LRB-3325/1
KP/MED/TJD:emw
2021 - 2022 LEGISLATURE
June 14, 2021 - Introduced by Representatives Cabral-Guevara, Magnafici,
Brandtjen, Brooks, Callahan, Gundrum, Kitchens, Knodl, Krug,
Kuglitsch, Kurtz, Macco, Murphy, Petersen, J. Rodriguez, Rozar,
Skowronski, Snyder, Tauchen, Tittl, Tusler, Wichgers, Riemer and
Dittrich, cosponsored by Senators Testin,
Felzkowski, Marklein, Stroebel
and Jacque. Referred to Committee on Health.
AB396,3,2
1An Act to repeal 50.01 (1b), 77.54 (14) (f) 3., 118.2925 (1) (b), 146.89 (1) (r) 3.,
2252.01 (1c), 440.03 (13) (b) 3., 440.03 (13) (b) 42., 440.08 (2) (a) 4m., 440.08 (2)
3(a) 50., 441.11 (title), 441.11 (1), 441.11 (3), 441.15, 441.16, 441.19, 448.035 (1)
4(a) and 450.01 (1m);
to renumber and amend 253.13 (1), 255.06 (1) (d), 441.06
5(7) and 441.11 (2);
to amend 14.87 (title), 29.193 (1m) (a) 2. (intro.), 29.193 (2)
6(b) 2., 29.193 (2) (c) 3., 29.193 (2) (cd) 2. b., 29.193 (2) (cd) 2. c., 29.193 (2) (e),
729.193 (3) (a), 45.40 (1g) (a), 46.03 (44), 50.08 (2), 50.09 (1) (a) (intro.), 50.09 (1)
8(f) 1., 50.09 (1) (h), 50.09 (1) (k), 50.49 (1) (b) (intro.), 51.41 (1d) (b) 4., 70.47 (8)
9(intro.), 77.54 (14) (f) 4., 97.59, 102.13 (1) (a), 102.13 (1) (b) (intro.), 1., 3. and 4.,
10102.13 (1) (d) 1., 2., 3. and 4., 102.13 (2) (a), 102.13 (2) (b), 102.17 (1) (d) 1. and
112., 102.29 (3), 102.42 (2) (a), 106.30 (1), 118.15 (3) (a), 118.25 (1) (a), 118.29 (1)
12(e), 118.2925 (3), 118.2925 (4) (c), 118.2925 (5), 146.343 (1) (c), 146.82 (3) (a),
13146.89 (1) (r) 1., 146.89 (1) (r) 8., 146.89 (6), 154.01 (1g), 252.07 (8) (a) 2., 252.07
14(9) (c), 252.10 (7), 252.11 (2), (4), (5), (7) and (10), 252.15 (3m) (d) 11. b. and 13.,
1(5g) (c), (5m) (d) 2. and (e) 2. and 3. and (7m) (intro.) and (b), 252.16 (3) (c)
2(intro.), 252.17 (3) (c) (intro.), 253.07 (4) (d), 253.115 (4), 253.115 (7) (a) (intro.),
3253.15 (2), 255.06 (2) (d), 255.07 (1) (d), 257.01 (5) (a) and (b), 341.14 (1a), (1e)
4(a), (1m) and (1q), 343.16 (5) (a), 343.51 (1), 343.62 (4) (a) 4., 440.094 (1) (c) 1.,
5440.094 (2) (a) (intro.), 440.981 (1), 440.982 (1), 440.987 (2), 441.01 (3), 441.01
6(4), 441.01 (7) (a) (intro.), 441.01 (7) (b), 441.06 (3), 441.06 (4), 441.07 (1g)
7(intro.), (a), (c) and (e), 441.10 (7), 441.18 (2) (a) (intro.), 441.18 (2) (b), 441.18
8(3), subchapter II (title) of chapter 441 [precedes 441.51], 441.51 (title), 448.03
9(2) (a), 448.035 (2), (3) and (4), 448.56 (1) and (1m) (b), 448.62 (2m), 448.67 (2),
10448.956 (1m), 450.01 (16) (h) 2., 450.01 (16) (hr) 2., 450.03 (1) (e), 450.11 (1g) (b),
11450.11 (1i) (a) 1., 450.11 (1i) (b) 2. b., 450.11 (7) (b), 450.11 (8) (e), 450.13 (5) (b),
12450.135 (7) (b), 462.04, 655.001 (7t), 655.001 (9), 655.005 (2) (a), 961.01 (19) (a)
13and 961.395;
to repeal and recreate 46.03 (44), 50.08 (2), 70.47 (8) (intro.),
14146.82 (3) (a), 146.89 (1) (r) 1., 155.01 (1g) (b), 255.07 (1) (d), 343.16 (5) (a),
15441.06 (title), 448.03 (2) (a), 448.035 (2), (3) and (4), 448.956 (1m), 450.11 (1g)
16(b), 450.11 (1i) (a) 1., 462.04 and 961.01 (19) (a); and
to create 253.115 (1) (f),
17253.13 (1) (a), 253.15 (1) (em), 255.06 (1) (f) 2., 440.03 (13) (b) 39m., 440.08 (2)
18(a) 47., 441.001 (1c), 441.001 (1m), 441.001 (3c), 441.001 (3g), 441.001 (3n),
19441.001 (3r), 441.001 (3w), 441.001 (5), 441.01 (7) (c), 441.09 and 441.092 of the
20statutes;
relating to: advanced practice registered nurses, extending the time
1limit for emergency rule procedures, providing an exemption from emergency
2rule procedures, and granting rule-making authority.
Analysis by the Legislative Reference Bureau
Nursing practice and licensure
This bill makes various changes to practice, licensure, and certification
requirements for nurses, which are administered by the Board of Nursing.
Licensure of advanced practice registered nurses
Under current law, a person who wishes to practice professional nursing must
be licensed by the Board of Nursing as a registered nurse (RN). This bill creates an
additional system of licensure for advanced practice registered nurses (APRNs), to
be administered by the board. Under the bill, in order to apply for an APRN license,
a person must 1) hold, or concurrently apply for, an RN license; 2) have completed
an accredited graduate-level or postgraduate-level education program preparing
the person to practice as an APRN in one of four recognized roles and hold a current
national certification approved by the board; 3) possess malpractice liability
insurance in an amount determined as provided in the bill; 4) pay a fee determined
by the Department of Safety and Professional Services; and 5) satisfy certain other
criteria specified in the bill. The bill also allows a person who has not completed an
accredited education program described above to receive an APRN license if the
person 1) on January 1, 2019, was both licensed as an RN in Wisconsin and practicing
in one of the four recognized roles; and 2) satisfies additional practice or education
criteria established by the board. The bill also, however, automatically grants
licenses to certain RNs, as further described below. The four recognized roles, as
defined in the bill, are 1) certified nurse-midwife; 2) certified registered nurse
anesthetist; 3) clinical nurse specialist; and 4) nurse practitioner. The bill requires
the board, upon granting a person an APRN license, to also grant the person one or
more specialty designations corresponding to the recognized role or roles for which
the person qualifies.
The holder of an APRN license may append the title “A.P.R.N." to his or her
name, as well as a title corresponding to whichever specialty designations that the
person possesses. The bill prohibits any person from using the title “A.P.R.N.," and
from otherwise indicating that he or she is an APRN, unless the person is licensed
by the board as an APRN. The bill also prohibits the use of titles and abbreviations
corresponding to a recognized role unless the person has a specialty designation for
that role. However, the bill allows an APRN to delegate a task or order to another
clinically trained health care worker if the task or order is within the scope of the
APRN's practice, the APRN is competent to perform the task or issue the order, and
the APRN has reasonable evidence that the health care worker is minimally
competent to perform the task or issue the order under the circumstances. The bill
requires an APRN to adhere to professional standards when managing situations
that are beyond the APRN's expertise.
Under the bill, when an APRN renews his or her APRN license, the board must
grant the person the renewal of both the person's RN license and the person's APRN
license. The bill requires all APRNs to complete continuing education requirements
each biennium in clinical pharmacology or therapeutics relevant to the APRN's area
of practice and to satisfy certain other requirements when renewing a license.
Practice of nurse-midwifery
This bill repeals licensure and practice requirements specific to
nurse-midwives and the practice of nurse-midwifery, including specific
requirements to practice with an obstetrician. Under the bill, “certified
nurse-midwife" is one of the four recognized roles for APRNs, and a person who is
licensed as a nurse-midwife under current law is automatically granted an APRN
license with a certified nurse-midwife specialty designation. The bill otherwise
allows nurse-midwives to be licensed as APRNs if they satisfy the licensure
requirements, except that the bill also requires that a person applying for a certified
nurse-midwife specialty designation be certified by the American Midwifery
Certification Board. The bill also requires APRNs with a specialty designation as a
certified nurse-midwife to file and keep current with DSPS a plan for involving a
hospital or physician in treating certain patients if the APRN practices outside of a
hospital.
Prescribing authority
Under current law, a person licensed as an RN may apply to the board for a
certificate to issue prescription orders if the person meets certain requirements
established by the board. An RN holding a certificate is subject to various practice
requirements and limitations established by the board and must possess malpractice
liability insurance in an amount determined by the board.
The bill eliminates certificates to issue prescription orders and generally
authorizes APRNs to issue prescription orders. A person who is certified to issue
prescription orders under current law is automatically granted an APRN license
with his or her appropriate specialty designation. RNs who were practicing in a
recognized role on January 1, 2019, but who did not hold a certificate to issue
prescription orders on that date and who are granted an APRN license under the bill
may not issue prescription orders. As under current law, an APRN issuing
prescription orders is subject to various practice requirements and limitations
established by the board.
The bill repeals a provision concerning the ability of advanced practice nurses
who are certified to issue prescription orders and who are required to work in
collaboration with or under the supervision of a physician to obtain and practice
under a federal waiver to dispense narcotic drugs to individuals for addiction
treatment.
Other changes
The bill makes numerous other changes throughout the statutes relating to
APRNs, including various terminology changes and technical changes relating to the
Nurse Licensure Compact.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB396,1
1Section 1
. 14.87 (title) of the statutes is amended to read:
AB396,5,2
214.87 (title)
Enhanced nurse Nurse licensure compact.
AB396,2
3Section 2
. 29.193 (1m) (a) 2. (intro.) of the statutes is amended to read:
AB396,5,84
29.193
(1m) (a) 2. (intro.) Has a permanent substantial loss of function in one
5or both arms or one or both hands and fails to meet the minimum standards of any
6one of the following standard tests, administered under the direction of a licensed
7physician, a licensed physician assistant, a licensed chiropractor, or a
certified 8licensed advanced practice
registered nurse
prescriber:
AB396,3
9Section 3
. 29.193 (2) (b) 2. of the statutes is amended to read:
AB396,5,1510
29.193
(2) (b) 2. An applicant shall submit an application on a form prepared
11and furnished by the department, which shall include a written statement or report
12prepared and signed by a licensed physician, a licensed physician assistant, a
13licensed chiropractor, a licensed podiatrist, or a
certified licensed advanced practice
14registered nurse
prescriber prepared no more than 6 months preceding the
15application and verifying that the applicant is physically disabled.
AB396,4
16Section 4
. 29.193 (2) (c) 3. of the statutes is amended to read:
AB396,6,717
29.193
(2) (c) 3. The department may issue a Class B permit to an applicant
18who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under
19subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the
20applicant and the recommendation of a licensed physician, a licensed physician
21assistant, a licensed chiropractor, a licensed podiatrist, or a
certified licensed
1advanced practice
registered nurse
prescriber selected by the applicant from a list
2of licensed physicians, licensed physician assistants, licensed chiropractors, licensed
3podiatrists, and
certified licensed advanced practice
nurse prescribers registered
4nurses compiled by the department, the department finds that issuance of a permit
5complies with the intent of this subsection. The use of this review procedure is
6discretionary with the department and all costs of the review procedure shall be paid
7by the applicant.
AB396,5
8Section 5
. 29.193 (2) (cd) 2. b. of the statutes is amended to read:
AB396,6,149
29.193
(2) (cd) 2. b. The person has a permanent substantial loss of function
10in one or both arms and fails to meet the minimum standards of the standard upper
11extremity pinch test, the standard grip test, or the standard nine-hole peg test,
12administered under the direction of a licensed physician, a licensed physician
13assistant, a licensed chiropractor, or a
certified
licensed advanced practice
registered 14nurse
prescriber.
AB396,6
15Section 6
. 29.193 (2) (cd) 2. c. of the statutes is amended to read:
AB396,6,2016
29.193
(2) (cd) 2. c. The person has a permanent substantial loss of function in
17one or both shoulders and fails to meet the minimum standards of the standard
18shoulder strength test, administered under the direction of a licensed physician, a
19licensed physician assistant, a licensed chiropractor, or a
certified licensed advanced
20practice
registered nurse
prescriber.
AB396,7
21Section 7
. 29.193 (2) (e) of the statutes is amended to read:
AB396,7,622
29.193
(2) (e)
Review of decisions. An applicant denied a permit under this
23subsection, except a permit under par. (c) 3., may obtain a review of that decision by
24a licensed physician, a licensed physician assistant, a licensed chiropractor, a
25licensed podiatrist, or a
certified licensed advanced practice
registered nurse
1prescriber designated by the department and with an office located in the
2department district in which the applicant resides. The department shall pay for the
3cost of a review under this paragraph unless the denied application on its face fails
4to meet the standards set forth in par. (c) 1. or 2. A review under this paragraph is
5the only method of review of a decision to deny a permit under this subsection and
6is not subject to further review under ch. 227.
AB396,8
7Section 8
. 29.193 (3) (a) of the statutes is amended to read:
AB396,7,118
29.193
(3) (a) Produces a certificate from a licensed physician, a licensed
9physician assistant, a licensed optometrist, or a
certified licensed advanced practice
10registered nurse
prescriber stating that his or her sight is impaired to the degree that
11he or she cannot read ordinary newspaper print with or without corrective glasses.
AB396,9
12Section 9
. 45.40 (1g) (a) of the statutes is amended to read:
AB396,7,1713
45.40
(1g) (a) “Health care provider" means an advanced practice
registered 14nurse
prescriber certified who may issue prescription orders under s.
441.16
441.09 15(2), an audiologist licensed under ch. 459, a dentist licensed under ch. 447, an
16optometrist licensed under ch. 449, a physician licensed under s. 448.02, or a
17podiatrist licensed under s. 448.63.
AB396,10
18Section 10
. 46.03 (44) of the statutes is amended to read:
AB396,8,219
46.03
(44) Sexually transmitted disease treatment information. Prepare and
20keep current an information sheet to be distributed to a patient by a physician,
a 21physician assistant, or
certified an advanced practice
registered nurse
prescriber 22who may issue prescription orders under s. 441.09 (2) providing expedited partner
23therapy to that patient under s.
441.092 or 448.035. The information sheet shall
24include information about sexually transmitted diseases and their treatment and
25about the risk of drug allergies. The information sheet shall also include a statement
1advising a person with questions about the information to contact his or her
2physician, pharmacist, or local health department, as defined in s. 250.01 (4).
AB396,8,135
46.03
(44) Sexually transmitted disease treatment information. Prepare and
6keep current an information sheet to be distributed to a patient by a physician,
7physician assistant, or an advanced practice registered nurse who may issue
8prescription orders under s. 441.09 (2) providing expedited partner therapy to that
9patient under s. 441.092, 448.035, or 448.9725. The information sheet shall include
10information about sexually transmitted diseases and their treatment and about the
11risk of drug allergies. The information sheet shall also include a statement advising
12a person with questions about the information to contact his or her physician,
13pharmacist, or local health department, as defined in s. 250.01 (4).
AB396,12
14Section
12. 50.01 (1b) of the statutes is repealed.
AB396,13
15Section 13
. 50.08 (2) of the statutes is amended to read:
AB396,8,2016
50.08
(2) A physician, an advanced practice
registered nurse
prescriber 17certified who may issue prescription orders under s.
441.16 441.09 (2), or a physician
18assistant licensed under ch. 448, who prescribes a psychotropic medication to a
19nursing home resident who has degenerative brain disorder shall notify the nursing
20home if the prescribed medication has a boxed warning under
21 CFR 201.57.
AB396,9,223
50.08
(2) A physician, an advanced practice registered nurse who may issue
24prescription orders under s. 441.09 (2), or a physician assistant, who prescribes a
25psychotropic medication to a nursing home resident who has degenerative brain
1disorder shall notify the nursing home if the prescribed medication has a boxed
2warning under
21 CFR 201.57.
AB396,15
3Section 15
. 50.09 (1) (a) (intro.) of the statutes is amended to read:
AB396,9,114
50.09
(1) (a) (intro.) Private and unrestricted communications with the
5resident's family, physician, physician assistant, advanced practice
registered nurse
6prescriber, attorney, and any other person, unless medically contraindicated as
7documented by the resident's physician, physician assistant, or advanced practice
8registered nurse
prescriber in the resident's medical record, except that
9communications with public officials or with the resident's attorney shall not be
10restricted in any event. The right to private and unrestricted communications shall
11include, but is not limited to, the right to:
AB396,16
12Section 16
. 50.09 (1) (f) 1. of the statutes is amended to read:
AB396,9,1713
50.09
(1) (f) 1. Privacy for visits by spouse or domestic partner. If both spouses
14or both domestic partners under ch. 770 are residents of the same facility, the spouses
15or domestic partners shall be permitted to share a room unless medically
16contraindicated as documented by the resident's physician, physician assistant, or
17advanced practice
registered nurse
prescriber in the resident's medical record.
AB396,17
18Section 17
. 50.09 (1) (h) of the statutes is amended to read:
AB396,9,2219
50.09
(1) (h) Meet with, and participate in activities of social, religious, and
20community groups at the resident's discretion, unless medically contraindicated as
21documented by the resident's physician, physician assistant, or advanced practice
22registered nurse
prescriber in the resident's medical record.
AB396,18
23Section 18
. 50.09 (1) (k) of the statutes is amended to read:
AB396,9,2524
50.09
(1) (k) Be free from mental and physical abuse, and be free from chemical
25and physical restraints except as authorized in writing by a physician, physician
1assistant, or advanced practice
registered nurse
prescriber for a specified and
2limited period of time and documented in the resident's medical record. Physical
3restraints may be used in an emergency when necessary to protect the resident from
4injury to himself or herself or others or to property. However, authorization for
5continuing use of the physical restraints shall be secured from a physician, physician
6assistant, or advanced practice
registered nurse
prescriber within 12 hours. Any use
7of physical restraints shall be noted in the resident's medical records. “
Physical
8restraints" includes, but is not limited to, any article, device, or garment that
9interferes with the free movement of the resident and that the resident is unable to
10remove easily, and confinement in a locked room.