AB396,88
6Section 88
. 440.982 (1) of the statutes is amended to read:
AB396,41,117
440.982
(1) No person may engage in the practice of midwifery unless the
8person is granted a license under this subchapter, is granted a temporary permit
9pursuant to a rule promulgated under s. 440.984 (2m), or is licensed as
a
10nurse-midwife under s. 441.15 an advanced practice registered nurse and possesses
11a certified nurse-midwife specialty designation under s. 441.09.
AB396,89
12Section 89
. 440.987 (2) of the statutes is amended to read:
AB396,41,1613
440.987
(2) One member who is licensed as
a nurse-midwife under s. 441.15 14an advanced practice registered nurse and possesses a certified nurse-midwife
15specialty designation under s. 441.09 and who practices in an out-of-hospital
16setting.
AB396,90
17Section 90
. 441.001 (1c) of the statutes is created to read:
AB396,41,2318
441.001
(1c) Advanced practice registered nursing. “Advanced practice
19registered nursing” means the advanced practice of nursing in one of the 4 recognized
20roles based on advanced clinical knowledge and skills focusing on direct care of
21individuals, greater responsibility, autonomy, and accountability for the provision of
22care, health promotion and maintenance, including prescribing pharmacological
23agents and therapeutics, and management of patient conditions.
AB396,91
24Section 91
. 441.001 (1m) of the statutes is created to read:
AB396,42,8
1441.001
(1m) Clinical pharmacology or therapeutics. “Clinical
2pharmacology or therapeutics” means the identification of individual and classes of
3drugs, their indications and contraindications, their efficacy, their side effects, and
4their interactions, as well as clinical judgment skills and decision-making based on
5thorough interviewing, history taking, physical assessment, test selection and
6interpretation, pathophysiology, epidemiology, diagnostic reasoning, differentiation
7of conditions, treatment decisions, case evaluation, and nonpharmacological
8interventions.
AB396,92
9Section
92. 441.001 (3c) of the statutes is created to read:
AB396,42,1410
441.001
(3c) Practice of a certified nurse-midwife. “Practice of a certified
11nurse-midwife” means practice in the management of women's health care,
12pregnancy, childbirth, postpartum care for newborns, family planning, and
13gynecological services consistent with the standards of practice of the American
14College of Nurse-Midwives or its successor.
AB396,93
15Section
93. 441.001 (3g) of the statutes is created to read:
AB396,42,2216
441.001
(3g) Practice of a certified registered nurse anesthetist. “Practice
17of a certified registered nurse anesthetist” means providing anesthesia care, pain
18management care, and care related to anesthesia and pain management for persons
19across their lifespan, whose health status may range from healthy through all levels
20of acuity, including persons with immediate, severe, or life-threatening illness or
21injury, in diverse settings, including hospitals, ambulatory surgery centers,
22outpatient clinics, medical offices, and home health care settings.
AB396,94
23Section
94. 441.001 (3n) of the statutes is created to read:
AB396,43,224
441.001
(3n) Practice of a clinical nurse specialist. “Practice of a clinical
25nurse specialist” means providing advanced nursing care, primarily in health care
1facilities, including the diagnosis and treatment of illness for identified specific
2populations based on a specialty.
AB396,95
3Section
95. 441.001 (3r) of the statutes is created to read:
AB396,43,74
441.001
(3r) Practice of a nurse practitioner. “Practice of a nurse
5practitioner” means practice in ambulatory, acute, and long-term care settings as a
6primary and specialty care provider who assesses, diagnoses, treats, and manages
7acute, episodic, and chronic illnesses.
AB396,96
8Section
96. 441.001 (3w) of the statutes is created to read:
AB396,43,109
441.001
(3w) Prescription order. “Prescription order” has the meaning given
10in s. 450.01 (21).
AB396,97
11Section 97
. 441.001 (5) of the statutes is created to read:
AB396,43,1312
441.001
(5) Recognized role. “Recognized role” means one of the following
13roles:
AB396,43,1414
(a) Certified nurse-midwife.
AB396,43,1515
(b) Certified registered nurse anesthetist.
AB396,43,1616
(c) Clinical nurse specialist.
AB396,43,1717
(d) Nurse practitioner.
AB396,98
18Section 98
. 441.01 (3) of the statutes is amended to read:
AB396,43,2519
441.01
(3) The board may
promulgate rules to establish minimum standards
20for schools for professional nurses
and, schools for licensed practical nurses,
and
21schools for advanced practice registered nurses, including all related clinical units
22and facilities, and make and provide periodic surveys and consultations to such
23schools.
It The board may also
establish promulgate rules to prevent unauthorized
24persons from practicing professional nursing.
It shall approve all rules for the
25administration of this chapter in accordance with ch. 227.
AB396,99
1Section
99. 441.01 (4) of the statutes is amended to read:
AB396,44,72
441.01
(4) The board shall direct that those schools that qualify be placed on
3a list of schools the board has approved for professional nurses
or, of schools the board
4has approved for licensed practical nurses
, or of schools the board has approved for
5advanced practice registered nurses on application and proof of qualifications
;, and
6the board shall make a study of nursing education and
initiate promulgate rules and
7policies to improve it.
AB396,100
8Section 100
. 441.01 (7) (a) (intro.) of the statutes is amended to read:
AB396,44,129
441.01
(7) (a) (intro.) The board shall require each applicant for the renewal
10of a registered nurse
or, licensed practical nurse
, or advanced practice registered
11nurse license issued under this chapter to do all of the following as a condition for
12renewing the license:
AB396,101
13Section 101
. 441.01 (7) (b) of the statutes is amended to read:
AB396,44,2014
441.01
(7) (b) The board may not renew a registered nurse
or, licensed practical
15nurse
, or advanced practice registered nurse license under this chapter unless the
16renewal applicant has completed the nursing workforce survey to the satisfaction of
17the board. The board shall establish standards to determine whether the survey has
18been completed. The board shall, by no later than June 30 of each odd-numbered
19year, submit all completed nursing workforce survey forms to the department of
20workforce development.
AB396,102
21Section 102
. 441.01 (7) (c) of the statutes is created to read:
AB396,44,2422
441.01
(7) (c) An applicant who is renewing both a registered nurse and
23advanced practice registered nurse license under s. 441.09 (1) (c) is only required to
24pay a single fee under par. (a) 2.
AB396,103
25Section 103
. 441.06 (title) of the statutes is repealed and recreated to read:
AB396,45,1
1441.06 (title)
Registered nurses; civil liability exemption.
AB396,104
2Section
104. 441.06 (3) of the statutes is amended to read:
AB396,45,83
441.06
(3) A Except as provided in s. 441.09 (1) (c), a registered nurse
4practicing for compensation shall, on or before the applicable renewal date specified
5under s. 440.08 (2) (a), submit to the board on furnished forms a statement giving
6name, residence, and other facts that the board requires, with the nursing workforce
7survey and fee required under s. 441.01 (7) and the applicable renewal fee
8determined by the department under s. 440.03 (9) (a).
AB396,105
9Section 105
. 441.06 (4) of the statutes is amended to read:
AB396,45,1810
441.06
(4) Except as provided in s. 257.03, no person may practice or attempt
11to practice professional nursing, nor use the title, letters, or anything else to indicate
12that he or she is a registered or professional nurse unless he or she is licensed under
13this section. Except as provided in s. 257.03, no person not so licensed may use in
14connection with his or her nursing employment or vocation any title or anything else
15to indicate that he or she is a trained, certified or graduate nurse. This subsection
16does not apply to any registered nurse who holds a multistate license, as defined in
17s. 441.51 (2) (h), issued by a jurisdiction, other than this state, that has adopted the
18enhanced nurse licensure compact
under s. 441.51.
AB396,106
19Section
106. 441.06 (7) of the statutes is renumbered 441.09 (7) and amended
20to read:
AB396,45,2321
441.09
(7) Civil liability. No person
certified licensed as an advanced practice
22registered nurse
prescriber under
s. 441.16 (2) this section is liable for civil damages
23for any of the following:
AB396,46,324
(a) Reporting in good faith to the department of transportation under s. 146.82
25(3) a patient's name and other information relevant to a physical or mental condition
1of the patient that in the advanced practice
nurse prescriber's registered nurse's 2judgment impairs the patient's ability to exercise reasonable and ordinary control
3over a motor vehicle.
AB396,46,84
(b) In good faith, not reporting to the department of transportation under s.
5146.82 (3) a patient's name and other information relevant to a physical or mental
6condition of the patient that in the advanced practice
nurse prescriber's registered
7nurse's judgment does not impair the patient's ability to exercise reasonable and
8ordinary control over a motor vehicle.
AB396,107
9Section
107. 441.07 (1g) (intro.), (a), (c) and (e) of the statutes are amended
10to read:
AB396,46,1811
441.07
(1g) (intro.) Subject to the rules promulgated under s. 440.03 (1), the
12board may deny an initial license or revoke, limit, suspend, or deny the renewal of
13a license of a registered nurse,
nurse-midwife
advanced practice registered nurse,
14or licensed practical nurse
; deny an initial certificate or revoke, limit, suspend, or
15deny the renewal of a certificate to prescribe drugs or devices granted under s.
16441.16; or reprimand a registered nurse,
nurse-midwife advanced practice
17registered nurse, or licensed practical nurse
, if the board finds that the applicant or
18licensee committed any of the following:
AB396,46,1919
(a) Fraud in the procuring or renewal of the
certificate or license.
AB396,46,2220
(c) Acts
which that show the registered nurse,
nurse-midwife advanced
21practice registered nurse, or licensed practical nurse to be unfit or incompetent by
22reason of negligence, abuse of alcohol or other drugs
, or mental incompetency.
AB396,46,2523
(e) A violation of any state or federal law that regulates prescribing or
24dispensing drugs or devices, if the person
has a certificate to prescribe drugs or
25devices under s. 441.16 may issue prescription orders under s. 441.09 (2).
AB396,108
1Section
108. 441.09 of the statutes is created to read:
AB396,47,5
2441.09 Advanced practice registered nurses; civil liability exemption.
3(1) License. (a) An applicant who satisfies all of the following requirements may
4apply to the board for initial licensure by the board as an advanced practice
5registered nurse:
AB396,47,66
1. The applicant satisfies one of the following criteria:
AB396,47,87
a. The applicant holds a valid license to practice as a registered nurse issued
8under s. 441.06 (1), (1c), or (1m).
AB396,47,109
b. The applicant applies concurrently for a license under s. 441.06 (1), (1c), or
10(1m) with the application for a license under this paragraph.
AB396,47,1311
c. The applicant is a registered nurse who holds a multistate license, as defined
12in s. 441.51 (2) (h), issued by a jurisdiction, other than this state, that has adopted
13the nurse licensure compact.
AB396,47,1514
2. The applicant provides evidence satisfactory to the board that he or she
15satisfies one of the following criteria:
AB396,47,2016
a. The applicant has completed a graduate-level or postgraduate-level
17education program that is approved by the board and that prepares the applicant for
18the practice of advanced practice registered nursing in one of the 4 recognized roles,
19and the applicant holds a current certification by a national certifying body approved
20by the board.
AB396,47,2421
b. On January 1, 2019, the applicant was licensed as a registered nurse in this
22state and was practicing in a recognized role, and the applicant satisfies additional
23criteria established by the board by rule under sub. (6) (c) relating to practice,
24education, or certification.
AB396,47,2525
3. The applicant pays the fee specified under s. 440.05 (1).
AB396,48,2
14. The applicant provides evidence of any malpractice liability insurance
2coverage required under sub. (5).
AB396,48,63
5. If the applicant is applying to receive a certified nurse-midwife specialty
4designation under par. (b) 1., the applicant provides evidence satisfactory to the
5board that the applicant is currently certified by the American Midwifery
6Certification Board or its successor.
AB396,48,87
6. The applicant does not have an arrest or conviction record, subject to ss.
8111.321, 111.322, and 111.335.
AB396,48,119
7. The applicant meets any other criteria established by the board by rule under
10sub. (6) (c) relating to the education, training, or experience required for each
11recognized role.
AB396,48,1712
(b) 1. a. Subject to subd. 3. and s. 441.07 (1g), the board shall grant an advanced
13practice registered nurse license to an applicant the board determines meets the
14requirements under par. (a). The board shall also grant a person who is granted a
15license under this subd. 1. a. one or more specialty designations corresponding to the
16recognized roles for which the board determines that the person qualifies based on
17the person's qualifications under par. (a).
AB396,48,2318
b. The board shall grant an advanced practice registered nurse license to each
19individual who, on the day before the effective date of this subd. 1. b. .... [LRB inserts
20date], was certified to issue prescription orders under s. 441.16, 2019 stats. The
21board shall also grant a person who is granted a license under this subd. 1. b. one or
22more specialty designations corresponding to the recognized roles for which the
23board determines that the person qualifies based on the person's qualifications.
AB396,49,324
c. The board shall grant an advanced practice registered nurse license to each
25individual who, on the day before the effective date of this subd. 1. c. .... [LRB inserts
1date], was licensed as a nurse-midwife under s. 441.15, 2019 stats. The board shall
2also grant a person who is granted a license under this subd. 1. c. a nurse-midwife
3specialty designation.
AB396,49,54
2. Each specialty designation granted under subd. 1. shall appear on the
5person's advanced practice registered nurse license.
AB396,49,86
3. The board may not grant an advanced practice registered nurse license to
7a person applying concurrently for a license under s. 441.06 (1), (1c), or (1m), unless
8the board also grants the person the license under s. 441.06 (1), (1c), or (1m).
AB396,49,109
4. The board may place specific limitations on a person licensed as an advanced
10practice registered nurse as a condition of licensure.
AB396,49,1311
5. If all of the following apply to a person, a notation indicating that the person
12may not issue prescription orders shall appear on the person's advanced practice
13registered nurse license:
AB396,49,1614
a. The person is granted an advanced practice registered nurse license under
15subd. 1. a. and satisfies only par. (a) 2. b. but not par. (a) 2. a., or the person is granted
16an advanced practice registered nurse license under subd. 1. c.
AB396,49,1817
b. On January 1, 2019, the person did not hold a certificate under s. 441.16 (2),
182019 Stats.
AB396,50,619
(c) On or before the applicable renewal date specified under s. 440.08 (2) (a),
20an advanced practice registered nurse shall submit to the board on a form furnished
21by the board a statement giving his or her name and residence, the nursing workforce
22survey and fee required under s. 441.01 (7), evidence of having satisfied the
23continuing education requirements under sub. (4), evidence of any malpractice
24liability insurance coverage required under sub. (5), current evidence that the person
25satisfies each of the requirements under par. (a) 1., 2., 5., and 7. that apply with
1respect to the person, and any other information that the board requires by rule, with
2the applicable renewal fee determined by the department under s. 440.03 (9) (a). The
3board shall grant to a person who satisfies the requirements under this paragraph
4the renewal of his or her advanced practice registered nurse license and specialty
5designations granted under par. (b) 1. and shall, if the person holds a license under
6s. 441.06 (1), (1c), or (1m), also grant the renewal of that license.
AB396,50,10
7(2) Prescribing authority. (a) Except as provided in par. (b), an advanced
8practice registered nurse may issue prescription orders, subject to the rules
9promulgated under sub. (6) (a) and (d), and may provide expedited partner therapy
10in the manner described in s. 441.092.
AB396,50,1411
(b) An advanced practice registered nurse may not issue prescription orders if
12a notation under sub. (1) (b) 5. indicating that the advanced practice registered nurse
13may not issue prescription orders appears on the advanced practice registered
14nurse's license.
AB396,50,17
15(3) Practice; titles. (a) 1. The holder of a license issued under this section is
16an “advanced practice registered nurse," may append to his or her name the title
17“A.P.R.N.," and is authorized to practice advanced practice registered nursing.
AB396,50,2018
2. The holder of a specialty designation for a recognized role granted under sub.
19(1) (b) 1. may append to his or her name the title and an abbreviation corresponding
20to that recognized role.
AB396,50,2521
(b) 1. Except as provided in par. (d) and s. 257.03, no person may practice or
22attempt to practice advanced practice registered nursing, nor use the title “advanced
23practice registered nurse," the title “A.P.R.N.," or anything else to indicate that he
24or she is an advanced practice registered nurse unless he or she is licensed under this
25section.
AB396,51,1
12. Except as provided in s. 257.03, no person may do any of the following:
AB396,51,42
a. Use the title “certified nurse-midwife,” the title “C.N.M.,” or anything else
3to indicate that he or she is a certified nurse-midwife unless he or she has been
4granted a certified nurse-midwife specialty designation under sub. (1) (b) 1.
AB396,51,85
b. Use the title “certified registered nurse anesthetist,” the title “C.R.N.A.,” or
6anything else to indicate that he or she is a certified registered nurse anesthetist
7unless he or she has been granted a certified registered nurse anesthetist specialty
8designation under sub. (1) (b) 1.
AB396,51,119
c. Use the title “clinical nurse specialist,” the title “C.N.S.,” or anything else to
10indicate that he or she is a clinical nurse specialist unless he or she has been granted
11a clinical nurse specialist specialty designation under sub. (1) (b) 1.
AB396,51,1412
d. Use the title “nurse practitioner,” the title “N.P.,” or anything else to indicate
13that he or she is a nurse practitioner unless he or she has been granted a nurse
14practitioner specialty designation under sub. (1) (b) 1.
AB396,51,2015
(c) An advanced practice registered nurse shall adhere to professional
16standards when managing situations that are beyond the advanced practice
17registered nurse's expertise. If a particular patient's needs are beyond the advanced
18practice registered nurse's expertise, the advanced practice registered nurse shall
19consult or collaborate with another health care provider or refer the patient to
20another health care provider, as warranted by the patient's needs.
AB396,52,221
(d) An advanced practice registered nurse licensed under this section may
22delegate a task or order to another clinically trained health care worker if the task
23or order is within the scope of the advanced practice registered nurse's practice, the
24advanced practice registered nurse is competent to perform the task or issue the
25order, and the advanced practice registered nurse has reasonable evidence that the
1health care worker is minimally competent to perform the task or issue the order
2under the circumstances.
AB396,52,83
(e) If an advanced practice registered nurse with a certified nurse-midwife
4specialty designation under sub. (1) (b) 1. practices outside of a hospital setting, the
5advanced practice registered nurse shall file and keep current with the department
6a proactive plan for involving a hospital or a physician who has admitting privileges
7at a hospital in the treatment of patients with higher acuity or emergency care needs
8that exceed the advanced practice registered nurse's scope of practice.
AB396,52,129
(f) Nothing in this section prohibits an employer, hospital, or other entity with
10a relationship with an advanced practice registered nurse from establishing
11employment practice requirements on the advanced practice registered nurse as a
12condition of employment.
AB396,52,17
13(4) Continuing education. Every advanced practice registered nurse shall
14submit to the board evidence of having completed at least 16 contact hours per
15biennium in clinical pharmacology or therapeutics relevant to the advanced practice
16registered nurse's area of practice. The board may promulgate rules regarding the
17continuing education requirements under this subsection.
AB396,53,2
18(5) Malpractice liability insurance. Except for a person whose employer has
19in effect malpractice liability insurance that provides coverage for the person in the
20amounts specified under s. 655.23 (4), no person may practice advanced practice
21registered nursing unless he or she at all times has in effect malpractice liability
22insurance coverage in the minimum amounts required by the rules of the board. An
23advanced practice registered nurse shall submit evidence of that coverage to the
24board when applying for an initial license under this section or a renewal of a license
1under this section. An advanced practice registered nurse shall also submit such
2evidence to the board upon request of the board.