Bill Text: MN HF2803 | 2013-2014 | 88th Legislature | Introduced
Bill Title: Health profession license provisions changed.
Sponsorship: Partisan Bill (Democrat 2)
Status: (Introduced - Dead) 2014-03-06 - Introduction and first reading, referred to Health and Human Services Policy [HF2803 Detail]
Download: Minnesota-2013-HF2803-Introduced.html
1.2relating to health; changing provisions for certain licensed health professions;
1.3amending Minnesota Statutes 2012, sections 147.081, subdivision 3; 148.171,
1.4subdivisions 3, 5, 6, 10, 11, 13, 16, 21, by adding subdivisions; 148.211, by
1.5adding subdivisions; 148.235, subdivisions 2, 2a, 4, 4a, 4b, 6; 148.261, by adding
1.6subdivisions; Minnesota Statutes 2013 Supplement, section 147.012.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2013 Supplement, section 147.012, is amended to read:
1.9147.012 OVERSIGHT OF ALLIED HEALTH PROFESSIONS.
1.10(a) The board has responsibility for the oversight of the following allied health
1.11professions: physician assistants under chapter 147A; acupuncture practitioners under
1.12chapter 147B; respiratory care practitioners under chapter 147C; traditional midwives
1.13under chapter 147D; registered naturopathic doctors under chapter 147E;and athletic
1.14trainers under sections148.7801 to
148.7815 ; and advanced practice nurses under section
1.15148.211, subdivisions 1a and 1b.
1.16(b) The board shall appoint physicians who work with advanced practice registered
1.17nurses to the joint subcommittee established under section 148.261, subdivision 6, to
1.18investigate complaints against advanced practice registered nurses licensed under chapter
1.19148. The joint subcommittee shall make recommendations for any discipline to the
1.20Board of Nursing.
1.21 Sec. 2. Minnesota Statutes 2012, section 147.081, subdivision 3, is amended to read:
1.22 Subd. 3. Practice of medicine defined. (a) For purposes of this chapter, a person
1.23not exempted under section147.09 is "practicing medicine" or engaged in the "practice of
1.24medicine" if the person does any of the following:
2.1(1) advertises, holds out to the public, or represents in any manner that the person is
2.2authorized to practice medicine in this state;
2.3(2) offers or undertakes to prescribe, give, or administer any drug or medicine for
2.4the use of another;
2.5(3) offers or undertakes to prevent or to diagnose, correct, or treat in any manner or
2.6by any means, methods, devices, or instrumentalities, any disease, illness, pain, wound,
2.7fracture, infirmity, deformity or defect of any person;
2.8(4) offers or undertakes to perform any surgical operation including any invasive
2.9or noninvasive procedures involving the use of a laser or laser assisted device, upon
2.10any person;
2.11(5) offers to undertake to use hypnosis for the treatment or relief of any wound,
2.12fracture, or bodily injury, infirmity, or disease;or
2.13(6) uses in the conduct of any occupation or profession pertaining to the diagnosis
2.14of human disease or conditions, the designation "doctor of medicine," "medical doctor,"
2.15"doctor of osteopathy," "osteopath," "osteopathic physician," "physician," "surgeon,"
2.16"M.D.," "D.O.," or any combination of these designations.; or
2.17(7) performs the following interventions in the course of diagnosing or treating pain
2.18which is chronic, persistent and intractable, or occurs outside of a surgical, obstetrical,
2.19or postoperative course of care:
2.20(i) ablation of targeted nerves;
2.21(ii) percutaneous precision needle placement within or adjacent to the spinal column
2.22with injection of contrast materials or drugs such as local anesthetics, steroids, and
2.23analgesics using fluoroscopy, computed tomography, ultrasound, or other image-guidance
2.24modalities; or
2.25(iii) laser or endoscopic discectomy, the surgical placement of intrathecal infusion
2.26pumps, or spinal cord stimulators.
2.27(b) Nothing in this section shall be construed to prohibit or restrict the performance
2.28of surgical or obstetrical anesthesia services or postoperative pain control by a certified
2.29registered nurse anesthetist performed perioperatively in a hospital as defined in section
2.30144.50 or outpatient surgical centers as defined in section 144.55.
2.31 Sec. 3. Minnesota Statutes 2012, section 148.171, subdivision 3, is amended to read:
2.32 Subd. 3. Advanced practice registered nurse. "Advanced practice registered
2.33nurse," abbreviated APRN, means an individual licensed asa an advanced practice
2.34 registered nurse by the board and certified by a national nurse certification organization
3.1acceptable to the board to practice as a clinical nurse specialist, nurse anesthetist,
3.2nurse-midwife, or nurse practitioner.
3.3 Sec. 4. Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
3.4to read:
3.5 Subd. 4a. Board of Medical Practice. "Board of Medical Practice" means the
3.6Board of Medical Practice that is established in chapter 147.
3.7 Sec. 5. Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
3.8to read:
3.9 Subd. 4b. Joint subcommittee. "Joint subcommittee" means the subcommittee
3.10composed of an equal number of advanced practice registered nurses appointed by
3.11the Board of Nursing and physicians who work with advanced practice registered
3.12nurses appointed by the Board of Medical Practice with the responsibility to review
3.13investigations and recommend disciplinary action to the Board of Nursing for advanced
3.14practice registered nurses.
3.15 Sec. 6. Minnesota Statutes 2012, section 148.171, subdivision 5, is amended to read:
3.16 Subd. 5. Clinical nurse specialist practice. "Clinical nurse specialist practice"
3.17means the provision of patient care in a particular specialty or subspecialty of advanced
3.18practice registered nursingwithin the context of collaborative management, and includes:
3.19(1) diagnosing illness and disease;
3.20(2) providingnonpharmacologic limited pharmacologic treatment, including in
3.21accordance with section 148.235;
3.22(3) providing psychotherapy;
3.23(3) (4) promoting wellness; and
3.24(4) (5) preventing illness and disease; and
3.25 (6) collaborating with, consulting with, and referring to physicians and other health
3.26care providers when needed for optimal patient care.
3.27 The certified clinical nurse specialist is certified for advanced practice registered
3.28nursing in a specific field of clinical nurse specialist practice.
3.29 Sec. 7. Minnesota Statutes 2012, section 148.171, subdivision 6, is amended to read:
3.30 Subd. 6.Collaborative management Collaboration. "Collaborative management"
3.31is a mutually agreed-upon plan between an advanced practice registered nurse and
3.32one or more physicians or surgeons licensed under chapter 147 that designates the
4.1scope of collaboration necessary to manage the care of patients. The advanced practice
4.2registered nurse and the one or more physicians must have experience in providing care to
4.3patients with the same or similar medical problems, except that certified registered nurse
4.4anesthetists may continue to provide anesthesia in collaboration with physicians, including
4.5surgeons, podiatrists licensed under chapter 153, and dentists licensed under chapter
4.6150A. Certified registered nurse anesthetists must provide anesthesia services at the same
4.7hospital, clinic, or health care setting as the physician, surgeon, podiatrist, or dentist.
4.8 "Collaboration" means a mutually agreed upon process in which health professionals
4.9jointly contribute to the health care provided to a patient with each collaborator performing
4.10actions that the professional is licensed, certified, or otherwise authorized to perform.
4.11Collaboration includes the systematic formal planning and evaluation in a patient's care,
4.12including but not limited to the care that is best for the patient, emergency backup plans,
4.13and referral arrangements to other health care professionals.
4.14 Sec. 8. Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
4.15to read:
4.16 Subd. 7c. Integrated clinical setting. "Integrated clinical setting" means a place
4.17of practice where an advanced practice registered nurse works with physicians and other
4.18practitioners in the same location.
4.19 Sec. 9. Minnesota Statutes 2012, section 148.171, subdivision 10, is amended to read:
4.20 Subd. 10. Nurse-midwife practice. "Nurse-midwife practice" means the
4.21management of women's primary health care, focusing on pregnancy, childbirth, the
4.22postpartum period, care of the newborn partner care management relating to sexual health,
4.23and the family planning and gynecological needs of women and includes diagnosing
4.24and, providing nonpharmacologic limited pharmacologic treatment within a system that
4.25provides for consultation, collaborative management, and referral as indicated by the
4.26health status of patients in accordance with section 148.235 and collaborating with,
4.27consulting with, and referring to physicians and other health care providers when needed
4.28for optimal patient care.
4.29 Sec. 10. Minnesota Statutes 2012, section 148.171, subdivision 11, is amended to read:
4.30 Subd. 11. Nurse practitioner practice. "Nurse practitioner practice" means, within
4.31the context of collaborative management the provision of patient care in a particular
4.32specialty or subspecialty of advanced practice registered nursing and includes: (1)
4.33diagnosing, directly managing, and preventing acute and chronic illness and disease;and
5.1 (2) promoting wellness, including health assessment and screening activities; (3) health
5.2promotion, disease prevention, health education, and patient counseling; (4) providing
5.3limited pharmacologic and nonpharmacologic treatment in accordance with section
5.4148.235; and (5) collaborating with, consulting with, and referring to physicians and
5.5other health care providers when needed for optimal patient care. The certified nurse
5.6practitioner is certified for advanced registered nurse practice in a specific field of nurse
5.7practitioner practice.
5.8 Sec. 11. Minnesota Statutes 2012, section 148.171, subdivision 13, is amended to read:
5.9 Subd. 13. Practice of advanced practice registered nursing. The "practice of
5.10advanced practice registered nursing" means the performance of clinical nurse specialist
5.11practice, nurse-midwife practice, nurse practitioner practice, or registered nurse anesthetist
5.12practice as defined in subdivisions 5, 10, 11, and 21. The practice includes functioning as
5.13a direct care provider, case manager, consultant, educator, and researcher. The practice of
5.14advanced practice registered nursing also includes accepting referrals from, consulting
5.15with, cooperating with, or referring to all other types of health care providers, including
5.16but not limited to physicians, chiropractors, podiatrists, and dentists, provided that the
5.17advanced practice registered nurse and the other provider are practicing within their
5.18scopes of practice as defined in state law. The advanced practice registered nurse must
5.19practice within a health caresystem setting that provides for consultation, collaborative
5.20management collaboration, and referral as indicated by the health status of the patient.
5.21An advanced practice registered nurse who is practicing in a setting that is not a
5.22hospital licensed under chapter 144 or a clinic where there are one or more physicians
5.23practicing on site must make available to patients:
5.24(1) the designation of a physician, physician clinic, or other health care group
5.25practice with whom the advanced practice registered nurse has a preestablished
5.26relationship for consultation, collaboration, and referral;
5.27(2) the designation of a physician, physician clinic, or other health care group
5.28practice with whom the advanced practice registered nurse has a preestablished
5.29arrangement to accept the transfer of care if the advanced practice registered nurse is
5.30without admitting privileges or has to transfer care to another provider;
5.31(3) the designation of hospitals or other inpatient facilities where patients requiring
5.32admission will be referred; and
5.33(4) the plan for transfer of or access to health records.
5.34 Sec. 12. Minnesota Statutes 2012, section 148.171, subdivision 16, is amended to read:
6.1 Subd. 16. Prescribing. "Prescribing" means the act of generating a prescription for
6.2the preparation of, use of, or manner of using a drug or therapeutic device in accordance
6.3with the provisions of section148.235 . Prescribing does not include recommending the
6.4use of a drug or therapeutic device which is not required by the federal Food and Drug
6.5Administration to meet the labeling requirements for prescription drugs and devices.
6.6Prescribing also does not include recommending or administering a drug or therapeutic
6.7deviceperioperatively for surgical or obstetrical anesthesia or for postoperative pain
6.8control by a certified registered nurse anesthetist.
6.9 Sec. 13. Minnesota Statutes 2012, section 148.171, subdivision 21, is amended to read:
6.10 Subd. 21. Registered nurse anesthetist practice. "Registered nurse anesthetist
6.11practice" means the provision of anesthesia care and related serviceswithin the context of
6.12collaborative management, including selecting, obtaining, and administering drugs and
6.13therapeutic devices to facilitate diagnostic, therapeutic, and surgical procedures upon
6.14request, assignment, or referral by a patient's physician, dentist, or podiatrist. A registered
6.15nurse anesthetist shall be prohibited from performing any procedures constituting the
6.16practice of interventional or invasive pain management as defined in section 147.081,
6.17subdivision 3, clause (7).
6.18 Sec. 14. Minnesota Statutes 2012, section 148.211, is amended by adding a subdivision
6.19to read:
6.20 Subd. 1a. Initial advanced practice registered nurse licensure. (a) An applicant
6.21for a license to practice as an advanced practice registered nurse (APRN) shall apply to
6.22the board for a license in a format prescribed by the board and pay a fee in an amount
6.23determined by statute. In no case may fees be refunded. In addition, an APRN must also
6.24register with the Board of Medical Practice.
6.25(b) To be eligible for licensure:
6.26(1) the applicant must hold a current Minnesota professional nursing license or
6.27demonstrate eligibility for licensure as a registered nurse in this jurisdiction;
6.28(2) the applicant shall not hold an encumbered license as a registered nurse in any
6.29state or territory;
6.30(3) the applicant must have completed a graduate-level APRN program accredited
6.31by a nursing or nursing-related accrediting body that is recognized by the United States
6.32Secretary of Education or the Council for Higher Education Accreditation as acceptable
6.33to the board. The education must be in one of the four APRN roles and at least one
6.34population focus;
7.1(4) the applicant must be currently certified by a national certifying body recognized
7.2by the board in the APRN role appropriate to educational preparation;
7.3(5) the applicant must report any criminal conviction, nolo contendere plea, Alford
7.4plea, or other plea arrangement in lieu of conviction; and
7.5(6) the applicant must have committed no acts or omissions which are grounds
7.6for disciplinary action in another jurisdiction or, if such acts have been committed and
7.7would be grounds for disciplinary action under section 148.261, the board has found after
7.8investigation that sufficient restitution has been made.
7.9(c) After December 31, 2015, all new graduates applying for advanced practice
7.10registered nurse licensure must meet the licensure requirements in this chapter.
7.11 Sec. 15. Minnesota Statutes 2012, section 148.211, is amended by adding a subdivision
7.12to read:
7.13 Subd. 1b. Advanced practice registered nurse grandfather provision. Any
7.14advanced practice registered nurse with authority to practice as an advanced practice
7.15registered nurse in this state that is valid on December 31, 2015, shall be eligible to apply
7.16for licensure with the board and apply for registration with the Board of Medical Practice
7.17as an advanced practice registered nurse under the provisions of this chapter with current
7.18privileges and shall be eligible for license renewal under the conditions and standards
7.19prescribed in this chapter.
7.20 Sec. 16. Minnesota Statutes 2012, section 148.235, subdivision 2, is amended to read:
7.21 Subd. 2. Certified nurse practitioners. (a) A certified nurse practitioner who has
7.22a written agreement with a physician based on standards established by the Minnesota
7.23Nurses Association and the Minnesota Medical Association that defines the delegated
7.24responsibilities related to the prescription of drugs and therapeutic devices, successfully
7.25completed no less than 30 hours of formal study from a college, university, or university
7.26health care institution which included instruction in health assessment, medication
7.27classifications, indications, dosages, contraindications, and side effects; supervised
7.28practice; and competence evaluation including evidence of the application of knowledge
7.29pertaining to prescribing for and therapeutic management of the clinical type of patients
7.30in the certified nurse practitioner's practice application, and who has practiced in an
7.31integrated clinical setting for at least three years, may prescribe and administer drugs and
7.32therapeutic devices, excluding schedule II controlled substances, within the scope ofthe
7.33written agreement and within practice as a certified nurse practitioner.
8.1(b) A certified nurse practitioner who has practiced fewer than three years in an
8.2integrated clinical setting or a certified nurse practitioner who wants to prescribe and
8.3administer schedule II controlled substances must have a written agreement with a
8.4physician based on standards established by the Minnesota Nurses Association and the
8.5Minnesota Medical Association that defines the delegated responsibilities related to the
8.6prescription of drugs and therapeutic devices. The agreement must include processes
8.7for appropriate review of prescribing practices by the physician to assist with quality
8.8improvement and to ensure patient safety. The written agreement required under this
8.9subdivision shall be based on standards established by the Minnesota Nurses Association
8.10and the Minnesota Medical Association as of January 1, 1996, unless both associations
8.11agree to revisions. Written prescribing agreements shall be mutually reviewed between all
8.12parties to the agreement on at least an annual basis.
8.13 Sec. 17. Minnesota Statutes 2012, section 148.235, subdivision 2a, is amended to read:
8.14 Subd. 2a. Certified registered nurse anesthetists. A certified registered nurse
8.15anesthetist who has a written agreement with a physician based on standards established
8.16by the Minnesota Nurses Association and the Minnesota Medical Association that defines
8.17the delegated responsibilities related to the prescription of drugs and therapeutic devices,
8.18may prescribe and administer drugs and therapeutic devices within the scope of the
8.19written agreement and within practice as a certified registered nurse anesthetist. Nothing
8.20in this section shall permit the performance of procedures constituting the practice of
8.21interventional or invasive pain management as defined in section 147.081, subdivision
8.223, clause (7).
8.23 Sec. 18. Minnesota Statutes 2012, section 148.235, subdivision 4, is amended to read:
8.24 Subd. 4. Certified clinical nurse specialists in psychiatric and mental health
8.25nursing. (a) A certified clinical nurse specialist who(1) has successfully completed no
8.26less than 30 hours of formal study in the prescribing of psychotropic medications and
8.27medications to treat their side effects which included instruction in health assessment,
8.28psychotropic classifications, psychopharmacology, indications, dosages, contraindications,
8.29side effects, and evidence of application; and (2) has and who has practiced in an
8.30integrated clinical setting for at lest three years may prescribe and administer drugs
8.31used to treat psychiatric and behavioral disorders and the side effects of those drugs,
8.32excluding schedule II controlled substances, within the scope of practice as a certified
8.33clinical nurse specialist in psychiatric and mental health nursing. A certified clinical
8.34nurse specialist who has practiced fewer than three years in an integrated clinical setting
9.1or a certified clinical nurse specialist who wants to prescribe and administer schedule II
9.2controlled substances must have a written agreement with a psychiatrist or other physician
9.3based on standards established by the Minnesota Nurses Association and the Minnesota
9.4Psychiatric Association that specifies and defines the delegated responsibilities related to
9.5the prescription of drugs in relationship to the diagnosis, may prescribe and administer
9.6drugs used to treat psychiatric and behavioral disorders and the side effects of those drugs
9.7within the scope of the written agreement and within practice as a certified clinical
9.8nurse specialist in psychiatric and mental health nursing. The agreement must include
9.9processes for appropriate review of prescribing practices by the physician to assist with
9.10quality improvement and ensure patient safety. The written agreement required under this
9.11subdivision shall be based on standards established by the Minnesota Nurses Association
9.12and the Minnesota Psychiatric Association as of January 1, 1996, unless both associations
9.13agree to revisions. Written prescribing agreements shall be mutually reviewed between all
9.14parties to the agreement on at least an annual basis.
9.15(b) Nothing in this subdivision removes or limits the legal professional liability of
9.16the treating psychiatrist, certified clinical nurse specialist, mental health clinic or hospital
9.17for the prescription and administration of drugs by a certified clinical nurse specialist in
9.18accordance with this subdivision.
9.19 Sec. 19. Minnesota Statutes 2012, section 148.235, subdivision 4a, is amended to read:
9.20 Subd. 4a. Other certified clinical nurse specialists. A certified clinical nurse
9.21specialist who: (1) has successfully completed no less than 30 hours of formal study from
9.22a college, university, or university health care institution, which included the following:
9.23instruction in health assessment, medication classifications, indications, dosages,
9.24contraindications, and side effects; supervised practice; and competence evaluation,
9.25including evidence of the application of knowledge pertaining to prescribing for and
9.26therapeutic management of the clinical type of patients in the certified clinical nurse
9.27specialist's practice; and (2) has, and who has practiced in an integrated clinical setting for
9.28at least three years, may prescribe and administer drugs and therapeutic devices, excluding
9.29schedule II controlled substances, within the scope of practice as a certified clinical nurse
9.30specialist. A certified clinical nurse specialist who practiced fewer than three years in an
9.31integrated clinical setting or a certified clinical nurse specialist who wants to prescribe
9.32and administer schedule II controlled substances must have a written agreement with a
9.33physician based on standards established by the Minnesota Nurses Association and the
9.34Minnesota Medical Association that defines the delegated responsibilities related to the
9.35prescription of drugs and therapeutic devices, may prescribe and administer drugs and
10.1therapeutic devices within the scope of the written agreement and within practice as a
10.2certified clinical nurse specialist. The agreement must include processes for appropriate
10.3review of prescribing practices by the physician to assist with quality improvement and to
10.4ensure patient safety. Written prescribing agreements shall be mutually reviewed between
10.5all parties to the agreement on at least an annual basis.
10.6 Sec. 20. Minnesota Statutes 2012, section 148.235, subdivision 4b, is amended to read:
10.7 Subd. 4b. Dispensing authority. An advanced practice registered nurse who is
10.8authorized under this section to prescribe drugs is authorized to dispense drugs subject to
10.9the same requirements established for the prescribing of drugs.This authority to dispense
10.10extends only to those drugs described in the written agreement entered into under this
10.11section. The authority to dispense includes, but is not limited to, the authority to receive
10.12and dispense sample drugs.
10.13 Sec. 21. Minnesota Statutes 2012, section 148.235, subdivision 6, is amended to read:
10.14 Subd. 6. Standards for written agreements; review and filing. Written
10.15agreements required under this section shall be maintained at the primary practice site of
10.16the advanced practice registered nurse and of the collaborating physician. The written
10.17agreement does not need to be filed with the Board of Nursing or the Board of Medical
10.18Practice but must be reviewed on an annual basis by the parties to the agreement.
10.19 Sec. 22. Minnesota Statutes 2012, section 148.261, is amended by adding a subdivision
10.20to read:
10.21 Subd. 6. Actions against an APRN. The joint subcommittee comprised of an equal
10.22number of advanced practice nurses appointed by the Board of Nursing and physicians
10.23who work with advanced practice registered nurses appointed by the Board of Medical
10.24Practice shall review complaints against an advanced practice registered nurse that are
10.25in violation of chapter 147 or 148 and recommend disciplinary action as described in
10.26sections 148.261 or 148.262 to the Board of Nursing.
10.27 Sec. 23. Minnesota Statutes 2012, section 148.261, is amended by adding a subdivision
10.28to read:
10.29 Subd. 7. Standard of care. An advanced practice registered nurse licensed under
10.30this chapter who is diagnosing, treating, or prescribing under chapter 148 shall be held
10.31to the same standard of care as that of a physician licensed under chapter 147 by the
10.32state of Minnesota.
1.3amending Minnesota Statutes 2012, sections 147.081, subdivision 3; 148.171,
1.4subdivisions 3, 5, 6, 10, 11, 13, 16, 21, by adding subdivisions; 148.211, by
1.5adding subdivisions; 148.235, subdivisions 2, 2a, 4, 4a, 4b, 6; 148.261, by adding
1.6subdivisions; Minnesota Statutes 2013 Supplement, section 147.012.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2013 Supplement, section 147.012, is amended to read:
1.9147.012 OVERSIGHT OF ALLIED HEALTH PROFESSIONS.
1.10(a) The board has responsibility for the oversight of the following allied health
1.11professions: physician assistants under chapter 147A; acupuncture practitioners under
1.12chapter 147B; respiratory care practitioners under chapter 147C; traditional midwives
1.13under chapter 147D; registered naturopathic doctors under chapter 147E;
1.14trainers under sections
1.15148.211, subdivisions 1a and 1b.
1.16(b) The board shall appoint physicians who work with advanced practice registered
1.17nurses to the joint subcommittee established under section 148.261, subdivision 6, to
1.18investigate complaints against advanced practice registered nurses licensed under chapter
1.19148. The joint subcommittee shall make recommendations for any discipline to the
1.20Board of Nursing.
1.21 Sec. 2. Minnesota Statutes 2012, section 147.081, subdivision 3, is amended to read:
1.22 Subd. 3. Practice of medicine defined. (a) For purposes of this chapter, a person
1.23not exempted under section
1.24medicine" if the person does any of the following:
2.1(1) advertises, holds out to the public, or represents in any manner that the person is
2.2authorized to practice medicine in this state;
2.3(2) offers or undertakes to prescribe, give, or administer any drug or medicine for
2.4the use of another;
2.5(3) offers or undertakes to prevent or to diagnose, correct, or treat in any manner or
2.6by any means, methods, devices, or instrumentalities, any disease, illness, pain, wound,
2.7fracture, infirmity, deformity or defect of any person;
2.8(4) offers or undertakes to perform any surgical operation including any invasive
2.9or noninvasive procedures involving the use of a laser or laser assisted device, upon
2.10any person;
2.11(5) offers to undertake to use hypnosis for the treatment or relief of any wound,
2.12fracture, or bodily injury, infirmity, or disease;
2.13(6) uses in the conduct of any occupation or profession pertaining to the diagnosis
2.14of human disease or conditions, the designation "doctor of medicine," "medical doctor,"
2.15"doctor of osteopathy," "osteopath," "osteopathic physician," "physician," "surgeon,"
2.16"M.D.," "D.O.," or any combination of these designations
2.17(7) performs the following interventions in the course of diagnosing or treating pain
2.18which is chronic, persistent and intractable, or occurs outside of a surgical, obstetrical,
2.19or postoperative course of care:
2.20(i) ablation of targeted nerves;
2.21(ii) percutaneous precision needle placement within or adjacent to the spinal column
2.22with injection of contrast materials or drugs such as local anesthetics, steroids, and
2.23analgesics using fluoroscopy, computed tomography, ultrasound, or other image-guidance
2.24modalities; or
2.25(iii) laser or endoscopic discectomy, the surgical placement of intrathecal infusion
2.26pumps, or spinal cord stimulators.
2.27(b) Nothing in this section shall be construed to prohibit or restrict the performance
2.28of surgical or obstetrical anesthesia services or postoperative pain control by a certified
2.29registered nurse anesthetist performed perioperatively in a hospital as defined in section
2.30144.50 or outpatient surgical centers as defined in section 144.55.
2.31 Sec. 3. Minnesota Statutes 2012, section 148.171, subdivision 3, is amended to read:
2.32 Subd. 3. Advanced practice registered nurse. "Advanced practice registered
2.33nurse," abbreviated APRN, means an individual licensed as
2.34 registered nurse by the board and certified by a national nurse certification organization
3.1acceptable to the board to practice as a clinical nurse specialist, nurse anesthetist,
3.2nurse-midwife, or nurse practitioner.
3.3 Sec. 4. Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
3.4to read:
3.5 Subd. 4a. Board of Medical Practice. "Board of Medical Practice" means the
3.6Board of Medical Practice that is established in chapter 147.
3.7 Sec. 5. Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
3.8to read:
3.9 Subd. 4b. Joint subcommittee. "Joint subcommittee" means the subcommittee
3.10composed of an equal number of advanced practice registered nurses appointed by
3.11the Board of Nursing and physicians who work with advanced practice registered
3.12nurses appointed by the Board of Medical Practice with the responsibility to review
3.13investigations and recommend disciplinary action to the Board of Nursing for advanced
3.14practice registered nurses.
3.15 Sec. 6. Minnesota Statutes 2012, section 148.171, subdivision 5, is amended to read:
3.16 Subd. 5. Clinical nurse specialist practice. "Clinical nurse specialist practice"
3.17means the provision of patient care in a particular specialty or subspecialty of advanced
3.18practice registered nursing
3.19(1) diagnosing illness and disease;
3.20(2) providing
3.21accordance with section 148.235;
3.22(3) providing psychotherapy;
3.23
3.24
3.25 (6) collaborating with, consulting with, and referring to physicians and other health
3.26care providers when needed for optimal patient care.
3.27 The certified clinical nurse specialist is certified for advanced practice registered
3.28nursing in a specific field of clinical nurse specialist practice.
3.29 Sec. 7. Minnesota Statutes 2012, section 148.171, subdivision 6, is amended to read:
3.30 Subd. 6.
3.31
3.32
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8 "Collaboration" means a mutually agreed upon process in which health professionals
4.9jointly contribute to the health care provided to a patient with each collaborator performing
4.10actions that the professional is licensed, certified, or otherwise authorized to perform.
4.11Collaboration includes the systematic formal planning and evaluation in a patient's care,
4.12including but not limited to the care that is best for the patient, emergency backup plans,
4.13and referral arrangements to other health care professionals.
4.14 Sec. 8. Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
4.15to read:
4.16 Subd. 7c. Integrated clinical setting. "Integrated clinical setting" means a place
4.17of practice where an advanced practice registered nurse works with physicians and other
4.18practitioners in the same location.
4.19 Sec. 9. Minnesota Statutes 2012, section 148.171, subdivision 10, is amended to read:
4.20 Subd. 10. Nurse-midwife practice. "Nurse-midwife practice" means the
4.21management of women's primary health care, focusing on pregnancy, childbirth, the
4.22postpartum period, care of the newborn partner care management relating to sexual health,
4.23and the family planning and gynecological needs of women and includes diagnosing
4.24
4.25
4.26
4.27consulting with, and referring to physicians and other health care providers when needed
4.28for optimal patient care.
4.29 Sec. 10. Minnesota Statutes 2012, section 148.171, subdivision 11, is amended to read:
4.30 Subd. 11. Nurse practitioner practice. "Nurse practitioner practice" means
4.31
4.32specialty or subspecialty of advanced practice registered nursing and includes: (1)
4.33diagnosing, directly managing, and preventing acute and chronic illness and disease;
5.1 (2) promoting wellness, including health assessment and screening activities; (3) health
5.2promotion, disease prevention, health education, and patient counseling; (4) providing
5.3limited pharmacologic and nonpharmacologic treatment in accordance with section
5.4148.235; and (5) collaborating with, consulting with, and referring to physicians and
5.5other health care providers when needed for optimal patient care. The certified nurse
5.6practitioner is certified for advanced registered nurse practice in a specific field of nurse
5.7practitioner practice.
5.8 Sec. 11. Minnesota Statutes 2012, section 148.171, subdivision 13, is amended to read:
5.9 Subd. 13. Practice of advanced practice registered nursing. The "practice of
5.10advanced practice registered nursing" means the performance of clinical nurse specialist
5.11practice, nurse-midwife practice, nurse practitioner practice, or registered nurse anesthetist
5.12practice as defined in subdivisions 5, 10, 11, and 21. The practice includes functioning as
5.13a direct care provider, case manager, consultant, educator, and researcher. The practice of
5.14advanced practice registered nursing also includes accepting referrals from, consulting
5.15with, cooperating with, or referring to all other types of health care providers, including
5.16but not limited to physicians, chiropractors, podiatrists, and dentists, provided that the
5.17advanced practice registered nurse and the other provider are practicing within their
5.18scopes of practice as defined in state law. The advanced practice registered nurse must
5.19practice within a health care
5.20
5.21An advanced practice registered nurse who is practicing in a setting that is not a
5.22hospital licensed under chapter 144 or a clinic where there are one or more physicians
5.23practicing on site must make available to patients:
5.24(1) the designation of a physician, physician clinic, or other health care group
5.25practice with whom the advanced practice registered nurse has a preestablished
5.26relationship for consultation, collaboration, and referral;
5.27(2) the designation of a physician, physician clinic, or other health care group
5.28practice with whom the advanced practice registered nurse has a preestablished
5.29arrangement to accept the transfer of care if the advanced practice registered nurse is
5.30without admitting privileges or has to transfer care to another provider;
5.31(3) the designation of hospitals or other inpatient facilities where patients requiring
5.32admission will be referred; and
5.33(4) the plan for transfer of or access to health records.
5.34 Sec. 12. Minnesota Statutes 2012, section 148.171, subdivision 16, is amended to read:
6.1 Subd. 16. Prescribing. "Prescribing" means the act of generating a prescription for
6.2the preparation of, use of, or manner of using a drug or therapeutic device in accordance
6.3with the provisions of section
6.4use of a drug or therapeutic device which is not required by the federal Food and Drug
6.5Administration to meet the labeling requirements for prescription drugs and devices.
6.6Prescribing also does not include recommending or administering a drug or therapeutic
6.7device
6.8control by a certified registered nurse anesthetist.
6.9 Sec. 13. Minnesota Statutes 2012, section 148.171, subdivision 21, is amended to read:
6.10 Subd. 21. Registered nurse anesthetist practice. "Registered nurse anesthetist
6.11practice" means the provision of anesthesia care and related services
6.12
6.13therapeutic devices to facilitate diagnostic, therapeutic, and surgical procedures upon
6.14request, assignment, or referral by a patient's physician, dentist, or podiatrist. A registered
6.15nurse anesthetist shall be prohibited from performing any procedures constituting the
6.16practice of interventional or invasive pain management as defined in section 147.081,
6.17subdivision 3, clause (7).
6.18 Sec. 14. Minnesota Statutes 2012, section 148.211, is amended by adding a subdivision
6.19to read:
6.20 Subd. 1a. Initial advanced practice registered nurse licensure. (a) An applicant
6.21for a license to practice as an advanced practice registered nurse (APRN) shall apply to
6.22the board for a license in a format prescribed by the board and pay a fee in an amount
6.23determined by statute. In no case may fees be refunded. In addition, an APRN must also
6.24register with the Board of Medical Practice.
6.25(b) To be eligible for licensure:
6.26(1) the applicant must hold a current Minnesota professional nursing license or
6.27demonstrate eligibility for licensure as a registered nurse in this jurisdiction;
6.28(2) the applicant shall not hold an encumbered license as a registered nurse in any
6.29state or territory;
6.30(3) the applicant must have completed a graduate-level APRN program accredited
6.31by a nursing or nursing-related accrediting body that is recognized by the United States
6.32Secretary of Education or the Council for Higher Education Accreditation as acceptable
6.33to the board. The education must be in one of the four APRN roles and at least one
6.34population focus;
7.1(4) the applicant must be currently certified by a national certifying body recognized
7.2by the board in the APRN role appropriate to educational preparation;
7.3(5) the applicant must report any criminal conviction, nolo contendere plea, Alford
7.4plea, or other plea arrangement in lieu of conviction; and
7.5(6) the applicant must have committed no acts or omissions which are grounds
7.6for disciplinary action in another jurisdiction or, if such acts have been committed and
7.7would be grounds for disciplinary action under section 148.261, the board has found after
7.8investigation that sufficient restitution has been made.
7.9(c) After December 31, 2015, all new graduates applying for advanced practice
7.10registered nurse licensure must meet the licensure requirements in this chapter.
7.11 Sec. 15. Minnesota Statutes 2012, section 148.211, is amended by adding a subdivision
7.12to read:
7.13 Subd. 1b. Advanced practice registered nurse grandfather provision. Any
7.14advanced practice registered nurse with authority to practice as an advanced practice
7.15registered nurse in this state that is valid on December 31, 2015, shall be eligible to apply
7.16for licensure with the board and apply for registration with the Board of Medical Practice
7.17as an advanced practice registered nurse under the provisions of this chapter with current
7.18privileges and shall be eligible for license renewal under the conditions and standards
7.19prescribed in this chapter.
7.20 Sec. 16. Minnesota Statutes 2012, section 148.235, subdivision 2, is amended to read:
7.21 Subd. 2. Certified nurse practitioners. (a) A certified nurse practitioner who has
7.22
7.23
7.24
7.25completed no less than 30 hours of formal study from a college, university, or university
7.26health care institution which included instruction in health assessment, medication
7.27classifications, indications, dosages, contraindications, and side effects; supervised
7.28practice; and competence evaluation including evidence of the application of knowledge
7.29pertaining to prescribing for and therapeutic management of the clinical type of patients
7.30in the certified nurse practitioner's practice application, and who has practiced in an
7.31integrated clinical setting for at least three years, may prescribe and administer drugs and
7.32therapeutic devices, excluding schedule II controlled substances, within the scope of
7.33
8.1(b) A certified nurse practitioner who has practiced fewer than three years in an
8.2integrated clinical setting or a certified nurse practitioner who wants to prescribe and
8.3administer schedule II controlled substances must have a written agreement with a
8.4physician based on standards established by the Minnesota Nurses Association and the
8.5Minnesota Medical Association that defines the delegated responsibilities related to the
8.6prescription of drugs and therapeutic devices. The agreement must include processes
8.7for appropriate review of prescribing practices by the physician to assist with quality
8.8improvement and to ensure patient safety. The written agreement required under this
8.9subdivision shall be based on standards established by the Minnesota Nurses Association
8.10and the Minnesota Medical Association as of January 1, 1996, unless both associations
8.11agree to revisions. Written prescribing agreements shall be mutually reviewed between all
8.12parties to the agreement on at least an annual basis.
8.13 Sec. 17. Minnesota Statutes 2012, section 148.235, subdivision 2a, is amended to read:
8.14 Subd. 2a. Certified registered nurse anesthetists. A certified registered nurse
8.15anesthetist who has a written agreement with a physician based on standards established
8.16by the Minnesota Nurses Association and the Minnesota Medical Association that defines
8.17the delegated responsibilities related to the prescription of drugs and therapeutic devices,
8.18may prescribe and administer drugs and therapeutic devices within the scope of the
8.19written agreement and within practice as a certified registered nurse anesthetist. Nothing
8.20in this section shall permit the performance of procedures constituting the practice of
8.21interventional or invasive pain management as defined in section 147.081, subdivision
8.223, clause (7).
8.23 Sec. 18. Minnesota Statutes 2012, section 148.235, subdivision 4, is amended to read:
8.24 Subd. 4. Certified clinical nurse specialists in psychiatric and mental health
8.25nursing. (a) A certified clinical nurse specialist who
8.26less than 30 hours of formal study in the prescribing of psychotropic medications and
8.27medications to treat their side effects which included instruction in health assessment,
8.28psychotropic classifications, psychopharmacology, indications, dosages, contraindications,
8.29side effects, and evidence of application
8.30integrated clinical setting for at lest three years may prescribe and administer drugs
8.31used to treat psychiatric and behavioral disorders and the side effects of those drugs,
8.32excluding schedule II controlled substances, within the scope of practice as a certified
8.33clinical nurse specialist in psychiatric and mental health nursing. A certified clinical
8.34nurse specialist who has practiced fewer than three years in an integrated clinical setting
9.1or a certified clinical nurse specialist who wants to prescribe and administer schedule II
9.2controlled substances must have a written agreement with a psychiatrist or other physician
9.3based on standards established by the Minnesota Nurses Association and the Minnesota
9.4Psychiatric Association that specifies and defines the delegated responsibilities related to
9.5the prescription of drugs in relationship to the diagnosis, may prescribe and administer
9.6drugs used to treat psychiatric and behavioral disorders and the side effects of those drugs
9.7within the scope of the written agreement and within practice as a certified clinical
9.8nurse specialist in psychiatric and mental health nursing. The agreement must include
9.9processes for appropriate review of prescribing practices by the physician to assist with
9.10quality improvement and ensure patient safety. The written agreement required under this
9.11subdivision shall be based on standards established by the Minnesota Nurses Association
9.12and the Minnesota Psychiatric Association as of January 1, 1996, unless both associations
9.13agree to revisions. Written prescribing agreements shall be mutually reviewed between all
9.14parties to the agreement on at least an annual basis.
9.15(b) Nothing in this subdivision removes or limits the legal professional liability of
9.16the treating psychiatrist, certified clinical nurse specialist, mental health clinic or hospital
9.17for the prescription and administration of drugs by a certified clinical nurse specialist in
9.18accordance with this subdivision.
9.19 Sec. 19. Minnesota Statutes 2012, section 148.235, subdivision 4a, is amended to read:
9.20 Subd. 4a. Other certified clinical nurse specialists. A certified clinical nurse
9.21specialist who
9.22a college, university, or university health care institution, which included the following:
9.23instruction in health assessment, medication classifications, indications, dosages,
9.24contraindications, and side effects; supervised practice; and competence evaluation,
9.25including evidence of the application of knowledge pertaining to prescribing for and
9.26therapeutic management of the clinical type of patients in the certified clinical nurse
9.27specialist's practice
9.28at least three years, may prescribe and administer drugs and therapeutic devices, excluding
9.29schedule II controlled substances, within the scope of practice as a certified clinical nurse
9.30specialist. A certified clinical nurse specialist who practiced fewer than three years in an
9.31integrated clinical setting or a certified clinical nurse specialist who wants to prescribe
9.32and administer schedule II controlled substances must have a written agreement with a
9.33physician based on standards established by the Minnesota Nurses Association and the
9.34Minnesota Medical Association that defines the delegated responsibilities related to the
9.35prescription of drugs and therapeutic devices, may prescribe and administer drugs and
10.1therapeutic devices within the scope of the written agreement and within practice as a
10.2certified clinical nurse specialist. The agreement must include processes for appropriate
10.3review of prescribing practices by the physician to assist with quality improvement and to
10.4ensure patient safety. Written prescribing agreements shall be mutually reviewed between
10.5all parties to the agreement on at least an annual basis.
10.6 Sec. 20. Minnesota Statutes 2012, section 148.235, subdivision 4b, is amended to read:
10.7 Subd. 4b. Dispensing authority. An advanced practice registered nurse who is
10.8authorized under this section to prescribe drugs is authorized to dispense drugs subject to
10.9the same requirements established for the prescribing of drugs.
10.10
10.11
10.12and dispense sample drugs.
10.13 Sec. 21. Minnesota Statutes 2012, section 148.235, subdivision 6, is amended to read:
10.14 Subd. 6. Standards for written agreements; review and filing. Written
10.15agreements required under this section shall be maintained at the primary practice site of
10.16the advanced practice registered nurse and of the collaborating physician. The written
10.17agreement does not need to be filed with the Board of Nursing or the Board of Medical
10.18Practice but must be reviewed on an annual basis by the parties to the agreement.
10.19 Sec. 22. Minnesota Statutes 2012, section 148.261, is amended by adding a subdivision
10.20to read:
10.21 Subd. 6. Actions against an APRN. The joint subcommittee comprised of an equal
10.22number of advanced practice nurses appointed by the Board of Nursing and physicians
10.23who work with advanced practice registered nurses appointed by the Board of Medical
10.24Practice shall review complaints against an advanced practice registered nurse that are
10.25in violation of chapter 147 or 148 and recommend disciplinary action as described in
10.26sections 148.261 or 148.262 to the Board of Nursing.
10.27 Sec. 23. Minnesota Statutes 2012, section 148.261, is amended by adding a subdivision
10.28to read:
10.29 Subd. 7. Standard of care. An advanced practice registered nurse licensed under
10.30this chapter who is diagnosing, treating, or prescribing under chapter 148 shall be held
10.31to the same standard of care as that of a physician licensed under chapter 147 by the
10.32state of Minnesota.
