Bill Text: FL S0810 | 2024 | Regular Session | Introduced


Bill Title: Autonomous Practice by Advanced Practice Registered Nurses

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2024-03-08 - Died in Health Policy [S0810 Detail]

Download: Florida-2024-S0810-Introduced.html
       Florida Senate - 2024                                     SB 810
       
       
        
       By Senator Ingoglia
       
       
       
       
       
       11-00206A-24                                           2024810__
    1                        A bill to be entitled                      
    2         An act relating to autonomous practice by advanced
    3         practice registered nurses; amending s. 395.0191,
    4         F.S.; exempting certain certified advanced practice
    5         registered nurses from specified medical direction
    6         requirements for clinical privileges in hospitals;
    7         providing an exception; amending s. 464.012, F.S.;
    8         revising the functions that certain certified
    9         registered nurse anesthetists may perform without an
   10         established protocol; providing construction; amending
   11         s. 464.0123, F.S.; revising the scope of autonomous
   12         practice for certain advanced practice registered
   13         nurses; providing for the future expiration of the
   14         Council on Advanced Practice Registered Nurse
   15         Autonomous Practice; amending s. 1009.65, F.S.;
   16         conforming a provision to changes made by the act;
   17         providing an effective date.
   18          
   19  Be It Enacted by the Legislature of the State of Florida:
   20  
   21         Section 1. Paragraph (b) of subsection (2) of section
   22  395.0191, Florida Statutes, is amended to read:
   23         395.0191 Staff membership and clinical privileges.—
   24         (2)
   25         (b) An advanced practice registered nurse who is certified
   26  as a registered nurse anesthetist licensed under part I of
   27  chapter 464 shall administer anesthesia under the onsite medical
   28  direction of a professional licensed under chapter 458, chapter
   29  459, or chapter 466, and in accordance with an established
   30  protocol approved by the medical staff. The medical direction
   31  shall specifically address the needs of the individual patient.
   32  This paragraph does not apply to an autonomous advanced practice
   33  registered nurse registered under s. 464.0123 who is a certified
   34  registered nurse anesthetist under part I of chapter 464, except
   35  that a facility may require such certified registered nurse
   36  anesthetist to perform specified acts under a protocol
   37  established by the medical staff or governing board of the
   38  facility.
   39         Section 2. Paragraph (b) of subsection (4) of section
   40  464.012, Florida Statutes, is amended to read:
   41         464.012 Licensure of advanced practice registered nurses;
   42  fees; controlled substance prescribing.—
   43         (4) In addition to the general functions specified in
   44  subsection (3), an advanced practice registered nurse may
   45  perform the following acts within his or her specialty:
   46         (b) The certified registered nurse anesthetist may perform
   47  any of the following functions, to the extent authorized by
   48  established protocol approved by the medical staff of the
   49  facility in which the anesthetic service is performed or, if
   50  registered and practicing as an autonomous advanced practice
   51  registered nurse under s. 464.0123, without an established
   52  protocol, perform any or all of the following:
   53         1. Determine the health status of the patient as it relates
   54  to the risk factors and to the anesthetic management of the
   55  patient through the performance of the general functions.
   56         2. Based on history, physical assessment, and supplemental
   57  laboratory results, determine, with the consent of the
   58  responsible physician, the appropriate type of anesthesia within
   59  the framework of the protocol. A certified registered nurse
   60  anesthetist registered and practicing under s. 464.0123 may make
   61  this determination without an established protocol.
   62         3. Order under the protocol preanesthetic medication. A
   63  certified registered nurse anesthetist registered and practicing
   64  under s. 464.0123 may order preanesthetic medication without an
   65  established protocol.
   66         4. Perform under the protocol, unless registered and
   67  practicing under s. 464.0123 without an established protocol,
   68  procedures commonly used to render the patient insensible to
   69  pain during the performance of surgical, obstetrical,
   70  therapeutic, or diagnostic clinical procedures. These procedures
   71  include ordering and administering regional, spinal, and general
   72  anesthesia; inhalation agents and techniques; intravenous agents
   73  and techniques; and techniques of hypnosis.
   74         5. Order or perform monitoring procedures indicated as
   75  pertinent to the anesthetic health care management of the
   76  patient.
   77         6. Support life functions during anesthesia health care,
   78  including induction and intubation procedures, the use of
   79  appropriate mechanical supportive devices, and the management of
   80  fluid, electrolyte, and blood component balances.
   81         7. Recognize and take appropriate corrective action for
   82  abnormal patient responses to anesthesia, adjunctive medication,
   83  or other forms of therapy.
   84         8. Recognize and treat a cardiac arrhythmia while the
   85  patient is under anesthetic care.
   86         9. Participate in management of the patient while in the
   87  postanesthesia recovery area, including ordering the
   88  administration of fluids and drugs.
   89         10. Place special peripheral and central venous and
   90  arterial lines for blood sampling and monitoring as appropriate.
   91  
   92  A certified registered nurse anesthetist registered and
   93  practicing as an autonomous advanced practice registered nurse
   94  under s. 464.0123 may perform any of the functions specified in
   95  this paragraph without an established protocol, but only to the
   96  extent such functions are authorized under this part.
   97         Section 3. Paragraph (a) of subsection (3) of section
   98  464.0123, Florida Statutes, is amended, and paragraph (e) is
   99  added to subsection (4) of that section, to read:
  100         464.0123 Autonomous practice by an advanced practice
  101  registered nurse.—
  102         (3) PRACTICE REQUIREMENTS.—
  103         (a) An advanced practice registered nurse who is registered
  104  under this section may:
  105         1. Engage in autonomous practice only in primary care
  106  practice, including family medicine, general pediatrics, and
  107  general internal medicine, and in anesthesia, as defined by
  108  board rule.
  109         2. For certified nurse midwives, engage in autonomous
  110  practice in the performance of the acts listed in s.
  111  464.012(4)(c).
  112         3. Perform the general functions of an advanced practice
  113  registered nurse under s. 464.012(3) related to primary care.
  114         4. For certified registered nurse anesthetists, engage in
  115  autonomous practice in the performance of the acts specified in
  116  s. 464.012(4)(b).
  117         5. For a patient who requires the services of a health care
  118  facility, as defined in s. 408.032(8):
  119         a. Admit the patient to the facility.
  120         b. Manage the care received by the patient in the facility.
  121         c. Discharge the patient from the facility, unless
  122  prohibited by federal law or rule.
  123         6.5. Provide a signature, certification, stamp,
  124  verification, affidavit, or endorsement that is otherwise
  125  required by law to be provided by a physician, except an
  126  advanced practice registered nurse registered under this section
  127  may not issue a physician certification under s. 381.986.
  128         (4) COUNCIL ON ADVANCED PRACTICE REGISTERED NURSE
  129  AUTONOMOUS PRACTICE.—
  130         (e)The council shall dissolve, and this subsection
  131  expires, on July 1, 2025.
  132         Section 4. Paragraph (b) of subsection (1) of section
  133  1009.65, Florida Statutes, is amended to read:
  134         1009.65 Medical Education Reimbursement and Loan Repayment
  135  Program.—
  136         (1) To encourage qualified medical professionals to
  137  practice in underserved locations where there are shortages of
  138  such personnel, there is established the Medical Education
  139  Reimbursement and Loan Repayment Program. The function of the
  140  program is to make payments that offset loans and educational
  141  expenses incurred by students for studies leading to a medical
  142  or nursing degree, medical or nursing licensure, or advanced
  143  practice registered nurse licensure or physician assistant
  144  licensure. The following licensed or certified health care
  145  professionals are eligible to participate in this program:
  146         (b) Advanced practice registered nurses registered to
  147  engage in autonomous practice under s. 464.0123 and practicing
  148  in the primary care specialties of family medicine, general
  149  pediatrics, general internal medicine, or midwifery, or
  150  anesthesia. From the funds available, the Department of Health
  151  shall make payments of up to $15,000 per year to advanced
  152  practice registered nurses registered under s. 464.0123 who
  153  demonstrate, as required by department rule, active employment
  154  providing primary care services in a public health program, an
  155  independent practice, or a group practice that serves Medicaid
  156  recipients and other low-income patients and that is located in
  157  a primary care health professional shortage area. Only loans to
  158  pay the costs of tuition, books, medical equipment and supplies,
  159  uniforms, and living expenses may be covered. For the purposes
  160  of this paragraph:
  161         1. “Primary care health professional shortage area” means a
  162  geographic area, an area having a special population, or a
  163  facility with a score of at least 18, as designated and
  164  calculated by the Federal Health Resources and Services
  165  Administration or a rural area as defined by the Federal Office
  166  of Rural Health Policy.
  167         2. “Public health program” means a county health
  168  department, the Children’s Medical Services program, a federally
  169  funded community health center, a federally funded migrant
  170  health center, or any other publicly funded or nonprofit health
  171  care program designated by the department.
  172         Section 5. This act shall take effect July 1, 2024.

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