DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part of the
legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law
or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 495 Reengrossed 2021 Regular Session Ivey
Abstract: Allows full practice authority for advanced practice registered nurses through the repeal
of collaborative practice agreement requirements and sets forth transition to practice
requirements for certain advanced practice registered nurses to practice independently.
Proposed law repeals from present law relative to the practice of nursing the defined terms
"collaborative practice" and "collaborative practice agreement" and their corresponding definitions.
Additionally, repeals occurrences of these terms in present law relative to behavioral health.
Present law defines "advanced practice registered nursing", in part, to include the following:
(1)Analyzing multiple sources of data and identifying and performing certain acts of medical
diagnosis in accordance with the collaborative practice agreement.
(2)Making decisions in solving patient care problems and selecting treatment regimens in
collaboration with a licensed physician, dentist, or other healthcare provider as indicated.
(3)Consulting with or referring patients to licensed physicians, dentists, and other healthcare
providers in accordance with a collaborative practice agreement.
Proposed law deletes from the provisions of present law listed above all references to collaborative
practice agreements and collaboration with a licensed physician, dentist, or other healthcare provider.
Also deletes from present law references to nurses performing acts of medical diagnosis. Otherwise,
retains present law.
Proposed law repeals from present law references to a collaborating physician in provisions relative
to advanced practice registered nurses providing certain treatment for substance use disorders and
in other laws pertaining to behavioral health.
Proposed law repeals from present law references to collaborative practice agreements in provisions
relative to advanced practice registered nurses administering anesthetics.
Proposed law repeals from present law a requirement that advanced practice registered nurses
employed by public health clinics perform the following procedures only under a protocol approved
by a licensed physician:
(1)Inserting into the subcutaneous space a medication implant to treat sexually transmitted diseases or to prevent pregnancy.
(2)Distributing a therapeutic regimen of medication, to be consumed by a patient off premises,
to treat sexually transmitted diseases or to prevent pregnancy.
Proposed law requires the Louisiana State Board of Nursing (board) to grant prescribing authority
through the advanced practice registered nurse license. Provides that such prescribing authority shall
include the authority of the advanced practice registered nurse to do all of the following:
(1)Diagnose, prescribe, and institute therapy or referrals of patients to healthcare agencies or
other healthcare providers and to community resources.
(2)Prescribe and administer pharmacological agents, including over-the-counter medications,
legend drugs, and controlled substances, within his scope of practice.
(3)Plan and initiate a therapeutic regimen that includes ordering and prescribing
non-pharmacological interventions including but not limited to durable medical equipment,
medical devices, nutrition, blood and blood products, and diagnostic and supportive services
including but not limited to home health care, hospice, and physical and occupational
therapy.
Proposed law provides that if a provision of present law or present administrative rule requires a
signature, certification, stamp, verification, affidavit, or endorsement by a physician, the requirement
may be fulfilled by an advanced practice registered nurse practicing within his scope of practice in
accordance with the provisions of present law and proposed law.
Proposed law establishes the following transition to practice requirements for certain advanced
practice registered nurses:
(1)Each nurse practitioner, certified nurse midwife, and clinical nurse specialist shall collaborate
for at least 6,000 hours with a licensed physician or be employed by a clinic that has a
medical director who is a licensed physician.
(2)Any nurse practitioner, certified nurse midwife, or clinical nurse specialist who practices in
any specialty and transitions to independent practice shall do so in collaboration with a
physician who practices in that same specialty.
(3)Each nurse practitioner, certified nurse midwife, and clinical nurse specialist shall submit
written evidence to the board upon completion of the clinical experience required by
proposed law.
(4)Hours of clinical experience gained in another state may count toward the clinical experience
requirement provided in proposed law, subject to approval by the board.
(5)Any nurse practitioner, certified nurse midwife, or clinical nurse specialist who did not complete 4,000 clinical hours as a registered nurse prior to achieving advanced practice
certification shall collaborate for an additional 4,000 hours beyond the minimum 6,000-hour
requirement provided in proposed law.
(6)A nurse practitioner, certified nurse midwife, or clinical nurse specialist shall hold a current,
unencumbered license issued by the board.
(7)Any nurse practitioner, certified nurse midwife, or clinical nurse specialist who is deemed
by the board to have met the requirements of proposed law necessary for independent
practice on and after the effective date of proposed law shall be eligible to transition to
independent practice.
Proposed law provides that no nurse practitioner, certified nurse midwife, or clinical nurse specialist
who has completed the requirements of proposed law and practices independently in a specialty may
practice independently in a different specialty unless he completes all requirements of proposed law
again for that different specialty.
Proposed law stipulates that the board shall not prohibit an advanced practice registered nurse from
practicing under a collaborative practice agreement. Provides that for purposes of proposed law,
"collaborative practice agreement" means a formal written statement addressing the parameters of
collaboration, as defined in present law, which are mutually agreed upon by an advanced practice
registered nurse and one or more licensed physicians which includes but shall not be limited to the
following provisions:
(1)Availability of the collaborating physician for consultation, referral, or both.
(2)Methods of management of the collaborative practice which shall include clinical practice
guidelines.
(3)Coverage of the healthcare needs of a patient during any absence of the advanced practice
registered nurse or physician.
Proposed law creates within the Louisiana Department of Health the Independent Practice Advisory
Panel (advisory panel). Provides that the advisory panel shall be composed of the following
members:
(1)One physician appointed by the Louisiana State Medical Society.
(2)One physician appointed by the Louisiana Medical Association.
(3)One physician appointed by the Louisiana Academy of Family Physicians.
(4)Two advanced practice registered nurses appointed by the Louisiana Association of Nurse
Practitioners. (5)One advanced practice registered nurse appointed by the Louisiana Council of
Administrators of Nursing Education.
(6)The executive director of the Louisiana State Board of Nursing, who shall be a nonvoting
member.
(7)The executive director of the Louisiana State Board of Medical Examiners, who shall be a
nonvoting member.
Proposed law provides that the advisory panel shall have the following duties and responsibilities:
(1)Ensure quality of care post discipline action.
(2)Make recommendations on education items to reduce recurring violations.
(3)Review complaints and concerns regarding advanced practice registered nurses who practice
independently and regarding physicians who collaborate with advanced practice registered
nurses.
(4)Develop advisory or practice opinions of any items brought before the panel.
(5)Make recommendations to the La. State Board of Nursing and the La. State Board of Medical
Examiners concerning administrative rules to be jointly promulgated by both boards to
govern independent practice by advanced practice registered nurses.
Proposed law creating and providing for the advisory panel terminates on Aug. 1, 2025.
(Amends R.S. 28:2(28), 51.1(A)(3)(a), (b), and (d), and 53(B)(1) and R.S. 37:913(3)(a)(vii)-(ix), (b),
and (c), 930(E) and (F), and 933; Adds R.S. 36:259(B)(39) and R.S. 37:936-939, 1020.51, and
1020.52; Repeals R.S. 28:51.1(A)(3)(c) and R.S. 37:913(8) and (9))
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Health and Welfare to the
original bill:
1. Delete proposed law which would have revised present law to authorize certified
registered nurse anesthetists to provide anesthesia care within their scope of practice
under the direction and supervision of a physician or dentist who is licensed to practice
under the laws of this state.
2. Revise present law to provide that certified registered nurse anesthetists shall not be
required to have prescriptive authority to provide anesthesia care within their scope of
practice under the direction and supervision of a physician or dentist who is licensed to practice under the laws of this state.
The House Floor Amendments to the engrossed bill:
1. Restore to present law the defined term "collaboration" and its corresponding definition
which proposed law formerly repealed.
2. Establish the following transition to practice requirements for certain advanced practice
registered nurses:
a. Each nurse practitioner, certified nurse midwife, and clinical nurse specialist shall
collaborate for at least 6,000 hours with a licensed physician or be employed by
a clinic that has a medical director who is a licensed physician.
b. Any nurse practitioner, certified nurse midwife, or clinical nurse specialist who
practices in any specialty and transitions to independent practice shall do so in
collaboration with a physician who practices in that same specialty.
c. Each nurse practitioner, certified nurse midwife, and clinical nurse specialist shall
submit written evidence to the board upon completion of the clinical experience
required by proposed law.
d. Hours of clinical experience gained in another state may count toward the clinical
experience requirement provided in proposed law, subject to approval by the
board.
e. Any nurse practitioner, certified nurse midwife, or clinical nurse specialist who
did not complete 4,000 clinical hours as a registered nurse prior to achieving
advanced practice certification shall collaborate for an additional 4,000 hours
beyond the minimum 6,000-hour requirement provided in proposed law.
f. A nurse practitioner, certified nurse midwife, or clinical nurse specialist shall
hold a current, unencumbered license issued by the La. State Board of Nursing
(board).
g. Any nurse practitioner, certified nurse midwife, or clinical nurse specialist who
is deemed by the board to have met the requirements of proposed law necessary
for independent practice on and after the effective date of proposed law shall be
eligible to transition to independent practice.
3. Provide that no nurse practitioner, certified nurse midwife, or clinical nurse specialist
who has completed the requirements of proposed law and practices independently in a
specialty may practice independently in a different specialty unless he completes all
requirements of proposed law again for that different specialty. 4. Stipulate that the board shall not prohibit an advanced practice registered nurse from
practicing under a collaborative practice agreement. Provide that for purposes of
proposed law, "collaborative practice agreement" means a formal written statement
addressing the parameters of collaboration, as defined in present law, which are mutually
agreed upon by an advanced practice registered nurse and one or more licensed
physicians which includes but shall not be limited to the following provisions:
a. Availability of the collaborating physician for consultation, referral, or both.
b. Methods of management of the collaborative practice which shall include clinical
practice guidelines.
c. Coverage of the healthcare needs of a patient during any absence of the advanced
practice registered nurse or physician.
5. Creates within the La. Department of Health the Independent Practice Advisory Panel
(advisory panel) and provides for the membership of the advisory panel to include three
physicians, three advanced practice registered nurses, the executive director of the La.
State Board of Nursing, who shall be a nonvoting member, and the executive director of
the La. State Board of Medical Examiners, who shall be a nonvoting member.
6. Provide that the advisory panel shall have the following duties and responsibilities:
a. Ensure quality of care post discipline action.
b. Make recommendations on education items to reduce recurring violations.
c. Review complaints and concerns regarding advanced practice registered nurses
who practice independently and regarding physicians who collaborate with
advanced practice registered nurses.
d. Develop advisory or practice opinions of any items brought before the panel.
e. Make recommendations to the La. State Board of Nursing and the La. State
Board of Medical Examiners concerning administrative rules to be jointly
promulgated by both boards to govern independent practice by advanced practice
registered nurses.
7. Terminate proposed law creating and providing for the advisory panel on Aug. 1, 2025.
8. Make technical changes.