Bill Text: MI HB4359 | 2021-2022 | 101st Legislature | Introduced
Bill Title: Health occupations: nurses; scope of practice of registered professional nurse holding a specialty certification as a nurse anesthetist; modify. Amends secs. 17210 & 17708 of 1978 PA 368 (MCL 333.17210 & 333.17708)
Spectrum: Slight Partisan Bill (Republican 15-6)
Status: (Passed) 2021-07-14 - Assigned Pa 53'21 With Immediate Effect [HB4359 Detail]
Download: Michigan-2021-HB4359-Introduced.html
HOUSE BILL NO. 4359
February 24, 2021, Introduced by Reps.
Whiteford, Roth, Borton, Allor, Markkanen, Steven Johnson, Wozniak, Brann,
Meerman, Thanedar, Sneller, Cherry, Brabec, Cambensy, Rabhi, Paquette,
Farrington, Bellino, Martin, O'Malley and Calley and referred to the
Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 17210 and 17708 (MCL 333.17210 and 333.17708), section 17210 as amended by 2017 PA 22 and section 17708 as amended by 2020 PA 4.
the people of the state of michigan enact:
Sec. 17210. (1) The Michigan board of nursing may grant a specialty certification to a registered professional nurse who has advanced training beyond that required for initial licensure, who has demonstrated competency through examination or other evaluative processes, and who practices in 1 of the following health profession specialty fields:
(a) Nurse midwifery.
(b) Nurse anesthetist.
(c) Nurse practitioner.
(d) Subject to subsection (2), clinical nurse specialist.
(2) The Michigan board of nursing shall promulgate rules establishing the qualifications for the training and competency of the health profession specialty field of clinical nurse specialist. The Michigan board of nursing shall not grant a specialty certification as a clinical nurse specialist under subsection (1) until after the effective date of the rules promulgated under this subsection.
(3) All of the
following apply to a registered professional nurse who holds a specialty
certification as a nurse anesthetist:
(a) In addition
to performing duties within the scope of the practice of nursing, his or her
scope of practice includes any of the following anesthesia and analgesia
services:
(i) Development of a plan of care.
(ii) Performance of all patient assessments, procedures,
and monitoring to implement the plan of care or to address patient emergencies
that arise during implementation of the plan of care.
(iii) Selection, ordering, or prescribing and the administration
of anesthesia and analgesic agents, including pharmacological agents that are
prescription drugs as defined in section 17708 or controlled substances. For
purposes of this subparagraph, the authority of a registered professional nurse
who holds a specialty certification as a nurse anesthetist to prescribe
pharmacological agents is limited to pharmacological agents for administration
to patients as described in subdivision (b), (c), or (d), and his or her
authority does not include any activity that would permit a patient to self-administer,
obtain, or receive pharmacological agents, including prescription drugs or
controlled substances, outside of the facility in which the anesthetic or
analgesic service is performed or beyond the perioperative, periobstetrical, or
periprocedural period.
(b) He or she may
provide the anesthesia and analgesia services described in subdivision (a)
without supervision and as the sole and independent anesthesia provider while
he or she is collaboratively participating in a patient-centered care team. As
used in this subdivision:
(i) "Health care professional" means an
individual who is licensed or registered to perform a health profession under
this article.
(ii) "Patient-centered care team" means a group
of health care professionals, which may include, but is not limited to, a
physician, podiatrist, or dentist, who directly or indirectly care for a
patient by each contributing his or her specialized knowledge, skill, and
experience to the care of the patient.
(c) He or she may
provide the anesthesia and analgesia services described in subdivision (a) in
any of the following:
(i) A hospital inpatient or outpatient facility.
(ii) A freestanding surgical outpatient facility.
(iii) An office of a physician, podiatrist, or dentist.
(iv) Any other office or facility in which diagnostic or
therapeutic procedures are provided to a patient, including, but not limited
to, imaging, endoscopy, or cystoscopy services.
(d) The
anesthesia and analgesia services described in subdivision (a) may be performed
for and during the perioperative, periobstetrical, or periprocedural period.
(4) A health care
facility may adopt policies relating to the provision of anesthesia and
analgesia services. As used in this subsection, "health care
facility" means a facility or office described in subsection (3)(c).
(5) Subsection
(3) does not require new or additional third party reimbursement or mandated
worker's compensation benefits for anesthesia and analgesia services provided
under that subsection by a registered professional nurse who holds a specialty
certification as a nurse anesthetist under this part.
Sec. 17708. (1)
"Preceptor" means a pharmacist approved by the board to direct the
training of an intern in an approved pharmacy.
(2) "Prescriber" means a
any of the following:
(a)
A licensed dentist. , a
(b)
A licensed doctor of medicine. , a
(c)
A licensed doctor of osteopathic medicine and surgery. , a
(d)
A licensed doctor of podiatric medicine and surgery.
, a
(e)
A licensed physician's assistant.
, a
(f)
A licensed optometrist certified under part 174 to administer and
prescribe therapeutic pharmaceutical agents.
, an
(g)
An advanced practice registered nurse as that term is defined in section
17201 who meets the requirements of section 17211a.
, a
(h)
A licensed veterinarian. , or another
(i)
A registered professional nurse who holds a specialty certification as a nurse
anesthetist under section 17210 when he or she is engaging in the practice of
nursing and providing the anesthesia and analgesia services described in section
17210(3). For purposes of this subdivision, the authority of a registered
professional nurse who holds a specialty certification as a nurse anesthetist
under section 17210 to prescribe pharmacological agents is limited to
pharmacological agents for administration to patients as described in section
17210(3)(b), (c), or (d).
(j)
Any other licensed health professional acting under the delegation and
using, recording, or otherwise indicating the name of the delegating licensed
doctor of medicine or licensed doctor of osteopathic medicine and surgery.
(3) "Prescription" means an order by a prescriber
to fill, compound, or dispense a drug or device written and signed; written or
created in an electronic format, signed, and transmitted by facsimile; or
transmitted electronically or by other means of communication. An order
transmitted in other than written or hard-copy form must be electronically
recorded, printed, or written and immediately dated by the pharmacist, and that
record is considered the original prescription. In a health facility or agency
licensed under article 17 or other medical institution, an order for a drug or
device in the patient's chart is considered for the purposes of this definition
the original prescription. For purposes of this part, prescription also
includes a standing order issued under section 17744e. Subject to section
17751(2) and (5), prescription includes, but is not limited to, an order for a
drug, not including a controlled substance except under circumstances described
in section 17763(e), written and signed; written or created in an electronic
format, signed, and transmitted by facsimile; or transmitted electronically or
by other means of communication by a physician prescriber, dentist prescriber,
or veterinarian prescriber who is licensed to practice dentistry, medicine,
osteopathic medicine and surgery, or veterinary medicine in another state.
(4) "Prescription drug" means a drug to which 1 or
more of the following apply:
(a) The drug is dispensed pursuant to a prescription.
(b) The drug bears the federal legend "CAUTION: federal
law prohibits dispensing without prescription" or "Rx only".
(c) The drug is designated by the board as a drug that may
only be dispensed pursuant to a prescription.
(5) "Remote pharmacy" means a pharmacy described in
sections 17742a and 17742b.
(6)
Subsection (2)(i) does not require new or additional third party reimbursement
or mandated worker's compensation benefits for anesthesia and analgesia
services provided under section 17210(3) by a registered professional nurse who
holds a specialty certification as a nurse anesthetist under section 17210.
Enacting section 1. This amendatory act takes effect 90 days after the date it is enacted into law.
