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