Bill Summary – FastDemocracy

Enrolled Copy                                                                         H.B. 336
                         NURSE PRACTICE ACT AMENDMENTS
                                      2019 GENERAL SESSION
                                           STATE OF UTAH
                              Chief Sponsor: James A. Dunnigan
                               Senate Sponsor: Curtis S. Bramble
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 LONG TITLE
 General Description:
        This bill amends provisions relating to the prescriptive authority of certain licensed
 nurse practitioners.
 Highlighted Provisions:
        This bill:
        < amends definitions;
        < permits certain licensed nurse practitioners to prescribe a Schedule II controlled
 substance; and
        < amends certain requirements for advanced practice nurse practitioners to have
 prescriptive authority for controlled substances.
 Money Appropriated in this Bill:
        None
 Other Special Clauses:
        None
 Utah Code Sections Affected:
 AMENDS:
        58-31b-102, as last amended by Laws of Utah 2016, Chapters 26 and 127
        58-31b-502, as last amended by Laws of Utah 2018, Third Special Session, Chapter 1
        58-31b-803, as enacted by Laws of Utah 2016, Chapter 127
        58-31d-103, as last amended by Laws of Utah 2016, Chapter 127
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 Be it enacted by the Legislature of the state of Utah:
        Section 1. Section 58-31b-102 is amended to read:
        58-31b-102. Definitions.
        In addition to the definitions in Section 58-1-102, as used in this chapter:
        (1) "Administrative penalty" means a monetary fine or citation imposed by the division
 for acts or omissions determined to constitute unprofessional or unlawful conduct in
 accordance with a fine schedule established by rule and as a result of an adjudicative
 proceeding conducted in accordance with Title 63G, Chapter 4, Administrative Procedures Act.
        (2) "Applicant" means a person who applies for licensure or certification under this
 chapter by submitting a completed application for licensure or certification and the required
 fees to the department.
        (3) "Approved education program" means a nursing education program that is
 accredited by an accrediting body for nursing education that is approved by the United States
 Department of Education.
        (4) "Board" means the Board of Nursing created in Section 58-31b-201.
        (5) "Consultation and referral plan" means a written plan jointly developed by an
 advanced practice registered nurse and, except as provided in Subsection 58-31b-803(4), a
 consulting physician that permits the advanced practice registered nurse to prescribe Schedule
 II controlled substances in consultation with the consulting physician.
        (6) "Consulting physician" means a physician and surgeon or osteopathic physician and
 surgeon licensed in accordance with this title who has agreed to consult with an advanced
 practice registered nurse with a controlled substance license, a DEA registration number, and
 who will be prescribing Schedule II controlled substances.
        (7) "Diagnosis" means the identification of and discrimination between physical and
 psychosocial signs and symptoms essential to the effective execution and management of
 health care.
        (8) "Examinee" means a person who applies to take or does take any examination
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 required under this chapter for licensure.
        (9) "Licensee" means a person who is licensed or certified under this chapter.
        (10) "Long-term care facility" means any of the following facilities licensed by the
 Department of Health pursuant to Title 26, Chapter 21, Health Care Facility Licensing and
 Inspection Act:
        (a) a nursing care facility;
        (b) a small health care facility;
        (c) an intermediate care facility for people with an intellectual disability;
        (d) an assisted living facility Type I or II; or
        (e) a designated swing bed unit in a general hospital.
        (11) "Medication aide certified" means a certified nurse aide who:
        (a) has a minimum of 2,000 hours experience working as a certified nurse aide;
        (b) has received a minimum of 60 hours of classroom and 40 hours of practical training
 that is approved by the division in collaboration with the board, in administering routine
 medications to patients or residents of long-term care facilities; and
        (c) is certified by the division as a medication aide certified.
        (12) "Pain clinic" means the same as that term is defined in Section 58-1-102.
        (13) (a) "Practice as a medication aide certified" means the limited practice of nursing
 under the supervision, as defined by the division by administrative rule, of a licensed nurse,
 involving routine patient care that requires minimal or limited specialized or general
 knowledge, judgment, and skill, to an individual who:
        (i) is ill, injured, infirm, has a physical, mental, developmental, or intellectual
 disability; and
        (ii) is in a regulated long-term care facility.
        (b) "Practice as a medication aide certified":
        (i) includes:
        (A) providing direct personal assistance or care; and
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         (B) administering routine medications to patients in accordance with a formulary and
 protocols to be defined by the division by rule; and
         (ii) does not include assisting a resident of an assisted living facility, a long term care
 facility, or an intermediate care facility for people with an intellectual disability to self
 administer a medication, as regulated by the Department of Health by administrative rule.
         (14) "Practice of advanced practice registered nursing" means the practice of nursing
 within the generally recognized scope and standards of advanced practice registered nursing as
 defined by rule and consistent with professionally recognized preparation and education
 standards of an advanced practice registered nurse by a person licensed under this chapter as an
 advanced practice registered nurse. Advanced practice registered nursing includes:
         (a) maintenance and promotion of health and prevention of disease;
         (b) diagnosis, treatment, correction, consultation, and referral for common health
 problems;
         (c) prescription or administration of prescription drugs or devices including:
         (i) local anesthesia;
         (ii) Schedule III-V controlled substances; and
         (iii) Subject to Section 58-31b-803, Schedule II controlled substances[ in accordance
 with Section 58-31b-803]; or
         (d) the provision of preoperative, intraoperative, and postoperative anesthesia care and
 related services upon the request of a licensed health care professional by an advanced practice
 registered nurse specializing as a certified registered nurse anesthetist, including:
         (i) preanesthesia preparation and evaluation including:
         (A) performing a preanesthetic assessment of the patient;
         (B) ordering and evaluating appropriate lab and other studies to determine the health of
 the patient; and
         (C) selecting, ordering, or administering appropriate medications;
         (ii) anesthesia induction, maintenance, and emergence, including:
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        Enrolled Copy                                                                           H.B. 336
        (A) selecting and initiating the planned anesthetic technique;
        (B) selecting and administering anesthetics and adjunct drugs and fluids; and
        (C) administering general, regional, and local anesthesia;
        (iii) postanesthesia follow-up care, including:
        (A) evaluating the patient's response to anesthesia and implementing corrective
 actions; and
        (B) selecting, ordering, or administering the medications and studies listed in
 Subsection (14)(d); and
        (iv) other related services within the scope of practice of a certified registered nurse
 anesthetist, including:
        (A) emergency airway management;
        (B) advanced cardiac life support; and
        (C) the establishment of peripheral, central, and arterial invasive lines; and
        (v) for purposes of Subsection (14)(d), "upon the request of a licensed health care
 professional":
        (A) means a health care professional practicing within the scope of the health care
 professional's license, requests anesthesia services for a specific patient; and
        (B) does not require an advanced practice registered nurse specializing as a certified
 registered nurse anesthetist to enter into a consultation and referral plan or obtain additional
 authority to select, administer, or provide preoperative, intraoperative, or postoperative
 anesthesia care and services.
        (15) "Practice of nursing" means assisting individuals or groups to maintain or attain
 optimal health, implementing a strategy of care to accomplish defined goals and evaluating
 responses to care and treatment. The practice of nursing requires substantial specialized or
 general knowledge, judgment, and skill based upon principles of the biological, physical,
 behavioral, and social sciences, and includes:
        (a) initiating and maintaining comfort measures;
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        (b) promoting and supporting human functions and responses;
        (c) establishing an environment conducive to well-being;
        (d) providing health counseling and teaching;
        (e) collaborating with health care professionals on aspects of the health care regimen;
        (f) performing delegated procedures only within the education, knowledge, judgment,
 and skill of the licensee; and
        (g) delegating nurse interventions that may be performed by others and are not in
 conflict with this chapter.
        (16) "Practice of practical nursing" means the performance of nursing acts in the
 generally recognized scope of practice of licensed practical nurses as defined by rule and as
 provided in this Subsection (16) by a person licensed under this chapter as a licensed practical
 nurse and under the direction of a registered nurse, licensed physician, or other specified health
 care professional as defined by rule. Practical nursing acts include:
        (a) contributing to the assessment of the health status of individuals and groups;
        (b) participating in the development and modification of the strategy of care;
        (c) implementing appropriate aspects of the strategy of care;
        (d) maintaining safe and effective nursing care rendered to a patient directly or
 indirectly; and
        (e) participating in the evaluation of responses to interventions.
        (17) "Practice of registered nursing" means performing acts of nursing as provided in
 this Subsection (17) by a person licensed under this chapter as a registered nurse within the
 generally recognized scope of practice of registered nurses as defined by rule. Registered
 nursing acts include:
        (a) assessing the health status of individuals and groups;
        (b) identifying health care needs;
        (c) establishing goals to meet identified health care needs;
        (d) planning a strategy of care;
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        Enrolled Copy                                                                           H.B. 336
         (e) prescribing nursing interventions to implement the strategy of care;
         (f) implementing the strategy of care;
         (g) maintaining safe and effective nursing care that is rendered to a patient directly or
 indirectly;
         (h) evaluating responses to interventions;
         (i) teaching the theory and practice of nursing; and
         (j) managing and supervising the practice of nursing.
         (18) "Routine medications":
         (a) means established medications administered to a medically stable individual as
 determined by a licensed health care practitioner or in consultation with a licensed medical
 practitioner; and
         (b) is limited to medications that are administered by the following routes:
         (i) oral;
         (ii) sublingual;
         (iii) buccal;
         (iv) eye;
         (v) ear;
         (vi) nasal;
         (vii) rectal;
         (viii) vaginal;
         (ix) skin ointments, topical including patches and transdermal;
         (x) premeasured medication delivered by aerosol/nebulizer; and
         (xi) medications delivered by metered hand-held inhalers.
         (19) "Unlawful conduct" means the same as that term is defined in Sections 58-1-501
 and 58-31b-501.
         (20) "Unlicensed assistive personnel" means any unlicensed person, regardless of title,
 to whom tasks are delegated by a licensed nurse as permitted by rule and in accordance with
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 the standards of the profession.
         (21) "Unprofessional conduct" means the same as that term is defined in Sections
 58-1-501 and 58-31b-502 and as may be further defined by rule.
         Section 2. Section 58-31b-502 is amended to read:
         58-31b-502. Unprofessional conduct.
         (1) "Unprofessional conduct" includes:
         (a) failure to safeguard a patient's right to privacy as to the patient's person, condition,
 diagnosis, personal effects, or any other matter about which the licensee is privileged to know
 because of the licensee's or person with a certification's position or practice as a nurse or
 practice as a medication aide certified;
         (b) failure to provide nursing service or service as a medication aide certified in a
 manner that demonstrates respect for the patient's human dignity and unique personal character
 and needs without regard to the patient's race, religion, ethnic background, socioeconomic
 status, age, sex, or the nature of the patient's health problem;
         (c) engaging in sexual relations with a patient during any:
         (i) period when a generally recognized professional relationship exists between the
 person licensed or certified under this chapter and the patient; or
         (ii) extended period when a patient has reasonable cause to believe a professional
 relationship exists between the person licensed or certified under the provisions of this chapter
 and the patient;
         (d) (i) as a result of any circumstance under Subsection (1)(c), exploiting or using
 information about a patient or exploiting the licensee's or the person with a certification's
 professional relationship between the licensee or holder of a certification under this chapter and
 the patient; or
         (ii) exploiting the patient by use of the licensee's or person with a certification's
 knowledge of the patient obtained while acting as a nurse or a medication aide certified;
         (e) unlawfully obtaining, possessing, or using any prescription drug or illicit drug;
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        Enrolled Copy                                                                            H.B. 336
        (f) unauthorized taking or personal use of nursing supplies from an employer;
        (g) unauthorized taking or personal use of a patient's personal property;
        (h) knowingly entering into any medical record any false or misleading information or
 altering a medical record in any way for the purpose of concealing an act, omission, or record
 of events, medical condition, or any other circumstance related to the patient and the medical or
 nursing care provided;
        (i) unlawful or inappropriate delegation of nursing care;
        (j) failure to exercise appropriate supervision of persons providing patient care services
 under supervision of the licensed nurse;
        (k) employing or aiding and abetting the employment of an unqualified or unlicensed
 person to practice as a nurse;
        (l) failure to file or record any medical report as required by law, impeding or
 obstructing the filing or recording of such a report, or inducing another to fail to file or record
 such a report;
        (m) breach of a statutory, common law, regulatory, or ethical requirement of
 confidentiality with respect to a person who is a patient, unless ordered by a court;
        (n) failure to pay a penalty imposed by the division;
        (o) prescribing a Schedule II [or III] controlled substance without complying with the
 requirements in Section 58-31b-803, if applicable;
        (p) violating Section 58-31b-801;
        (q) violating the dispensing requirements