Florida 2022 Regular Session

Florida House Bill H0437 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	HB 437 2022
4	4
5	5
6	6
7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb0437-00
9	9	Page 1 of 7
10	10	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
11	11
12	12
13	13
14	14	A bill to be entitled 1
15	15	An act relating to collaborative practice of certified 2
16	16	registered nurse anesthetists; amending s. 395.0191, 3
17	17	F.S.; authorizing an advanced practice registered 4
18	18	nurse who is certified as a registered nurse 5
19	19	anesthetist to administer anesthesia in collaboration 6
20	20	with specified licensed physicians; amending s. 7
21	21	464.003, F.S.; revising and providing definitions; 8
22	22	amending s. 464.012, F.S.; revising general functions 9
23	23	a certified nurse anesthetist may perform in 10
24	24	collaboration with specified licensed health care 11
25	25	practitioners; amending s. 960.28, F.S.; conforming a 12
26	26	cross-reference; providing an effective date. 13
27	27	14
28	28	Be It Enacted by the Legislature of the State of Florida: 15
29	29	16
30	30	Section 1. Paragraph (b) of subsection (2) of section 17
31	31	395.0191, Florida Statutes, is amended to read: 18
32	32	395.0191 Staff membership and clinical privileges. — 19
33	33	(2) 20
34	34	(b) An advanced practice registered nurse who is certified 21
35	35	as a registered nurse anestheti st licensed under part I of 22
36	36	chapter 464 shall administer anesthesia in collaboration with 23
37	37	under the onsite medical direction of a health care practitioner 24
38	38	professional licensed under chapter 458, chapter 459, or chapter 25
39	39
40	40	HB 437 2022
41	41
42	42
43	43
44	44	CODING: Words stricken are deletions; words underlined are additions.
45	45	hb0437-00
46	46	Page 2 of 7
47	47	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
48	48
49	49
50	50
51	51	466. For purposes of this paragraph, the term "collaboration" 26
52	52	has the same meaning as provided in s. 464.003 , and in 27
53	53	accordance with an established protocol approved by the medical 28
54	54	staff. The medical direction shall specifically address the 29
55	55	needs of the individual patient . 30
56	56	Section 2. Subsections (10) though (22) of section 31
57	57	464.003, Florida Statutes, are renumbered as subsections (11) 32
58	58	through (23), respectively, subsection (2) is amended, and a new 33
59	59	subsection (10) is added to that section, to read: 34
60	60	464.003 Definitions. —As used in this part, the term: 35
61	61	(2) "Advanced or specialized nursing practice" means, in 36
62	62	addition to the practice of professional nursing, the 37
63	63	performance of advanced -level nursing acts approved by the board 38
64	64	which, by virtue of postbasic specialized education, training, 39
65	65	and experience, are appropriately performed by an advanced 40
66	66	practice registered nurse. Within the context of advanced or 41
67	67	specialized nursing practice, the advanced practice registered 42
68	68	nurse may perform acts of nursing diagnosis and nursing 43
69	69	treatment of alterations of the health status. The advanced 44
70	70	practice registered nurse may also perform acts of medical 45
71	71	diagnosis and treatment, prescription, and operation as 46
72	72	authorized within the framework of an established supervisory 47
73	73	protocol or in collaboration with a l icensed health care 48
74	74	practitioner as provided under s. 464.012 . The department may, 49
75	75	by rule, require that a copy of the protocol be filed with the 50
76	76
77	77	HB 437 2022
78	78
79	79
80	80
81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb0437-00
83	83	Page 3 of 7
84	84	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
85	85
86	86
87	87
88	88	department along with the notice required by s. 458.348. 51
89	89	(10) "Collaboration" means the collaborative relati onship 52
90	90	between a health care practitioner licensed under chapter 458, 53
91	91	chapter 459, or chapter 466, who is performing a medical or 54
92	92	surgical procedure or directly involved in such procedure, and 55
93	93	an advanced practice registered nurse who is certified as a 56
94	94	registered nurse anesthetist performing the functions described 57
95	95	in s. 464.012(4)(b) before, during, or after a medical or 58
96	96	surgical procedure. The term includes the joint formulation and 59
97	97	discussion of patient treatment, in which each health care 60
98	98	practitioner contributes his or her respective expertise in the 61
99	99	management and delivery of health care. 62
100	100	Section 3. Subsection (3) and paragraph (b) of subsection 63
101	101	(4) of section 464.012, Florida Statutes, are amended to read: 64
102	102	464.012 Licensure of advanced practice registered nurses; 65
103	103	fees; controlled substance prescribing. — 66
104	104	(3) An advanced practice registered nurse shall perform 67
105	105	those functions authorized in this section within the framework 68
106	106	of an established protocol that must be maintained on site at 69
107	107	the location or locations at which an advanced practice 70
108	108	registered nurse practices, unless the advanced practice 71
109	109	registered nurse is registered and practicing under s. 464.0123 , 72
110	110	or is certified and practicing as a certified registered nurse 73
111	111	anesthetist in collaboratio n with a licensed health care 74
112	112	practitioner. In the case of multiple supervising physicians in 75
113	113
114	114	HB 437 2022
115	115
116	116
117	117
118	118	CODING: Words stricken are deletions; words underlined are additions.
119	119	hb0437-00
120	120	Page 4 of 7
121	121	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
122	122
123	123
124	124
125	125	the same group, an advanced practice registered nurse must enter 76
126	126	into a supervisory protocol with at least one physician within 77
127	127	the physician group practice. A pr actitioner currently licensed 78
128	128	under chapter 458, chapter 459, or chapter 466 shall maintain 79
129	129	supervision for directing the specific course of medical 80
130	130	treatment. Within the established framework, an advanced 81
131	131	practice registered nurse may: 82
132	132	(a) Prescribe, dispense, administer, or order any drug; 83
133	133	however, an advanced practice registered nurse may prescribe or 84
134	134	dispense a controlled substance as defined in s. 893.03 only if 85
135	135	the advanced practice registered nurse has graduated from a 86
136	136	program leading to a master's or doctoral degree in a clinical 87
137	137	nursing specialty area with training in specialized practitioner 88
138	138	skills. 89
139	139	(b) Initiate appropriate therapies for certain conditions. 90
140	140	(c) Perform additional functions as may be determined by 91
141	141	rule in accordance with s. 464.003(2). 92
142	142	(d) Order diagnostic tests and physical and occupational 93
143	143	therapy. 94
144	144	(e) Order any medication for administration to a patient 95
145	145	in a facility licensed under chapter 395 or part II of chapter 96
146	146	400, notwithstanding any provisions in chapter 465 or chapter 97
147	147	893. 98
148	148	(4) In addition to the general functions specified in 99
149	149	subsection (3), an advanced practice registered nurse may 100
150	150
151	151	HB 437 2022
152	152
153	153
154	154
155	155	CODING: Words stricken are deletions; words underlined are additions.
156	156	hb0437-00
157	157	Page 5 of 7
158	158	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
159	159
160	160
161	161
162	162	perform the following acts within his or her specialty: 101
163	163	(b) The certified registered nurse anesthetist may, in 102
164	164	collaboration with a licensed health care practitioner to the 103
165	165	extent authorized by established protocol approved by the 104
166	166	medical staff of the facility in which the anesthetic service is 105
167	167	performed, perform any or all of the following: 106
168	168	1. Determine the health status of the patient as it 107
169	169	relates to the risk factors and to the anesthetic management of 108
170	170	the patient through the performance of the general functions. 109
171	171	2. Based on history, physical assessment, and supplemental 110
172	172	laboratory results, determine , with the consent of the 111
173	173	responsible physician, the appropriate type of anesthesia within 112
174	174	the framework of the protocol . 113
175	175	3. Order under the protocol preanesthetic medication. 114
176	176	4. Perform under the protocol procedures commonly used to 115
177	177	render the patient insensible to pain durin g the performance of 116
178	178	surgical, obstetrical, therapeutic, or diagnostic clinical 117
179	179	procedures. These procedures include ordering and administering 118
180	180	regional, spinal, and general anesthesia; inhalation agents and 119
181	181	techniques; intravenous agents and techniques; a nd techniques of 120
182	182	hypnosis. 121
183	183	5. Order or perform monitoring procedures indicated as 122
184	184	pertinent to the anesthetic health care management of the 123
185	185	patient. 124
186	186	6. Support life functions during anesthesia health care, 125
187	187
188	188	HB 437 2022
189	189
190	190
191	191
192	192	CODING: Words stricken are deletions; words underlined are additions.
193	193	hb0437-00
194	194	Page 6 of 7
195	195	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
196	196
197	197
198	198
199	199	including induction and intubation procedures, the use of 126
200	200	appropriate mechanical supportive devices, and the management of 127
201	201	fluid, electrolyte, and blood component balances. 128
202	202	7. Recognize and take appropriate corrective action for 129
203	203	abnormal patient responses to anesthesia, adjunctive medication, 130
204	204	or other forms of therapy. 131
205	205	8. Recognize and treat a cardiac arrhythmia while the 132
206	206	patient is under anesthetic care. 133
207	207	9. Participate in management of the patient while in the 134
208	208	postanesthesia recovery area, including ordering the 135
209	209	administration of fluids and drug s. 136
210	210	10. Place special peripheral and central venous and 137
211	211	arterial lines for blood sampling and monitoring as appropriate. 138
212	212	Section 4. Subsection (2) of section 960.28, Florida 139
213	213	Statutes, is amended to read: 140
214	214	960.28 Payment for victims' initial forensic physical 141
215	215	examinations.— 142
216	216	(2) The Crime Victims' Services Office of the department 143
217	217	shall pay for medical expenses connected with an initial 144
218	218	forensic physical examination of a victim of sexual battery as 145
219	219	defined in chapter 794 or a lewd or lascivious offens e as 146
220	220	defined in chapter 800. Such payment shall be made regardless of 147
221	221	whether the victim is covered by health or disability insurance 148
222	222	and whether the victim participates in the criminal justice 149
223	223	system or cooperates with law enforcement. The payment shall b e 150
224	224
225	225	HB 437 2022
226	226
227	227
228	228
229	229	CODING: Words stricken are deletions; words underlined are additions.
230	230	hb0437-00
231	231	Page 7 of 7
232	232	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
233	233
234	234
235	235
236	236	made only out of moneys allocated to the Crime Victims' Services 151
237	237	Office for the purposes of this section, and the payment may not 152
238	238	exceed $1,000 with respect to any violation. The department 153
239	239	shall develop and maintain separate protocols for the initial 154
240	240	forensic physical examination of adults and children. Payment 155
241	241	under this section is limited to medical expenses connected with 156
242	242	the initial forensic physical examination, and payment may be 157
243	243	made to a medical provider using an examiner qualified under 158
244	244	part I of chapter 464, excluding s. 464.003(16) s. 464.003(15); 159
245	245	chapter 458; or chapter 459. Payment made to the medical 160
246	246	provider by the department shall be considered by the provider 161
247	247	as payment in full for the initial forensic physical examination 162
248	248	associated with the collection of evidence. The victim may not 163
249	249	be required to pay, directly or indirectly, the cost of an 164
250	250	initial forensic physical examination performed in accordance 165
251	251	with this section. 166
252	252	Section 5. This act shall take effect July 1, 2022. 167