Florida Senate - 2012                          SENATOR AMENDMENT
       Bill No. HB 5301
                                Barcode 461642                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                 Floor: WD/2R          .                                
             02/23/2012 06:13 PM       .                                

       Senator Bennett moved the following:
    1         Senate Amendment to Amendment (588096) (with title
    2  amendment)
    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.
   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.
  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