SB394: Bill Text

SB394,89 Section 89 . 440.987 (2) of the statutes is amended to read:

SB394,41,16 440.987 (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.

SB394,90 Section 90 . 441.001 (1c) of the statutes is created to read:

SB394,41,23 441.001 (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.

SB394,91 Section 91 . 441.001 (1m) of the statutes is created to read:

SB394,42,8 441.001 (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.

SB394,92 Section 92. 441.001 (3c) of the statutes is created to read:

SB394,42,14 441.001 (3c) Practice of a certified nurse-midwife. “Practice of a certified nurse-midwife” means practice in the management of women's health care, pregnancy, childbirth, postpartum care for newborns, family planning, and gynecological services consistent with the standards of practice of the American College of Nurse-Midwives or its successor.

SB394,93 Section 93. 441.001 (3g) of the statutes is created to read:

SB394,42,22 441.001 (3g) Practice of a certified registered nurse anesthetist. “Practice of a certified registered nurse anesthetist” means providing anesthesia care, pain management care, and care related to anesthesia and pain management for persons across their lifespan, whose health status may range from healthy through all levels of acuity, including persons with immediate, severe, or life-threatening illness or injury, in diverse settings, including hospitals, ambulatory surgery centers, outpatient clinics, medical offices, and home health care settings.

SB394,94 Section 94. 441.001 (3n) of the statutes is created to read:

SB394,43,2 441.001 (3n) Practice of a clinical nurse specialist. “Practice of a clinical nurse specialist” means providing advanced nursing care, primarily in health care facilities, including the diagnosis and treatment of illness for identified specific populations based on a specialty.

SB394,95 Section 95. 441.001 (3r) of the statutes is created to read:

SB394,43,7 441.001 (3r) Practice of a nurse practitioner. “Practice of a nurse practitioner” means practice in ambulatory, acute, and long-term care settings as a primary and specialty care provider who assesses, diagnoses, treats, and manages acute, episodic, and chronic illnesses.

SB394,96 Section 96. 441.001 (3w) of the statutes is created to read:

SB394,43,10 441.001 (3w) Prescription order. “Prescription order” has the meaning given in s. 450.01 (21).

SB394,97 Section 97 . 441.001 (5) of the statutes is created to read:

SB394,43,13 441.001 (5) Recognized role. “Recognized role” means one of the following roles:

SB394,43,14 (a) Certified nurse-midwife.

SB394,43,15 (b) Certified registered nurse anesthetist.

SB394,43,16 (c) Clinical nurse specialist.

SB394,43,17 (d) Nurse practitioner.

SB394,98 Section 98 . 441.01 (3) of the statutes is amended to read:

SB394,43,25 441.01 (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.

SB394,99 Section 99. 441.01 (4) of the statutes is amended to read:

SB394,44,7 441.01 (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.

SB394,100 Section 100 . 441.01 (7) (a) (intro.) of the statutes is amended to read:

SB394,44,12 441.01 (7) (a) (intro.) The board shall require each applicant for the renewal of a registered nurse or, licensed practical nurse, or advanced practice registered nurse license issued under this chapter to do all of the following as a condition for renewing the license:

SB394,101 Section 101 . 441.01 (7) (b) of the statutes is amended to read:

SB394,44,20 441.01 (7) (b) The board may not renew a registered nurse or, licensed practical nurse, or advanced practice registered nurse 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.

SB394,102 Section 102 . 441.01 (7) (c) of the statutes is created to read:

SB394,44,24 441.01 (7) (c) An applicant who is renewing both a registered nurse and advanced practice registered nurse license under s. 441.09 (1) (c) is only required to pay a single fee under par. (a) 2.

SB394,103 Section 103 . 441.06 (title) of the statutes is repealed and recreated to read:

SB394,45,1 441.06 (title) Registered nurses; civil liability exemption.

SB394,104 Section 104. 441.06 (3) of the statutes is amended to read:

SB394,45,8 441.06 (3) A Except as provided in s. 441.09 (1) (c), 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).

SB394,105 Section 105 . 441.06 (4) of the statutes is amended to read:

SB394,45,18 441.06 (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.

SB394,106 Section 106. 441.06 (7) of the statutes is renumbered 441.09 (7) and amended to read:

SB394,45,23 441.09 (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:

SB394,46,3 (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.

SB394,46,8 (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.

SB394,107 Section 107. 441.07 (1g) (intro.), (a), (c) and (e) of the statutes are amended to read:

SB394,46,18 441.07 (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 or revoke, limit, suspend, or deny the renewal of a certificate to prescribe drugs or devices granted under s. 441.16; 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:

SB394,46,19 (a) Fraud in the procuring or renewal of the certificate or license.

SB394,46,22 (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.

SB394,46,25 (e) A violation of any state or federal law that regulates prescribing or dispensing drugs or devices, if the person has a certificate to prescribe drugs or devices under s. 441.16 may issue prescription orders under s. 441.09 (2).

SB394,108 Section 108. 441.09 of the statutes is created to read:

SB394,47,5 441.09 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:

SB394,47,6 1. The applicant satisfies one of the following criteria:

SB394,47,8 a. The applicant holds a valid license to practice as a registered nurse issued under s. 441.06 (1), (1c), or (1m).

SB394,47,10 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.

SB394,47,13 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.

SB394,47,15 2. The applicant provides evidence satisfactory to the board that he or she satisfies one of the following criteria:

SB394,47,20 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.

SB394,47,24 b. On January 1, 2019, 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 sub. (6) (c) relating to practice, education, or certification.

SB394,47,25 3. The applicant pays the fee specified under s. 440.05 (1).

SB394,48,2 4. The applicant provides evidence of any malpractice liability insurance coverage required under sub. (5).

SB394,48,6 5. If the applicant is applying to receive a certified nurse-midwife specialty designation under par. (b) 1., the applicant provides evidence satisfactory to the board that the applicant is currently certified by the American Midwifery Certification Board or its successor.

SB394,48,8 6. The applicant does not have an arrest or conviction record, subject to ss. 111.321, 111.322, and 111.335.

SB394,48,11 7. The applicant meets any other criteria established by the board by rule under sub. (6) (c) relating to the education, training, or experience required for each recognized role.

SB394,48,17 (b) 1. a. 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 under this subd. 1. 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).

SB394,48,23 b. The board shall grant an advanced practice registered nurse license to each individual who, on the day before the effective date of this subd. 1. b. .... [LRB inserts date], was certified to issue prescription orders under s. 441.16, 2019 stats. The board shall also grant a person who is granted a license under this subd. 1. b. 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.

SB394,49,3 c. The board shall grant an advanced practice registered nurse license to each individual who, on the day before the effective date of this subd. 1. c. .... [LRB inserts date], was licensed as a nurse-midwife under s. 441.15, 2019 stats. The board shall also grant a person who is granted a license under this subd. 1. c. a nurse-midwife specialty designation.

SB394,49,5 2. Each specialty designation granted under subd. 1. shall appear on the person's advanced practice registered nurse license.

SB394,49,8 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).

SB394,49,10 4. The board may place specific limitations on a person licensed as an advanced practice registered nurse as a condition of licensure.

SB394,49,13 5. If all of the following apply to a person, a notation indicating that the person may not issue prescription orders shall appear on the person's advanced practice registered nurse license:

SB394,49,16 a. The person is granted an advanced practice registered nurse license under subd. 1. a. and satisfies only par. (a) 2. b. but not par. (a) 2. a., or the person is granted an advanced practice registered nurse license under subd. 1. c.

SB394,49,18 b. On January 1, 2019, the person did not hold a certificate under s. 441.16 (2), 2019 Stats.

SB394,50,6 (c) 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. (b) 1. and shall, if the person holds a license under s. 441.06 (1), (1c), or (1m), also grant the renewal of that license.

SB394,50,10 (2) Prescribing authority. (a) Except as provided in par. (b), an advanced practice registered nurse 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. 441.092.

SB394,50,14 (b) An advanced practice registered nurse may not issue prescription orders if a notation under sub. (1) (b) 5. indicating that the advanced practice registered nurse may not issue prescription orders appears on the advanced practice registered nurse's license.

SB394,50,17 (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.

SB394,50,20 2. The holder of a specialty designation for a recognized role granted under sub. (1) (b) 1. may append to his or her name the title and an abbreviation corresponding to that recognized role.

SB394,50,25 (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.

SB394,51,1 2. Except as provided in s. 257.03, no person may do any of the following:

SB394,51,4 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) (b) 1.

SB394,51,8 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) (b) 1.

SB394,51,11 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) (b) 1.

SB394,51,14 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) (b) 1.

SB394,51,20 (c) An advanced practice registered nurse shall adhere to professional standards when managing situations that are beyond the advanced practice registered nurse's expertise. If a particular patient's needs are beyond the advanced practice registered nurse's expertise, the advanced practice registered nurse shall consult or collaborate with another health care provider or refer the patient to another health care provider, as warranted by the patient's needs.

SB394,52,2 (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.

SB394,52,8 (e) If an advanced practice registered nurse with a certified nurse-midwife specialty designation under sub. (1) (b) 1. practices outside of a hospital setting, the advanced practice registered nurse shall file and keep current with the department a proactive plan for involving a hospital or a physician who has admitting privileges at a hospital in the treatment of patients with higher acuity or emergency care needs that exceed the advanced practice registered nurse's scope of practice.

SB394,52,12 (f) Nothing in this section prohibits an employer, hospital, or other entity with a relationship with an advanced practice registered nurse from establishing employment practice requirements on the advanced practice registered nurse as a condition of employment.

SB394,52,17 (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.

SB394,53,2 (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.

SB394,53,8 (5m) Nurse anesthetists. (b) Opt-out of federal certified registered nurse anesthetist supervision requirement. 1. The legislature finds that allowing certified registered nurse anesthetists to administer anesthesia without supervision or direction from an operating practitioner, physician, or anesthesiologist increases access to quality anesthesia services throughout the state and is in the best interests of the citizens of the state.

SB394,53,11 2. The state, including the governor, the board, and the medical examining board, shall act to maintain an opt-out of the federal requirement for physician supervision of certified registered nurse anesthetists pursuant to 42 CFR 482.52 (c).