Florida 2024 Regular Session

Florida House Bill H0257 Compare Versions

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

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3	3	HB 257 2024
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7	7	CODING: Words stricken are deletions; words underlined are additions.
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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
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14	14	A bill to be entitled 1
15	15	An act relating to autonomous practice by a certified 2
16	16	registered nurse anesthetist; amending s. 395.0191, 3
17	17	F.S.; revising staff membership and clinical 4
18	18	privileges for certain certified registered nurse 5
19	19	anesthetists; amending s. 464.012, F.S.; authorizing 6
20	20	certain certified registered nurse anesthetists to 7
21	21	perform specified acts under certain circumstances; 8
22	22	amending s. 464.0123, F.S.; revising practice 9
23	23	requirements for autonomous advanced practice 10
24	24	registered nurses; authorizing autonomous advanced 11
25	25	practice registered nurses to perform certain acts; 12
26	26	providing for expiration of the Council on Advanced 13
27	27	Practice Registered Nurse Autonomous Practice; 14
28	28	amending s. 1009.65, F .S.; authorizing certain 15
29	29	advanced practice registered nurses practicing in the 16
30	30	specialty of anesthesia to participate in the Medical 17
31	31	Education Reimbursement and Loan Repayment Program; 18
32	32	providing an effective date. 19
33	33	20
34	34	Be It Enacted by the Legislature of t he State of Florida: 21
35	35	22
36	36	Section 1. Paragraph (b) of subsection (2) of section 23
37	37	395.0191, Florida Statutes, is amended to read: 24
38	38	395.0191 Staff membership and clinical privileges. — 25
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40	40	HB 257 2024
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44	44	CODING: Words stricken are deletions; words underlined are additions.
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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
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51	51	(2) 26
52	52	(b) An advanced practice registered nurse who is certified 27
53	53	as a registered nurse anesthetist licensed under part I of 28
54	54	chapter 464 shall administer anesthesia under the onsite medical 29
55	55	direction of a professional licensed under chapter 458, chapter 30
56	56	459, or chapter 466, and in accordance with an established 31
57	57	protocol approved by the medical staff. The medical direction 32
58	58	shall specifically address the needs of the individual patient. 33
59	59	This paragraph does not apply to an autonomous advanced practice 34
60	60	registered nurse registered under s. 464.0123 who is certified 35
61	61	as a registered nurse anesthetist licensed under part I of 36
62	62	chapter 464; however, a facility may require a certified 37
63	63	registered nurse anesthetist who is registered and practicing 38
64	64	under s. 464.0123 to perform acts under an established protocol 39
65	65	approved by the medical staff or the governing board of the 40
66	66	facility. 41
67	67	Section 2. Paragraph (b) of subsection (4) of section 42
68	68	464.012, Florida Statutes, is amended to read: 43
69	69	464.012 Licensure of advanced practice registered nurses; 44
70	70	fees; controlled substance prescribing. — 45
71	71	(4) In addition to the general functions specified in 46
72	72	subsection (3), an advanced practice registered nurse may 47
73	73	perform the following acts within his or her specialty: 48
74	74	(b) The certified registered nurse anesthetist may, to the 49
75	75	extent authorized by an established protocol approved by the 50
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77	77	HB 257 2024
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81	81	CODING: Words stricken are deletions; words underlined are additions.
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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
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88	88	medical staff of the facility in which the anesthetic service is 51
89	89	performed unless the certified registered nurse anesthetist is 52
90	90	registered and practicing under s. 464.0123 without an 53
91	91	established protocol , perform any or all of the fo llowing: 54
92	92	1. Determine the health status of the patient as it 55
93	93	relates to the risk factors and to the anesthetic management of 56
94	94	the patient through the performance of the general functions. 57
95	95	2. Based on history, physical assessment, and supplemental 58
96	96	laboratory results, determine, with the consent of the 59
97	97	responsible physician, the appropriate type of anesthesia within 60
98	98	the framework of the protocol unless the certified registered 61
99	99	nurse anesthetist is registered and practicing under s. 464.0123 62
100	100	without an established protocol. 63
101	101	3. Order under the protocol preanesthetic medication under 64
102	102	the protocol, unless the certified registered nurse anesthetist 65
103	103	is registered and practicing under s. 464.0123 without an 66
104	104	established protocol . 67
105	105	4. Perform under the protocol procedures commonly used to 68
106	106	render the patient insensible to pain during the performance of 69
107	107	surgical, obstetrical, therapeutic, or diagnostic clinical 70
108	108	procedures under the protocol unless the certified registered 71
109	109	nurse anesthetist is registered and practici ng under s. 464.0123 72
110	110	without an established protocol . These procedures include 73
111	111	ordering and administering regional, spinal, and general 74
112	112	anesthesia; inhalation agents and techniques; intravenous agents 75
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114	114	HB 257 2024
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118	118	CODING: Words stricken are deletions; words underlined are additions.
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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
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125	125	and techniques; and techniques of hypnosis. 76
126	126	5. Order or perform monitoring procedures indicated as 77
127	127	pertinent to the anesthetic health care management of the 78
128	128	patient. 79
129	129	6. Support life functions during anesthesia health care, 80
130	130	including induction and intubation procedures, the use of 81
131	131	appropriate mechanical sup portive devices, and the management of 82
132	132	fluid, electrolyte, and blood component balances. 83
133	133	7. Recognize and take appropriate corrective action for 84
134	134	abnormal patient responses to anesthesia, adjunctive medication, 85
135	135	or other forms of therapy. 86
136	136	8. Recognize and treat a cardiac arrhythmia while the 87
137	137	patient is under anesthetic care. 88
138	138	9. Participate in management of the patient while in the 89
139	139	postanesthesia recovery area, including ordering the 90
140	140	administration of fluids and drugs. 91
141	141	10. Place special peripheral and central venous and 92
142	142	arterial lines for blood sampling and monitoring as appropriate. 93
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144	144	A certified registered nurse anesthetist registered and 95
145	145	practicing under s. 464.0123 without an established protocol may 96
146	146	only perform acts authorized under part I of this chapter. 97
147	147	Section 3. Paragraph (a) of subsection (3) of section 98
148	148	464.0123, Florida Statutes, is amended and paragraph (e) is 99
149	149	added to subsection (4) of that section, to read: 100
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151	151	HB 257 2024
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155	155	CODING: Words stricken are deletions; words underlined are additions.
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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
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162	162	464.0123 Autonomous practice by an advanced practice 101
163	163	registered nurse.— 102
164	164	(3) PRACTICE REQUIREMENTS. — 103
165	165	(a) An advanced practice registered nurse who is 104
166	166	registered under this section may: 105
167	167	1. Engage in autonomous practice only in primary care 106
168	168	practice, including family medicine, general pediatrics, and 107
169	169	general internal medicine, and anesthesia, as defined by board 108
170	170	rule. 109
171	171	2. For certified nurse midwives, engage in autonomous 110
172	172	practice in the performance of the acts listed in s. 111
173	173	464.012(4)(c). 112
174	174	3. Perform the general functions of an advanced practice 113
175	175	registered nurse under s. 464.01 2(3) related to primary care. 114
176	176	4. For certified registered nurse anesthetists registered 115
177	177	and practicing under this section, perform the acts listed in s. 116
178	178	464.012(4)(b). 117
179	179	5.4. For a patient who requires the services of a health 118
180	180	care facility, as defined i n s. 408.032(8): 119
181	181	a. Admit the patient to the facility. 120
182	182	b. Manage the care received by the patient in the 121
183	183	facility. 122
184	184	c. Discharge the patient from the facility, unless 123
185	185	prohibited by federal law or rule. 124
186	186	6.5. Provide a signature, certification, stamp, 125
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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
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197	197
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199	199	verification, affidavit, or endorsement that is otherwise 126
200	200	required by law to be provided by a physician, except an 127
201	201	advanced practice registered nurse registered under this section 128
202	202	may not issue a physician certification under s. 381.986. 129
203	203	(4) COUNCIL ON ADVANCED PRACTICE REGISTERED NURSE 130
204	204	AUTONOMOUS PRACTICE. — 131
205	205	(e) The council expires on July 1, 2025. 132
206	206	Section 4. Paragraph (b) of subsection (1) of section 133
207	207	1009.65, Florida Statutes, is amended to read: 134
208	208	1009.65 Medical Education Reimbursement and Loan Repayment 135
209	209	Program.— 136
210	210	(1) To encourage qualified medical professionals to 137
211	211	practice in underserved locations where there are shortages of 138
212	212	such personnel, there is established the Medical Education 139
213	213	Reimbursement and Loan Repayment Program. The function of th e 140
214	214	program is to make payments that offset loans and educational 141
215	215	expenses incurred by students for studies leading to a medical 142
216	216	or nursing degree, medical or nursing licensure, or advanced 143
217	217	practice registered nurse licensure or physician assistant 144
218	218	licensure. The following licensed or certified health care 145
219	219	professionals are eligible to participate in this program: 146
220	220	(b) Advanced practice registered nurses registered to 147
221	221	engage in autonomous practice under s. 464.0123 and practicing 148
222	222	in the primary care specialt ies of family medicine, general 149
223	223	pediatrics, general internal medicine, or midwifery, or 150
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225	225	HB 257 2024
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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
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236	236	anesthesia. From the funds available, the Department of Health 151
237	237	shall make payments of up to $15,000 per year to advanced 152
238	238	practice registered nurses registered under s. 464.0123 who 153
239	239	demonstrate, as required by department rule, active employment 154
240	240	providing primary care services in a public health program, an 155
241	241	independent practice, or a group practice that serves Medicaid 156
242	242	recipients and other low -income patients and that is l ocated in 157
243	243	a primary care health professional shortage area. Only loans to 158
244	244	pay the costs of tuition, books, medical equipment and supplies, 159
245	245	uniforms, and living expenses may be covered. For the purposes 160
246	246	of this paragraph: 161
247	247	1. "Primary care health professio nal shortage area" means 162
248	248	a geographic area, an area having a special population, or a 163
249	249	facility with a score of at least 18, as designated and 164
250	250	calculated by the Federal Health Resources and Services 165
251	251	Administration or a rural area as defined by the Federal O ffice 166
252	252	of Rural Health Policy. 167
253	253	2. "Public health program" means a county health 168
254	254	department, the Children's Medical Services program, a federally 169
255	255	funded community health center, a federally funded migrant 170
256	256	health center, or any other publicly funded or nonp rofit health 171
257	257	care program designated by the department. 172
258	258	Section 5. This act shall take effect July 1, 2024. 173