| 1 | 1 | | REFERENCE TITLE: nurse anesthetists; clinical rotations; appropriation State of Arizona Senate Fifty-sixth Legislature First Regular Session 2023 SB 1269 Introduced by Senators Shamp: Kavanagh An Act amending sections 32-1601 and 32-1634.04, Arizona Revised Statutes; amending title 36, chapter 16, Arizona Revised Statutes, by adding article 2; amending Laws 2022, chapter 330, section 3; appropriating monies; relating to workforce development. (TEXT OF BILL BEGINS ON NEXT PAGE) |
|---|
| 2 | 2 | | |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | |
|---|
| 6 | 6 | | |
|---|
| 7 | 7 | | |
|---|
| 8 | 8 | | |
|---|
| 9 | 9 | | REFERENCE TITLE: nurse anesthetists; clinical rotations; appropriation |
|---|
| 10 | 10 | | State of Arizona Senate Fifty-sixth Legislature First Regular Session 2023 |
|---|
| 11 | 11 | | SB 1269 |
|---|
| 12 | 12 | | Introduced by Senators Shamp: Kavanagh |
|---|
| 13 | 13 | | |
|---|
| 14 | 14 | | REFERENCE TITLE: nurse anesthetists; clinical rotations; appropriation |
|---|
| 15 | 15 | | |
|---|
| 16 | 16 | | |
|---|
| 17 | 17 | | |
|---|
| 18 | 18 | | |
|---|
| 19 | 19 | | |
|---|
| 20 | 20 | | |
|---|
| 21 | 21 | | |
|---|
| 22 | 22 | | |
|---|
| 23 | 23 | | |
|---|
| 24 | 24 | | State of Arizona |
|---|
| 25 | 25 | | |
|---|
| 26 | 26 | | Senate |
|---|
| 27 | 27 | | |
|---|
| 28 | 28 | | Fifty-sixth Legislature |
|---|
| 29 | 29 | | |
|---|
| 30 | 30 | | First Regular Session |
|---|
| 31 | 31 | | |
|---|
| 32 | 32 | | 2023 |
|---|
| 33 | 33 | | |
|---|
| 34 | 34 | | |
|---|
| 35 | 35 | | |
|---|
| 36 | 36 | | |
|---|
| 37 | 37 | | |
|---|
| 38 | 38 | | |
|---|
| 39 | 39 | | |
|---|
| 40 | 40 | | SB 1269 |
|---|
| 41 | 41 | | |
|---|
| 42 | 42 | | |
|---|
| 43 | 43 | | |
|---|
| 44 | 44 | | Introduced by |
|---|
| 45 | 45 | | |
|---|
| 46 | 46 | | Senators Shamp: Kavanagh |
|---|
| 47 | 47 | | |
|---|
| 48 | 48 | | |
|---|
| 49 | 49 | | |
|---|
| 50 | 50 | | |
|---|
| 51 | 51 | | |
|---|
| 52 | 52 | | |
|---|
| 53 | 53 | | |
|---|
| 54 | 54 | | |
|---|
| 55 | 55 | | |
|---|
| 56 | 56 | | |
|---|
| 57 | 57 | | |
|---|
| 58 | 58 | | |
|---|
| 59 | 59 | | |
|---|
| 60 | 60 | | |
|---|
| 61 | 61 | | |
|---|
| 62 | 62 | | |
|---|
| 63 | 63 | | |
|---|
| 64 | 64 | | An Act |
|---|
| 65 | 65 | | |
|---|
| 66 | 66 | | |
|---|
| 67 | 67 | | |
|---|
| 68 | 68 | | amending sections 32-1601 and 32-1634.04, Arizona Revised Statutes; amending title 36, chapter 16, Arizona Revised Statutes, by adding article 2; amending Laws 2022, chapter 330, section 3; appropriating monies; relating to workforce development. |
|---|
| 69 | 69 | | |
|---|
| 70 | 70 | | |
|---|
| 71 | 71 | | |
|---|
| 72 | 72 | | (TEXT OF BILL BEGINS ON NEXT PAGE) |
|---|
| 73 | 73 | | |
|---|
| 74 | 74 | | |
|---|
| 75 | 75 | | |
|---|
| 76 | 76 | | Be it enacted by the Legislature of the State of Arizona: Section 1. Section 32-1601, Arizona Revised Statutes, is amended to read: START_STATUTE32-1601. Definitions In this chapter, unless the context otherwise requires: 1. "Absolute discharge from the sentence" means completion of any sentence, including imprisonment, probation, parole, community supervision or any form of court supervision. 2. "Appropriate health care professional" means a licensed health care professional whose scope of practice, education, experience, training and accreditation are appropriate for the situation or condition of the patient who is the subject of a consultation or referral. 3. "Approval" means that a regulated training or educational program to prepare persons for licensure, certification or registration has met standards established by the board. 4. "Board" means the Arizona state board of nursing. 5. "Certified nurse midwife" means a registered nurse who: (a) Is certified by the board. (b) Has completed a nurse midwife education program approved or recognized by the board and educational requirements prescribed by the board by rule. (c) Holds a national certification as a certified nurse midwife from a national certifying body recognized by the board. (d) Has an expanded scope of practice in providing health care services for women from adolescence to beyond menopause, including antepartum, intrapartum, postpartum, reproductive, gynecologic and primary care, for normal newborns during the first twenty-eight days of life and for men for the treatment of sexually transmitted diseases. The expanded scope of practice under this subdivision includes: (i) Assessing patients, synthesizing and analyzing data and understanding and applying principles of health care at an advanced level. (ii) Managing the physical and psychosocial health care of patients. (iii) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem and selecting, implementing and evaluating appropriate treatment. (iv) Making independent decisions in solving complex patient care problems. (v) Diagnosing, performing diagnostic and therapeutic procedures and prescribing, administering and dispensing therapeutic measures, including legend drugs, medical devices and controlled substances, within the scope of the certified nurse midwife practice after meeting requirements established by the board. (vi) Recognizing the limits of the nurse's knowledge and experience by consulting with or referring patients to other appropriate health care professionals if a situation or condition occurs that is beyond the knowledge and experience of the nurse or if the referral will protect the health and welfare of the patient. (vii) Delegating to a medical assistant pursuant to section 32-1456. (viii) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a certified nurse midwife. 6. "Certified nursing assistant" means a person who is registered on the registry of nursing assistants pursuant to this chapter to provide or assist in delivering nursing or nursing-related services under the supervision and direction of a licensed nursing staff member. Certified nursing assistant does not include a person who: (a) Is a licensed health care professional. (b) Volunteers to provide nursing assistant services without monetary compensation. (c) Is a licensed nursing assistant. 7. "Certified registered nurse" means a registered nurse who has been certified by a national nursing credentialing agency recognized by the board. 8. "Certified registered nurse anesthetist" means a registered nurse who meets the requirements of section 32-1634.03 and who practices pursuant to the requirements of section 32-1634.04. 9. "Clinical nurse specialist" means a registered nurse who: (a) Is certified by the board as a clinical nurse specialist. (b) Holds a graduate degree with a major in nursing and completes educational requirements as prescribed by the board by rule. (c) Is nationally certified as a clinical nurse specialist or, if certification is not available, provides proof of competence to the board. (d) Has an expanded scope of practice based on advanced education in a clinical nursing specialty that includes: (i) Assessing clients, synthesizing and analyzing data and understanding and applying nursing principles at an advanced level. (ii) Managing directly and indirectly a client's physical and psychosocial health status. (iii) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem and selecting appropriate nursing interventions. (iv) Developing, planning and guiding programs of care for populations of patients. (v) Making independent nursing decisions to solve complex client care problems. (vi) Using research skills and acquiring and applying critical new knowledge and technologies to nursing practice. (vii) Prescribing and dispensing durable medical equipment. (viii) Consulting with or referring a client to other health care providers based on assessment of the client's health status and needs. (ix) Facilitating collaboration with other disciplines to attain the desired client outcome across the continuum of care. (x) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a clinical nurse specialist. (xi) Prescribing, ordering and dispensing pharmacological agents subject to the requirements and limits specified in section 32-1651. 10. "Conditional license" or "conditional approval" means a license or approval that specifies the conditions under which the regulated party is allowed to practice or to operate and that is prescribed by the board pursuant to section 32-1644 or 32-1663. 11. "Delegation" means transferring to a competent individual the authority to perform a selected nursing task in a designated situation in which the nurse making the delegation retains accountability for the delegation. 12. "Disciplinary action" means a regulatory sanction of a license, certificate or approval pursuant to this chapter in any combination of the following: (a) A civil penalty for each violation of this chapter, not to exceed $1,000 for each violation. (b) Restitution made to an aggrieved party. (c) A decree of censure. (d) A conditional license or a conditional approval that fixed a period and terms of probation. (e) Limited licensure. (f) Suspension of a license, a certificate or an approval. (g) Voluntary surrender of a license, a certificate or an approval. (h) Revocation of a license, a certificate or an approval. 13. "Health care institution" has the same meaning prescribed in section 36-401. 14. "Licensed health aide" means a person who: (a) Is licensed pursuant to this chapter to provide or to assist in providing nursing-related services authorized pursuant to section 36-2939. (b) Is the parent, guardian or family member of the Arizona long-term care system member receiving services who may provide licensed health aide services only to that member and only consistent with that member's plan of care. (c) Has a scope of practice that is the same as a licensed nursing assistant and may also provide medication administration, tracheostomy care and enteral care and therapy and any other tasks approved by the board in rule. 15. "Licensed nursing assistant" means a person who is licensed pursuant to this chapter to provide or assist in delivering nursing or nursing-related services under the supervision and direction of a licensed nursing staff member. Licensed nursing assistant does not include a person who: (a) Is a licensed health care professional. (b) Volunteers to provide nursing assistant services without monetary compensation. (c) Is a certified nursing assistant. 16. "Licensee" means a person who is licensed pursuant to this chapter or in a party state as defined in section 32-1668. 17. "Limited license" means a license that restricts the scope or setting of a licensee's practice. 18. "Medication order" means a written or verbal communication given by a certified registered nurse anesthetist to a health care professional to administer a drug or medication, including controlled substances. 19. "Practical nurse" means a person who holds a practical nurse license issued pursuant to this chapter or pursuant to a multistate compact privilege and who practices practical nursing as defined in this section. 20. "Practical nursing" includes the following activities that are performed under the supervision of a physician or a registered nurse: (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 aspects of the strategy of care within the nurse's scope of practice. (d) Maintaining safe and effective nursing care that is rendered directly or indirectly. (e) Participating in the evaluation of responses to interventions. (f) Delegating nursing activities within the scope of practice of a practical nurse. (g) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a practical nurse. 21. "Presence" means within the same health care institution or office as specified in section 32-1634.04, subsection A, and available as necessary. 22. 21. "Registered nurse" or "professional nurse" means a person who practices registered nursing and who holds a registered nurse license issued pursuant to this chapter or pursuant to a multistate compact privilege. 23. 22. "Registered nurse practitioner" means a registered nurse who: (a) Is certified by the board. (b) Has completed a nurse practitioner education program approved or recognized by the board and educational requirements prescribed by the board by rule. (c) If applying for certification after July 1, 2004, holds national certification as a nurse practitioner from a national certifying body recognized by the board. (d) Has an expanded scope of practice within a specialty area that includes: (i) Assessing clients, synthesizing and analyzing data and understanding and applying principles of health care at an advanced level. (ii) Managing the physical and psychosocial health status of patients. (iii) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem and selecting, implementing and evaluating appropriate treatment. (iv) Making independent decisions in solving complex patient care problems. (v) Diagnosing, performing diagnostic and therapeutic procedures, and prescribing, administering and dispensing therapeutic measures, including legend drugs, medical devices and controlled substances within the scope of registered nurse practitioner practice on meeting the requirements established by the board. (vi) Recognizing the limits of the nurse's knowledge and experience by consulting with or referring patients to other appropriate health care professionals if a situation or condition occurs that is beyond the knowledge and experience of the nurse or if the referral will protect the health and welfare of the patient. (vii) Delegating to a medical assistant pursuant to section 32-1456. (viii) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a nurse practitioner. 24. 23. "Registered nursing" includes the following: (a) Diagnosing and treating human responses to actual or potential health problems. (b) Assisting individuals and groups to maintain or attain optimal health by implementing a strategy of care to accomplish defined goals and evaluating responses to care and treatment. (c) Assessing the health status of individuals and groups. (d) Establishing a nursing diagnosis. (e) Establishing goals to meet identified health care needs. (f) Prescribing nursing interventions to implement a strategy of care. (g) Delegating nursing interventions to others who are qualified to do so. (h) Providing for the maintenance of safe and effective nursing care that is rendered directly or indirectly. (i) Evaluating responses to interventions. (j) Teaching nursing knowledge and skills. (k) Managing and supervising the practice of nursing. (l) Consulting and coordinating with other health care professionals in the management of health care. (m) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a registered nurse. 25. 24. "Registry of nursing assistants" means the nursing assistants registry maintained by the board pursuant to the omnibus budget reconciliation act of 1987 (P.L. 100-203; 101 Stat. 1330), as amended by the medicare catastrophic coverage act of 1988 (P.L. 100-360; 102 Stat. 683). 26. 25. "Regulated party" means any person or entity that is licensed, certified, registered, recognized or approved pursuant to this chapter. 27. 26. "Unprofessional conduct" includes the following, whether occurring in this state or elsewhere: (a) Committing fraud or deceit in obtaining, attempting to obtain or renewing a license or a certificate issued pursuant to this chapter. (b) Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case, conviction by a court of competent jurisdiction or a plea of no contest is conclusive evidence of the commission. (c) Aiding or abetting in a criminal abortion or attempting, agreeing or offering to procure or assist in a criminal abortion. (d) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public. (e) Being mentally incompetent or physically unsafe to a degree that is or might be harmful or dangerous to the health of a patient or the public. (f) Having a license, certificate, permit or registration to practice a health care profession denied, suspended, conditioned, limited or revoked in another jurisdiction and not reinstated by that jurisdiction. (g) Wilfully or repeatedly violating a provision of this chapter or a rule adopted pursuant to this chapter. (h) Committing an act that deceives, defrauds or harms the public. (i) Failing to comply with a stipulated agreement, consent agreement or board order. (j) Violating this chapter or a rule that is adopted by the board pursuant to this chapter. (k) Failing to report to the board any evidence that a registered or practical nurse or a nursing assistant is or may be: (i) Incompetent to practice. (ii) Guilty of unprofessional conduct. (iii) Mentally or physically unable to safely practice nursing or to perform nursing-related duties. A nurse who is providing therapeutic counseling for a nurse who is in a drug rehabilitation program is required to report that nurse only if the nurse providing therapeutic counseling has personal knowledge that patient safety is being jeopardized. (l) Failing to self-report a conviction for a felony or undesignated offense within ten days after the conviction. (m) Cheating or assisting another to cheat on a licensure or certification examination. END_STATUTE Sec. 2. Section 32-1634.04, Arizona Revised Statutes, is amended to read: START_STATUTE32-1634.04. Certified registered nurse anesthetist; scope of practice; physician and surgeon immunity A. A certified registered nurse anesthetist may administer anesthetics under the direction of and in the presence of a physician or surgeon in connection with the preoperative, intraoperative or postoperative care of a patient or as part of a procedure performed by a physician or surgeon in the following settings: 1. A health care institution. 2. An office of a health care professional who is licensed pursuant to chapter 7, 11, 13 or 17 of this title. 3. An ambulance. B. In connection with the preoperative, intraoperative or postoperative care of a patient or as part of the procedure in the settings prescribed in subsection A of this section, a certified registered nurse anesthetist, as part of the care or procedure, may: 1. Issue a medication order for drugs or medications, including controlled substances, to be administered by a licensed, certified or registered health care provider. 2. Assess the health status of an individual as that status relates to the relative risks associated with anesthetic management of an individual. 3. Obtain informed consent. 4. Order and evaluate laboratory and diagnostic test results and perform point-of-care testing that the certified registered nurse anesthetist is qualified to perform. 5. Order and evaluate radiographic imaging studies that the certified registered nurse anesthetist is qualified to order and interpret. 6. Identify, develop, implement and evaluate an anesthetic plan of care for a patient to promote, maintain and restore health. 7. Take action necessary in response to an emergency situation. 8. Perform therapeutic procedures that the certified registered nurse anesthetist is qualified to perform. C. A certified registered nurse anesthetist's prescribing authority to administer anesthetics or to issue a medication order as prescribed by this section does not include the ability to write or issue a prescription for medications to be filled or dispensed for a patient for use outside of the settings prescribed in subsection A of this section. D. A physician or surgeon is not liable for any act or omission of a certified registered nurse anesthetist who orders or administers anesthetics under this section. END_STATUTE Sec. 3. Title 36, chapter 16, Arizona Revised Statutes, is amended by adding article 2, to read: ARTICLE 2. CLINICAL ROTATIONS START_STATUTE36-1811. Student registered nurse anesthetists; clinical rotation program; grants; definitions A. The student registered nurse anesthetist clinical rotation program is established in the administration to expand the capacity of preceptor training programs at health care institutions for nurse anesthetist students. B. The administration shall develop a grant program to distribute monies appropriated for the student registered nurse anesthetist clinical rotation program to health care institutions that are licensed pursuant to chapter 4 of this title only to expand or create clinical training placements for nurse anesthetist students, with preference given to the expansion or development of clinical rotations in obstetrics, pediatrics and cardiovascular care. C. Grant monies awarded pursuant to this section are intended to supplement and not supplant existing training program expenses covered by the health care institution grantee. D. The administration shall establish an application process for the grant program and may award grants for multiyear programs. The administration shall consider the following factors when determining grant awards: 1. The geographic and population distribution. 2. The number of nurse anesthetist students planned to be trained and retained. 3. The cost of the proposal for the number of nurse anesthetist students expected to participate and to be retained compared to other proposals. E. For the purposes of this section: 1. "Administration" means the Arizona health care cost containment system administration. 2. "Health care institution" has the same meaning prescribed in section 36-401. END_STATUTE Sec. 4. Laws 2022, chapter 330, section 3 is amended to read: START_STATUTESec. 3. Delayed repeal Title 36, chapter 16, article 1, Arizona Revised Statutes, as added by this act, is repealed from and after December 31, 2026. END_STATUTE Sec. 5. Appropriation; Arizona health care cost containment system administration; student registered nurse anesthetist clinical rotation program; exemption A. The sum of $200,000 is appropriated from the state general fund in fiscal year 2023-2024 to the Arizona health care cost containment system administration for the student registered nurse anesthetist clinical rotation program established by section 36-1811, Arizona Revised Statutes, as added by this act. B. The appropriation made in subsection A of this section is exempt from the provisions of section 35-190, Arizona Revised Statutes, relating to lapsing of appropriations. |
|---|
| 77 | 77 | | |
|---|
| 78 | 78 | | Be it enacted by the Legislature of the State of Arizona: |
|---|
| 79 | 79 | | |
|---|
| 80 | 80 | | Section 1. Section 32-1601, Arizona Revised Statutes, is amended to read: |
|---|
| 81 | 81 | | |
|---|
| 82 | 82 | | START_STATUTE32-1601. Definitions |
|---|
| 83 | 83 | | |
|---|
| 84 | 84 | | In this chapter, unless the context otherwise requires: |
|---|
| 85 | 85 | | |
|---|
| 86 | 86 | | 1. "Absolute discharge from the sentence" means completion of any sentence, including imprisonment, probation, parole, community supervision or any form of court supervision. |
|---|
| 87 | 87 | | |
|---|
| 88 | 88 | | 2. "Appropriate health care professional" means a licensed health care professional whose scope of practice, education, experience, training and accreditation are appropriate for the situation or condition of the patient who is the subject of a consultation or referral. |
|---|
| 89 | 89 | | |
|---|
| 90 | 90 | | 3. "Approval" means that a regulated training or educational program to prepare persons for licensure, certification or registration has met standards established by the board. |
|---|
| 91 | 91 | | |
|---|
| 92 | 92 | | 4. "Board" means the Arizona state board of nursing. |
|---|
| 93 | 93 | | |
|---|
| 94 | 94 | | 5. "Certified nurse midwife" means a registered nurse who: |
|---|
| 95 | 95 | | |
|---|
| 96 | 96 | | (a) Is certified by the board. |
|---|
| 97 | 97 | | |
|---|
| 98 | 98 | | (b) Has completed a nurse midwife education program approved or recognized by the board and educational requirements prescribed by the board by rule. |
|---|
| 99 | 99 | | |
|---|
| 100 | 100 | | (c) Holds a national certification as a certified nurse midwife from a national certifying body recognized by the board. |
|---|
| 101 | 101 | | |
|---|
| 102 | 102 | | (d) Has an expanded scope of practice in providing health care services for women from adolescence to beyond menopause, including antepartum, intrapartum, postpartum, reproductive, gynecologic and primary care, for normal newborns during the first twenty-eight days of life and for men for the treatment of sexually transmitted diseases. The expanded scope of practice under this subdivision includes: |
|---|
| 103 | 103 | | |
|---|
| 104 | 104 | | (i) Assessing patients, synthesizing and analyzing data and understanding and applying principles of health care at an advanced level. |
|---|
| 105 | 105 | | |
|---|
| 106 | 106 | | (ii) Managing the physical and psychosocial health care of patients. |
|---|
| 107 | 107 | | |
|---|
| 108 | 108 | | (iii) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem and selecting, implementing and evaluating appropriate treatment. |
|---|
| 109 | 109 | | |
|---|
| 110 | 110 | | (iv) Making independent decisions in solving complex patient care problems. |
|---|
| 111 | 111 | | |
|---|
| 112 | 112 | | (v) Diagnosing, performing diagnostic and therapeutic procedures and prescribing, administering and dispensing therapeutic measures, including legend drugs, medical devices and controlled substances, within the scope of the certified nurse midwife practice after meeting requirements established by the board. |
|---|
| 113 | 113 | | |
|---|
| 114 | 114 | | (vi) Recognizing the limits of the nurse's knowledge and experience by consulting with or referring patients to other appropriate health care professionals if a situation or condition occurs that is beyond the knowledge and experience of the nurse or if the referral will protect the health and welfare of the patient. |
|---|
| 115 | 115 | | |
|---|
| 116 | 116 | | (vii) Delegating to a medical assistant pursuant to section 32-1456. |
|---|
| 117 | 117 | | |
|---|
| 118 | 118 | | (viii) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a certified nurse midwife. |
|---|
| 119 | 119 | | |
|---|
| 120 | 120 | | 6. "Certified nursing assistant" means a person who is registered on the registry of nursing assistants pursuant to this chapter to provide or assist in delivering nursing or nursing-related services under the supervision and direction of a licensed nursing staff member. Certified nursing assistant does not include a person who: |
|---|
| 121 | 121 | | |
|---|
| 122 | 122 | | (a) Is a licensed health care professional. |
|---|
| 123 | 123 | | |
|---|
| 124 | 124 | | (b) Volunteers to provide nursing assistant services without monetary compensation. |
|---|
| 125 | 125 | | |
|---|
| 126 | 126 | | (c) Is a licensed nursing assistant. |
|---|
| 127 | 127 | | |
|---|
| 128 | 128 | | 7. "Certified registered nurse" means a registered nurse who has been certified by a national nursing credentialing agency recognized by the board. |
|---|
| 129 | 129 | | |
|---|
| 130 | 130 | | 8. "Certified registered nurse anesthetist" means a registered nurse who meets the requirements of section 32-1634.03 and who practices pursuant to the requirements of section 32-1634.04. |
|---|
| 131 | 131 | | |
|---|
| 132 | 132 | | 9. "Clinical nurse specialist" means a registered nurse who: |
|---|
| 133 | 133 | | |
|---|
| 134 | 134 | | (a) Is certified by the board as a clinical nurse specialist. |
|---|
| 135 | 135 | | |
|---|
| 136 | 136 | | (b) Holds a graduate degree with a major in nursing and completes educational requirements as prescribed by the board by rule. |
|---|
| 137 | 137 | | |
|---|
| 138 | 138 | | (c) Is nationally certified as a clinical nurse specialist or, if certification is not available, provides proof of competence to the board. |
|---|
| 139 | 139 | | |
|---|
| 140 | 140 | | (d) Has an expanded scope of practice based on advanced education in a clinical nursing specialty that includes: |
|---|
| 141 | 141 | | |
|---|
| 142 | 142 | | (i) Assessing clients, synthesizing and analyzing data and understanding and applying nursing principles at an advanced level. |
|---|
| 143 | 143 | | |
|---|
| 144 | 144 | | (ii) Managing directly and indirectly a client's physical and psychosocial health status. |
|---|
| 145 | 145 | | |
|---|
| 146 | 146 | | (iii) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem and selecting appropriate nursing interventions. |
|---|
| 147 | 147 | | |
|---|
| 148 | 148 | | (iv) Developing, planning and guiding programs of care for populations of patients. |
|---|
| 149 | 149 | | |
|---|
| 150 | 150 | | (v) Making independent nursing decisions to solve complex client care problems. |
|---|
| 151 | 151 | | |
|---|
| 152 | 152 | | (vi) Using research skills and acquiring and applying critical new knowledge and technologies to nursing practice. |
|---|
| 153 | 153 | | |
|---|
| 154 | 154 | | (vii) Prescribing and dispensing durable medical equipment. |
|---|
| 155 | 155 | | |
|---|
| 156 | 156 | | (viii) Consulting with or referring a client to other health care providers based on assessment of the client's health status and needs. |
|---|
| 157 | 157 | | |
|---|
| 158 | 158 | | (ix) Facilitating collaboration with other disciplines to attain the desired client outcome across the continuum of care. |
|---|
| 159 | 159 | | |
|---|
| 160 | 160 | | (x) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a clinical nurse specialist. |
|---|
| 161 | 161 | | |
|---|
| 162 | 162 | | (xi) Prescribing, ordering and dispensing pharmacological agents subject to the requirements and limits specified in section 32-1651. |
|---|
| 163 | 163 | | |
|---|
| 164 | 164 | | 10. "Conditional license" or "conditional approval" means a license or approval that specifies the conditions under which the regulated party is allowed to practice or to operate and that is prescribed by the board pursuant to section 32-1644 or 32-1663. |
|---|
| 165 | 165 | | |
|---|
| 166 | 166 | | 11. "Delegation" means transferring to a competent individual the authority to perform a selected nursing task in a designated situation in which the nurse making the delegation retains accountability for the delegation. |
|---|
| 167 | 167 | | |
|---|
| 168 | 168 | | 12. "Disciplinary action" means a regulatory sanction of a license, certificate or approval pursuant to this chapter in any combination of the following: |
|---|
| 169 | 169 | | |
|---|
| 170 | 170 | | (a) A civil penalty for each violation of this chapter, not to exceed $1,000 for each violation. |
|---|
| 171 | 171 | | |
|---|
| 172 | 172 | | (b) Restitution made to an aggrieved party. |
|---|
| 173 | 173 | | |
|---|
| 174 | 174 | | (c) A decree of censure. |
|---|
| 175 | 175 | | |
|---|
| 176 | 176 | | (d) A conditional license or a conditional approval that fixed a period and terms of probation. |
|---|
| 177 | 177 | | |
|---|
| 178 | 178 | | (e) Limited licensure. |
|---|
| 179 | 179 | | |
|---|
| 180 | 180 | | (f) Suspension of a license, a certificate or an approval. |
|---|
| 181 | 181 | | |
|---|
| 182 | 182 | | (g) Voluntary surrender of a license, a certificate or an approval. |
|---|
| 183 | 183 | | |
|---|
| 184 | 184 | | (h) Revocation of a license, a certificate or an approval. |
|---|
| 185 | 185 | | |
|---|
| 186 | 186 | | 13. "Health care institution" has the same meaning prescribed in section 36-401. |
|---|
| 187 | 187 | | |
|---|
| 188 | 188 | | 14. "Licensed health aide" means a person who: |
|---|
| 189 | 189 | | |
|---|
| 190 | 190 | | (a) Is licensed pursuant to this chapter to provide or to assist in providing nursing-related services authorized pursuant to section 36-2939. |
|---|
| 191 | 191 | | |
|---|
| 192 | 192 | | (b) Is the parent, guardian or family member of the Arizona long-term care system member receiving services who may provide licensed health aide services only to that member and only consistent with that member's plan of care. |
|---|
| 193 | 193 | | |
|---|
| 194 | 194 | | (c) Has a scope of practice that is the same as a licensed nursing assistant and may also provide medication administration, tracheostomy care and enteral care and therapy and any other tasks approved by the board in rule. |
|---|
| 195 | 195 | | |
|---|
| 196 | 196 | | 15. "Licensed nursing assistant" means a person who is licensed pursuant to this chapter to provide or assist in delivering nursing or nursing-related services under the supervision and direction of a licensed nursing staff member. Licensed nursing assistant does not include a person who: |
|---|
| 197 | 197 | | |
|---|
| 198 | 198 | | (a) Is a licensed health care professional. |
|---|
| 199 | 199 | | |
|---|
| 200 | 200 | | (b) Volunteers to provide nursing assistant services without monetary compensation. |
|---|
| 201 | 201 | | |
|---|
| 202 | 202 | | (c) Is a certified nursing assistant. |
|---|
| 203 | 203 | | |
|---|
| 204 | 204 | | 16. "Licensee" means a person who is licensed pursuant to this chapter or in a party state as defined in section 32-1668. |
|---|
| 205 | 205 | | |
|---|
| 206 | 206 | | 17. "Limited license" means a license that restricts the scope or setting of a licensee's practice. |
|---|
| 207 | 207 | | |
|---|
| 208 | 208 | | 18. "Medication order" means a written or verbal communication given by a certified registered nurse anesthetist to a health care professional to administer a drug or medication, including controlled substances. |
|---|
| 209 | 209 | | |
|---|
| 210 | 210 | | 19. "Practical nurse" means a person who holds a practical nurse license issued pursuant to this chapter or pursuant to a multistate compact privilege and who practices practical nursing as defined in this section. |
|---|
| 211 | 211 | | |
|---|
| 212 | 212 | | 20. "Practical nursing" includes the following activities that are performed under the supervision of a physician or a registered nurse: |
|---|
| 213 | 213 | | |
|---|
| 214 | 214 | | (a) Contributing to the assessment of the health status of individuals and groups. |
|---|
| 215 | 215 | | |
|---|
| 216 | 216 | | (b) Participating in the development and modification of the strategy of care. |
|---|
| 217 | 217 | | |
|---|
| 218 | 218 | | (c) Implementing aspects of the strategy of care within the nurse's scope of practice. |
|---|
| 219 | 219 | | |
|---|
| 220 | 220 | | (d) Maintaining safe and effective nursing care that is rendered directly or indirectly. |
|---|
| 221 | 221 | | |
|---|
| 222 | 222 | | (e) Participating in the evaluation of responses to interventions. |
|---|
| 223 | 223 | | |
|---|
| 224 | 224 | | (f) Delegating nursing activities within the scope of practice of a practical nurse. |
|---|
| 225 | 225 | | |
|---|
| 226 | 226 | | (g) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a practical nurse. |
|---|
| 227 | 227 | | |
|---|
| 228 | 228 | | 21. "Presence" means within the same health care institution or office as specified in section 32-1634.04, subsection A, and available as necessary. |
|---|
| 229 | 229 | | |
|---|
| 230 | 230 | | 22. 21. "Registered nurse" or "professional nurse" means a person who practices registered nursing and who holds a registered nurse license issued pursuant to this chapter or pursuant to a multistate compact privilege. |
|---|
| 231 | 231 | | |
|---|
| 232 | 232 | | 23. 22. "Registered nurse practitioner" means a registered nurse who: |
|---|
| 233 | 233 | | |
|---|
| 234 | 234 | | (a) Is certified by the board. |
|---|
| 235 | 235 | | |
|---|
| 236 | 236 | | (b) Has completed a nurse practitioner education program approved or recognized by the board and educational requirements prescribed by the board by rule. |
|---|
| 237 | 237 | | |
|---|
| 238 | 238 | | (c) If applying for certification after July 1, 2004, holds national certification as a nurse practitioner from a national certifying body recognized by the board. |
|---|
| 239 | 239 | | |
|---|
| 240 | 240 | | (d) Has an expanded scope of practice within a specialty area that includes: |
|---|
| 241 | 241 | | |
|---|
| 242 | 242 | | (i) Assessing clients, synthesizing and analyzing data and understanding and applying principles of health care at an advanced level. |
|---|
| 243 | 243 | | |
|---|
| 244 | 244 | | (ii) Managing the physical and psychosocial health status of patients. |
|---|
| 245 | 245 | | |
|---|
| 246 | 246 | | (iii) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem and selecting, implementing and evaluating appropriate treatment. |
|---|
| 247 | 247 | | |
|---|
| 248 | 248 | | (iv) Making independent decisions in solving complex patient care problems. |
|---|
| 249 | 249 | | |
|---|
| 250 | 250 | | (v) Diagnosing, performing diagnostic and therapeutic procedures, and prescribing, administering and dispensing therapeutic measures, including legend drugs, medical devices and controlled substances within the scope of registered nurse practitioner practice on meeting the requirements established by the board. |
|---|
| 251 | 251 | | |
|---|
| 252 | 252 | | (vi) Recognizing the limits of the nurse's knowledge and experience by consulting with or referring patients to other appropriate health care professionals if a situation or condition occurs that is beyond the knowledge and experience of the nurse or if the referral will protect the health and welfare of the patient. |
|---|
| 253 | 253 | | |
|---|
| 254 | 254 | | (vii) Delegating to a medical assistant pursuant to section 32-1456. |
|---|
| 255 | 255 | | |
|---|
| 256 | 256 | | (viii) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a nurse practitioner. |
|---|
| 257 | 257 | | |
|---|
| 258 | 258 | | 24. 23. "Registered nursing" includes the following: |
|---|
| 259 | 259 | | |
|---|
| 260 | 260 | | (a) Diagnosing and treating human responses to actual or potential health problems. |
|---|
| 261 | 261 | | |
|---|
| 262 | 262 | | (b) Assisting individuals and groups to maintain or attain optimal health by implementing a strategy of care to accomplish defined goals and evaluating responses to care and treatment. |
|---|
| 263 | 263 | | |
|---|
| 264 | 264 | | (c) Assessing the health status of individuals and groups. |
|---|
| 265 | 265 | | |
|---|
| 266 | 266 | | (d) Establishing a nursing diagnosis. |
|---|
| 267 | 267 | | |
|---|
| 268 | 268 | | (e) Establishing goals to meet identified health care needs. |
|---|
| 269 | 269 | | |
|---|
| 270 | 270 | | (f) Prescribing nursing interventions to implement a strategy of care. |
|---|
| 271 | 271 | | |
|---|
| 272 | 272 | | (g) Delegating nursing interventions to others who are qualified to do so. |
|---|
| 273 | 273 | | |
|---|
| 274 | 274 | | (h) Providing for the maintenance of safe and effective nursing care that is rendered directly or indirectly. |
|---|
| 275 | 275 | | |
|---|
| 276 | 276 | | (i) Evaluating responses to interventions. |
|---|
| 277 | 277 | | |
|---|
| 278 | 278 | | (j) Teaching nursing knowledge and skills. |
|---|
| 279 | 279 | | |
|---|
| 280 | 280 | | (k) Managing and supervising the practice of nursing. |
|---|
| 281 | 281 | | |
|---|
| 282 | 282 | | (l) Consulting and coordinating with other health care professionals in the management of health care. |
|---|
| 283 | 283 | | |
|---|
| 284 | 284 | | (m) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a registered nurse. |
|---|
| 285 | 285 | | |
|---|
| 286 | 286 | | 25. 24. "Registry of nursing assistants" means the nursing assistants registry maintained by the board pursuant to the omnibus budget reconciliation act of 1987 (P.L. 100-203; 101 Stat. 1330), as amended by the medicare catastrophic coverage act of 1988 (P.L. 100-360; 102 Stat. 683). |
|---|
| 287 | 287 | | |
|---|
| 288 | 288 | | 26. 25. "Regulated party" means any person or entity that is licensed, certified, registered, recognized or approved pursuant to this chapter. |
|---|
| 289 | 289 | | |
|---|
| 290 | 290 | | 27. 26. "Unprofessional conduct" includes the following, whether occurring in this state or elsewhere: |
|---|
| 291 | 291 | | |
|---|
| 292 | 292 | | (a) Committing fraud or deceit in obtaining, attempting to obtain or renewing a license or a certificate issued pursuant to this chapter. |
|---|
| 293 | 293 | | |
|---|
| 294 | 294 | | (b) Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case, conviction by a court of competent jurisdiction or a plea of no contest is conclusive evidence of the commission. |
|---|
| 295 | 295 | | |
|---|
| 296 | 296 | | (c) Aiding or abetting in a criminal abortion or attempting, agreeing or offering to procure or assist in a criminal abortion. |
|---|
| 297 | 297 | | |
|---|
| 298 | 298 | | (d) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public. |
|---|
| 299 | 299 | | |
|---|
| 300 | 300 | | (e) Being mentally incompetent or physically unsafe to a degree that is or might be harmful or dangerous to the health of a patient or the public. |
|---|
| 301 | 301 | | |
|---|
| 302 | 302 | | (f) Having a license, certificate, permit or registration to practice a health care profession denied, suspended, conditioned, limited or revoked in another jurisdiction and not reinstated by that jurisdiction. |
|---|
| 303 | 303 | | |
|---|
| 304 | 304 | | (g) Wilfully or repeatedly violating a provision of this chapter or a rule adopted pursuant to this chapter. |
|---|
| 305 | 305 | | |
|---|
| 306 | 306 | | (h) Committing an act that deceives, defrauds or harms the public. |
|---|
| 307 | 307 | | |
|---|
| 308 | 308 | | (i) Failing to comply with a stipulated agreement, consent agreement or board order. |
|---|
| 309 | 309 | | |
|---|
| 310 | 310 | | (j) Violating this chapter or a rule that is adopted by the board pursuant to this chapter. |
|---|
| 311 | 311 | | |
|---|
| 312 | 312 | | (k) Failing to report to the board any evidence that a registered or practical nurse or a nursing assistant is or may be: |
|---|
| 313 | 313 | | |
|---|
| 314 | 314 | | (i) Incompetent to practice. |
|---|
| 315 | 315 | | |
|---|
| 316 | 316 | | (ii) Guilty of unprofessional conduct. |
|---|
| 317 | 317 | | |
|---|
| 318 | 318 | | (iii) Mentally or physically unable to safely practice nursing or to perform nursing-related duties. A nurse who is providing therapeutic counseling for a nurse who is in a drug rehabilitation program is required to report that nurse only if the nurse providing therapeutic counseling has personal knowledge that patient safety is being jeopardized. |
|---|
| 319 | 319 | | |
|---|
| 320 | 320 | | (l) Failing to self-report a conviction for a felony or undesignated offense within ten days after the conviction. |
|---|
| 321 | 321 | | |
|---|
| 322 | 322 | | (m) Cheating or assisting another to cheat on a licensure or certification examination. END_STATUTE |
|---|
| 323 | 323 | | |
|---|
| 324 | 324 | | Sec. 2. Section 32-1634.04, Arizona Revised Statutes, is amended to read: |
|---|
| 325 | 325 | | |
|---|
| 326 | 326 | | START_STATUTE32-1634.04. Certified registered nurse anesthetist; scope of practice; physician and surgeon immunity |
|---|
| 327 | 327 | | |
|---|
| 328 | 328 | | A. A certified registered nurse anesthetist may administer anesthetics under the direction of and in the presence of a physician or surgeon in connection with the preoperative, intraoperative or postoperative care of a patient or as part of a procedure performed by a physician or surgeon in the following settings: |
|---|
| 329 | 329 | | |
|---|
| 330 | 330 | | 1. A health care institution. |
|---|
| 331 | 331 | | |
|---|
| 332 | 332 | | 2. An office of a health care professional who is licensed pursuant to chapter 7, 11, 13 or 17 of this title. |
|---|
| 333 | 333 | | |
|---|
| 334 | 334 | | 3. An ambulance. |
|---|
| 335 | 335 | | |
|---|
| 336 | 336 | | B. In connection with the preoperative, intraoperative or postoperative care of a patient or as part of the procedure in the settings prescribed in subsection A of this section, a certified registered nurse anesthetist, as part of the care or procedure, may: |
|---|
| 337 | 337 | | |
|---|
| 338 | 338 | | 1. Issue a medication order for drugs or medications, including controlled substances, to be administered by a licensed, certified or registered health care provider. |
|---|
| 339 | 339 | | |
|---|
| 340 | 340 | | 2. Assess the health status of an individual as that status relates to the relative risks associated with anesthetic management of an individual. |
|---|
| 341 | 341 | | |
|---|
| 342 | 342 | | 3. Obtain informed consent. |
|---|
| 343 | 343 | | |
|---|
| 344 | 344 | | 4. Order and evaluate laboratory and diagnostic test results and perform point-of-care testing that the certified registered nurse anesthetist is qualified to perform. |
|---|
| 345 | 345 | | |
|---|
| 346 | 346 | | 5. Order and evaluate radiographic imaging studies that the certified registered nurse anesthetist is qualified to order and interpret. |
|---|
| 347 | 347 | | |
|---|
| 348 | 348 | | 6. Identify, develop, implement and evaluate an anesthetic plan of care for a patient to promote, maintain and restore health. |
|---|
| 349 | 349 | | |
|---|
| 350 | 350 | | 7. Take action necessary in response to an emergency situation. |
|---|
| 351 | 351 | | |
|---|
| 352 | 352 | | 8. Perform therapeutic procedures that the certified registered nurse anesthetist is qualified to perform. |
|---|
| 353 | 353 | | |
|---|
| 354 | 354 | | C. A certified registered nurse anesthetist's prescribing authority to administer anesthetics or to issue a medication order as prescribed by this section does not include the ability to write or issue a prescription for medications to be filled or dispensed for a patient for use outside of the settings prescribed in subsection A of this section. |
|---|
| 355 | 355 | | |
|---|
| 356 | 356 | | D. A physician or surgeon is not liable for any act or omission of a certified registered nurse anesthetist who orders or administers anesthetics under this section. END_STATUTE |
|---|
| 357 | 357 | | |
|---|
| 358 | 358 | | Sec. 3. Title 36, chapter 16, Arizona Revised Statutes, is amended by adding article 2, to read: |
|---|
| 359 | 359 | | |
|---|
| 360 | 360 | | ARTICLE 2. CLINICAL ROTATIONS |
|---|
| 361 | 361 | | |
|---|
| 362 | 362 | | START_STATUTE36-1811. Student registered nurse anesthetists; clinical rotation program; grants; definitions |
|---|
| 363 | 363 | | |
|---|
| 364 | 364 | | A. The student registered nurse anesthetist clinical rotation program is established in the administration to expand the capacity of preceptor training programs at health care institutions for nurse anesthetist students. |
|---|
| 365 | 365 | | |
|---|
| 366 | 366 | | B. The administration shall develop a grant program to distribute monies appropriated for the student registered nurse anesthetist clinical rotation program to health care institutions that are licensed pursuant to chapter 4 of this title only to expand or create clinical training placements for nurse anesthetist students, with preference given to the expansion or development of clinical rotations in obstetrics, pediatrics and cardiovascular care. |
|---|
| 367 | 367 | | |
|---|
| 368 | 368 | | C. Grant monies awarded pursuant to this section are intended to supplement and not supplant existing training program expenses covered by the health care institution grantee. |
|---|
| 369 | 369 | | |
|---|
| 370 | 370 | | D. The administration shall establish an application process for the grant program and may award grants for multiyear programs. The administration shall consider the following factors when determining grant awards: |
|---|
| 371 | 371 | | |
|---|
| 372 | 372 | | 1. The geographic and population distribution. |
|---|
| 373 | 373 | | |
|---|
| 374 | 374 | | 2. The number of nurse anesthetist students planned to be trained and retained. |
|---|
| 375 | 375 | | |
|---|
| 376 | 376 | | 3. The cost of the proposal for the number of nurse anesthetist students expected to participate and to be retained compared to other proposals. |
|---|
| 377 | 377 | | |
|---|
| 378 | 378 | | E. For the purposes of this section: |
|---|
| 379 | 379 | | |
|---|
| 380 | 380 | | 1. "Administration" means the Arizona health care cost containment system administration. |
|---|
| 381 | 381 | | |
|---|
| 382 | 382 | | 2. "Health care institution" has the same meaning prescribed in section 36-401. END_STATUTE |
|---|
| 383 | 383 | | |
|---|
| 384 | 384 | | Sec. 4. Laws 2022, chapter 330, section 3 is amended to read: |
|---|
| 385 | 385 | | |
|---|
| 386 | 386 | | START_STATUTESec. 3. Delayed repeal |
|---|
| 387 | 387 | | |
|---|
| 388 | 388 | | Title 36, chapter 16, article 1, Arizona Revised Statutes, as added by this act, is repealed from and after December 31, 2026. END_STATUTE |
|---|
| 389 | 389 | | |
|---|
| 390 | 390 | | Sec. 5. Appropriation; Arizona health care cost containment system administration; student registered nurse anesthetist clinical rotation program; exemption |
|---|
| 391 | 391 | | |
|---|
| 392 | 392 | | A. The sum of $200,000 is appropriated from the state general fund in fiscal year 2023-2024 to the Arizona health care cost containment system administration for the student registered nurse anesthetist clinical rotation program established by section 36-1811, Arizona Revised Statutes, as added by this act. |
|---|
| 393 | 393 | | |
|---|
| 394 | 394 | | B. The appropriation made in subsection A of this section is exempt from the provisions of section 35-190, Arizona Revised Statutes, relating to lapsing of appropriations. |
|---|