SB249: Bill Text

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.

SB249,95 Section 95 . 441.11 (1) of the statutes is repealed.

SB249,96 Section 96. 441.11 (2) of the statutes is renumbered 441.09 (5m) and amended to read:

SB249,48,23 441.09 (5m) Nurse anesthetists. The provisions of s. 448.04 (1) (g) do not apply to a an advanced practice registered nurse licensed under this section who possesses a certified registered nurse anesthetist specialty designation under sub. (1) (c) 1. a.

SB249,97 Section 97. 441.11 (3) of the statutes is repealed.

SB249,98 Section 98. 441.15 of the statutes is repealed.

SB249,99 Section 99. 441.16 of the statutes is repealed.

SB249,100 Section 100 . 441.18 (2) (a) (intro.) of the statutes is amended to read:

SB249,49,5 441.18 (2) (a) (intro.) An advanced practice registered nurse certified who holds a permit to issue prescription orders under s. 441.16 441.09 (2) may do any of the following:

SB249,101 Section 101 . 441.18 (2) (b) of the statutes is amended to read:

SB249,49,13 441.18 (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.

SB249,102 Section 102 . 441.18 (3) of the statutes is amended to read:

SB249,49,20 441.18 (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.

SB249,103 Section 103 . 441.19 of the statutes is repealed.

SB249,104 Section 104 . Subchapter II (title) of chapter 441 [precedes 441.51] of the statutes is amended to read:

SB249,49,24 Chapter 441

SB249,49,25 SUBCHAPTER II

SB249,50,1 ENHANCED NURSE LICENSURE COMPACT

SB249,105 Section 105 . 441.51 (title) of the statutes is amended to read:

SB249,50,3 441.51 (title) Enhanced nurse Nurse licensure compact.

SB249,106 Section 106 . 448.03 (2) (a) of the statutes is amended to read:

SB249,50,11 448.03 (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.

SB249,107 Section 107. 448.035 (1) (a) of the statutes is repealed.

SB249,108 Section 108 . 448.035 (2), (3) and (4) of the statutes are amended to read:

SB249,51,3 448.035 (2) Notwithstanding the requirements of s. 448.30, a physician, a physician assistant, or certified an advanced practice registered nurse prescriber who holds a permit to issue prescription orders under s. 441.09 (2) 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."

SB249,51,8 (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.

SB249,51,13 (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.

SB249,51,17 (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.

SB249,109 Section 109 . 448.56 (1) and (1m) (b) of the statutes are amended to read:

SB249,52,8 448.56 (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.

SB249,52,14 (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.

SB249,110 Section 110 . 448.62 (2m) of the statutes is amended to read:

SB249,52,19 448.62 (2m) An advanced practice registered nurse who is certified to issue prescription orders under s. 441.16 and who is providing nonsurgical patient services as directed, supervised, and inspected by a podiatrist who has the power to direct, decide, and oversee the implementation of the patient services rendered.

SB249,111 Section 111 . 448.67 (2) of the statutes is amended to read:

SB249,53,5 448.67 (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.

SB249,112 Section 112 . 448.956 (1m) of the statutes is amended to read:

SB249,53,12 448.956 (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.

SB249,113 Section 113. 450.01 (1m) of the statutes is repealed.

SB249,114 Section 114 . 450.01 (16) (h) 2. of the statutes is amended to read:

SB249,53,18 450.01 (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 holds a permit to issue prescription orders under s. 441.09 (2).

SB249,115 Section 115 . 450.01 (16) (hr) 2. of the statutes is amended to read:

SB249,53,21 450.01 (16) (hr) 2. An advanced practice registered nurse prescriber who holds a permit to issue prescription orders under s. 441.09 (2).

SB249,116 Section 116 . 450.03 (1) (e) of the statutes is amended to read:

SB249,54,4 450.03 (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.

SB249,117 Section 117 . 450.11 (1i) (a) 1. of the statutes is amended to read:

SB249,54,16 450.11 (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.

SB249,118 Section 118 . 450.11 (1i) (b) 2. b. of the statutes is amended to read:

SB249,54,20 450.11 (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.

SB249,119 Section 119 . 450.11 (7) (b) of the statutes is amended to read:

SB249,54,25 450.11 (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.

SB249,120 Section 120. 450.11 (8) (e) of the statutes is amended to read:

SB249,55,3 450.11 (8) (e) The board of nursing, insofar as this section applies to advanced practice nurse prescribers registered nurses.

SB249,121 Section 121 . 450.13 (5) (b) of the statutes is amended to read:

SB249,55,8 450.13 (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 holds a permit to issue prescription orders under s. 441.09 (2).

SB249,122 Section 122 . 450.135 (7) (b) of the statutes is amended to read:

SB249,55,13 450.135 (7) (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 holds a permit to issue prescription orders under s. 441.09 (2).

SB249,123 Section 123 . 462.04 of the statutes is amended to read:

SB249,55,22 462.04 Prescription or order required. A person who holds a license or limited X-ray machine operator permit under this chapter may not use diagnostic X-ray equipment on humans for diagnostic purposes unless authorized to do so by prescription or order of a physician licensed under s. 448.04 (1) (a), a dentist licensed under s. 447.04 (1), a podiatrist licensed under s. 448.63, a chiropractor licensed under s. 446.02, an advanced practice registered nurse certified licensed under s. 441.16 (2) 441.09, a physician assistant licensed under s. 448.04 (1) (f), or, subject to s. 448.56 (7) (a), a physical therapist licensed under s. 448.53.

SB249,124 Section 124. 655.001 (7t) of the statutes is amended to read:

SB249,56,3 655.001 (7t) “Health care practitioner" means a health care professional, as defined in s. 180.1901 (1m), who is an employee of a health care provider described in s. 655.002 (1) (d), (e), (em), or (f) and who has the authority to provide health care services that are not in collaboration with a physician under s. 441.15 (2) (b) or under the direction and supervision of a physician or nurse anesthetist.