SB249: Bill Text

SB249,37,4 440.987 (2) One member who is licensed as a nurse-midwife under s. 441.15 an advanced practice registered nurse and possesses a certified nurse-midwife specialty designation under s. 441.09 and who practices in an out-of-hospital setting.

SB249,79 Section 79 . 441.001 (1c) of the statutes is created to read:

SB249,37,11 441.001 (1c) Advanced practice registered nursing. “Advanced practice registered nursing” means the advanced practice of nursing 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, including prescribing pharmacological agents and therapeutics, and management of patient conditions.

SB249,80 Section 80 . 441.001 (1m) of the statutes is created to read:

SB249,37,20 441.001 (1m) Clinical pharmacology or therapeutics. “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.

SB249,81 Section 81 . 441.001 (5) of the statutes is created to read:

SB249,37,23 441.001 (5) Recognized role. “Recognized role” means one of the following roles:

SB249,37,24 (a) Certified nurse-midwife.

SB249,37,25 (b) Certified registered nurse anesthetist.

SB249,38,1 (c) Clinical nurse specialist.

SB249,38,2 (d) Nurse practitioner.

SB249,82 Section 82 . 441.01 (3) of the statutes is amended to read:

SB249,38,10 441.01 (3) The board may promulgate rules to establish minimum standards for schools for professional nurses and, schools for licensed practical nurses, and schools for advanced practice registered nurses, including all related clinical units and facilities, and make and provide periodic surveys and consultations to such schools. It The board may also establish promulgate rules to prevent unauthorized persons from practicing professional nursing. It shall approve all rules for the administration of this chapter in accordance with ch. 227.

SB249,83 Section 83 . 441.01 (4) of the statutes is amended to read:

SB249,38,17 441.01 (4) The board shall direct that those schools that qualify be placed on a list of schools the board has approved for professional nurses or, of schools the board has approved for licensed practical nurses, or of schools the board has approved for advanced practice registered nurses on application and proof of qualifications;, and the board shall make a study of nursing education and initiate promulgate rules and policies to improve it.

SB249,84 Section 84 . 441.01 (7) (a) (intro.) of the statutes is amended to read:

SB249,38,22 441.01 (7) (a) (intro.) The board shall require each applicant for the renewal of a registered nurse or, licensed practical nurse, or advanced practice registered license issued under this chapter to do all of the following as a condition for renewing the license:

SB249,85 Section 85 . 441.01 (7) (b) of the statutes is amended to read:

SB249,39,5 441.01 (7) (b) The board may not renew a registered nurse or, licensed practical nurse, or advanced practice registered license under this chapter unless the renewal applicant has completed the nursing workforce survey to the satisfaction of the board. The board shall establish standards to determine whether the survey has been completed. The board shall, by no later than June 30 of each odd-numbered year, submit all completed nursing workforce survey forms to the department of workforce development.

SB249,86 Section 86 . 441.01 (7) (c) of the statutes is created to read:

SB249,39,9 441.01 (7) (c) An applicant who is renewing both a registered nurse and advanced practice registered nurse license under s. 441.09 (1) (d) is only required to pay a single fee under par. (a) 2.

SB249,87 Section 87 . 441.06 (title) of the statutes is repealed and recreated to read:

SB249,39,11 441.06 (title) Registered nurses; civil liability exemption.

SB249,88 Section 88. 441.06 (3) of the statutes is amended to read:

SB249,39,18 441.06 (3) A Except as provided in s. 441.09 (1) (d), a registered nurse practicing for compensation shall, on or before the applicable renewal date specified under s. 440.08 (2) (a), submit to the board on furnished forms a statement giving name, residence, and other facts that the board requires, with the nursing workforce survey and fee required under s. 441.01 (7) and the applicable renewal fee determined by the department under s. 440.03 (9) (a).

SB249,89 Section 89 . 441.06 (4) of the statutes is amended to read:

SB249,40,3 441.06 (4) Except as provided in s. 257.03, 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. Except as provided in s. 257.03, 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 registered nurse who holds a multistate license, as defined in s. 441.51 (2) (h), issued by a jurisdiction, other than this state, that has adopted the enhanced nurse licensure compact under s. 441.51.

SB249,90 Section 90. 441.06 (7) of the statutes is renumbered 441.09 (7) and amended to read:

SB249,40,8 441.09 (7) Civil liability. No person certified licensed as an advanced practice registered nurse prescriber under s. 441.16 (2) this section is liable for civil damages for any of the following:

SB249,40,13 (a) Reporting in good faith to the department of transportation under s. 146.82 (3) a patient's name and other information relevant to a physical or mental condition of the patient that in the advanced practice nurse prescriber's registered nurse's judgment impairs the patient's ability to exercise reasonable and ordinary control over a motor vehicle.

SB249,40,18 (b) In good faith, not reporting to the department of transportation under s. 146.82 (3) a patient's name and other information relevant to a physical or mental condition of the patient that in the advanced practice nurse prescriber's registered nurse's judgment does not impair the patient's ability to exercise reasonable and ordinary control over a motor vehicle.

SB249,91 Section 91. 441.07 (1g) (intro.), (a), (c) and (e) of the statutes are amended to read:

SB249,41,4 441.07 (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 permit to issue prescription orders under s. 441.09 (2) or revoke, limit, suspend, or deny the renewal of a certificate permit to prescribe drugs or devices granted under s. 441.16 issue prescription orders; 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:

SB249,41,5 (a) Fraud in the procuring or renewal of the certificate permit or license.

SB249,41,8 (c) Acts which that 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.

SB249,41,11 (e) A violation of any state or federal law that regulates prescribing or dispensing drugs or devices, if the person has holds a certificate permit to prescribe drugs or devices under s. 441.16 issue prescription orders under s. 441.09 (2).

SB249,92 Section 92. 441.09 of the statutes is created to read:

SB249,41,16 441.09 Advanced practice registered nurses; civil liability exemption. (1) License. (a) An applicant who satisfies all of the following requirements may apply to the board for initial licensure by the board as an advanced practice registered nurse:

SB249,41,17 1. The applicant satisfies one of the following criteria:

SB249,41,19 a. The applicant holds a valid license to practice as a registered nurse issued under s. 441.06 (1), (1c), or (1m).

SB249,41,21 b. The applicant applies concurrently for a license under s. 441.06 (1), (1c), or (1m) with the application for a license under this paragraph.

SB249,41,24 c. The applicant is a registered nurse who holds a multistate license, as defined in s. 441.51 (2) (h), issued by a jurisdiction, other than this state, that has adopted the nurse licensure compact.

SB249,42,2 2. The applicant provides evidence satisfactory to the board that he or she satisfies one of the following criteria:

SB249,42,7 a. The applicant has completed a graduate-level or postgraduate-level education program that is approved by the board and that prepares the applicant for the practice of advanced practice registered nursing in one of the 4 recognized roles, and the applicant holds a current certification by a national certifying body approved by the board.

SB249,42,11 b. On January 1, 2017, the applicant was licensed as a registered nurse in this state and was practicing in a recognized role, and the applicant satisfies additional criteria established by the board by rule under this subd. 2. b. relating to practice, education, or certification.

SB249,42,12 3. The applicant pays the fee specified under s. 440.05 (1).

SB249,42,14 4. The applicant provides evidence of any malpractice liability insurance coverage required under sub. (5).

SB249,42,18 5. If the applicant is applying to receive a certified nurse-midwife specialty designation under par. (c) 1. a., the applicant provides evidence satisfactory to the board that the applicant is currently certified by a national certifying body approved by the board.

SB249,42,20 6. The applicant does not have an arrest or conviction record, subject to ss. 111.321, 111.322, and 111.335.

SB249,42,22 7. The applicant meets any other criteria established by the board by rule relating to the education, training, or experience required for each recognized role.

SB249,43,2 (b) An applicant who satisfies the requirements established by the board under sub. (6) (c) may, concurrently with his or her application for an advanced practice registered nurse under par. (a) and upon payment of the additional fee required for the permit under sub. (2) (b) 3., apply for a permit to issue prescription orders under sub. (2).

SB249,43,6 (c) 1. Subject to subd. 3. and s. 441.07 (1g), the board shall grant an advanced practice registered nurse license to an applicant the board determines meets the requirements under par. (a). The board shall also grant a person who is granted a license all of the following:

SB249,43,9 a. One or more specialty designations corresponding to the recognized roles for which the board determines that the person qualifies based on the person's qualifications under par. (a).

SB249,43,12 b. A permit to issue prescription orders under sub. (2), if the applicant applies for a permit under par. (b) and the board determines the applicant satisfies the requirements under sub. (6) (c).

SB249,43,14 2. Each specialty designation granted under subd. 1. a. shall appear on the person's advanced practice registered nurse license.

SB249,43,17 3. The board may not grant an advanced practice registered nurse license to a person applying concurrently for a license under s. 441.06 (1), (1c), or (1m), unless the board also grants the person the license under s. 441.06 (1), (1c), or (1m).

SB249,43,19 4. The board may place specific limitations on a person licensed as an advanced practice registered nurse as a condition of licensure.

SB249,44,7 (d) On or before the applicable renewal date specified under s. 440.08 (2) (a), an advanced practice registered nurse 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. (4), evidence of any malpractice liability insurance coverage required under sub. (5), current evidence that the person satisfies each of the requirements under par. (a) 1., 2., 5., and 7. that apply with respect to the person, and any 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 paragraph the renewal of his or her advanced practice registered nurse license and specialty designations granted under par. (c) 1. a. and shall, if the person holds a license under s. 441.06 (1), (1c), or (1m), also grant the renewal of that license.

SB249,44,9 (2) Permit to issue prescription orders. (a) In this subsection, “prescription order” has the meaning given in s. 450.01 (21).

SB249,44,11 (b) Subject to s. 441.07 (1g), the board shall grant a permit to issue prescription orders to an applicant who satisfies all of the following:

SB249,44,15 1. The applicant is licensed as an advanced practice registered nurse under sub. (1) or the applicant applies for the permit under sub. (1) (b) concurrently with his or her application for a license under sub. (1) (a) and is granted the license under sub. (1) (c).

SB249,44,17 2. The applicant meets the additional requirements for granting the permit established by the board under sub. (6) (c).

SB249,44,18 3. The applicant pays the fee specified under s. 440.05 (1).

SB249,44,25 (c) On or before the applicable renewal date specified under s. 440.08 (2) (a), a person issued a permit under par. (b) shall submit to the board on a form furnished by the board a statement giving his or her name and residence and any 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 paragraph the renewal of his or her permit to issue prescription orders.

SB249,45,4 (d) An advanced practice registered nurse who holds a permit under this subsection may issue prescription orders, subject to the rules promulgated under sub. (6) (a) and (d), and may provide expedited partner therapy in the manner described in s. 448.035.

SB249,45,7 (3) Practice; titles. (a) 1. The holder of a license issued under this section is an “advanced practice registered nurse," may append to his or her name the title “A.P.R.N.," and is authorized to practice advanced practice registered nursing.

SB249,45,10 2. The holder of a specialty designation for a recognized role granted under sub. (1) (c) 1. a. may append to his or her name the title and an abbreviation corresponding to that recognized role.

SB249,45,15 (b) 1. Except as provided in par. (d) and 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.

SB249,45,16 2. Except as provided in s. 257.03, no person may do any of the following:

SB249,45,19 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 specialty designation under sub. (1) (c) 1. a.

SB249,45,23 b. 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 specialty designation under sub. (1) (c) 1. a.

SB249,46,3 c. 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 specialty designation under sub. (1) (c) 1. a.

SB249,46,6 d. 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 specialty designation under sub. (1) (c) 1. a.

SB249,46,9 (c) An advanced practice registered nurse shall adhere to professional standards when managing situations that are beyond the advanced practice nurse's expertise.

SB249,46,16 (d) An advanced practice registered nurse licensed under this section may delegate a task or order to another clinically trained health care worker if the task or order is within the scope of the advanced practice registered nurse's practice, the advanced practice registered nurse is competent to perform the task or issue the order, and the advanced practice registered nurse has reasonable evidence that the health care worker is minimally competent to perform the task or issue the order under the circumstances.

SB249,46,21 (4) 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 board may promulgate rules regarding the continuing education requirements under this subsection.

SB249,47,5 (5) Malpractice liability insurance. Except for a person whose employer has in effect malpractice liability insurance that provides coverage for the person in the amounts specified under s. 655.23 (4), no person may practice advanced practice registered nursing unless he or she at all times has 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.

SB249,47,7 (6) Rules. The board shall promulgate rules necessary to administer this section, including rules for all of the following:

SB249,47,11 (a) Further defining the scope of practice of an advanced practice registered nurse, defining the scope of practice for each recognized role, and defining the scope of practice within which an advanced practice registered nurse who holds a permit issued under sub. (2) may issue prescription orders.

SB249,47,13 (b) Determining acceptable national certification for purposes of sub. (1) (a) 2. a.

SB249,47,17 (c) 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 a permit to issue prescription orders under sub. (2).

SB249,47,20 (d) Specifying the classes of drugs, individual drugs, or devices that may not be prescribed by an advanced practice registered nurse who holds a permit to issue prescription orders under sub. (2).

SB249,47,21 (e) Specifying the conditions to be met for registered nurses to do the following:

SB249,47,22 1. Administer a drug prescribed by an advanced practice registered nurse.

SB249,47,23 2. Administer a drug at the direction of an advanced practice registered nurse.

SB249,48,2 (f) Establishing the minimum amount of malpractice liability insurance coverage that an advanced practice registered nurse must at all times have in effect for purposes of sub. (5). The board shall promulgate rules under this paragraph in consultation with the commissioner of insurance.

SB249,93 Section 93 . 441.10 (7) of the statutes is amended to read:

SB249,48,16 441.10 (7) No license is required for practical nursing, but, except as provided in s. 257.03, 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 subsection does not apply to any licensed practical nurse who holds a multistate license, as defined in s. 441.51 (2) (h), issued by a jurisdiction, other than this state, that has adopted the enhanced nurse licensure compact under s. 441.51.

SB249,94 Section 94. 441.11 (title) of the statutes is repealed.