F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 437 2022
1 A bill to be entitled
2 An act relating to collaborative practice of certified
3 registered nurse anesthetists; amending s. 395.0191,
4 F.S.; authorizing an advanced practice registered
5 nurse who is certified as a registered nurse
6 anesthetist to administer anesthesia in collaboration
7 with specified licensed physicians; amending s.
8 464.003, F.S.; revising and providing definitions;
9 amending s. 464.012, F.S.; revising general functions
10 a certified nurse anesthetist may perform in
11 collaboration with specified licensed health care
12 practitioners; amending s. 960.28, F.S.; conforming a
13 cross-reference; providing an effective date.
14
15 Be It Enacted by the Legislature of the State of Florida:
16
17 Section 1. Paragraph (b) of subsection (2) of section
18 395.0191, Florida Statutes, is amended to read:
19 395.0191 Staff membership and clinical privileges. —
20 (2)
21 (b) An advanced practice registered nurse who is certified
22 as a registered nurse anesthetist licensed under part I of
23 chapter 464 shall administer anesthesia in collaboration with
24 under the onsite medical direction of a health care practitioner
25 professional licensed under chapter 458, chapter 459, or chapter
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26 466. For purposes of this paragraph, the term "collaboration"
27 has the same meaning as provided in s. 464.003, and in
28 accordance with an established protocol approved by the medical
29 staff. The medical direction shall specifically address the
30 needs of the individual patient.
31 Section 2. Subsections (10) though (22) of section
32 464.003, Florida Statutes, are renumbered as subsections (11)
33 through (23), respectively, subsection (2) is amended, and a new
34 subsection (10) is added to that section, to read:
35 464.003 Definitions.—As used in this part, the term:
36 (2) "Advanced or specialized nursing practice" means, in
37 addition to the practice of professional nursing, the
38 performance of advanced-level nursing acts approved by the board
39 which, by virtue of postbasic specialized education, training,
40 and experience, are appropriately performed by an advanced
41 practice registered nurse. Within the context of advanced or
42 specialized nursing practice, the advanced practice registered
43 nurse may perform acts of nursing diagnosis and nursing
44 treatment of alterations of the health status. The advanced
45 practice registered nurse may also perform acts of medical
46 diagnosis and treatment, prescription, and operation as
47 authorized within the framework of an established supervisory
48 protocol or in collaboration with a licensed health care
49 practitioner as provided under s. 464.012. The department may,
50 by rule, require that a copy of the protocol be filed with the
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51 department along with the notice required by s. 458.348.
52 (10) "Collaboration" means the collaborative relationship
53 between a health care practitioner licensed under chapter 458,
54 chapter 459, or chapter 466, who is performing a medical or
55 surgical procedure or directly involved in such procedure, and
56 an advanced practice registered nurse who is certified as a
57 registered nurse anesthetist performing the functions described
58 in s. 464.012(4)(b) before, during, or after a medical or
59 surgical procedure. The term includes the joint formulation and
60 discussion of patient treatment, in which each health care
61 practitioner contributes his or her respective expertise in the
62 management and delivery of health care.
63 Section 3. Subsection (3) and paragraph (b) of subsection
64 (4) of section 464.012, Florida Statutes, are amended to read:
65 464.012 Licensure of advanced practice registered nurses;
66 fees; controlled substance prescribing.—
67 (3) An advanced practice registered nurse shall perform
68 those functions authorized in this section within the framework
69 of an established protocol that must be maintained on site at
70 the location or locations at which an advanced practice
71 registered nurse practices, unless the advanced practice
72 registered nurse is registered and practicing under s. 464.0123 ,
73 or is certified and practicing as a certified registered nurse
74 anesthetist in collaboration with a licensed health care
75 practitioner. In the case of multiple supervising physicians in
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76 the same group, an advanced practice registered nurse must enter
77 into a supervisory protocol with at least one physician within
78 the physician group practice. A practitioner currently licensed
79 under chapter 458, chapter 459, or chapter 466 shall maintain
80 supervision for directing the specific course of medical
81 treatment. Within the established framework, an advanced
82 practice registered nurse may:
83 (a) Prescribe, dispense, administer, or order any drug;
84 however, an advanced practice registered nurse may prescribe or
85 dispense a controlled substance as defined in s. 893.03 only if
86 the advanced practice registered nurse has graduated from a
87 program leading to a master's or doctoral degree in a clinical
88 nursing specialty area with training in specialized practitioner
89 skills.
90 (b) Initiate appropriate therapies for certain conditions.
91 (c) Perform additional functions as may be determined by
92 rule in accordance with s. 464.003(2).
93 (d) Order diagnostic tests and physical and occupational
94 therapy.
95 (e) Order any medication for administration to a patient
96 in a facility licensed under chapter 395 or part II of chapter
97 400, notwithstanding any provisions in chapter 465 or chapter
98 893.
99 (4) In addition to the general functions specified in
100 subsection (3), an advanced practice registered nurse may
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101 perform the following acts within his or her specialty:
102 (b) The certified registered nurse anesthetist may, in
103 collaboration with a licensed health care practitioner to the
104 extent authorized by established protocol approved by the
105 medical staff of the facility in which the anesthetic service is
106 performed, perform any or all of the following:
107 1. Determine the health status of the patient as it
108 relates to the risk factors and to the anesthetic management of
109 the patient through the performance of the general functions.
110 2. Based on history, physical assessment, and supplemental
111 laboratory results, determine, with the consent of the
112 responsible physician, the appropriate type of anesthesia within
113 the framework of the protocol.
114 3. Order under the protocol preanesthetic medication.
115 4. Perform under the protocol procedures commonly used to
116 render the patient insensible to pain during the performance of
117 surgical, obstetrical, therapeutic, or diagnostic clinical
118 procedures. These procedures include ordering and administering
119 regional, spinal, and general anesthesia; inhalation agents and
120 techniques; intravenous agents and techniques; and techniques of
121 hypnosis.
122 5. Order or perform monitoring procedures indicated as
123 pertinent to the anesthetic health care management of the
124 patient.
125 6. Support life functions during anesthesia health care,
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126 including induction and intubation procedures, the use of
127 appropriate mechanical supportive devices, and the management of
128 fluid, electrolyte, and blood component balances.
129 7. Recognize and take appropriate corrective action for
130 abnormal patient responses to anesthesia, adjunctive medication,
131 or other forms of therapy.
132 8. Recognize and treat a cardiac arrhythmia while the
133 patient is under anesthetic care.
134 9. Participate in management of the patient while in the
135 postanesthesia recovery area, including ordering the
136 administration of fluids and drugs.
137 10. Place special peripheral and central venous and
138 arterial lines for blood sampling and monitoring as appropriate.
139 Section 4. Subsection (2) of section 960.28, Florida
140 Statutes, is amended to read:
141 960.28 Payment for victims' initial forensic physical
142 examinations.—
143 (2) The Crime Victims' Services Office of the department
144 shall pay for medical expenses connected with an initial
145 forensic physical examination of a victim of sexual battery as
146 defined in chapter 794 or a lewd or lascivious offens e as
147 defined in chapter 800. Such payment shall be made regardless of
148 whether the victim is covered by health or disability insurance
149 and whether the victim participates in the criminal justice
150 system or cooperates with law enforcement. The payment shall be
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151 made only out of moneys allocated to the Crime Victims' Services
152 Office for the purposes of this section, and the payment may not
153 exceed $1,000 with respect to any violation. The department
154 shall develop and maintain separate protocols for the initial
155 forensic physical examination of adults and children. Payment
156 under this section is limited to medical expenses connected with
157 the initial forensic physical examination, and payment may be
158 made to a medical provider using an examiner qualified under
159 part I of chapter 464, excluding s. 464.003(16) s. 464.003(15);
160 chapter 458; or chapter 459. Payment made to the medical
161 provider by the department shall be considered by the provider
162 as payment in full for the initial forensic physical examination
163 associated with the collection of evidence. The victim may not
164 be required to pay, directly or indirectly, the cost of an
165 initial forensic physical examination performed in accordance
166 with this section.
167 Section 5. This act shall take effect July 1, 2022.
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Statutes affected: H 437 Filed: 395.0191, 960.28