SB497: Bill Text

SB497,37,23 441.07 (1g) (intro.) Subject to the rules promulgated under s. 440.03 (1), the board may deny an initial license or revoke, limit, suspend, or deny the renewal of a license of a registered nurse, nurse-midwife advanced practice registered nurse, or licensed practical nurse; deny an initial certificate or revoke, limit, suspend, or deny the renewal of a certificate to prescribe drugs or devices granted under s. 441.16; or reprimand a registered nurse, nurse-midwife advanced practice registered nurse, or licensed practical nurse, if the board finds that the applicant or licensee committed any of the following:

SB497,37,24 (a) Fraud in the procuring or renewal of the certificate or license.

SB497,38,3 (c) Acts which show the registered nurse, nurse-midwife advanced practice registered nurse, or licensed practical nurse to be unfit or incompetent by reason of negligence, abuse of alcohol or other drugs, or mental incompetency.

SB497,38,6 (e) A violation of any state or federal law that regulates prescribing or dispensing drugs or devices, if the person has a certificate to prescribe drugs or devices under s. 441.16 is authorized to issue prescription orders under s. 441.09.

SB497,82 Section 82. 441.09 of the statutes is created to read:

SB497,38,9 441.09 Advanced practice registered nurses. (1) Definitions. In this section:

SB497,38,14 (a) “Advanced practice registered nursing” means practicing in one of the 4 recognized roles based on advanced clinical knowledge and skills focusing on direct care of individuals, greater responsibility, autonomy, and accountability for the provision of care, health promotion and maintenance, management of patient conditions, and the use and prescription of pharmacological interventions.

SB497,38,21 (b) “Clinical pharmacology or therapeutics” means the identification of individual and classes of drugs, their indications and contraindications, their 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 nonpharmacological interventions.

SB497,39,2 (c) “Practice of nurse-midwifery" means the management of women's health care, pregnancy, childbirth, postpartum care for newborns, family planning, and gynecological services consistent with the standards of practice of the American College of Nurse-Midwives and the education, training, and experience of the nurse-midwife.

SB497,39,3 (d) “Recognized role” means one of the following roles:

SB497,39,4 1. Certified nurse-midwife.

SB497,39,5 2. Certified registered nurse anesthetist.

SB497,39,6 3. Clinical nurse specialist.

SB497,39,7 4. Nurse practitioner.

SB497,39,10 (2) Initial license. (a) Any person who satisfies all of the following requirements may apply to the department for initial licensure by the board as an advanced practice registered nurse:

SB497,39,13 1. The person holds a valid license to practice as a registered nurse issued under s. 441.06 (1) or (1m) or applies concurrently for a license under s. 441.06 (1) or (1m) with the application for a license under this paragraph.

SB497,39,15 2. The person provides evidence satisfactory to the board that he or she satisfies one of the following criteria:

SB497,39,18 a. The person has completed an accredited graduate-level or postgraduate-level education program that prepares the person for the practice of advanced practice registered nursing.

SB497,39,22 b. On January 1, 2017, the person was licensed as a registered nurse in this state and was practicing in a recognized role, and the person satisfies additional criteria established by the board by rule under this subd. 2. b. relating to practice or education.

SB497,39,23 3. The person pays the fee specified under s. 440.05 (1).

SB497,39,25 4. The person provides evidence of malpractice liability insurance coverage as provided in sub. (7).

SB497,40,3 5. If the person is applying to receive a certified nurse-midwife endorsement under par. (b), the person provides evidence satisfactory to the board that the person is certified by the American Midwifery Certification Board.

SB497,40,12 (b) The board shall grant an advanced practice registered nurse license to a person the board determines meets the requirements under par. (a). The board shall also grant a person who receives a license under this paragraph one or more endorsements corresponding to the recognized roles for which the board determines that the person qualifies based on the person's education and experience under par. (a) 2. a. or b. and, if applicable, the person's certification under par. (a) 5. The board may not grant a license under this paragraph to a person applying concurrently for a license under s. 441.06 (1) or (1m), unless the board also grants the person a license to practice as a registered nurse.

SB497,40,20 (c) The board, upon application, shall also grant authority to issue prescription orders to a person who is granted a license under this subsection and who meets the education, training, and examination requirements established by the board for authority to issue prescription orders. The board shall maintain a register of all advanced practice registered nurses authorized to issue prescription orders under this paragraph. An advanced practice registered nurse with the authority to issue prescription orders under this paragraph may provide expedited partner therapy in the manner described in s. 448.035.

SB497,41,6 (3) License renewal. On or before the applicable renewal date specified under s. 440.08 (2) (a), a person issued a license under sub. (2) shall submit to the board on a form furnished by the board a statement giving his or her name and residence, the nursing workforce survey and fee required under s. 441.01 (7), evidence of having satisfied the continuing education requirements under sub. (6), evidence of malpractice liability insurance coverage as provided in sub. (7), and other information that the board requires by rule, with the applicable renewal fee determined by the department under s. 440.03 (9) (a). The board shall grant to a person who satisfies the requirements under this subsection the renewal of his or her advanced practice registered nurse license and endorsements granted under sub. (2) (b) and shall grant the renewal of his or her license to practice as a registered nurse.

SB497,41,9 (4) Practice; titles. (a) 1. The holder of a license issued under this section is an “advanced practice registered nurse" and may append to his or her name the title “A.P.R.N." and is authorized to practice advanced practice registered nursing.

SB497,41,12 2. The holder of an endorsement for a recognized role granted under sub. (2) (b) may append to his or her name the title and an abbreviation corresponding to that recognized role.

SB497,41,15 3. The holder of a certified nurse-midwife endorsement granted under sub. (2) (b) is a certified nurse-midwife and is authorized to engage in the practice of nurse-midwifery.

SB497,41,19 (b) 1. Except as provided in s. 257.03, no person may practice or attempt to practice advanced practice registered nursing, nor use the title “advanced practice registered nurse," the title “A.P.R.N.," or anything else to indicate that he or she is an advanced practice registered nurse unless he or she is licensed under this section.

SB497,41,20 2. Except as provided in s. 257.03, no person may do any of the following:

SB497,41,23 a. Use the title “certified nurse-midwife,” the title “C.N.M.,” or anything else to indicate that he or she is a certified nurse-midwife unless he or she has been granted a certified nurse-midwife endorsement under sub. (2) (b).

SB497,41,25 b. Engage in the practice of nurse-midwifery unless he or she has been granted a certified nurse-midwife endorsement under sub. (2) (b).

SB497,42,4 c. Use the title “certified registered nurse anesthetist,” the title “C.R.N.A.,” or anything else to indicate that he or she is a certified registered nurse anesthetist unless he or she has been granted a certified registered nurse anesthetist endorsement under sub. (2) (b).

SB497,42,7 d. Use the title “clinical nurse specialist,” the title “C.N.S.,” or anything else to indicate that he or she is a clinical nurse specialist unless he or she has been granted a clinical nurse specialist endorsement under sub. (2) (b).

SB497,42,10 e. Use the title “nurse practitioner,” the title “N.P.,” or anything else to indicate that he or she is a nurse practitioner unless he or she has been granted a nurse practitioner endorsement under sub. (2) (b).

SB497,42,16 (6) Continuing education. Every advanced practice registered nurse shall submit to the board evidence of having completed at least 16 contact hours per biennium in clinical pharmacology or therapeutics relevant to the advanced practice registered nurse's area of practice. The hours required under this subsection must include at least 2 contact hours regarding best practices in prescribing controlled substances.

SB497,42,23 (7) Malpractice liability insurance. Every advanced practice registered nurse shall at all times have in effect malpractice liability insurance coverage in the minimum amounts required by the rules of the board. An advanced practice registered nurse shall submit evidence of that coverage to the board when applying for an initial license under this section or a renewal of a license under this section. An advanced practice registered nurse shall also submit such evidence to the board upon request of the board.

SB497,43,2 (8) Delegation. An advanced practice registered nurse who has authority to issue prescription orders may not delegate the act of issuing a prescription order to any nurse who is not authorized to issue prescription orders. Nothing in this section prohibits a nurse from issuing a prescription order as an act delegated by a physician.

SB497,43,4 (9) Rules. The board shall promulgate rules necessary to administer this section, including rules for all of the following:

SB497,43,8 (a) Establishing the appropriate education, training, or experience requirements that a registered nurse must satisfy to be an advanced practice registered nurse and to qualify to be granted the authority to issue prescription orders under sub. (2) (c).

SB497,43,11 (b) Specifying the classes of drugs, individual drugs, or devices that may not be prescribed by an advanced practice registered nurse authorized to issue prescription orders under sub. (2) (c).

SB497,43,12 (c) Specifying the conditions to be met for registered nurses to do the following:

SB497,43,13 1. Administer a drug prescribed by an advanced practice registered nurse.

SB497,43,14 2. Administer a drug at the direction of an advanced practice registered nurse.

SB497,83 Section 83. 441.11 (title) of the statutes is repealed.

SB497,84 Section 84. 441.11 (1) of the statutes is repealed.

SB497,85 Section 85. 441.11 (2) of the statutes is renumbered 441.09 (8m) and amended to read:

SB497,43,21 441.09 (8m) Nurse anesthetists. The provisions of s. 448.04 (1) (g) do not apply to a licensed advanced practice registered nurse who possesses a certified registered nurse anesthetist endorsement under this section.

SB497,86 Section 86. 441.11 (3) of the statutes is repealed.

SB497,87 Section 87. 441.15 of the statutes is repealed.

SB497,88 Section 88. 441.16 of the statutes is repealed.

SB497,89 Section 89. 441.18 (2) (a) (intro.) of the statutes is amended to read:

SB497,44,3 441.18 (2) (a) (intro.) An advanced practice registered nurse certified to issue prescription orders under s. 441.16 who has prescribing authority under s. 441.09 (2) (c) may do any of the following:

SB497,90 Section 90. 441.18 (2) (b) of the statutes is amended to read:

SB497,44,11 441.18 (2) (b) An advanced practice registered nurse who prescribes or delivers an opioid antagonist under par. (a) 1. shall ensure that the person to whom the opioid antagonist is prescribed has or has the capacity to provide the knowledge and training necessary to safely administer the opioid antagonist to an individual undergoing an opioid-related overdose and that the person demonstrates the capacity to ensure that any individual to whom the person further delivers the opioid antagonist has or receives that knowledge and training.

SB497,91 Section 91. 441.18 (3) of the statutes is amended to read:

SB497,44,18 441.18 (3) An advanced practice registered nurse who, acting in good faith, prescribes or delivers an opioid antagonist in accordance with sub. (2), or who, acting in good faith, otherwise lawfully prescribes or dispenses an opioid antagonist, shall be immune from criminal or civil liability and may not be subject to professional discipline under s. 441.07 for any outcomes resulting from prescribing, delivering, or dispensing the opioid antagonist.

SB497,92 Section 92. 448.03 (2) (a) of the statutes is amended to read:

SB497,45,2 448.03 (2) (a) Any person lawfully practicing within the scope of a license, permit, registration, certificate or certification granted to practice midwifery under subch. XIII of ch. 440, to practice professional or , practical, or advanced practice registered nursing or nurse-midwifery under ch. 441, to practice chiropractic under ch. 446, to practice dentistry or dental hygiene under ch. 447, to practice optometry under ch. 449, to practice acupuncture under ch. 451 or under any other statutory provision, or as otherwise provided by statute.

SB497,93 Section 93. 448.035 (1) (a) of the statutes is repealed.

SB497,94 Section 94. 448.035 (2), (3) and (4) of the statutes are amended to read:

SB497,45,19 448.035 (2) Notwithstanding the requirements of s. 448.30, a physician, physician assistant, or certified advanced practice registered nurse prescriber who has prescribing authority under s. 441.09 (2) (c) may provide expedited partner therapy if the patient is diagnosed as infected with a chlamydial infection, gonorrhea, or trichomoniasis and the patient has had sexual contact with a sexual partner during which the chlamydial infection, gonorrhea, or trichomoniasis may have been transmitted to or from the sexual partner. The physician, physician assistant, or certified advanced practice registered nurse prescriber shall attempt to obtain the name of the patient's sexual partner. A prescription order for an antimicrobial drug prepared under this subsection shall include the name and address of the patient's sexual partner, if known. If the physician, physician assistant, or certified advanced practice registered nurse prescriber is unable to obtain the name of the patient's sexual partner, the prescription order shall include, in ordinary bold-faced capital letters, the words, “expedited partner therapy" or the letters “EPT."

SB497,45,24 (3) The physician, physician assistant, or certified advanced practice registered nurse prescriber shall provide the patient with a copy of the information sheet prepared by the department of health services under s. 46.03 (44) and shall request that the patient give the information sheet to the person with whom the patient had sexual contact.

SB497,46,5 (4) (a) Except as provided in par. (b), a physician, physician assistant, or certified advanced practice registered nurse prescriber is immune from civil liability for injury to or the death of a person who takes any antimicrobial drug if the antimicrobial drug is prescribed, dispensed, or furnished under this section and if expedited partner therapy is provided as specified under this section.

SB497,46,9 (b) The immunity under par. (a) does not extend to the donation, distribution, furnishing, or dispensing of an antimicrobial drug by a physician, physician assistant, or certified advanced practice registered nurse prescriber whose act or omission involves reckless, wanton, or intentional misconduct.

SB497,95 Section 95. 448.56 (1) and (1m) (b) of the statutes are amended to read:

SB497,46,25 448.56 (1) Written referral. Except as provided in this subsection and s. 448.52, a person may practice physical therapy only upon the written referral of a physician, physician assistant, chiropractor, dentist, podiatrist, or advanced practice registered nurse prescriber certified under s. 441.16 (2). Written referral is not required if a physical therapist provides services in schools to children with disabilities, as defined in s. 115.76 (5), pursuant to rules promulgated by the department of public instruction; provides services as part of a home health care agency; provides services to a patient in a nursing home pursuant to the patient's plan of care; provides services related to athletic activities, conditioning, or injury prevention; or provides services to an individual for a previously diagnosed medical condition after informing the individual's physician, physician assistant, chiropractor, dentist, podiatrist, or advanced practice registered nurse prescriber certified under s. 441.16 (2) who made the diagnosis. The examining board may promulgate rules establishing additional services that are excepted from the written referral requirements of this subsection.

SB497,47,6 (1m) (b) The examining board shall promulgate rules establishing the requirements that a physical therapist must satisfy if a physician, physician assistant, chiropractor, dentist, podiatrist, or advanced practice registered nurse prescriber makes a written referral under sub. (1). The purpose of the rules shall be to ensure continuity of care between the physical therapist and the health care practitioner.

SB497,96 Section 96. 448.67 (2) of the statutes is amended to read:

SB497,47,17 448.67 (2) Separate billing required. Except as provided in sub. (4), a licensee who renders any podiatric service or assistance, or gives any podiatric advice or any similar advice or assistance, to any patient, podiatrist, physician, physician assistant, advanced practice registered nurse prescriber certified under s. 441.16 (2), partnership, or corporation, or to any other institution or organization, including a hospital, for which a charge is made to a patient, shall, except as authorized by Title 18 or Title 19 of the federal Social Security Act, render an individual statement or account of the charge directly to the patient, distinct and separate from any statement or account by any other podiatrist, physician, physician assistant, advanced practice registered nurse prescriber, or other person.

SB497,97 Section 97. 448.956 (1m) of the statutes is amended to read:

SB497,47,24 448.956 (1m) Subject to sub. (1) (a), a licensee may provide athletic training to an individual without a referral, except that a licensee may not provide athletic training as described under s. 448.95 (5) (d) or (e) in an outpatient rehabilitation setting unless the licensee has obtained a written referral for the individual from a practitioner licensed or certified under subch. II, III, IV, V, or VII of this chapter; under ch. 446; or under s. 441.16 (2) 441.09.

SB497,98 Section 98. 450.01 (1m) of the statutes is repealed.

SB497,99 Section 99. 450.01 (16) (h) 2. of the statutes is amended to read:

SB497,48,5 450.01 (16) (h) 2. The patient's advanced practice registered nurse prescriber, if the advanced practice registered nurse prescriber has entered into a written agreement to collaborate with a physician has prescribing authority under s. 441.09 (2) (c).

SB497,100 Section 100. 450.01 (16) (hr) 2. of the statutes is amended to read:

SB497,48,8 450.01 (16) (hr) 2. An advanced practice registered nurse prescriber who has prescribing authority under s. 441.09 (2) (c).

SB497,101 Section 101. 450.03 (1) (e) of the statutes is amended to read:

SB497,48,16 450.03 (1) (e) Any person lawfully practicing within the scope of a license, permit, registration, certificate, or certification granted to provide home medical oxygen under s. 450.076, to practice professional or , practical, or advanced practice registered nursing or nurse-midwifery under ch. 441, to practice dentistry or dental hygiene under ch. 447, to practice medicine and surgery under ch. 448, to practice optometry under ch. 449 or to practice veterinary medicine under ch. 89, or as otherwise provided by statute.

SB497,102 Section 102. 450.11 (1i) (a) 1. of the statutes is amended to read:

SB497,49,3 450.11 (1i) (a) 1. A pharmacist may, upon and in accordance with the prescription order of an advanced practice registered nurse prescriber under s. 441.18 (2) (a) 1., or of a physician or physician assistant under s. 448.037 (2) (a) 1., that complies with the requirements of sub. (1), deliver an opioid antagonist to a person specified in the prescription order and may, upon and in accordance with the standing order of an advanced practice registered nurse prescriber under s. 441.18 (2) (a) 2., or of a physician or physician assistant under s. 448.037 (2) (a) 2., that complies with the requirements of sub. (1), deliver an opioid antagonist to an individual in accordance with the order. The pharmacist shall provide a consultation in accordance with rules promulgated by the board for the delivery of a prescription to the person to whom the opioid antagonist is delivered.

SB497,103 Section 103. 450.11 (1i) (b) 2. b. of the statutes is amended to read:

SB497,49,7 450.11 (1i) (b) 2. b. An advanced practice registered nurse prescriber may only deliver or dispense an opioid antagonist in accordance with s. 441.18 (2) or in accordance with his or her other legal authority to dispense prescription drugs.

SB497,104 Section 104. 450.11 (7) (b) of the statutes is amended to read:

SB497,49,12 450.11 (7) (b) Information communicated to a physician, physician assistant, or advanced practice registered nurse prescriber in an effort to procure unlawfully a prescription drug or the administration of a prescription drug is not a privileged communication.

SB497,105 Section 105. 450.11 (8) (e) of the statutes is amended to read:

SB497,49,15 450.11 (8) (e) The board of nursing, insofar as this section applies to advanced practice nurse prescribers registered nurses.

SB497,106 Section 106. 450.13 (5) (b) of the statutes is amended to read:

SB497,49,19 450.13 (5) (b) The patient's advanced practice registered nurse prescriber, if the advanced practice registered nurse prescriber has entered into a written agreement to collaborate with a physician has prescribing authority under s. 441.09 (2) (c).