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.
b. On January 1, 2024, the person did not hold a certificate under s. 441.16 (2), 2021 stats.
(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), any plan required under sub. (3m) (f), current evidence that the person satisfies each of the requirements under par. (a) 1., 2., 5. a., 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.
(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) 1. and 4., and may provide expedited partner therapy in the manner described in s. 441.092.
(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.
(3) License required; use of 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.
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.
(b) 1. Except as provided in sub. (3m) (e) 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.
2. Except as provided in s. 257.03, no person may do any of the following:
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.
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.
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.
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.
(3m) Practice requirements and limitations. (a) 1. An advanced practice registered nurse licensed under this section may, except as provided in subd. 2. and par. (b), practice advanced practice registered nursing only in collaboration with a physician or dentist.
2. Subdivision 1. does not apply to an advanced practice registered nurse with a certified nurse-midwife specialty designation.
(b) 1. An advanced practice registered nurse to whom par. (a) 1. applies may, except as provided in pars. (bg) 1. and (c), practice advanced practice registered nursing in a recognized role without being supervised by or collaborating with, and independent of, a physician or dentist if the board verifies, upon application of the advanced practice registered nurse, that the advanced practice registered nurse has completed 5,760 clinical hours of advanced practice registered nursing practice in that recognized role while working with a physician or dentist during those 5,760 hours of practice. For purposes of this subdivision, during the completion of these hours, the advanced practice registered nurse must have continuously satisfied all of the following requirements:
a. Maintained a mutual, professional relationship with at least one physician or dentist.
b. Maintained, and provided to the board upon request, documentation indicating the relationships the advanced practice registered nurse had with one or more physicians or dentists to deal with issues outside of his or her licensed scope of practice.
c. Maintained evidence that he or she was subject to a quality assurance program, peer review process, or other similar program or process that was implemented for and designed to ensure the provision of competent and quality patient care and that also included participation by a physician or dentist. Such a program or process may include a program or process administered through the advanced practice registered nurse’s employer, hospital, ambulatory surgery center, clinic, or other outpatient facility.
2. For purposes of subd. 1., hours of advanced practice registered nursing practice may include the lawful practice of advanced practice registered nursing outside this state or the lawful practice of advanced practice registered nursing in this state prior to the effective date of this subdivision .... [LRB inserts date].
(bg) 1. An advanced practice registered nurse may provide pain management services only while working in a collaborative relationship with a physician. Except as provided in subd. 2., this subdivision applies regardless of whether the advanced practice registered nurse has qualified for independent practice under par. (b).
2. Except as provided in par. (c), subd. 1. does not apply to an advanced practice registered nurse who is providing pain management services in a hospital, as defined in s. 50.33 (2), or a clinic associated with a hospital, and who has qualified for independent practice under par. (b).
(bm) For purposes of pars. (a) 1. and (bg) 1., a collaborative relationship is a process in which an advanced practice registered nurse is working with a physician or dentist, in each other’s presence when necessary, to deliver health care services within the scope of the advanced practice registered nurse’s training, education, and experience. The advanced practice registered nurse shall document such a collaborative relationship.
(c) Nothing in this section prohibits an entity employing or with a relationship with an advanced practice registered nurse from establishing additional requirements for an advanced practice registered nurse as a condition of employment or relationship.
(d) 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, as warranted by the patient’s needs, consult or collaborate with or refer the patient to at least one of the following:
1. A physician licensed under ch. 448.
2. Another health care provider for whom the advanced practice registered nurse has reasonable evidence of having a scope of practice that includes the authorization to address the patient’s needs.
(e) 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.
(f) An advanced practice registered nurse with a certified nurse-midwife specialty designation may not offer to deliver babies outside of a hospital setting unless the advanced practice registered nurse files with the board, and the board approves, a proactive plan for ensuring appropriate care or care transitions conforming with professional standards for patients with higher acuity or emergency care needs that exceed the advanced practice registered nurse’s scope of practice. An advanced practice registered nurse who offers to deliver babies outside of a hospital setting shall file a plan under this paragraph when applying for an initial license under this section or a renewal of a license under this section, shall keep the plan current with the board, and shall follow the plan.