Chapter 441

441.16(3)(a) (a) Establishing the education, training or experience requirements that a registered nurse must satisfy to be an advanced practice nurse. The rules promulgated under this paragraph shall require a registered nurse to have education, training or experience that is in addition to the education, training or experience required for licensure as a registered nurse.

441.16(3)(am) (am) Establishing the appropriate education, training and examination requirements that an advanced practice nurse must satisfy to qualify for a certificate to issue prescription orders.

441.16(3)(b) (b) Defining the scope of practice within which an advanced practice nurse may issue prescription orders.

441.16(3)(c) (c) Specifying the classes of drugs, individual drugs or devices that may not be prescribed by an advanced practice nurse.

441.16(3)(cm) (cm) Specifying the conditions to be met for a registered nurse to do the following:

441.16(3)(cm)1. 1. Administer a drug prescribed by an advanced practice nurse who is certified to issue prescription orders.

441.16(3)(cm)2. 2. Administer a drug at the direction of an advanced practice nurse who is certified to issue prescription orders.

441.16(3)(d) (d) Establishing procedures for maintaining a certificate to issue prescription orders, including requirements for continuing education.

441.16(3)(e) (e) Establishing the minimum amount of malpractice liability insurance coverage that an advanced practice nurse shall have if he or she is certified to issue prescription orders. The board shall promulgate rules under this paragraph in consultation with the commissioner of insurance.

441.16(4) (4) Every advanced practice nurse who is certified to issue prescription orders shall annually submit to the board evidence satisfactory to the board that he or she has in effect malpractice liability insurance coverage in the minimum amounts required by the rules of the board.

441.16(5) (5) An advanced practice nurse who is certified to issue prescription orders may not delegate the act of issuing a prescription order to any nurse who is not certified to issue prescription orders.

441.16(6) (6) Nothing in this section prohibits a nurse from issuing a prescription order as an act delegated by a physician, and nothing in this section prohibits an advanced practice nurse certified under this section from issuing a prescription order as an act delegated by a podiatrist.

441.16 History History: 1993 a. 138; 1995 a. 448; 2009 a. 28, 280; 2013 a. 114; 2017 a. 227, 329.

441.16 Cross-reference Cross-reference: See also ch. N 8, Wis. adm. code.

441.18 441.18 Prescriptions for and delivery of opioid antagonists.

441.18(1) (1) In this section:

441.18(1)(a) (a) “Administer” has the meaning given in s. 450.01 (1).

441.18(1)(b) (b) “Deliver” has the meaning given in s. 450.01 (5).

441.18(1)(c) (c) “Dispense” has the meaning given in s. 450.01 (7).

441.18(1)(d) (d) “Opioid antagonist” has the meaning given in s. 450.01 (13v).

441.18(1)(e) (e) “Opioid-related drug overdose” has the meaning given in s. 256.40 (1) (d).

441.18(1)(f) (f) “Standing order” has the meaning given in s. 450.01 (21p).

441.18(2) (2) 

441.18(2)(a) (a) An advanced practice nurse certified to issue prescription orders under s. 441.16 may do any of the following:

441.18(2)(a)1. 1. Prescribe an opioid antagonist to a person in a position to assist an individual at risk of undergoing an opioid-related drug overdose and may deliver the opioid antagonist to that person. A prescription order under this subdivision need not specify the name and address of the individual to whom the opioid antagonist will be administered, but shall instead specify the name of the person to whom the opioid antagonist is prescribed.

441.18(2)(a)2. 2. Issue a standing order to one or more persons authorizing the dispensing of an opioid antagonist.

441.18(2)(b) (b) An advanced practice nurse who prescribes or delivers an opioid antagonist under par. (a) 1. shall ensure that the person to whom the opioid antagonist is prescribed has or has the capacity to provide the knowledge and training necessary to safely administer the opioid antagonist to an individual undergoing an opioid-related overdose and that the person demonstrates the capacity to ensure that any individual to whom the person further delivers the opioid antagonist has or receives that knowledge and training.

441.18(3) (3) An advanced practice nurse who, acting in good faith, prescribes or delivers an opioid antagonist in accordance with sub. (2), or who, acting in good faith, otherwise lawfully prescribes or dispenses an opioid antagonist, shall be immune from criminal or civil liability and may not be subject to professional discipline under s. 441.07 for any outcomes resulting from prescribing, delivering, or dispensing the opioid antagonist.

441.18 History History: 2013 a. 200; 2015 a. 115.

441.19 441.19 Maintenance and detoxification treatment under federal waiver.

441.19(1) (1) In this section, “waiver” means a waiver issued by the federal department of health and human services under 21 USC 823 (g) (2) (A).

441.19(2) (2) With respect to the ability of an advanced practice nurse who is certified to issue prescription orders to obtain and practice under a waiver, a physician who meets any of the conditions specified in 21 USC 823 (g) (2) (G) (ii) shall be considered eligible to serve as a qualifying physician for purposes of the requirement under 21 USC 823 (g) (2) (G) (iv) (III), regardless of whether the physician himself or herself holds a waiver.

441.19 History History: 2017 a. 262.

subch. II of ch. 441 SUBCHAPTER II

NURSE LICENSURE COMPACT

441.51 441.51 Nurse licensure compact.

441.51(1) (1) Article I — Findings and declaration of purpose.

441.51(1)(a) (a) The party states find all of the following:

441.51(1)(a)1. 1. That the health and safety of the public are affected by the degree of compliance with and the effectiveness of enforcement activities related to state nurse licensure laws.

441.51(1)(a)2. 2. That violations of nurse licensure and other laws regulating the practice of nursing may result in injury or harm to the public.

441.51(1)(a)3. 3. That the expanded mobility of nurses and the use of advanced communication technologies as part of our nation’s health care delivery system require greater coordination and cooperation among states in the areas of nurse licensure and regulation.

441.51(1)(a)4. 4. That new practice modalities and technology make compliance with individual state nurse licensure laws difficult and complex.

441.51(1)(a)5. 5. That the current system of duplicative licensure for nurses practicing in multiple states is cumbersome and redundant for both nurses and states.

441.51(1)(a)6. 6. That uniformity of nurse licensure requirements throughout the states promotes public safety and public health benefits.

441.51(1)(b) (b) The general purposes of this compact are as follows:

441.51(1)(b)1. 1. To facilitate the states’ responsibility to protect the public’s health and safety.

441.51(1)(b)2. 2. To ensure and encourage the cooperation of party states in the areas of nurse licensure and regulation.

441.51(1)(b)3. 3. To facilitate the exchange of information between party states in the areas of nurse regulation, investigation, and adverse actions.

441.51(1)(b)4. 4. To promote compliance with the laws governing the practice of nursing in each jurisdiction.

441.51(1)(b)5. 5. To invest all party states with the authority to hold a nurse accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered through the mutual recognition of party state licenses.

441.51(1)(b)6. 6. To decrease redundancies in the consideration and issuance of nurse licenses.

441.51(1)(b)7. 7. To provide opportunities for interstate practice by nurses who meet uniform licensure requirements.

441.51(2) (2) Article II — Definitions. As used in this compact:

441.51(2)(a) (a) “Adverse action” means any administrative, civil, equitable, or criminal action permitted by a state’s laws which is imposed by a licensing board or other authority against a nurse, including actions against an individual’s license or multistate licensure privilege such as revocation, suspension, probation, monitoring of the licensee, limitation on the licensee’s practice, or any other encumbrance on licensure affecting a nurse’s authorization to practice, including issuance of a cease and desist action.

441.51(2)(b) (b) “Alternative program” means a nondisciplinary monitoring program approved by a licensing board.

441.51(2)(c) (c) “Coordinated licensure information system” means an integrated process for collecting, storing, and sharing information on nurse licensure and enforcement activities related to nurse licensure laws that is administered by a nonprofit organization composed of and controlled by licensing boards.

441.51(2)(d) (d) “Current significant investigative information” means any of the following:

441.51(2)(d)1. 1. Investigative information that a licensing board, after a preliminary inquiry that includes notification and an opportunity for the nurse to respond, if required by state law, has reason to believe is not groundless and, if proved true, would indicate more than a minor infraction.

441.51(2)(d)2. 2. Investigative information that indicates that the nurse represents an immediate threat to public health and safety regardless of whether the nurse has been notified and had an opportunity to respond.

441.51(2)(e) (e) “Encumbrance” means a revocation or suspension of, or any limitation on, the full and unrestricted practice of nursing imposed by a licensing board.

441.51(2)(f) (f) “Home state” means the party state which is the nurse’s primary state of residence.

441.51(2)(g) (g) “Licensing board” means a party state’s regulatory body responsible for issuing nurse licenses.

441.51(2)(h) (h) “Multistate license” means a license to practice as a registered or a licensed practical/vocational nurse issued by a home state licensing board that authorizes the licensed nurse to practice in all party states under a multistate licensure privilege.

441.51(2)(i) (i) “Multistate licensure privilege” means a legal authorization associated with a multistate license permitting the practice of nursing as either a registered nurse or licensed practical/vocational nurse in a remote state.

441.51(2)(j) (j) “Nurse” means registered nurse or licensed practical/vocational nurse, as those terms are defined by each party state’s practice laws.

441.51(2)(k) (k) “Party state” means any state that has adopted this compact.

441.51(2)(L) (L) “Remote state” means a party state, other than the home state.

441.51(2)(m) (m) “Single-state license” means a nurse license issued by a party state that authorizes practice only within the issuing state and does not include a multistate licensure privilege to practice in any other party state.

441.51(2)(n) (n) “State” means a state, territory, or possession of the United States and the District of Columbia.

441.51(2)(o) (o) “State practice laws” means a party state’s laws, rules, and regulations that govern the practice of nursing, define the scope of nursing practice, and create the methods and grounds for imposing discipline. “State practice laws” does not include requirements necessary to obtain and retain a license, except for qualifications or requirements of the home state.

441.51(3) (3) Article III — General provisions and jurisdiction.

441.51(3)(a) (a) A multistate license to practice registered or licensed practical/vocational nursing issued by a home state to a resident in that state will be recognized by each party state as authorizing a nurse to practice as a registered nurse or as a licensed practical/vocational nurse, under a multistate licensure privilege, in each party state.

441.51(3)(b) (b) A state must implement procedures for considering the criminal history records of applicants for initial multistate license or licensure by endorsement. Such procedures shall include the submission of fingerprints or other biometric-based information by applicants for the purpose of obtaining an applicant’s criminal history record information from the federal bureau of investigation and the agency responsible for retaining that state’s criminal records.

441.51(3)(c) (c) Each party state shall require all of the following for an applicant to obtain or retain a multistate license in the home state:

441.51(3)(c)1. 1. Meets the home state’s qualifications for licensure or renewal of licensure, as well as, all other applicable state laws.

441.51(3)(c)2. 2. Satisfies one of the following:

441.51(3)(c)2.a. a. Has graduated or is eligible to graduate from a licensing board-approved registered nurse or licensed practical/vocational nurse prelicensure education program.

441.51(3)(c)2.b. b. Has graduated from a foreign registered nurse or licensed practical/vocational nurse prelicensure education program that has been approved by the authorized accrediting body in the applicable country and has been verified by an independent credentials review agency to be comparable to a licensing board-approved prelicensure education program.

441.51(3)(c)3. 3. Has, if a graduate of a foreign prelicensure education program not taught in English or if English is not the individual’s native language, successfully passed an English proficiency examination that includes the components of reading, speaking, writing, and listening.

441.51(3)(c)4. 4. Has successfully passed an NCLEX-RN or NCLEX-PN Examination or recognized predecessor, as applicable.

441.51(3)(c)5. 5. Is eligible for or holds an active, unencumbered license.

441.51(3)(c)6. 6. Has submitted, in connection with an application for initial licensure or licensure by endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history record information from the federal bureau of investigation and the agency responsible for retaining that state’s criminal records.

441.51(3)(c)7. 7. Has not been convicted or found guilty, or has entered into an agreed disposition, of a felony offense under applicable state or federal criminal law.

441.51(3)(c)8. 8. Has not been convicted or found guilty, or has entered into an agreed disposition, of a misdemeanor offense related to the practice of nursing as determined on a case-by-case basis.

441.51(3)(c)9. 9. Is not currently enrolled in an alternative program.

441.51(3)(c)10. 10. Is subject to self-disclosure requirements regarding current participation in an alternative program.

441.51(3)(c)11. 11. Has a valid United States social security number.

441.51(3)(d) (d) All party states shall be authorized, in accordance with existing state due process law, to take adverse action against a nurse’s multistate licensure privilege such as revocation, suspension, probation or any other action that affects a nurse’s authorization to practice under a multistate licensure privilege, including cease and desist actions. If a party state takes such action, it shall promptly notify the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the home state of any such actions by remote states.

441.51(3)(e) (e) A nurse practicing in a party state must comply with the state practice laws of the state in which the client is located at the time service is provided. The practice of nursing is not limited to patient care, but shall include all nursing practice as defined by the state practice laws of the party state in which the client is located. The practice of nursing in a party state under a multistate licensure privilege will subject a nurse to the jurisdiction of the licensing board, the courts, and the laws of the party state in which the client is located at the time service is provided.