch. 449, or under an order of a person who is licensed to practice medicine, podiatry, dentistry or optometry in another state if that person prepared the order after examining the patient in that other state and directs that the order be carried out in this state. A simple act is one that does not require any substantial nursing skill, knowledge or training, or the application of nursing principles based on biological, physical or social sciences, or the understanding of cause and effect in such acts and is one that is of a nature of those approved by the board for the curriculum of schools for licensed practical nurses.

SB129, s. 10 Section 10. 441.11 (4) of the statutes is amended to read:

SB129,6,16 441.11 (4) Practice of professional nursing. The practice of professional nursing within the terms of this chapter subchapter means the performance for compensation of any act in the observation or care of the ill, injured or infirm, or for the maintenance of health or prevention of illness of others, which act requires substantial nursing skill, knowledge or training, or application of nursing principles based on biological, physical and social sciences, such as the observation and recording of symptoms and reactions, the execution of procedures and techniques in the treatment of the sick under the general or special supervision or direction of a physician, podiatrist licensed under ch. 448, dentist licensed under ch. 447 or optometrist licensed under ch. 449, or under an order of a person who is licensed to practice medicine, podiatry or dentistry in another state if that person prepared the order after examining the patient in that other state and directs that the order be carried out in this state, and the execution of general nursing procedures and techniques. Except as provided in s. 50.04 (2) (b), the practice of professional nursing includes the supervision of a patient and the supervision and direction of licensed practical nurses and less skilled assistants.

SB129, s. 11 Section 11. 441.11 (4) of the statutes, as affected by 1997 Wisconsin Act 62, is repealed and recreated to read:

SB129,7,9 441.11 (4) Practice of professional nursing. The practice of professional nursing within the terms of this subchapter means the performance for compensation of any act in the observation or care of the ill, injured or infirm, or for the maintenance of health or prevention of illness of others, which act requires substantial nursing skill, knowledge or training, or application of nursing principles based on biological, physical and social sciences, such as the observation and recording of symptoms and reactions, the execution of procedures and techniques in the treatment of the sick under the general or special supervision or direction of a physician, podiatrist licensed under ch. 448, dentist licensed under ch. 447 or optometrist licensed under ch. 449, or under an order of a person who is licensed to practice medicine, podiatry, dentistry or optometry in another state if that person prepared the order after examining the patient in that other state and directs that the order be carried out in this state, and the execution of general nursing procedures and techniques. Except as provided in s. 50.04 (2) (b), the practice of professional nursing includes the supervision of a patient and the supervision and direction of licensed practical nurses and less skilled assistants.

SB129, s. 12 Section 12. 441.115 (1) of the statutes is amended to read:

SB129,7,17 441.115 (1) This chapter shall not be construed to affect nursing by friends, members of the family or undergraduates in an accredited school, nor be construed to interfere with members of religious communities or orders having charge of hospitals or taking care of the sick in their homes, except that none of such excepted persons while engaged in such activities shall represent himself or herself as a registered, trained, certified or graduate nurse unless registered under this chapter subchapter.

SB129, s. 13 Section 13. 441.115 (2) (a) of the statutes is amended to read:

SB129,7,25 441.115 (2) (a) In this subsection, "nursing credential" means a license, permit or certificate of registration or certification that is granted to a person by another state or territory or by a foreign country or province and that authorizes or qualifies the person holding the credential to perform acts that are substantially the same as those performed by a person licensed as a registered nurse or licensed practical nurse under this chapter subchapter. In this paragraph, "state or territory" excludes any state or territory that has adopted the nurse licensure compact under s. 441.50.

SB129, s. 14 Section 14. 441.115 (2) (b) of the statutes is amended to read:

SB129,8,14 441.115 (2) (b) A person who holds a current, valid nursing credential may practice professional or practical nursing in this state, as provided under par. (c), for not more than 72 consecutive hours each year without holding a license granted by the board under this chapter subchapter if the board determines that the requirements for the nursing credential that the person holds are substantially equivalent to the requirements for licensure under this chapter subchapter. Except in an emergency, the person shall provide to the board, at least 7 days before practicing professional or practical nursing for the person who is specified under par. (c) 2., written notice that includes the name of the person providing notice, the type of nursing credential that the person holds and the name of the state, territory, foreign country or province that granted the nursing credential. In the event of an emergency, the person shall provide to the board written notice that includes the information otherwise required under this paragraph, as soon as practicable.

SB129, s. 15 Section 15. 441.13 of the statutes is amended to read:

SB129,8,18 441.13 Penalty. (1) Any person violating this chapter subchapter or knowingly employing another in violation of this chapter subchapter may be fined not more than $250 or imprisoned not more than one year in the county jail.

SB129,8,22 (2) No action may be brought or other proceeding had to recover compensation for professional nursing services unless at the time such services were rendered the person rendering the same was a registered nurse or had a temporary permit issued under this chapter subchapter.

SB129,8,23 (3) The remedy of injunction may be used in enforcing this chapter subchapter.

SB129, s. 16 Section 16. 441.15 (3) (a) of the statutes is amended to read:

SB129,9,5 441.15 (3) (a) The board shall grant a license to engage in the practice of nurse-midwifery to any person licensed as a registered nurse under this chapter subchapter or in a party state, as defined in s. 441.50 (2) (j), who meets the educational and training prerequisites established by the board for the practice of nurse-midwifery and who pays the fee specified under s. 440.05 (1).

SB129, s. 17 Section 17. Subchapter II of chapter 441 [precedes 441.50] of the statutes is created to read:

SB129,9,9 subchapter II nurse licensure compact

SB129,9,10 441.50 Nurse Licensure Compact.

SB129,9,11 (1) Article I - Findings and Declaration of Purpose.

SB129,9,12 (a) The party states find all of the following:

SB129,9,15 1. That the health and safety of the public are affected by the degree of compliance with and the effectiveness of enforcement activities related to state nurse licensure laws.

SB129,9,17 2. That violations of nurse licensure and other laws regulating the practice of nursing may result in injury or harm to the public.

SB129,9,21 3. That the expanded mobility of nurses and the use of advanced communication technologies as part of our nation's health care delivery system require greater coordination and cooperation among states in the areas of nurse licensure and regulation.

SB129,9,23 4. That new practice modalities and technology make compliance with individual state nurse licensure laws difficult and complex.

SB129,9,25 5. That the current system of duplicative licensure for nurses practicing in multiple states is cumbersome and redundant to both nurses and states.

SB129,10,1 (b) The general purposes of this compact are as follows:

SB129,10,2 1. To facilitate the states' responsibility to protect the public's health and safety.

SB129,10,4 2. To ensure and encourage the cooperation of party states in the areas of nurse licensure and regulation.

SB129,10,6 3. To facilitate the exchange of information between party states in the areas of nurse regulation, investigation and adverse actions.

SB129,10,8 4. To promote compliance with the laws governing the practice of nursing in each jurisdiction.

SB129,10,11 5. To invest all party states with the authority to hold a nurse accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered through the mutual recognition of party state licenses.

SB129,10,12 (2) Article II - Definitions. As used in this compact:

SB129,10,13 (a) "Adverse action" means a home or remote state action.

SB129,10,15 (b) "Alternative program" means a voluntary, nondisciplinary monitoring program approved by a nurse licensing board.

SB129,10,19 (c) "Coordinated licensure information system" means an integrated process for collecting, storing and sharing information on nurse licensure and enforcement activities related to nurse licensure laws, which is administered by a nonprofit organization composed of and controlled by state nurse licensing boards.

SB129,10,20 (d) "Current significant investigative information" means any of the following:

SB129,10,24 1. Investigative information that a licensing board, after a preliminary inquiry that includes notification and an opportunity for the nurse to respond if required by state law, has reason to believe is not groundless and, if proved true, would indicate more than a minor infraction.

SB129,11,3 2. Investigative information that indicates that the nurse represents an immediate threat to public health and safety regardless of whether the nurse has been notified and had an opportunity to respond.

SB129,11,5 (e) "Home state" means the party state that is the nurse's primary state of residence.

SB129,11,10 (f) "Home state action" means any administrative, civil, equitable or criminal action permitted by the home state's laws that are imposed on a nurse by the home state's licensing board or other authority including actions against an individual's license, such as revocation, suspension, probation or any other action that affects a nurse's authorization to practice.