Bill Text: MS HB1652 | 2024 | Regular Session | Introduced
Bill Title: Advanced practice registered nurses; revise provisions relating to the collaborative relationship requirement.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2024-03-05 - Died In Committee [HB1652 Detail]
Download: Mississippi-2024-HB1652-Introduced.html
MISSISSIPPI LEGISLATURE
2024 Regular Session
To: Public Health and Human Services
By: Representative Eubanks
House Bill 1652
AN ACT TO AMEND SECTION 73-15-5, MISSISSIPPI CODE OF 1972, TO DELETE CERTAIN DEFINITIONS AND REVISE CERTAIN DEFINITIONS IN THE NURSING PRACTICE LAW REGARDING ADVANCED NURSING PRACTICE; TO AMEND SECTION 73-15-20, MISSISSIPPI CODE OF 1972, TO REVISE CERTAIN PROVISIONS RELATING TO THE PRACTICE OF ADVANCED PRACTICE REGISTERED NURSES; TO PROVIDE THAT THE PHYSICIAN OR DENTIST WITH WHOM AN ADVANCED PRACTICE REGISTERED NURSE HAS ENTERED INTO A COLLABORATIVE/CONSULTATIVE RELATIONSHIP SHALL NOT CHARGE OR REQUIRE ANY PAYMENT FROM THE ADVANCED PRACTICE REGISTERED NURSE FOR SERVING IN THAT CAPACITY WITH THE ADVANCED PRACTICE REGISTERED NURSE; TO PROVIDE THAT AFTER AN ADVANCED PRACTICE REGISTERED NURSE, EXCEPT A CERTIFIED REGISTERED NURSE ANESTHETIST, HAS COMPLETED NOT LESS THAN 5,000 CLINICAL PRACTICE HOURS IN A COLLABORATIVE/CONSULTATIVE RELATIONSHIP WITH A PHYSICIAN OR WITH AN ADVANCED PRACTICE REGISTERED NURSE COMPLETED NOT LESS THAN 5,000 CLINICAL PRACTICE HOURS, THE ADVANCED PRACTICE REGISTERED NURSE IS EXEMPT FROM THE REQUIREMENT OF ENTERING AND MAINTAINING A COLLABORATIVE/CONSULTATIVE RELATIONSHIP WITH A LICENSED PHYSICIAN OR DENTIST; TO PROVIDE THAT AFTER A CERTIFIED REGISTERED NURSE ANESTHETIST HAS COMPLETED NOT LESS THAN 8,000 CLINICAL PRACTICE HOURS IN A COLLABORATIVE/CONSULTATIVE RELATIONSHIP WITH A PHYSICIAN OR WITH AN ADVANCED PRACTICE REGISTERED NURSE COMPLETED NOT LESS THAN 5,000 CLINICAL PRACTICE HOURS, THE CERTIFIED REGISTERED NURSE ANESTHETIST IS EXEMPT FROM MAINTAINING A COLLABORATIVE/CONSULTATIVE RELATIONSHIP WITH A LICENSED PHYSICIAN OR DENTIST; TO PROVIDE THAT ADVANCED PRACTICE REGISTERED NURSES MAY APPLY HOURS WORKED BEFORE THE EFFECTIVE DATE OF THIS ACT TO FULFILL THEIR RESPECTIVE CLINICAL PRACTICE HOUR REQUIREMENT; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 73-15-5, Mississippi Code of 1972, is amended as follows:
73-15-5. (1) "Board" means the Mississippi Board of Nursing.
(2) The "practice of nursing" by a registered nurse means the performance for compensation of services which requires substantial knowledge of the biological, physical, behavioral, psychological and sociological sciences and of nursing theory as the basis for assessment, diagnosis, planning, intervention and evaluation in the promotion and maintenance of health; management of individuals' responses to illness, injury or infirmity; the restoration of optimum function; or the achievement of a dignified death. "Nursing practice" includes, but is not limited to, administration, teaching, counseling, delegation and supervision of nursing, and execution of the medical regimen, including the administration of medications and treatments prescribed by any licensed or legally authorized physician, advanced practice registered nurse or dentist. The foregoing shall not be deemed to include acts of medical diagnosis or prescriptions of medical, therapeutic or corrective measures, except as may be set forth by rules and regulations promulgated and implemented by the Mississippi Board of Nursing.
* * *
( * * *3) "Advanced nursing practice"
means, in addition to the practice of professional nursing, the performance of
advanced-level nursing approved by the board which, by virtue of graduate
education and experience are appropriately performed by an advanced practice
registered nurse. The advanced practice registered nurse may diagnose, treat
and manage medical conditions. This may include prescriptive authority as
identified by the board. Except as otherwise authorized in Section 73-15-20(3),
advanced practice registered nurses must practice in a
collaborative/consultative relationship with a physician or dentist with an
unrestricted license to practice in the State of Mississippi and advanced
nursing must be performed within the framework of a standing protocol or
practice guidelines, as appropriate.
( * * *4) The "practice of nursing"
by a licensed practical nurse means the performance for compensation of
services requiring basic knowledge of the biological, physical, behavioral, psychological
and sociological sciences and of nursing procedures which do not require the
substantial skill, judgment and knowledge required of a registered nurse.
These services are performed under the direction of a registered nurse or a
licensed physician or licensed dentist and utilize standardized procedures in
the observation and care of the ill, injured and infirm; in the maintenance of
health; in action to safeguard life and health; and in the administration of
medications and treatments prescribed by any licensed physician * * *, licensed dentist or advanced practice
registered nurse authorized by state law to prescribe. On a selected basis,
and within safe limits, the role of the licensed practical nurse shall be expanded
by the board under its rule-making authority to more complex procedures and
settings commensurate with additional preparation and experience.
( * * *5) A "license" means an
authorization to practice nursing as a registered nurse, an advanced practice registered nurse or
a licensed practical nurse designated herein.
( * * *6) A "registered nurse" is a
person who is licensed or holds the privilege to practice under the provisions
of this article and who practices nursing as defined herein. "RN" is
the abbreviation for the title of Registered Nurse.
( * * *7) A "licensed practical nurse"
is a person who is licensed or holds the privilege to practice under this article
and who practices practical nursing as defined herein. "LPN" is the
abbreviation for the title of Licensed Practical Nurse.
( * * *8) A "registered nurse in
clinical practice" is one who functions in any health care delivery system
which provides nursing services.
* * *
(9) "Collaboration" or "collaborate" means the act of communicating pertinent information or consulting with a licensed physician or other licensed health care provider with each provider contributing the provider's respective expertise to optimize the overall care delivered to the patient.
( * * *10) An "advanced practice
registered nurse" is a person who is licensed or holds the privilege to
practice under this article as a professional nurse and who is * * *
licensed as an advanced practice registered nurse or specialized nursing
practice and includes certified registered nurse midwives, certified registered
nurse anesthetists, clinical nurse specialists and certified nurse
practitioners. "APRN" is the abbreviation for the title of advanced
practice registered nurse. As used in this subsection (10):
(a) "Certified
registered nurse midwife" means a registered nurse who holds certification
as a certified registered nurse midwife by a nationally recognized certifying
body approved by the board and is licensed by the board to engage in advanced
practice nursing in this state. "CNM" is the abbreviation for
the title of Certified Nurse Midwife * * *.
(b) "Certified registered nurse anesthetist" means a registered nurse who holds certification as a certified registered nurse anesthetist by a nationally recognized certifying body approved by the board and is licensed by the board to engage in advanced practice nursing in this state. "CRNA" is the abbreviation for the title of Certified Registered Nurse Anesthetist.
(c) "Certified nurse practitioner" means a registered nurse who holds certification as a certified nurse practitioner by a nationally recognized certifying body approved by the board and is licensed by the board to engage in advanced practice nursing in this state. "CNP" is the abbreviation for the title of Certified Nurse Practitioner.
(d) "Clinical nurse specialist" means a registered nurse who holds certification as a clinical nurse specialist by a nationally recognized certifying body approved by the board and is licensed by the board to engage in advanced practice nursing in this state. "CNS" is the abbreviation for the title of Clinical Nurse Specialist.
( * * *11) A "nurse educator" is a
registered nurse who meets the criteria for faculty as set forth in a state-accredited
program of nursing for registered nurses, or a state-approved program of
nursing for licensed practical nurses, and who functions as a faculty member.
( * * *12) A "consumer representative"
is a person representing the interests of the general public, who may use
services of a health agency or health professional organization or its members
but who is neither a provider of health services, nor employed in the health
services field, nor holds a vested interest in the provision of health services
at any level, nor has an immediate family member who holds vested interests in
the provision of health services at any level.
( * * *13) "Privilege to practice"
means the multistate licensure privilege to practice nursing in the state as
described in the Nurse Licensure Compact provided for in Section 73-15-201.
( * * *14) "Licensee" is a person
who has been issued a license to practice nursing or advanced practice
nursing in the state or who holds the privilege to practice nursing in the state.
(15) "Clinical practice hours" include, but are not limited to clinical practice hours completed in an APRN program, CRNA critical care nursing hours and practice hours completed as an authorized APRN in this state or any other state.
(16) "Critical care nursing hours" means any nursing hours received by a CRNA in a critical care setting required as a prerequisite for admission to a Nurse Anesthesia program.
SECTION 2. Section 73-15-20, Mississippi Code of 1972, is amended as follows:
73-15-20. (1) Advanced
practice registered nurses. Any nurse desiring to be * * * licensed as an advanced
practice registered nurse shall apply to the board and submit proof that he or
she holds a current license * * * as a registered
nurse and that he or she meets one or more of the following requirements:
(a) Satisfactory completion of a formal post-basic educational program of at least one (1) academic year, the primary purpose of which is to prepare nurses for advanced or specialized practice.
(b) Certification by a
board-approved certifying body. Such certification shall be required for
initial state * * *
licensure and any * * * recertification license renewal as a certified
registered nurse anesthetist, certified nurse practitioner, clinical nurse specialist or certified
registered nurse midwife. The board may by rule provide for provisional or
temporary state * * * licensure of graduate * * * advanced practice registered nurses for a period of time
determined to be appropriate for preparing and passing the National
Certification Examination. Those with provisional or temporary * * * licenses must practice
under the direct supervision of a licensed physician or * * *
an advanced practice registered nurse
with at least five (5) years of experience.
(c) Graduation from a
program leading to a master's or post-master's degree in a * * * program of
study preparing for one (1) of the described advanced practice registered nurse
roles.
(2) Rulemaking. The
board shall provide by rule the appropriate requirements for advanced practice registered
nurses in the categories of certified registered nurse anesthetist, certified registered
nurse midwife, clinical nurse specialist
and * * * certified nurse
practitioner.
(3) Collaboration. (a)
Except as otherwise authorized in this subsection (3), an advanced
practice registered nurse shall perform those functions authorized in this section
within a collaborative/consultative relationship with a dentist or physician
with an unrestricted license to practice dentistry or medicine in this state
and within an established protocol or practice guidelines, as appropriate, that
is filed with the board upon license application, license renewal, after
entering into a new collaborative/consultative relationship or making changes
to the protocol or practice guidelines or practice site. The board shall
review and approve the protocol to ensure compliance with applicable regulatory
standards. * * * The physician or dentist with whom
an advanced practice registered nurse has entered into a collaborative/consultative
relationship shall not charge or require any payment from the advanced practice
registered nurse for serving in that capacity with the advanced practice registered
nurse.
(b) After an advanced practice registered nurse, except a certified registered nurse anesthetist, has completed not less than five thousand (5,000) clinical practice hours in a collaborative/consultative relationship with a physician or with an advanced practice registered nurse completed not less than five thousand (5,000) clinical practice hours, the advanced practice registered nurse is exempt from the requirement of entering and maintaining a collaborative/consultative relationship with a licensed physician or dentist as provided under this subsection (3).
(c) After a certified registered nurse anesthetist has completed not less than eight thousand (8,000) clinical practice hours in a collaborative/consultative relationship with a physician or with an advanced practice registered nurse completed not less than five thousand (5,000) clinical practice hours, the certified registered nurse anesthetist is exempt from maintaining a collaborative/consultative relationship with a licensed physician or dentist as provided under this subsection (3).
(d) Advanced practice registered nurses may apply hours worked before July 1, 2024, to fulfill their respective clinical practice hour requirements under this subsection (3).
(4) Renewal. The
board shall renew a license for an advanced practice registered nurse upon
receipt of the renewal application, fees and any required protocol or
practice guidelines. The board shall adopt rules establishing procedures for
license renewals. The board shall by rule prescribe continuing education
requirements for advanced practice registered nurses * * * as a
condition for renewal of * * * a license or certificate licensure.
(5) Reinstatement.
Advanced practice registered nurses may reinstate a lapsed privilege to
practice upon submitting documentation of a current active license to practice
professional nursing, a reinstatement application and fee, * * * any required protocol or practice
guidelines, documentation of current certification as an advanced practice registered
nurse in a designated area of practice by a national certification organization
recognized by the board and documentation of at least forty (40) hours of continuing
education related to the advanced clinical practice of the * * * advanced
practice registered nurse within the previous two-year period. The
board shall adopt rules establishing the procedure for reinstatement.
(6) Changes in status. * * * An advanced practice registered
nurse who is required to have a collaborative/consultative relationship with
a licensed physician shall notify the board immediately regarding changes
in the collaborative/consultative relationship * * *. If
changes leave the advanced practice registered nurse without a board-approved
collaborative/consultative relationship with a physician or dentist, the
advanced practice nurse may not practice as an advanced practice registered
nurse.
(7) Practice requirements. The advanced practice registered nurse shall practice as follows:
(a) According to standards and guidelines of their respective professional organization and the National Certification Organization.
(b) In a collaborative/consultative relationship with a licensed physician or dentist whose practice is compatible with that of the nurse practitioner, except as otherwise authorized in subsection (3) of this section. Certified registered nurse anesthetists may collaborate/consult with licensed dentists. The advanced practice registered nurse must be able to communicate reliably with a collaborating/consulting physician or dentist while practicing. Advanced practice registered nurses who are not required to have a collaborative/consultative relationship with a licensed physician or dentist shall collaborate with other health care providers and refer or transfer patients as appropriate.
(c) According to a board-approved protocol or practice guidelines, except as otherwise authorized in subsection (3) of this section.
(d) Advanced practice registered nurses practicing as certified registered nurse anesthetists must practice according to board-approved practice guidelines that address pre-anesthesia preparation and evaluation; anesthesia induction, maintenance, and emergence; post-anesthesia care; peri-anesthetic and clinical support functions.
(e) Except as otherwise authorized in subsection (3) of this section, advanced practice registered nurses practicing in other specialty areas must practice according to a board-approved protocol that has been mutually agreed upon by the nurse practitioner and a Mississippi licensed physician or dentist whose practice or prescriptive authority is not limited as a result of voluntary surrender or legal/regulatory order.
(f) Each required collaborative/consultative relationship shall include and implement a formal quality assurance/quality improvement program which shall be maintained on site and shall be available for inspection by representatives of the board. This quality assurance/quality improvement program must be sufficient to provide a valid evaluation of the practice and be a valid basis for change, if any.
(g) * * * Advanced practice registered nurses may not
write prescriptions for, dispense or order the use of or administration of any
schedule of controlled substances except as contained in this chapter.
(8) Prescribing
controlled substances and medications. * * * Advanced practice registered
nurses may apply for controlled substance prescriptive authority
after completing a board-approved educational program. * * *
Advanced practice registered nurses
who have completed the program and received prescription authority from the
board may prescribe Schedules II-V. The words "administer," "controlled
substances" and "ultimate user," shall have the same meaning as
set forth in Section 41-29-105, unless the context otherwise requires. The
board shall promulgate rules governing prescribing of controlled substances,
including distribution, record keeping, drug maintenance, labeling and
distribution requirements and prescription guidelines for controlled substances
and all medications. Prescribing any controlled substance in violation of the
rules promulgated by the board shall constitute a violation of Section 73-15-29(1)(f),
(k) and (l) and shall be grounds for disciplinary action. The prescribing,
administering or distributing of any legend drug or other medication in
violation of the rules promulgated by the board shall constitute a violation of
Section 73-15-29(1)(f), (k) and (l) and shall be grounds for disciplinary action.
SECTION 3. This act shall take effect and be in force from and after July 1, 2024.
