SB45,1345,8 2. Except as provided in s. 257.03, no person may do any of the following:

SB45,1345,11 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.

SB45,1345,15 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.

SB45,1345,18 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.

SB45,1345,21 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.

SB45,1346,2 (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.

SB45,1346,4 2. Subdivision 1. does not apply to an advanced practice registered nurse with a certified nurse-midwife specialty designation.

SB45,1346,10 (b) An advanced practice registered nurse to whom par. (a) 1. applies may, except as provided in pars. (d) 1. and (f), 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 satisfies all of the following:

SB45,1346,17 1. The advanced practice registered nurse has, except as provided in subd. 3., completed 3,840 hours of professional nursing in a clinical setting. Clinical hours completed as a requirement of a nursing program offered by a qualifying school of nursing described under s. 441.06 (1) (c) may be used to satisfy the requirement under this subdivision. Hours completed to satisfy a requirement of an education program described in sub. (1) (a) 2. a. may not be used to satisfy the requirement under this subdivision.

SB45,1346,20 2. At least 24 months have elapsed since the advanced practice registered nurse first began completing the clinical hours required by a nursing program described under subd. 1.

SB45,1347,6 3. The advanced practice registered nurse has completed 3,840 clinical hours of advanced practice registered nursing practice in that recognized role while working with a physician or dentist who was immediately available for consultation and accepted responsibility for the actions of the advanced practice registered nurse during those 3,840 hours of practice. The advanced practice registered nurse may substitute additional hours of advanced practice registered nursing working with a physician or dentist described in this subdivision to count toward the requirement under subd. 1. Each such additional hour shall count toward one hour of the requirement under subd. 1.

SB45,1347,9 4. At least 24 months have elapsed since the advanced practice registered nurse first began practicing advanced practice registered nursing in that recognized role as described in subd. 3.

SB45,1347,13 (c) For purposes of par. (b) 3., 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 paragraph .... [LRB inserts date].

SB45,1347,19 (d) 1. Except as otherwise provided in this paragraph, an advanced practice registered nurse may provide chronic pain management services only while working in a collaborative relationship with a physician who, through education, training, and experience, specializes in pain management. This subdivision applies regardless of whether the advanced practice registered nurse has qualified for independent practice under par. (b).

SB45,1347,23 2. Except as provided in par. (f), subd. 1. does not apply to an advanced practice registered nurse who is providing chronic 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).

SB45,1348,4 3. Except as provided in par. (f), subd. 1. does not apply to an advanced practice registered nurse who has qualified for independent practice under par. (b) and has privileges in a hospital, as defined in s. 50.33 (2), to provide chronic pain management services without a collaborative relationship with a physician.

SB45,1348,10 (e) For purposes of pars. (a) 1. and (d) 1. and 3., 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.

SB45,1348,16 (em) Any advanced practice registered nurse who may provide chronic pain management services without a collaborative relationship with a physician as provided in par. (d) 3. shall inform the hospital in which the advanced practice registered nurse has privileges as described under par. (d) 3. that the advanced practice registered nurse may provide chronic pain management services without a collaborative relationship with a physician.

SB45,1348,20 (f) 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.

SB45,1349,2 (g) 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:

SB45,1349,3 1. A physician licensed under ch. 448.

SB45,1349,6 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.

SB45,1349,13 (h) 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.

SB45,1349,23 (i) 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.

SB45,1350,5 (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.

SB45,1350,14 (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 that provides coverage of not less than the amounts established under s. 655.23 (4). 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.

SB45,1350,16 (6) Rules. (a) The board shall promulgate rules necessary to administer this section, including rules for all of the following:

SB45,1350,21 1. Further defining the scope of practice of an advanced practice registered nurse, practice of a certified nurse-midwife, practice of a certified registered nurse anesthetist, practice of a nurse practitioner, and practice of a clinical nurse specialist and defining the scope of practice within which an advanced practice registered nurse may issue prescription orders under sub. (2).

SB45,1350,23 2. Determining acceptable national certification for purposes of sub. (1) (a) 2. a.