This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0771.HRS
DATE: 1/16/2024
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 771 Autonomous Practice for Certified Psychiatric Nurses
SPONSOR(S): Barnaby
TIED BILLS: IDEN./SIM. BILLS: SB 936
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee Osborne McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
An advanced practice registered nurse (APRN) is a licensed professional nurse who is additionally licensed in
an advanced nursing practice, including certified nurse midwives, certified nurse practitioners, certified
registered nurse anesthetists, clinical nurse specialists, and psychiatric nurses. Each specialty requires training
and education specific to the specialty area and certification with a national board. Currently, there are 62,545
APRNs actively licensed to practice in Florida.
APRNs are licensed and regulated by the Board of Nursing within the Department of Health. In addition to the
practice of professional nursing, APRNs perform advanced-level nursing acts approved by the BON as
appropriate for APRNs to perform by virtue of their post-basic, specialized education, training, and experience.
APRNs are generally required to practice under a supervising physician’s protocol and only to the extent that
the written protocol allows. In 2020, the Legislature passed legislation authorizing APRNs meeting certain
criteria to practice “autonomously,” or without physician supervision or a supervisory protocol, in specified
settings. Currently, there are 11,201 APRNs registered for autonomous practice.
Psychiatric nurses are licensed advanced practice registered nurses who hold a master’s or doctoral degree in
psychiatric nursing and a national advanced practice certification as a psychiatric mental health advanced
practice nurse. Psychiatric nurses with two years of post-master’s clinical experience under the supervision of
a physician may, within an established psychiatrist’s protocol, prescribe psychotropic controlled substances for
the treatment of mental disorders and Initiate an involuntary examination and provide related services as
permitted under the Florida Mental Health Act.
Under current law, a psychiatric nurse registered for autonomous practice may only engage in primary care-
related practice acts without a physician supervisory protocol in place. There are 3,458 psychiatric nurses
currently registered to practice in Florida, of which 1,093 are registered for primary care autonomous practice.
HB 771 authorizes a psychiatric nurse registered for autonomous practice to engage in the practice of
psychiatric mental health services, as defined by the BON, without an established physician protocol.
The bill has an indeterminate, insignificant negative fiscal impact on DOH which can be absorbed within
current resources. The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2024. STORAGE NAME: h0771.HRS PAGE: 2
DATE: 1/16/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Advanced Practice Registered Nurses
An advanced practice registered nurse (APRN) is a licensed professional nurse who is additionally
licensed in an advanced nursing practice, including certified nurse midwives, certified nurse
practitioners, certified registered nurse anesthetists, clinical nurse specialists, and psychiatric nurses.
1
Currently, there are approximately 62,545 APRNs licensed to practice in Florida.
2
APRNs are regulated under part I of ch. 464, F.S., the Nurse Practice Act. The Board of Nursing
(BON), housed within the Department of Health (DOH), is responsible for establishing by rule the
eligibility criteria for applicants to be licensed as APRNs and the applicable regulatory standards for
APRN nursing practices.
3
The BON is also responsible for disciplining an APRN who violates the
practice act.
4
To be eligible for licensure as an APRN, an applicant must submit an application and provide proof that
he or she;
5
Holds a current license to practice professional nursing or holds an active multistate license to
practice professional nursing under the Nurse Licensure Compact;
Is certified by the appropriate specialty board; and
Has a master’s degree in a clinical nursing specialty area with preparation in specialized
practitioner skills.
In addition to the practice of professional nursing,
6
APRNs perform advanced-level nursing acts
approved by the BON as appropriate for APRNs to perform by virtue of their post-basic, specialized
education, training, and experience. APRNs may only perform advanced nursing and medical acts only
to the extent that the written protocol allows, unless the APRN is registered for autonomous practice
under s. 464.0123, F.S.
7
Psychiatric Nurses
Psychiatric nurses are licensed advanced practice registered nurses who hold a master’s or doctoral
degree in psychiatric nursing and a national advanced practice certification as a psychiatric mental
health advanced practice nurse.
8
Psychiatric nurses are trained with a clinical focus on individuals,
families, or populations across the lifespan at risk for developing mental problems or having a
psychiatric diagnosis. They receive training in psychiatric assessment and diagnosis, advanced clinical
management of psychiatric disorders, including the prescription and management of psychotropic
medications, and therapy modalities.
9
1
S. 464.003(3), F.S. In 2018, the Florida Legislature enacted a law which changed the occupational title from “Advanced Registered
Nurse Practitioner (APRN)” to “Advanced Practice Registered Nurse (APRN),” and also reclassified a Clinical Nurse Specialist as a
type of APRN instead of a stand-alone occupation (see ch. 2018-106, Laws of Fla.).
2
Email from Daniel Leyte-Vidal, Deputy Legislative Planning Director, Florida Department of Health, RE: Information Request,
December 14, 2023. On file with the Healthcare Regulation Subcommittee.
3
S. 464.004, F.S.
4
S. 464.018, F.S.
5
S. 464.012(1), F.S. and Rule 64B9-4.002, F.A.C.
6
“Practice of professional nursing” means the performance of those acts requiring substantial specialized knowledge, judgment, and
nursing skill based upon applied principles of psychological, biological, physical, and social sciences. See s. 464.003(19), F.S.
7
Ss. 464.003 and 464.012, F.S.
8
S. 464.0123(1),F.S.
9
University of Florida, College of Nursing, Psychiatric-Mental Health Nurse Practitioners. Available at
https://nursing.ufl.edu/programs/doctor-of-nursing-practice-dnp/bsn-to-dnp/psychiatric-mental-health-nurse- STORAGE NAME: h0771.HRS PAGE: 3
DATE: 1/16/2024
For licensure as a psychiatric nurse, the applicant must hold one of the following certifications
recognized by the BON:
10
Psychiatric Mental Health Nurse Practitioner Certification;
Family Psychiatric and Mental Health Nurse Practitioner;
Adult Psychiatric and Mental Health Nurse Practitioner; or
Psychiatric Adult Clinical Nurse Specialist (CNS).
Under current law, a psychiatric nurse that has two years of post-master’s clinical experience under the
supervision of a physician may, within an established psychiatrist’s protocol, prescribe psychotropic
controlled substances for the treatment of mental disorders.
11
A psychiatric nurse with such experience
may also initiate an involuntary examination and provide related services as permitted under the Florida
Mental Health Act.
12
Autonomous APRNs
Eligibility
Current law authorizes an APRN who meets certain eligibility criteria to register for “autonomous”
practice, wherein they may then perform specified health care services without a supervising physician
or a physician’s written protocol.
13
To engage in autonomous practice, an APRN must hold active and
unencumbered Florida or multi-state license and have:
14
Completed at least 3,000 clinical practice hours or clinical instructional hours
supervised by a
physician with an active license within the five-year period immediately preceding the
registration request;
Not have been subject to any disciplinary action during the five years immediately preceding the
application;
Completed three graduate-level semester hours, or the equivalent, in pharmacology and three
graduate-level semester hours, or the equivalent, in differential diagnosis within the five-year
period preceding the registration request;
15
and
Any other registration requirements provided by BON rule.
The registration must be renewed biennially and the renewal coincides with the licensure renewal
period for the APRN. To maintain registration, an APRN must complete at least 10 hours of continuing
education approved by the BON for each biennial renewal in addition to the 30 hours of continuing
education required for renewal of the APRN license.
16
There are currently 11,201 APRNs registered
for autonomous practice in Florida.
17
Scope of Practice
Autonomous APRNs may engage in autonomous practice only in primary care practice, which includes
family medicine, general pediatrics, and general internal medicine, and general APRN functions as
practitioner/#:~:text=The%20psychiatric%2Dmental%20health%20nurse,or%20having%20a%20psychiatric%20diagnosis. (last visited
November 12, 2024).
10
Rule 64B9-4.002, F.A.C.; To be recognized by the BON, a specialty board must attest to the competency of nurses in the clinical
specialty area, identify standards or scope of practice statements as appropriate for the specialty, require a written examination for
certification, and require completion of a formal program prior to eligibility of examination
11
Ss. 394.455(36) and 464.012(4)(e), F.S.
12
S. 394.463(2)(a), F.S.; The Florida Mental Health Act is also known as the Baker Act.
13
S. 464.0123, F.S.
14
S. 464.0123(1)-(2), F.S.
15
See Rule 64B9-4.020(3), F.A.C.; The BON has defined the equivalent of three graduate-level semester hours in pharmacology and
the equivalent of three graduate-level semester hours in differential diagnosis as equal to forty-five (45) Continuing Education credits
offered in those areas by the entities set forth in Section 464.013(3)(b), F.S. and Fla. Admin. Code R. 64B9-4.002(2), (2023).
16
S. 464.0123(5), F.S.
17
Supra, note 2. STORAGE NAME: h0771.HRS PAGE: 4
DATE: 1/16/2024
related to primary care.
18
The BON has defined primary care by rule to include the “physical and mental
health promotion, assessment, evaluation, disease prevention, health maintenance, counseling, patient
education, diagnosis and treatment of acute and chronic illnesses, inclusive of behavioral and mental
health conditions.”
19
An autonomous APRN may not perform any surgical procedures except
subcutaneous surgical procedures.
20
Autonomous APRNs are authorized to admit patients to a health care facility, manage the patient’s care
in such facility, and discharge the patient from the facility unless otherwise prohibited by federal law or
rule.
21
An autonomous APRN may also provide any signature or other affirmation that is otherwise
required by law to be provided by a physician.
22
All APRN specialties are eligible for autonomous practice, however, only certified midwives are
currently authorized to practice any specific functions related to their specialty area without an
established physician protocol when registered for autonomous practice.
23
Psychiatric nurses may only
autonomously provide primary care-related services and must still adhere to an established protocol
with a psychiatrist when performing acts related to psychiatric mental health treatment.
24
There are
3,458 psychiatric nurses currently registered to practice in Florida, of which 1,093 are registered for
primary care autonomous practice.
25
Effect of the Bill
HB 771 authorizes a psychiatric nurse registered for autonomous practice to engage in the practice of
psychiatric mental health services, as defined by the BON, without an established physician protocol.
The bill provides an effective date of July 1, 2024.
B. SECTION DIRECTORY:
Section 1: Amends s. 464.0123, F.S., relating to autonomous practice by an advanced practice
registered nurse.
Section 2: Provides an effective date of July 1, 2024.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
18
S. 464.0123(3)(a)1., F.S.
19
Rule 64B9-4.001(12), F.A.C.
20
S. 464.0123(3)(c), F.S.
21
S. 464.0123(3), F.S.
22
S. 464.0123(3), F.S.; An autonomous APRN may not provide the physician certification required under s. 381.986, F.S., as a
perquisite for obtaining medical marijuana.
23
S. 464.0123(3)(a)2., F.S. Autonomous Certified Nurse Midwives practicing under this section must have a written patient transfer
agreement with a hospital and a written patient referral agreement with a physician licensed under chs. 458 or 459, F.S.
24
See, ss. 464.012(4)(e), 394.463(2)(f), F.S.
25
Email from Daniel Leyte-Vidal, Deputy Legislative Planning Director, Florida Department of Health, RE: Information Request,
December 14, 2023. On file with the Healthcare Regulation Subcommittee. STORAGE NAME: h0771.HRS PAGE: 5
DATE: 1/16/2024
The bill has an indeterminate, insignificant negative impact on DOH which is expected to be
absorbed within current resources.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The BON has sufficient rulemaking authority to implement this bill’s provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES