STORAGE NAME: h0883.HPP
DATE: 3/12/2025
1
FLORIDA HOUSE OF REPRESENTATIVES
BILL ANALYSIS
This bill analysis was prepared by nonpartisan committee staff and does not constitute an official statement of legislative intent.
BILL #: HB 883
TITLE: Advanced Practice Registered Nurse
Autonomous Practice
SPONSOR(S): Shoaf
COMPANION BILL: None
LINKED BILLS: None
RELATED BILLS: SB 758 (Simon)
Committee References
Health Professions & Programs
Health & Human Services
SUMMARY
Effect of the Bill:
HB 883 authorizes psychiatric nurses registered for autonomous practice to engage in the practice of psychiatric
mental health services, as determined by the Board of Nursing, without an established physician protocol.
Fiscal or Economic Impact:
The bill has an insignificant, negative fiscal impact on the Board of Nursing. See Fiscal or Economic Impact.
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
ANALYSIS
EFFECT OF THE BILL:
Currently an advanced practice registered nurse (APRN) who meets certain eligibility criteria may practice
autonomously.
1 Autonomous APRNs, excluding certified midwives, may engage in autonomous practice only in
primary care practice, irrespective of whether the APRN has been certified in a specialty.
2 Thus, a psychiatric
nurse, which is a specialty certification that an APRN can obtain, 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.
3
The bill authorizes a psychiatric nurse registered for autonomous practice to engage in the practice of psychiatric
mental health services, as defined by the Board of Nursing, without an established physician protocol. (Section 1)
The bill provides an effective date of July 1, 2025. (Section 2)
FISCAL OR ECONOMIC IMPACT:
STATE GOVERNMENT:
The Department of Health (DOH) estimates the cost to comply with the bill is $93,420 ($87,483/recurring,
$5,937/nonrecurring).
4
1
s. 464.0123, F.S.
2
s. 464.0123, F.S..
3
See, s. 464.012, F.S. 394.463(2)(f), F.S.
4
Department of Health, 2025 Agency Legislative Bill Analysis on HB 833, on file with the Health Professions & Programs
Subcommittee.
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
2
Currently, 13,470 autonomous APRNs hold a psychiatric certification, DOH estimates 50% may apply for
autonomous psychiatric certification. Based on this, DOH will require one additional full-time equivalent at an
estimated cost as follows:
5
Salary (010000): $80,269
Expense (040000): $6,862/Recurring $5,937/Non-Recurring
HR (107040): $352/Recurring
These costs can be absorbed within current resources.
RELEVANT INFORMATION
SUBJECT OVERVIEW:
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.
6 Currently, there are approximately 64,953
APRNs licensed to practice in Florida.
7
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, 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.
8 The BON is also
responsible for disciplining an APRN who violates the practice act.
9
To be eligible for licensure as an APRN, an applicant must apply and provide proof that he or she;
10
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,
11 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.
12
Autonomous Advanced Practice Registered Nurse
Eligibility
5
Id.
6
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.).
7
Supra, note 4.
8
S. 464.004, F.S.
9
S. 464.018, F.S.
10
S. 464.012(1), F.S. and Rule 64B9-4.002, F.A.C.
11
“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.
12
ss. 464.003, F.S. and 464.012, F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
3
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 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. There are currently 13,470 APRNs registered for autonomous practice in Florida.
16
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 related to primary
care.
17 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.”
18
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.
19 An
autonomous APRN may also provide any signature or other affirmation that is otherwise required by law to be
provided by a physician.
20
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.
21
Psychiatric Nurses
Psychiatric nurses are licensed APRNs 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.
22 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,
13
s. 464.0123, F.S.
14
S. s. 464.0123, F.S.
15
See Rule 64B9-4.020(3), F.A.C.; The Board of Nursing (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
Supra, note 4.
17
s. 464.0123, F.S..
18
Rule 64B9-4.001(12), F.A.C.
19
S. 464.0123(3), F.S.
20
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.
21
s. 464.0123, F.S.., 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.
22
s. 464.0123, F.S.. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
4
advanced clinical management of psychiatric disorders, including the prescription and management of
psychotropic medications, and therapy modalities.
23
For licensure as a psychiatric nurse, the applicant must hold one of the following certifications recognized by the
BON:
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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.
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.
25 A psychiatric nurse with such experience may also initiate an
involuntary examination and provide related services as permitted under the Florida Mental Health Act.
26
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.
27
There are 4,941 psychiatric nurses currently registered to practice in Florida, of which 1,563 are registered for
primary care autonomous practice.
28
BILL HISTORY
COMMITTEE REFERENCE ACTION DATE
STAFF
DIRECTOR/
POLICY CHIEF
ANALYSIS
PREPARED BY
Health Professions & Programs
Subcommittee
McElroy Clenord
Health & Human Services
Committee
23
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-
practitioner/#:~:text=The%20psychiatric%2Dmental%20health%20nurse,or%20having%20a%20psychiatric%20diagnosis.
(last visited Dec. 18, 2024).
24
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.
25
ss. 394.455, F.S. and 464.012(4)(e), F.S.
26
S. 394.463(2)(a), F.S.; The Florida Mental Health Act is also known as the Baker Act.
27
See, s. 464.012, F.S. 394.463(2)(f), F.S.
28
Email from Sam Keshavarzi, Legislative Coordinator, Florida Department of Health, RE: Information Request-Psychiatric
Nurses, February 27, 2025. On file with the Health Professions & Programs Subcommittee.