CR 16-020 Rule Text

Section 14 removes the mileage limitation but clarifies the dispensing of drugs is at the treatment facility.

Sections 15 and 16 update language. The word “care” is replaces “case” which is more reflective of current practice. One reference to advanced practice nurses is corrected to state advanced practice nurse prescribers. The Board removed the provision relating to notification to advanced practice nurses of mutual educational opportunities and available communication networks. The provisions regarding tests which may be ordered by an advanced practice nurse prescriber has been updated and clarified. The language regarding the collaborative relationship has been updated to reflect the standard language of “training, education and experience” instead of “professional expertise” and removing the requirement the physician shall document this relationship in recognition that the Board does not have jurisdiction over a physician.

Summary of, and comparison with, existing or proposed federal regulation: None

Comparison with rules in adjacent states:

Illinois: Illinois licenses nurses at three levels: licensed practice nurse, registered nurse and advance practice nurse. Illinois requires an advanced practice nurse to additionally hold a separate license for the prescribing of controlled substances. In Illinois a collaborating physician may delegate prescriptive authority to a nurse holding an advanced practice nurse license. An APN who has been given controlled substances prescriptive authority shall be required to obtain an Illinois mid-level practitioner controlled substances license. The requirements for obtaining a mid-level practitioner controlled substances license is to be a physician assistant or advanced practice nurse with an active license in good standing; provide the license number and controlled substances license number of the delegating or collaborating physician or podiatrist; written notice of delegation of prescriptive authority signed by the physician or podiatrist including the schedule of controlled substances or the specific Schedule II controlled substances that the mid-level practitioner may dispense or prescribe; and if license is issued with Schedule II authority, the advance practice nurse must have taken at least 45 hours of graduate contact hours in pharmacology. The mid-level practitioner controlled substances license requires 5 hours annually of continuing education in pharmacology. The mid-level practitioner controlled substances license only allows prescribing and dispensing of controlled substances the collaborating physician prescribes.

Iowa: Iowa licenses nurses at three levels: licensed practice nurse, registered nurse and advance registered nurse practitioner. The advanced registered nurse prescriber has a scope of practice which includes prescriptive authority. There is no equivalent certification in Iowa to the Wisconsin advance practice nurse prescriber certificate.

Michigan: Michigan licenses nurses at two levels: licensed practice nurse and registered nurse. Michigan has specialty certifications for a nurse anesthetist, nurse midwife and nurse practitioner. A physician who supervises a nurse practitioner or nurse midwife may delegate the prescribing of non-controlled prescriptions and Schedules 3-5 controlled substances if the delegating physician establishes a written authorization. A delegating physician may delegate the prescription of Schedule 2 controlled substances only if the nurse practitioner or nurse midwife is practicing in a surgical outpatient facility, hospital and hospice with the patient being located within the facility. There is no equivalent certification in Michigan to the Wisconsin advance practice nurse prescriber certificate.

Minnesota: Effective January 1, 2015, Minnesota licenses nurses at three levels: licensed practice nurse, registered nurse and advanced practice registered nurses. The advanced practice registered nurse has a scope of practice which includes prescriptive authority. There is no equivalent certification in Minnesota to the Wisconsin advance practice nurse prescriber certificate.

Summary of factual data and analytical methodologies:

The Board reviewed their rules and consulted with stakeholders.

Analysis and supporting documents used to determine effect on small business or in preparation of economic impact analysis:

This rule was posted for a period of 14 days for economic comments and none were received.

Fiscal Estimate and Economic Impact Analysis:

The Fiscal Estimate and Economic Impact Analysis is attached.

Effect on small business:

These proposed rules do not have an economic impact on small businesses, as defined in s. 227.114 (1), Stats. The Department’s Regulatory Review Coordinator may be contacted by email at [e-mail], or by calling [phone].

Agency contact person:

Sharon Henes, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, Wisconsin 53708; telephone [phone]; email at [e-mail].

Place where comments are to be submitted and deadline for submission:

Comments may be submitted to Sharon Henes, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, WI 53708-8366, or by email to [e-mail]. Comments must be received at or before the public hearing to be held on March 10, 2016 to be included in the record of rule-making proceedings.

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TEXT OF RULE

Section 1. N 8.02 (c) is amended to read:

N 8.02 (c) For applicants who receive national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist after July 1, 1998, the registered nurse holds a master’s or doctoral degree in nursing or a related health field granted by a college or university accredited by a regional accrediting agency approved by the board of education in the state in which the college or university is located.

Section 2. N 8.02 (4) is amended to read:

N 8.02 (4) “Clinical pharmacology or therapeutics” means the identification of individual and classes of drugs, their indications and contraindications, their likelihood of success 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 non-pharmacologic interventions.

Section 3. N 8.03 (intro) is amended to read:

N 8.03 Qualifications for certification Certification as an advanced practice nurse prescriber. An applicant for initial certification to issue prescription orders as an advanced practice nurse prescriber shall be granted a certificate by the board if the applicant complies with all of the following:

Section 4. N 8.03 (1) is renumberd to N 8.03 (1m) and amended to read:

N 8.03 (1) Has Provides evidence of holding a current license to practice as a professional nurse in this state or has a current license to practice professional nursing in another state which has adopted the nurse licensure compact.

Section 5. N 8.03 (1) is created to read:

N 8.03 (1) Submits an application form and the fee under s. 440.05(1), Stats.

Section 6. N 8.03 (2), (3), (4), and (5) are amended to read:

N 8.03 (2) Is currently certified Provides evidence of current certification by a national certifying body approved by the board as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist.

(3) For applicants who receive national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist after July 1, 1998, holds Provides evidence of a master’s or doctoral degree in nursing or a related health field granted by a college or university accredited by a regional accrediting agency organization approved by the state board of education in the state in which the college or university is located Council for Higher Education Accreditation. This subs. does not apply to those who received national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist before July 1, 1998.

(4) Has completed at least Provides evidence of completion of 45 contact hours in clinical pharmacology/ or therapeutics within 3 5 years preceding the application for a certificate to issue prescription orders.

(5) Has passed Evidence of passing a jurisprudence examination for advanced practice nurse prescribers.

Section 7. N 8.04 is repealed.

Section 8. N 8.045 is created to read:

N 8.045 Renewal. A person holding an advanced practice nurse prescriber may renew the certificate by doing all of the following:

(1) Pay the renewal fee as determined by the department under s. 440.03(9)(a), Stats., the workforce survey fee and any applicable late renewal fee.

(2) Complete the nursing workforce survey to the satisfaction of the board.

(3) Certify completion of the continuing education required under N 8.05.

(4) Provide evidence of current certification by a national certifying body approved by the board as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist.

Section 9. N 8.05 (1) is amended to read:

N 8.05 Continuing education. (1) Every advanced practice nurse prescriber shall submit to the board evidence of having completed an average of at least 8 complete 16 contact hours per year biennium in clinical pharmacology/ or therapeutics relevant to the advanced practice nurse prescriber’s area of practice, including at least 2 contact hours in responsible prescribing of controlled substances.

section 10. N 8.05 (2) is repealed.

Section 11. N 8.06 (3) (c) is amended to read: