Florida Senate - 2012 SENATOR AMENDMENT
Bill No. HB 5301
Barcode 461642
LEGISLATIVE ACTION
Senate . House
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Floor: WD/2R .
02/23/2012 06:13 PM .
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Senator Bennett moved the following:
1 Senate Amendment to Amendment (588096) (with title
2 amendment)
3
4 Between lines 1761 and 1762
5 insert:
6 Section 19. Subsection (3) and paragraph (a) of subsection
7 (4) of section 464.012, Florida Statutes, are amended to read:
8 464.012 Certification of advanced registered nurse
9 practitioners; fees.—
10 (3) An advanced registered nurse practitioner shall perform
11 those functions authorized in this section within the framework
12 of an established protocol that is filed with the board upon
13 biennial license renewal and within 30 days after entering into
14 a supervisory relationship with a physician or changes to the
15 protocol. The board shall review the protocol to ensure
16 compliance with applicable regulatory standards for protocols.
17 The board shall refer to the department licensees submitting
18 protocols that are not compliant with the regulatory standards
19 for protocols. A practitioner currently licensed under chapter
20 458, chapter 459, or chapter 466 shall maintain supervision for
21 directing the specific course of medical treatment. Within the
22 established framework, an advanced registered nurse practitioner
23 may:
24 (a) Order, administer, monitor, and alter any drug or drug
25 therapies that are necessary for the proper medical care and
26 treatment of a patient, including Schedule II through Schedule V
27 controlled substances under chapter 893 and those drugs agreed
28 upon by the advanced registered nurse practitioner and the
29 supervising practitioner and specified in the protocol. An
30 advanced registered nurse practitioner may order or administer
31 such drugs under the following conditions:
32 1. The drugs are ordered or administered by an advanced
33 registered nurse practitioner in accordance with a protocol
34 developed by the advanced registered nurse practitioner and the
35 supervising practitioner, and the drugs ordered are consistent
36 with the advanced registered nurse practitioner’s educational
37 preparation or for which clinical competency has been
38 established and maintained.
39 2. The protocol covering the order or administration of
40 drugs specifies the name of the advanced registered nurse
41 practitioner who may administer or order drugs, the drugs that
42 may be ordered and the circumstances under which they may be
43 ordered, the extent of the practitioner’s supervision of the
44 advanced registered nurse practitioner, and the method for
45 periodic reviewing the advanced registered nurse practitioner’s
46 competence, including peer review. The protocol for
47 administering Schedule II controlled substances must address the
48 illness, injury, or condition for which a Schedule II controlled
49 substance is administered.
50 3. The administering or ordering of drugs by an advanced
51 registered nurse practitioner occurs under practitioner
52 supervision. As used in this paragraph, the term “practitioner
53 supervision” means a collaboration between the advanced
54 registered nurse practitioner and the supervising practitioner
55 on the development of the protocol and the availability of the
56 supervising practitioner via telephonic contact at the time the
57 patient is examined by the advanced registered nurse
58 practitioner. The term does not mean that the physical presence
59 of the supervising practitioner is required. A practitioner may
60 not supervise more than four advanced registered nurse
61 practitioners at any one time.
62 4. The controlled substances are administered or ordered in
63 accordance with a patient-specific protocol approved by the
64 treating or supervising practitioner if Schedule II or Schedule
65 III controlled substances are administered or ordered by the
66 advanced registered nurse practitioner. A copy of the section of
67 the advanced registered nurse practitioner’s protocol relating
68 to controlled substances must be provided upon request to the
69 licensed pharmacist who dispenses the drugs.
70 5. The board has certified that the advanced registered
71 nurse practitioner has satisfactorily completed:
72 a. At least 6 months of direct supervision in the
73 administering and ordering of drugs; and
74 b. A course in pharmacology covering the order, use,
75 administration, and dispensing of controlled substances.
76
77 The board shall adopt rules to administer this paragraph.
78 (b) Initiate appropriate therapies for certain conditions.
79 (c) Perform additional functions as may be determined by
80 rule in accordance with s. 464.003(2).
81 (d) Order diagnostic tests and physical and occupational
82 therapy.
83 (4) In addition to the general functions specified in
84 subsection (3), an advanced registered nurse practitioner may
85 perform the following acts within his or her specialty:
86 (a) The certified registered nurse anesthetist may, to the
87 extent authorized by established protocol approved by the
88 medical staff of the facility in which the anesthetic service is
89 performed, perform any or all of the following:
90 1. Determine the health status of the patient as it relates
91 to the risk factors and to the anesthetic management of the
92 patient through the performance of the general functions.
93 2. Based on history, physical assessment, and supplemental
94 laboratory results, determine, with the consent of the
95 responsible physician, the appropriate type of anesthesia within
96 the framework of the protocol.
97 3. Order under the protocol preanesthetic medication.
98 4. Perform under the protocol procedures commonly used to
99 render the patient insensible to pain during the performance of
100 surgical, obstetrical, therapeutic, or diagnostic clinical
101 procedures. These procedures include ordering and administering
102 regional, spinal, and general anesthesia; inhalation agents and
103 techniques; intravenous agents and techniques; and techniques of
104 hypnosis.
105 5. Order or perform monitoring procedures indicated as
106 pertinent to the anesthetic health care management of the
107 patient.
108 6. Support life functions during anesthesia health care,
109 including induction and intubation procedures, the use of
110 appropriate mechanical supportive devices, and the management of
111 fluid, electrolyte, and blood component balances.
112 7. Recognize and take appropriate corrective action for
113 abnormal patient responses to anesthesia, adjunctive medication,
114 or other forms of therapy.
115 8. Recognize and treat a cardiac arrhythmia while the
116 patient is under anesthetic care.
117 9. Participate in management of the patient while in the
118 postanesthesia recovery area, including ordering the
119 administration of fluids and drugs, including those drugs that
120 are commonly used to alleviate pain.
121 10. Place special peripheral and central venous and
122 arterial lines for blood sampling and monitoring as appropriate.
123
124 ================= T I T L E A M E N D M E N T ================
125 And the title is amended as follows:
126 Delete line 1919
127 and insert:
128 Department of Elderly Affairs; amending s. 464.012,
129 F.S.; expanding the scope of practice to authorize an
130 advanced registered nurse practitioner to order,
131 administer, monitor, and alter any drug or drug
132 therapies that are necessary for the proper medical
133 care and treatment of a patient under specified
134 circumstances; requiring that the Board of Nursing
135 adopt rules; authorizing a certified registered nurse
136 anesthetist, while participating in the management of
137 a patient in the postanesthesia recovery area, to
138 order the administration of drugs that are commonly
139 used to alleviate pain; amending s. 31, chapter