The Board shall promulgate rules for its own guidance and for the guidance of the profession and define and enforce professional conduct and unethical practices not inconsistent with the law relating to the profession. [s. 15.08 (5) (b), Stats.] The Board shall promulgate rules necessary to administer s. 441.16, including rules for all of the following: • Establishing the education, training or experience requirements that a registered nurse must satisfy to be an advanced practice nurse. The rules shall require a registered nurse to have education, training or experience that is in addition to the education, training or experience required for licensure as a registered nurse.
• Establish the appropriate education, training and examination requirements that an advanced practice nurse must satisfy to qualify for a certificate to issue prescription orders.
• Defining the scope of practice within which an advanced practice nurse may issue prescription orders.
• Specifying the classes of drugs, individual drugs or devices that may not be prescribed by an advanced practice nurse.
• Establishing procedures for maintaining a certificate to issue prescription orders, including requirements for continuing education and a requirement to complete the nursing workforce survey and submit the fee required under s. 441.01 (7). [s. 441.16 (3), Stats] Related statute or rule: n/a
Plain language analysis:
Section 1 adds doctoral degree in nursing or a related health field as a qualifying degree. The Board recognizes that some schools are offering doctoral degrees in lieu of master’s degrees and did not want those obtaining a higher degree to be ineligible for the certificate.
Section 2 modifies the definition of “clinical pharmacology or therapeutics” by changing the phrase “likelihood of success” to “efficacy” in order to be clearer and more accurate.
Sections 3, 4, 5, 6 and 7 consolidate the qualifications required for the certification and the application requirements into one section. Language to accommodate this consolidation has been updated. The degree required is updated to recognize a doctoral degree in addition to the master’s degree. The applicant is required to have obtained 45 contact hours in clinical pharmacology or therapeutics 5 years, instead of 3 years, preceding the application in order to accommodate graduates from programs which offer the pharmacology course early in the curriculum sequence rather than requiring the applicant to repeat the course creating unnecessary delay and expense.
Section 8 creates a renewal provisions. In order to renew an advance practice nurse prescriber certificate the certificate holder must pay a renewal fee, complete the nursing workforce survey, certify completion of the continuing education and provide evidence of current certification by an approved certifying body of nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist.
Sections 9 and 10 updates the continuing education requirements. A nurse prescriber shall complete 16 contact hours during the biennium. It removes the provisions allowing for an average minimum number per year which is then reported on a schedule consistent with the national certifying body. The Board is requiring continuing education to be completed each biennium. In addition, two of those contact hours shall be in responsible prescribing of controlled substances The Board is requiring the specific hours in responsible prescribing of controlled substances due to the current prescription drug addiction public health crisis.
Section 11 clarifies that attention deficient hyperactivity disorder is included in hyperkinesis.
Section 12 updates language for the advance practice nurse prescriber to provide upon request evidence of the advance practice nurse prescriber certification.
Section 13 updates language to allow prescriptions to be submitted electronically as permitted by state and federal law and removes the outdated typewritten provision. It also updates language to require the drug enforcement agency number of the license.
Section 14 removes the mileage limitation but clarifies the dispensing of drugs is at the treatment facility.
Sections 15 and 16 update language. The word “care” is replaces “case” which is more reflective of current practice. One reference to advanced practice nurses is corrected to state advanced practice nurse prescribers. The Board removed the provision relating to notification to advanced practice nurses of mutual educational opportunities and available communication networks. The provisions regarding tests which may be ordered by an advanced practice nurse prescriber has been updated and clarified. The language regarding the collaborative relationship has been updated to reflect the standard language of “training, education and experience” instead of “professional expertise” and removing the requirement the physician shall document this relationship in recognition that the Board does not have jurisdiction over a physician.
Summary of, and comparison with, existing or proposed federal regulation: None
Comparison with rules in adjacent states:
Illinois: Illinois licenses nurses at three levels: licensed practice nurse, registered nurse and advance practice nurse. Illinois requires an advanced practice nurse to additionally hold a separate license for the prescribing of controlled substances. In Illinois a collaborating physician may delegate prescriptive authority to a nurse holding an advanced practice nurse license. An APN who has been given controlled substances prescriptive authority shall be required to obtain an Illinois mid-level practitioner controlled substances license. The requirements for obtaining a mid-level practitioner controlled substances license is to be a physician assistant or advanced practice nurse with an active license in good standing; provide the license number and controlled substances license number of the delegating or collaborating physician or podiatrist; written notice of delegation of prescriptive authority signed by the physician or podiatrist including the schedule of controlled substances or the specific Schedule II controlled substances that the mid-level practitioner may dispense or prescribe; and if license is issued with Schedule II authority, the advance practice nurse must have taken at least 45 hours of graduate contact hours in pharmacology. The mid-level practitioner controlled substances license requires 5 hours annually of continuing education in pharmacology. The mid-level practitioner controlled substances license only allows prescribing and dispensing of controlled substances the collaborating physician prescribes.
Iowa: Iowa licenses nurses at three levels: licensed practice nurse, registered nurse and advance registered nurse practitioner. The advanced registered nurse prescriber has a scope of practice which includes prescriptive authority. There is no equivalent certification in Iowa to the Wisconsin advance practice nurse prescriber certificate.
Michigan: Michigan licenses nurses at two levels: licensed practice nurse and registered nurse. Michigan has specialty certifications for a nurse anesthetist, nurse midwife and nurse practitioner. A physician who supervises a nurse practitioner or nurse midwife may delegate the prescribing of non-controlled prescriptions and Schedules 3-5 controlled substances if the delegating physician establishes a written authorization. A delegating physician may delegate the prescription of Schedule 2 controlled substances only if the nurse practitioner or nurse midwife is practicing in a surgical outpatient facility, hospital and hospice with the patient being located within the facility. There is no equivalent certification in Michigan to the Wisconsin advance practice nurse prescriber certificate.
Minnesota: Effective January 1, 2015, Minnesota licenses nurses at three levels: licensed practice nurse, registered nurse and advanced practice registered nurses. The advanced practice registered nurse has a scope of practice which includes prescriptive authority. There is no equivalent certification in Minnesota to the Wisconsin advance practice nurse prescriber certificate.
Summary of factual data and analytical methodologies:
The Board reviewed their rules and consulted with stakeholders.
Analysis and supporting documents used to determine effect on small business or in preparation of economic impact analysis:
This rule was posted for a period of 14 days for economic comments and none were received.
Fiscal Estimate and Economic Impact Analysis:
The Fiscal Estimate and Economic Impact Analysis is attached.
Effect on small business:
These proposed rules do not have an economic impact on small businesses, as defined in s. 227.114 (1), Stats. The Department’s Regulatory Review Coordinator may be contacted by email at Eric.Esser@wisconsin.gov, or by calling (608) 267-2435. Agency contact person:
Sharon Henes, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, Wisconsin 53708; telephone 608-261-2377; email at Sharon.Henes@wisconsin.gov. Place where comments are to be submitted and deadline for submission:
Comments may be submitted to Sharon Henes, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, WI 53708-8366, or by email to Sharon.Henes@wisconsin.gov. Comments must be received at or before the public hearing to be held on March 10, 2016 to be included in the record of rule-making proceedings. ---------------------------------------------------------------------------------------------------------------------
TEXT OF RULE
Section 1. N 8.02 (c) is amended to read:
N 8.02 (c) For applicants who receive national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist after July 1, 1998, the registered nurse holds a master’s or doctoral degree in nursing or a related health field granted by a college or university accredited by a regional accrediting agency approved by the board of education in the state in which the college or university is located.
Section 2. N 8.02 (4) is amended to read:
N 8.02 (4) “Clinical pharmacology or therapeutics” means the identification of individual and classes of drugs, their indications and contraindications, their likelihood of success efficacy, their side-effects and their interactions, as well as, clinical judgment skills and decision-making, based on thorough interviewing, history-taking, physical assessment, test selection and interpretation, pathophysiology, epidemiology, diagnostic reasoning, differentiation of conditions, treatment decisions, case evaluation and non-pharmacologic interventions.
Section 3. N 8.03 (intro) is amended to read:
N 8.03 Qualifications for certification Certification as an advanced practice nurse prescriber. An applicant for initial certification to issue prescription orders as an advanced practice nurse prescriber shall be granted a certificate by the board if the applicant complies with all of the following:
Section 4. N 8.03 (1) is renumberd to N 8.03 (1m) and amended to read:
N 8.03 (1) Has Provides evidence of holding a current license to practice as a professional nurse in this state or has a current license to practice professional nursing in another state which has adopted the nurse licensure compact.
