Florida Senate - 2012 SENATOR AMENDMENT
Bill No. SB 1988
Barcode 174054
LEGISLATIVE ACTION
Senate . House
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Floor: WD/2R .
02/23/2012 06:11 PM .
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Senator Bennett moved the following:
1 Senate Amendment (with title amendment)
2
3 Between lines 1855 and 1856
4 insert:
5 Section 19. Subsection (3) and paragraph (a) of subsection
6 (4) of section 464.012, Florida Statutes, are amended to read:
7 464.012 Certification of advanced registered nurse
8 practitioners; fees.—
9 (3) An advanced registered nurse practitioner shall perform
10 those functions authorized in this section within the framework
11 of an established protocol that is filed with the board upon
12 biennial license renewal and within 30 days after entering into
13 a supervisory relationship with a physician or changes to the
14 protocol. The board shall review the protocol to ensure
15 compliance with applicable regulatory standards for protocols.
16 The board shall refer to the department licensees submitting
17 protocols that are not compliant with the regulatory standards
18 for protocols. A practitioner currently licensed under chapter
19 458, chapter 459, or chapter 466 shall maintain supervision for
20 directing the specific course of medical treatment. Within the
21 established framework, an advanced registered nurse practitioner
22 may:
23 (a) Order, administer, monitor, and alter any drug or drug
24 therapies that are necessary for the proper medical care and
25 treatment of a patient, including Schedule II through Schedule V
26 controlled substances under chapter 893 and those drugs agreed
27 upon by the advanced registered nurse practitioner and the
28 supervising practitioner and specified in the protocol. An
29 advanced registered nurse practitioner may order or administer
30 such drugs under the following conditions:
31 1. The drugs are ordered or administered by an advanced
32 registered nurse practitioner in accordance with a protocol
33 developed by the advanced registered nurse practitioner and the
34 supervising practitioner, and the drugs ordered are consistent
35 with the advanced registered nurse practitioner’s educational
36 preparation or for which clinical competency has been
37 established and maintained.
38 2. The protocol covering the order or administration of
39 drugs specifies the name of the advanced registered nurse
40 practitioner who may administer or order drugs, the drugs that
41 may be ordered and the circumstances under which they may be
42 ordered, the extent of the practitioner’s supervision of the
43 advanced registered nurse practitioner, and the method for
44 periodic reviewing the advanced registered nurse practitioner’s
45 competence, including peer review. The protocol for
46 administering Schedule II controlled substances must address the
47 illness, injury, or condition for which a Schedule II controlled
48 substance is administered.
49 3. The administering or ordering of drugs by an advanced
50 registered nurse practitioner occurs under practitioner
51 supervision. As used in this paragraph, the term “practitioner
52 supervision” means a collaboration between the advanced
53 registered nurse practitioner and the supervising practitioner
54 on the development of the protocol and the availability of the
55 supervising practitioner via telephonic contact at the time the
56 patient is examined by the advanced registered nurse
57 practitioner. The term does not mean that the physical presence
58 of the supervising practitioner is required. A practitioner may
59 not supervise more than four advanced registered nurse
60 practitioners at any one time.
61 4. The controlled substances are administered or ordered in
62 accordance with a patient-specific protocol approved by the
63 treating or supervising practitioner if Schedule II or Schedule
64 III controlled substances are administered or ordered by the
65 advanced registered nurse practitioner. A copy of the section of
66 the advanced registered nurse practitioner’s protocol relating
67 to controlled substances must be provided upon request to the
68 licensed pharmacist who dispenses the drugs.
69 5. The board has certified that the advanced registered
70 nurse practitioner has satisfactorily completed:
71 a. At least 6 months of direct supervision in the
72 administering and ordering of drugs; and
73 b. A course in pharmacology covering the order, use,
74 administration, and dispensing of controlled substances.
75
76 The board shall adopt rules to administer this paragraph.
77 (b) Initiate appropriate therapies for certain conditions.
78 (c) Perform additional functions as may be determined by
79 rule in accordance with s. 464.003(2).
80 (d) Order diagnostic tests and physical and occupational
81 therapy.
82 (4) In addition to the general functions specified in
83 subsection (3), an advanced registered nurse practitioner may
84 perform the following acts within his or her specialty:
85 (a) The certified registered nurse anesthetist may, to the
86 extent authorized by established protocol approved by the
87 medical staff of the facility in which the anesthetic service is
88 performed, perform any or all of the following:
89 1. Determine the health status of the patient as it relates
90 to the risk factors and to the anesthetic management of the
91 patient through the performance of the general functions.
92 2. Based on history, physical assessment, and supplemental
93 laboratory results, determine, with the consent of the
94 responsible physician, the appropriate type of anesthesia within
95 the framework of the protocol.
96 3. Order under the protocol preanesthetic medication.
97 4. Perform under the protocol procedures commonly used to
98 render the patient insensible to pain during the performance of
99 surgical, obstetrical, therapeutic, or diagnostic clinical
100 procedures. These procedures include ordering and administering
101 regional, spinal, and general anesthesia; inhalation agents and
102 techniques; intravenous agents and techniques; and techniques of
103 hypnosis.
104 5. Order or perform monitoring procedures indicated as
105 pertinent to the anesthetic health care management of the
106 patient.
107 6. Support life functions during anesthesia health care,
108 including induction and intubation procedures, the use of
109 appropriate mechanical supportive devices, and the management of
110 fluid, electrolyte, and blood component balances.
111 7. Recognize and take appropriate corrective action for
112 abnormal patient responses to anesthesia, adjunctive medication,
113 or other forms of therapy.
114 8. Recognize and treat a cardiac arrhythmia while the
115 patient is under anesthetic care.
116 9. Participate in management of the patient while in the
117 postanesthesia recovery area, including ordering the
118 administration of fluids and drugs, including those drugs that
119 are commonly used to alleviate pain.
120 10. Place special peripheral and central venous and
121 arterial lines for blood sampling and monitoring as appropriate.
122
123 ================= T I T L E A M E N D M E N T ================
124 And the title is amended as follows:
125 Delete line 80
126 and insert:
127 Department of Elderly Affairs; amending s. 464.012,
128 F.S.; expanding the scope of practice to authorize an
129 advanced registered nurse practitioner to order,
130 administer, monitor, and alter any drug or drug
131 therapies that are necessary for the proper medical
132 care and treatment of a patient under specified
133 circumstances; requiring that the Board of Nursing
134 adopt rules; authorizing a certified registered nurse
135 anesthetist, while participating in the management of
136 a patient in the postanesthesia recovery area, to
137 order the administration of drugs that are commonly
138 used to alleviate pain; amending s. 31, chapter